Clinical patterns and associated factors in patients with hand eczema of primarily occupational origin

Background Hand eczema (HE) is the most common skin disease acquired at work. It presents in different clinical patterns. Objective To classify different types of HE according to their clinical pattern and associated factors in patients taking part in a tertiary individual prevention programme (TIP) for occupational skin diseases. Methods In a retrospective cohort study, the medical records of 843 patients taking part in the TIP were evaluated. HE was classified into three clinical subtypes: vesicular HE, hyperkeratotic HE and HE with erythema and desquamation. Results About 723 patients (85.8%) suffered from HE. Female TIP patients with HE were significantly younger (OR 0.97, 95% CI 0.96-0.99) and had a higher prevalence of flexural eczema (OR 1.60, 95% CI 1.15-2.23) and an atopic HE component (OR 1.84, 95% CI 1.36-2.48) than men. Vesicular HE was more common in women (OR 1.44, 95% CI 1.07-1.94) and significantly associated with hyperhidrosis (OR 1.69, 95% CI 1.23-2.33), flexural eczema (OR 1.37, 95% CI 0.99-1.89) and an atopic HE component (OR 1.93, 95% CI 1.44-2.61). Hyperkeratotic HE was more frequent in men (OR 3.70, 95% CI 2.27-6.25) and associated with older age (OR 1.04, 95% CI 1.02-1.06). The cohort of patients with HE characterized by erythema and desquamation was very heterogeneous. Vesicular HE was significantly associated with tobacco smoking (OR 1.94, 95% CI 1.40-2.68), while hyperkeratotic HE was significantly less common in smokers (OR 0.38, 95% CI 0.22-0.65). Conclusion Environmental and individual factors are associated with different clinical patterns of HE in patients taking part in the TIP. They may influence the prognosis and should be considered in the individual management of disease. Tobacco smoking may be in particular a risk factor for vesicular HE.