Severe cases of occupational hand eczema may predict unemployment or days missed from work

Hand eczema caused by soaps and other irritants in the workplace may lead to unemployment or prolonged sick leaves from work for some individuals, according to an article in the March issue of Archives of Dermatology, one of the JAMA/Archives journals.

Hand eczema or dermatitis is characterized by redness and inflammation of the hands, often due to irritants in soap, chemicals or detergents. "Occupational hand eczema (OHE) has become a disease of increasing importance during recent decades because of its serious consequences, such as frequent eruptions and risk of prolonged sick leave," background information in the article states. OHE also greatly affects quality of life (QOL). Past studies name OHE as the most frequently recognized occupational disease in Denmark and many Western countries.

Rikke Skoet Cvetkovski, M.D., Ph.D., of the University of Copenhagen, Hellerup, Denmark, and colleagues studied patients with OHE to identify predictive risk factors for the disease. Patients listed in the Danish National Board of Industrial Injuries Registry as having OHE between Oct. 1, 2001, and Nov. 10, 2002, received questionnaires regarding sick leave, loss of job, depression, health-related quality of life and their eczema's severity. A follow-up questionnaire was sent one year after the first was returned. Of the 621 patients who responded to the first questionnaire, 564 (386 women and 178 men) completed the follow-up.

During follow-up, 25 percent of surveyed patients had persistently severe or aggravated OHE, 41 percent improved and 34 percent of patients experienced unchanged minimal or mild to moderate OHE. The groups most affected by OHE were butchers, kitchen workers and cooks, hairdressers and patients aged 25 to 29 years. Having a severe case of OHE, being 40 years of age or older and having a low self-rated quality of life predicted unemployment and prolonged sick leave (more than five weeks in the past year). Also, patients with a lower socioeconomic status (based on education and job status) were at high risk for prolonged sick leave, a change of job and unemployment.

"Predictive factors could be used by clinicians to guide treatment and to select early risk management strategies," the authors write. "To avoid prolonged sick leave that may lead to social and economic decline, physicians must try to identify subgroups of patients who are at greater risk of a poor outcome."

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(Arch Dermatol. 2006; 142: 305 311. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by the Danish National Board of Industrial Injuries, the Danish Council for Research Policy, and the Danish National Institute of Occupational Health, Copenhagen.


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