Prevent chronification through early use of topical topical topicals

Hand eczema is associated with psychosocial and socioeconomic follow-up costs. The corona pandemic has significantly increased the prevalence of hand eczema. Affected persons and risk groups should be informed in good time about possible preventive and therapeutic measures. Patient education courses provide a suitable framework for this. Adequate skin care and early use of symptomatic topical topical topicals play an important role in prevention and treatment.

The prevalence of skin eczema in the population was reported to be about 10% before the corona pandemic, with much higher prevalence figures in certain occupational groups (e.g., hairdressers, bakers, medical professions) [1,2]. An increase in the incidence of hand eczema has been observed in association with the corona pandemic, which can be explained by more frequent hand washing and disinfection [3]. Irritants such as water, detergents, dirt or other allergens are among the most important risk factors, along with atopic skin diathesis and genetic factors [2,4]. Hand eczema is associated with a disturbed skin barrier, which promotes skin dehydration and associated itching symptoms.

Depending on the etiology, a distinction is made between contact allergic hand eczema, irritant/cumulative subtoxic hand eczema, and atopic hand eczema [2]. Chronic hand eczema is rarely caused monocausally, but mixed forms are usually present. “Pure allergic contact dermatitis is relatively rare,” said Prof. Dr. med. Swen Malte John, Head of the Department of Dermatology, Environmental Medicine and Health Sciences at the University of Osnabrück (D) at the SGDV Dermatoallergology training event [15]. If the inflammatory, non-infectious skin changes of the hands persist for less than three months and do not occur more often than once a year, they are acute and subacute hand eczema. If symptoms persist for more than three months or occur at least three times a year despite adequate treatment and patient adherence, it is chronic hand eczema [1,2]. By treating mild hand eczema quickly, chronicity can be counteracted (overview 1) .

Patient education and other preventive measures

Both the patient’s quality of life and ability to work can be severely limited by eczema. According to the Swiss Accident Insurance Fund (SUVA), one fifth of all occupational diseases affect the skin, with the hands frequently being affected [5]. Preventive measures play an essential role in the management of hand eczema [6]. First of all, all technical-organizational interventions should be exhausted, such as automating work processes, changing work organization, replacing hazardous substances with less toxic, less irritating and less allergic substances. If this is not possible, adequate application of a personal protection strategy in the form of skin protection preparations and protective gloves are important measures to avoid contact with various occupational noxious agents in the course of work. In addition, the use of skin care to support skin regeneration is recommended. In order to provide those affected with the necessary tools for the prevention and treatment of hand eczema, patient education sessions have proven effective, and the content should be repeated regularly in order to achieve a lasting effect, explains the speaker [15]. In the context of frequent hand washing and disinfection during the corona pandemic, the use of skin care products is particularly important, especially for workers in medical professions, explains Prof. John. This can also reduce the risk of nosocomial infections, the speaker said. Moisturizing skin care products and washing products without irritants have proven effective for basic skin care in order to protect the skin despite frequent cleansing (overview 2) [7,8]. Several studies show that skin protection and care is effective in reducing hand eczema (box) .

Topical externals: broad spectrum of treatment options

The use of skin care products plays an important role both in prevention and as a basic therapy of hand eczema and is used in all degrees of severity [9]. The goal is to improve hydration and lipid balance of the stratum corneum, reduce barrier disruption, and decrease itch symptoms and frequency of acute flare-ups. Lipid-rich creams and ointments containing ceramide, glycerin or urea are used to achieve this. Important factors are that the skin care products are absorbed quickly and are as free as possible from fragrances and preservatives in order to avoid renewed allergic type IV sensitization to these ingredients. The following is an overview of the most important groups of active ingredients for the treatment of hand eczema [10]:

Keratolytics: especially in hyperkeratotic forms of hand eczema, keratolytics such as salicylic acid and urea are used in a formulation of 3-20% salicylic acid to dissolve the stratum corneum and 5-20% urea to soften it. Low-percentage mixtures are recommended for occlusive therapy, as skin irritation, redness and burning may occur at high concentrations.

Topical corticosteroids: topical corticosteroids can be used in parallel with basic skin care and are very effective in the short term, but may promote recurrences when discontinued, so it is important to combine them with skin care products that repair the skin barrier [11]. Which steroid (class I-IV) is used in which formulation depends on the expression, severity and localization of the hand eczema.

Topical calcineurin inhibitors: pimecrolimus and tacrolimus can also be used to treat hand eczema, whether when tapering off steroids or alone in addition to basic care or as proactive maintenance therapy in patients with frequent exacerbations [9]. One advantage of topical calcineurin inhibitors is that they do not lead to skin barrier disruption or skin atrophy.

Other local therapeutics: If superinfection is present, disinfectant agents such as clioquinol, chlorhexidine, and octenisept as a wash lotion or hand bath and wearing Dermasilk gloves may provide relief [12]. Especially in cases of superinfected or atopic hand eczema colonized with Staphylococcus aureus, an allergen-free silk material processed with the antimicrobial substance AEM5772/5 can help to reduce symptoms overnight. There is also evidence of efficacy for Dermasilk as adjuvant therapy [13,14]. Furthermore, barrier gloves made of three-layer allergen-impermeable but evaporation-permitting material represent a therapeutic and prophylactic option for chronic hand eczema [10].

Step-adapted combination therapy

In addition to preventive measures and local treatment, there is a broad spectrum of further interventions that can be applied within the framework of the stage-adapted treatment strategy recommended in the guideline. These include phototherapy, iontophoresis [9] and various systemic therapies from alitretinoin [11] to systemic glucocorticosteroids, cyclosporine [11], acitretin [11], azathioprine or methotrexate to dupilumab [10]. Therapy with topical topicals is a cornerstone of treatment and often a combined treatment strategy is most promising.

Congress: SGDV Dermatoallergology 2021

Literature:

Ballmer-Weber BK, et al: Management of chronic hand eczema: Swiss consensus. Derm Hel 2012; 24: 28-36.
Thraen AC, Cozzio A, Ballmer-Weber BK: Chronic hand eczema. DERMATOLOGIE PRAXIS 2018; 28(3): 9-13.
Mahler V: Hand eczema – differential diagnoses, diagnostics and therapies. JDDG 2016; 14(1): 7-26.
Apfelbacher CJ, et al: Determinants of current hand eczema: results from case-control studies nested in the PACO follow-up study (PACO II). Contact Dermatitis 2010; 62(6): 363-370.
Müller R: Occupational rashes and skin eczema, SUVA, Dec. 16, 2020, www.suva.ch (last accessed Mar. 23, 2021).
Bauer A, et al: Primary prevention of occupational hand eczema, Arbeitsgemeinschaft Berufs- und Umweltdermatologie (ABD): Berufsdermatologie 2017, AKS03/01, https://onlinelibrary.wiley.com/doi/full/10.1111/ddg.13210
Kim S, et al: A consistent skin care regimen leads to objective and subjective improvements in dry human skin: investigator-blinded. Journal of Dermatological Treatment 2020; 1-22.
Wollenberg A, et al: European Task Force on Atopic Dermatitis statement on severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection and atopic dermatitis. JEADV 2020, https://doi.org/10.1111/jdv.16411
Berthold E, Weisshaar E: Therapy of hand eczema. Dermatologist 2019; 70:790-796.
Gorris A, Kinaciyan T: Hand eczema. close up 2020; 19: 162-170.
Diepgen TL, et al: Guidelines for diagnosis, prevention and treatment of hand eczema. J Dtsch Dermatol Ges 2015; 13: 1-22.
Koller DY, et al: Action of a silk fabric treated with AEGIS in children with atopic dermatitis: a 3-month trial. Pediatr Allergy Immunol 2007; 18: 335-338.
Schaunig C, Kopera D: Silk textile with antimicrobial AEM5772/5 (Dermasilk): a pilot study with positive influence on acne vulgaris on the back. Int J Dermatol 2017; 56: 589-591.
Fontanini C, et al: DermaSilk in long-term control of infantile atopic dermatitis: a double blind randomized controlled trial. G Ital Dermatol Venereol 2013; 148: 293-297.
John SM: Hand eczema, Prof. Dr. med. Swen Malte John, SGDV Dermatoallergologie, 19.03.2021
Balato A, et al: European Task Force on Contact Dermatitis statement on coronavirus disease-19 (COVID-19) outbreak and the risk of adverse cutaneous reactions. JEADV 2020 Volume 34(8): e353-e354.