Researchers Identify Potential Risk Factors of CHE in General Chinese Population 

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A Chinese study analyzed the risk factors for developing chronic hand eczema (CHE) and its severity in the general population.¹ It was found that working with wet hands for more than 5 hours per day as well as having chapped skin were the most significant risk factors.

The cross-sectional questionnaire included 121 CHE patients in a Wuhan hospital from December 2018 to December 2019. From this total, 59 were male and 62 were female with a mean age of 36 and an average disease duration of 3 years. All were 12 years of age and older with a clinical diagnosis and negative mycological test results. Each participant was given a contact allergen patch test along with a patient survey and interview with a doctor after diagnosis.

Investigators tracked data including age, gender, family history, symptoms, disease duration, hand washing frequency, work and lifestyle habits, prescription medications, transepidermal water loss (TEWL), Hand Eczema Severity Index scores (HECSI), and Dermatology Life Quality Index scores (DLQI). The average DLQI score was 8 and the mean daily duration of wet hand work was 1 hour. Participants held a variety of occupations including clerical work, construction, healthcare, cosmetology, farming, and culinary. Out of the group, 7 were students.

The most commonly reported symptoms were itching in 77.7%, scaling in 74.4%, and chapped skin in 73.6%. A greater proportion of patients with chapped skin had severe HECSI (p = 0.006). Furthermore, those with a higher HECSI score had worked with wet hands for longer periods of time (p = 0.006).

According to the patch testing, nickel sulfate 17 was the most common trigger in 25.75% of participants. This was followed by p-phenylenediamine and Carba mix, in 22.73% and 22.73%, respectively. More than 50% of CHE cases were caused by allergic contact dermatitis and irritant contact dermatitis. Although 67 patients had positive patch results, statistical analysis showed that there was an insignificant correlation between a positive patch test score and a high HECSI score. 

Working with wet hands for more than 5 hours a day, versus just 1 to 2 hours, was found to be the most common risk factor in patients with CHE (OR: 8.71, 95% CI: 1.27–59.97, p = 0.028). Chapped skin and an impaired barrier also had a significant correlation with severe CHE as the second most common risk factor (OR: 3.72, 95% CI: 1.27–10.91, p = 0.017). Those with chapped skin also had a higher TEWL. Moreover, strong correlations were identified between DLQI and HECSI scores (p = 0.002) and between TEWL and HECSI scores (p = 0.034). There were no statistical relationships between the HECSI and the number of hand washes or the disease duration.

“The chronicity and frequent recurrence of hand eczema significantly affect patients’ quality of life. The psychosocial burden caused by CHE is a phenomenon that cannot be ignored,” the authors wrote. “CHE influences patients’ DLQI score and may further contribute to patients’ psychiatric disorders, such as depression and anxiety.”

Several study limitations were considered, including the use of a single center with a small sample size. Additionally, the patch test only included common allergens. Further research can address these limitations and better understand the influencing risk factors for Chinese patients of CHE, thus guiding clinical work.

Employees exposed to “wet work,” such as healthcare workers, hairdressers, and food handlers have an increased incidence of CHE, with 0.7 to 1.5 cases per 1000 workers per year.² This study noted that symptoms improved significantly after removal from this type of work environment, but this can be addressed further in future trials.

References

1. Qu Z, Jiang Q, Wang B, et al. A cross-sectional study of clinical characteristics and risk factors for hand eczema in the general Chinese population. Sci Rep. 2024;14(1):29733. Published 2024 Nov 29. doi:10.1038/s41598-024-81610-9

2. Diepgen TL. Occupational skin-disease data in Europe. Int Arch Occup Environ Health. 2003;76(5):331-338. doi:10.1007/s00420-002-0418-1