Characterizing demographics and cost of care for dyshidrotic eczema.

BACKGROUND: Dyshidrotic eczema (DE) is a common form of eczema affecting the hands, feet, or both areas. To date, there has been little research examining demographics and cost burden associated with this disease. OBJECTIVE: This study seeks to characterize the demographics of patients affected and the direct costs of care associated with DE. METHODS: This is a retrospective analysis utilizing insurance claim information from IBM MarketScan. Pertinent data including demographic information, healthcare provider type, medications prescribed, and average cost of care were identified using the ICD 10 code L30.1 for DE for the year 2018. RESULTS: In 2018, 34 932 patients filed claims for DE, with 61% female and an average age of 37 years at first diagnosis. DE was mostly seen in employees from the service industry and the manufacturing of durable goods. The total annual direct cost was US $11 738 985. Average annual costs, however, did vary based on type of treating healthcare provider, level of care, and medications prescribed. CONCLUSIONS: Patients with DE can face an economic burden due to their disease and providers should aim to recognize this disease and its treatments to minimize healthcare costs for patients and improve quality of life.

Trend of relevant contact allergens of the feet in Spain over a period of 10 years.

INTRODUCTION: Allergic contact dermatitis (ACD) of the feet accounts for approximately 10% of all patch tested patients. OBJECTIVE: To study the clinical profile of patients with feet dermatitis and relevant contact allergens in Spain over a 10-year period. METHODS: Retrospective observational study of patients with suspected ACD from the GEIDAC (Spanish Research Group on Contact Dermatitis and Cutaneous Allergy) baseline series from eight hospitals in Spain between 2004 and 2014. The clinical data collected from each patient were age, sex, occupation, history of atopic dermatitis, and eczema location. RESULTS: A total of 450 cases clinically presented dermatitis affecting the feet; of these, 41% of were males and 5.6% were suspected to be of occupational origin. As much as 47% were diagnosed with ACD, 20% with atopic dermatitis/dyshidrotic eczema, and 5% with psoriasis. The "feet group" included statistically significantly more females in the age range of 21 to 60 years. The most frequent relevant contact allergens were potassium dichromate, cobalt(II) chloride, p-tert-butylphenol formaldehyde resin, mercapto mix, and mercaptobenzothiazole. CONCLUSIONS: ACD is the most frequent clinical diagnosis of feet dermatitis in our series. The most frequent allergens are similar to those published in other series of foot ACD in Europe and the trend has not changed in the studied decade.

Pattern of presentation of pompholyx at a principal referral point in Port Harcourt over a period of ten years

Background: Pompholyx is a type of hand eczema which is characterized by recurrent vesicles and bullae.It is seen commonly in the age group 20 -40 years, affects all races and has an equal sex distribution. It is commonly associated with contact allergic dermatitis and contact irritant dermatitis and atopy. Other associated factors include emotional stress, chronic illness such as HIV and physiological states like pregnancy. Pompholyx is said to be common in warm climate. In which the study area can be classified as such being a tropical climate in the Sub Saharan Africa. Pompholyx is a disease that reduces the quality of living of affected individuals and can bea cause of social stigmatization, often mistaken for a contagious infection such as scabies. It can also be a cause great discomfort to the body and mind leading to work and school absenteeism. Methodology:It was a retrospective cross sectional study of new pompholyx cases within the period of January 2006 to December 2015 from the new patient clinical register. Folders were retrieved and data was extracted using a semi-structured questionnaire developed from standard written medical literature on pompholyx. Data was analyzed using Statistical Package for Social Sciences version 20.Results:Thirty six new cases of pompholyx were seen within the period with an average incidence of 0.59% over the ten year period consisting of 22 females and 14 males with age range of 2- 65years.There was no statistical significant relationship between age categories and sex. The majority of cases were seen amongst students. The age 20-45 group constituted the highest number. 61% had a history of contact dermatitis with the major triggers being detergents, chemicals and metals. All patients were counseled and improved after receiving treatment from at least two of the five major classes of drugs- corticosteroids, antifungal, antibiotics, antihistamines and astringents. Conclusion:Pompholyx is a recurrent hand dermatitis characterized by vesicles and bullae though not common as the study reflects; it can be a source of mental and physical discomfort leading to a poor quality of life in affected individuals

Dyshidrosis is a risk factor for herpes zoster.

BACKGROUND: Endogenous factors such as stress-induced immune system reactivity were also associated with dyshidrosis. Herpes zoster (HZ) incidence has been demonstrated to increase with immune deficiencies. Therefore, a relationship between dyshidrosis and HZ may exist. OBJECTIVE: This study investigated whether there is an association between dyshidrosis and HZ. METHODS: We conducted a population-based cohort study by using Taiwan's Longitudinal Health Insurance Database (LHID2000) records from 1996 to 2011. The dyshidrosis group comprised 8488 patients with newly identified dyshidrosis and no history of HZ prior to diagnosis of dyshidrosis. For the non-dyshidrosis group, each dyshidrosis patient frequency matched according to age (5-year intervals), sex and index date year with four controls selected randomly from the LHID2000. RESULTS: After adjustments for confounding risk factors, the hazard ratio for HZ in the dyshidrosis group was 1.31 compared with the non-dyshidrosis group. Regardless of comorbidities, patients with dyshidrosis had a higher risk of HZ than did controls without dyshidrosis. Patients with more hospital visits that were due to dyshidrosis had a higher risk of HZ. CONCLUSION: Dyshidrosis is strongly associated with HZ. Patients treated for dyshidrosis should be warned of HZ risk.

Retrospective long-term follow-up in patients with chronic palmoplantar dermatoses after good response to bath PUVA therapy.

BACKGROUND: Numerous studies have confirmed the short-term effectiveness of 8-methoxypsoralen bath PUVA therapy in patients with chronic palmoplantar dermatoses; however, little is known about long-term results. PATIENTS AND METHODS: In this retrospective study we examined the long-term results in 79 patients (mean age: 48 years) with chronic palmoplantar dermatoses who were treated with bath PUVA three times a week over an 8-year period. A good clinical response (a reduction of more than 50% of the skin lesions) occurred after a mean of 23 treatments and a mean cumulative UVA dose of 39 J/cm(2) in 51 patients (65%). In 2007 a questionnaire was sent to these 51 patients to assess the long-term outcome. RESULTS: With bath PUVA treatment, the best results were found in patients with hyperkeratotic eczema (17/22; 77% good clinical response) followed by patients with palmoplantar psoriasis (26/41; 63%) and patients with dyshidrotic eczema (8/16; 50%). Thirty-four patients (67%) answered the questionnaire after a mean follow-up interval of 4.3 years (10-87 months). Among these patients, 36% reported an improved course of disease after PUVA therapy with reduced frequency and/or intensity of the skin rash, and 29% of patients reported continued complete clearance. 79% of our patients reported a long-term reduction in the use of topical corticosteroids during the follow-up period (mean: 4.3 years). In addition, 67% of patients reported a lasting improvement in quality of life. CONCLUSIONS: These data show that bath PUVA may have a long-term, beneficial influence on the course of disease in a majority of patients with recalcitrant chronic palmoplantar dermatoses.

Perfil de los pacientes con dermatosis en las manos remitidos a la Unidad de Contacto de un hospital terciario e impacto de las pruebas epicutáneas en el diagnóstico / Characteristics of Patients With Hand Dermatitis Referred to the Contact Dermatitis Unit of a Tertiary Hospital and Impact of Patch Testing on Diagnosis

Introducción. Se describe el perfil epidemiológico y clínico de los pacientes remitidos a una Unidad de Dermatitis de Contacto en los que el motivo de consulta había sido el presentar dermatosis en las manos. Material y métodos. Evaluación retrospectiva de los pacientes remitidos con dermatosis de las manos a la Unidad de Contacto del Hospital Germans Trias i Pujol entre los años 2004 y 2007. Resultados. Se incluyó un total de 96 pacientes. El diagnóstico más frecuente fue el de dermatitis de contacto irritativa (DCI), seguido por el de dermatitis de contacto alérgica (DCA), psoriasis, dishidrosis y dermatitis atópica. Se realizaron pruebas epicutáneas estándar en todos los casos y baterías complementarias en 42 (44 %). Las pruebas epicutáneas fueron positivas en el 59 % de los casos, considerándose de relevancia presente en el 22 %, pasada en el 6 % y desconocida en el resto. El diagnóstico inicial de DCA se confirmó en el 67 %de los casos en los que representó la primera propuesta diagnóstica. Los alérgenos con relevancia clínica más frecuentes fueron el cromo, el níquel, la colofonía, diversos alérgenos de plantas y la p-fenilendiamina. Conclusiones. Las dermatosis de las manos son un motivo habitual de consulta en la Unidad de Contacto, siendo el diagnóstico de DCI el más frecuente. Se encontró una buena correlación entre el diagnóstico de presunción de DCA y el hallazgo de alérgenos con relevancia clínica (AU)

Objective. This study aimed to define the epidemiological and clinical characteristics of patients referred to a contact dermatitis unit for hand dermatitis. Material and methods. We retrospectively analyzed patients referred for hand dermatitis to the contact dermatitis unit of the Hospital Germans Trias i Pujol, Barcelona, Spain, between 2004 and 2007.Results. A total of 96 patients were included. The most common diagnosis was irritant contact dermatitis, followed by allergic contact dermatitis, psoriasis, dyshydrosis, and atopic dermatitis. Standard patch tests were done for all patients and complementary batteries were ordered in 42 (44 %). Patch tests were positive in 59 %of the patients. Positive results were considered of present relevance in 59 %, of past relevance in 6 %, and of unknown relevance in the remaining positive tests. When proposed as the initial diagnosis, allergic contact dermatitis was confirmed in 67 % of the patients. The most frequent clinically relevant allergens were chrome, nickel, rosin, plant allergens, and p-phenylenediamine. Conclusions. Hand dermatitis is a frequent presenting complaint in our contact dermatitis unit, with allergic contact dermatitis being the most common. Good correlation was found between presumed diagnosis of allergic contact dermatitis and the finding of clinically relevant allergens (AU)

Dyshidrosis: epidemiology, clinical characteristics, and therapy.

Dyshidrosis is a common chronic dermatitis of the hands and feet that may cause significant physical discomfort, psychological distress, and occupational impairment. Topics reviewed in this article include epidemiology, clinical findings, quality of life, and therapeutic considerations. Dyshidrosis is often difficult to manage; therefore, extra attention is given in this review article to current treatment options.

[Factors associated with palmoplantar or plantar pompholyx: a case-control study]. / Facteurs associés à la dysidrose palmo-plantaire ou plantaire: étude cas-témoins.

BACKGROUND: Disydrosis or pompholyx is a chronic and recurrent form of dermatosis that poses a number of therapeutic issues. The etiopathology of the condition is unclear. The aim of this study was to identify factors associated with the palmoplantar and plantar dysidrosis. PATIENTS AND METHODS: This was a prospective case-control study conducted between June 2001 and February 2004 at the University Hospital of Lome (Togo). Each case (palmoplantar or plantar pompholyx) was matched for age (+/- 5 years) and sex with two controls. Examination for tinea pedis was performed in all participants (patients and controls) but mycologic culture alone was done in patients with interdigital-plantar intertrigo. RESULTS: One hundred patients with pompholyx were matched with 200 controls. Mean age was 32.8 +/- 14.8 years in the patient group and 31.4 +/- 14.8 years in the control group. For univariate analysis, the main factors associated with pompholyx were: personal atopy (OR = 12.6; CI95%: 6.4 - 25.1) and familial atopy (OR = 5.8; CI95%: 3.2 - 10.5); history of eczema (OR = 5.4; CI95%: 2.6 - 11.4); hyperhidrosis (OR=4.5; CI 95%: 5.5 - 40.7), sport (OR = 8.8; CI 95%: 3.9 - 20.8); tinea pedis (OR = 15.6; CI 95%: 7.5 - 32.9). In multivariate analysis, atopy (OR = 10.5; CI95%: 8.4 - 20.8) and tinea pedis (OR = 18; CI95%: 10.5 - 25.2) were the only factors associated with pompholyx. Trichophyton rubrum was the most common etiology of tinea pedis in both patients and controls. DISCUSSION: The results of this study show atopy and tinea pedis as factors statistically associated with palmoplantar or plantar pompholyx. However, only cohort studies can determine the precise causal relationship between tinea pedis and pompholyx.

Role of contact allergens in pompholyx.

Fifty patients of both sexes with clinically suspected pompholyx were patch tested with the Indian Standard Patch Test Battery approved by the Contact & Occupational Dermatosis Forum of India (CODFI). Most of these patients were young adults between 20-39 years of age with a mean age of 30 years. The mean duration of symptoms was 4 years. The occupational profile of the patients included students (20%), housewives (16%), housewives engaged in farming (12%), labourers (12%), farmers (12%) and paramedical workers (6%). The miscellaneous group, including salesmen, teachers and photographers, accounted for the remaining 22%. The clinical patterns of presentation of pompholyx included cheiropompholyx (60%), cheiropompholyx and podopompholyx (36%) and podopompholyx alone (4%). Patch test analysis of these patients revealed that, out of the 50 subjects tested, 20 (40%) reacted to one or more allergens. Nickel sulphate was the commonest offending allergen (14%) followed by potassium dichromate and phenylene diamine and nitrofurazone (8% each), fragrance mix (6%) and cobalt chloride (4%), in descending order of frequency. Hence, patch testing may be considered for all patients with recurrent episodes of pompholyx as allergic contact dermatitis may be relatively common in such patients and the avoidance of offending allergens may be of substantial benefit to these patients.

Estudio epidemiológico de la dermatitis alérgica de contacto en España (2001) / Epidemiological study of allergic contact dermatitis in Spain (2001)

Introducción: El estudio mediante pruebas de contacto estándar es fundamental para diagnosticar y tratar cualquier paciente en el que se sospeche una dermatitis de contacto. El primer estudio estadístico con pruebas epicutáneas estándar del Grupo Español de Investigación de Dermatitis de Contacto (GEIDC) data de 1977. Veinticinco años más tarde, se realiza este estudio que tiene como objetivo valorar la prevalencia y la relevancia de las positividades a los alergenos de la serie estándar del GEIDC. Métodos: Todos los pacientes fueron estudiados mediante la serie estándar del GEIDC (29 alergenos) en 13 centros dermatológicos. Se valoraron los siguientes parámetros: sexo, edad, localización, diagnóstico, causa del eccema, positividades y relevancia total, presente y pasada. Resultados: El 55,11% de los 3.832 pacientes estudiados (2.300 mujeres y 1.532 varones) tuvieron alguna positividad en la serie estándar. Los diagnósticos más frecuentes fueron la dermatitis de contacto alérgica en el 31,02% e irritativa en el 15,88%. El origen más común de la dermatitis fue profesional en el 16,66% de los casos, y la metalurgia y la construcción fueron las ocupaciones más prevalentes. Más de la mitad de los pacientes sufrían eccema en manos (54,34%). El alergeno más prevalente fue el níquel (26,64%) seguido de cobalto (9,89%) y cromo (8,66%). Conclusiones: Comparando los datos de este estudio con el realizado por el GEIDC en 1977 comprobamos cómo ha aumentado la alergia a níquel mientras ha disminuido la debida a cromo y cobalto. Alergenos no incluidos años atrás como tiomersal, mezcla de perfumes y Kathon CG muestran actualmente una alta prevalencia. Es siempre fundamental establecer la relevancia de las pruebas positivas, que es alta en este estudio para las gomas y para el níquel (AU)

[Prevalence of latex allergy among personnel at a hospital]. / Prévalence de l'allergie au latex parmi le personnel d'un hôpital.

The aim of this study was to compile a register of all the employees of a University Hospital Centre who complained of dermatosis of the hands due to latex. Recruitment was made by their spontaneous presentation in the service of the Workers Doctor (Médecine de Travail). The prevalence of clinical signs of contact eczema or professional urticaria is 2.3% for all personnel. 2.7% for nurses, 4.4% for care assistants or ancillary staff of the hospital service. In this population, 73% of subjects have shown previous atopy. The positive predictive value of the allergy tests was 51.3%, 2.32% of ASH-ASI, 1.75% of AS, 1.47% of IDE were allergic to latex, about 1.06% of the total personnel. 80% had atopy and 36.66% had a crossed allergy (banana, kiwi, avocat, pollen). Prevalence was zero amongst the administrative officers, but not systematic enquiry was made in the professional category. The orthoergical dermatoses were more frequent amongst the ASH-ASI, though the positive predictive value of tests was less. The considerable exposure to a number of caustic substances, as well as absence of precautions such as rinsing and drying of hands may explain this. All employees with allergy to latex have been declared to have a professional illness a card that mentions this allergy has been given to them.

Epidemiological, clinical and allergological observations on pompholyx.

We have studied a group of 104 patients with pompholyx, to investigate the relationship between allergological factors and its etiopathogenesis. The following examinations were performed: blood sampling (routine tests and IgE levels), allergological tests (patch, prick, intradermal, and oral provovation tests with nickel sulphate), skin biopsy to exclude pemphigus vulgaris or bullous pemphigoid. An accurate history of familial and personal allergic diathesis was enquired for and various possible aggravating factors (season, microclimate, perspiration and emotional stress) were considered. The results were age and sex-matched with a healthy control group (208 subjects). We found familial and personal atopic diathesis in 50% of patients versus 11.5% of controls (p less than 0.001); 39 patients (37.49%) also had high levels of IgE. Nickel sulphate was the allergen with the highest positivity on patch testing: 20.19% versus 6.25% of the control group (p less than 0.001). The % of patients allergic to nickel reached 26%, including those (6 patients) reacting to the oral provocation test. Season (43 patients) and hyperhidrosis (38) were the aggravating factors most commonly claimed. We detected no correlation between age, sex, grading of pompholyx and the allergological parameters investigated. Though several different allergological findings have previously been reported in dyshidrosis, their role in its pathogenesis has not yet been fully explained. We think that different haptens or antigens can produce the same clinical and histological picture of pompholyx in predisposed subjects.