Longterm Eczema

Background Long-term follow-up studies on the prognosis and consequences of
occupational hand eczema (OHE) and the prognostic risk factors for persistent
OHE are sparse.
Objectives To determine the medical and occupational outcome after a follow-up of
7–14 years in 605 patients diagnosed with OHE and to identify the prognostic
risk factors for the continuation of hand eczema.
Methods Patients examined at the Finnish Institute of Occupational Health in
1994–2001 completed a follow-up questionnaire 7–14 years after diagnosis.
Results The hand eczema had healed (no eczema during the last year) in 40% of
patients with OHE. The duration of hand eczema before diagnosis was strongly associated
with the continuation of eczema. Age, sex and diagnosis (allergic or irritant
contact dermatitis) were not associated with the prognosis, but skin atopy, and
especially respiratory atopy, were correlated with the continuation of hand eczema.
Contact allergies in general were not risk factors for persistent OHE, but the presence
of a work-related chromate allergy was associated with poor healing. A total
of 34% of patients had changed their occupation due to OHE, and their long-term
prognosis was better than those who had not. The hand eczema of patients originally
in food-related occupations continued on an unfavourable course.
Conclusions In the logistic model, risk factors for the continuation of OHE were a
long duration of hand eczema before diagnosis, respiratory atopy, skin atopy,
and continuation in the same occupation. Those who ended up changing
occupation due to their OHE had a better medical and economic prognosis.
Hand eczema is often a chronic condition. In follow-up studies
of nonoccupational hand eczema (non-OHE), healing rates
have ranged between 18% and 41%.1–6 In studies with varying
follow-up periods, occupational hand eczema (OHE) has
been reported to heal in 21–72% of all cases.7–20 Only a few
long-term follow-up studies have been published previously,
7,10,15,18–20 and the prognosis in these has not always been
better than that in short-term studies. In some studies, a
change of job or occupation has not led to improvement of
occupational skin disease.8–10,21 The most frequently reported
predictive factors for poor prognosis (continuation of the
OHE in the absence of further exposure) include
atopy,7,12,15,22 contact allergies,7,8,12,23 older age,21,24,25 and
the severity21,26 and duration26 of the eczema.
In our previous study, the occupational skin disease had
healed in 27% of the patients 6 months after diagnosis.27 To
determine the long-term prognosis of OHE, we sent a questionnaire
to the patients diagnosed with OHE at the Finnish
Institute of Occupational Health (FIOH) 7–14 years previously
who had answered the earlier questionnaire.
Materials and methods
Study population and design
FIOH is a national referral unit to which patients are referred
by insurance companies, occupational physicians and dermatologists.
Patients who were diagnosed with an occupational
skin disease during the period 1994–2001 at FIOH and who
had answered a follow-up questionnaire 6 months after their
diagnosis were sent a new questionnaire in 2008. In total,
605 patients who returned the completed questionnaire and
who had OHE in the fingers, palms, dorsa of the hands, wrists
or forearms were included in this study. The response rate
was 80Æ1% (605 of 755).