Review Finds Strong Association Between Atopic Dermatitis and Occupational Hand Eczema

A new meta-analysis published this week in the British Journal of Dermatology highlights the strong association between atopic dermatitis (AD) and hand eczema (HE). AD is a common, chronic and relapsing inflammatory skin condition. While several studies have addressed the relationship between AD and HE, the exact association remains unknown. In this review, Ruff et al., examined published literature on the association between AD and HE. Prevalence of HE was divided into the following 3 categories: occurrence over one’s lifetime, occurrence in the past year, and occurrence at the time of the study. Researchers then performed meta-analyses including 26 of the 35 relevant studies, which examined the connection between AD and the 3 categories of HE studied, respectively.

The researchers looked at whether patients’ gender, age, and occupation affected the relationship between AD exposure and HE outcome, and they also looked at the studies’ design and quality, as well as whether differences in the way the studies defined HE duration affected the results.

The study utilized 237 of 1596 articles found. A total of 26 studies with 90,336 participants were incorporated in the quantitative synthesis. Only 2 studies confirmed a current AD diagnosis by clinical examination; 24 studies determined a diagnosis of AD at some point in life by a questionnaire, 2 by interview, and 1 by review of medical records.

At the time of the meta-analysis:

• 6 studies found HE in individuals with AD that resulted in a combined odds-ratio (OR) of 2.35 (95% CI, 1.47-3.76)

In the past year:

• In 13 studies, respondents presented with HE in the past year, however, they did not currently have AD. These studies resulted in a combined OR of 4.29 (95% CI, 3.13-5.88)

Over one’s lifetime:

• 12 studies had respondents who reported having both HE and AD in their lifetime, which resulted in a combined OR of 4.06 (95% CI, 2.72-6.06)

Interestingly, the meta-analysis also found that in the past year, there were 6 studies that included reports of occupational HE. These studies presented an OR of 4.31 (95% CI, 2.08-8.91).

The systematic review and meta-analysis showed that individuals with present or past AD had a strongly increased risk of having experienced HE. The findings of this study reinforce the well-established impression that patients with (a history of) AD have an increased risk of developing HE. Due to the impaired skin barrier function, reduced inflammatory threshold, and increased risk of developing HE, physicians have advised that individuals with AD steer away from professions that include wet work and prolonged exposure to irritants and allergens.

Reference

Ruff SMD, Engebretsen KA, Zachariae C, et al. The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis [published online November 23, 2017]. Br J Dermatol. 2017; doi: 10.1111/bjd.16147