A combination of itch plus minimum of two skin signs such as dryness, erythema, fissures may be considered as diagnostic criteria for diagnosing hand eczema, suggests a study reported in the journal Contact Dermatitis.¹

Researchers from the University of Copenhagen in Denmark enrolled 1663 healthcare workers composed of nurses, physicians, midwives, physiotherapists, biotechnicians for this multicenter study. The participants were enquired about history of hand eczema during the Covid-19 pandemic from March 2020 to February 2021. A digital questionnaire was used to retrospectively analyse skin changes such as dryness, erythema, fissures, itch, scaling, stinging or vesicles. Through this study, the researchers aimed to investigate a correlation between self-reported skin signs and symptoms on the hands with self-reported HE and also attempted to define criteria for hand eczema.

Nearly 12% of those surveyed reported hand eczema. Majority of these (91.4%) reported having at least one skin-related symptom compared to 32.3% who did not self-report having hand eczema. The symptom that showed maximum correlation with hand eczema was itch with sensitivity and specificity of 78.5% and 78.6%, respectively followed by erythema with sensitivity and specificity of 77.4% and 78.2%, respectively. However, the PPV of erythema was low at 38.7% as almost 22% of participants without self-reported HE also reported erythema.

Fissures, scaling and vesicles had low sensitivity and positive predictive value (PPV) and hence lacked utility in identifying self-reported hand eczema. Dryness, though maybe regarded as a precursor of hand eczema even though it had low specificity and PPV.

Combining two or more signs such as erythema, scaling, fissures and vesicles with itch resulted in a sensitivity of around 53% and specificity of nearly 94%.

In this questionnaire-based  study, more than 90% of participants with self-reported HE had at least one of the following: erythema, scaling, fissures, vesicles. However, more than 30% of those who did not report hand eczema also had at least one of these signs. It is therefore important to carefully analyse and compare the self-reported HE and the signs and symptoms. Based on their findings, the authors suggest a minimum of two signs (i.e. erythema, scaling, fissures, vesicles) combined with itch as diagnostic criteria for hand eczema, although they recommend further studies to validate the accuracy of this association.

Reference

1. Yüksel YT, et al. A comparison between selfreported hand eczema and self-reported signs and symptoms of skin lesions indicating hand eczema. Contact Dermatitis. 2022;1‐7. doi:10.1111/cod.14183