SEOUL, SOUTH KOREA – A brief individual counseling session brought significant clinical improvement to physicians and other health care professionals with occupational hand eczema in a Danish randomized clinical trial.
At the core of the 20- to 25-minute one-on-one counseling intervention was instruction in a skin protection program, Dr. Kristina Sophie Ibler explained at the World Congress of Dermatology.
Dr. Kristina Sophie Ibler
She presented results of the Hand Eczema Trial (HET), which she described as the first clinical trial of secondary prevention of occupational hand eczema in health care workers. The multicenter, single-blind study involved 253 physicians, nurses, and lab technicians with hand eczema of less than 12 months duration. Participants were stratified according to their profession, hospital, and skin disease severity.
The secondary prevention trial was undertaken because hand eczema is the most common occupational skin disease in Denmark, with an incidence of 0.56 cases per 1,000 individuals annually. The prevalence of hand eczema among health care professionals is roughly 30%. It's a chronic condition that entails substantial sick leave, impaired quality of life, and even permanent work disability, observed Dr. Ibler, a dermatologist at the University of Copenhagen.
All participants in HET were assessed at baseline for disease severity using the standardized Hand Eczema Severity Index. They also completed the Dermatology Life Quality Index and filled out a brief questionnaire on their knowledge regarding skin protective behavior.
The intervention arm underwent patch and skin prick testing to the standard series supplemented by latex and chlorhexidine. Blood tests were obtained looking for elevated levels of specific IgE for latex, chlorhexidine, and ethylene oxide. Based on the results, patients were classified as having irritant or allergic contact dermatitis, atopic dermatitis, or endogenous dermatitis.
The individual counseling session included a demonstration of proper hand-washing technique and instruction in applying moisturizers containing a fluorescent agent so that investigators could assess whether participants were washing correctly. The counseling stressed reducing the number of hand washings per day, substituting a hand disinfectant whenever possible. A perfume-free emollient is to be applied three times during the work day: once upon arrival, so that the emollient has at least half an hour or so to take effect before protective gloves need to be donned, again at lunch time, and just before going home. The moisturizer should also be applied just before going to bed.
Patients also need to learn to consistently wear protective rubber gloves while doing wet work in the clinic or laboratory, as well as when preparing food or cleaning. If they have a latex allergy, their protective gloves should be vinyl. Any time protective gloves are to be worn for longer than 5-10 minutes, a pair of thin cotton gloves needs to be worn underneath in order to minimize humidity.
After roughly 5 months, the active intervention group had statistically and clinically significant reductions in their Hand Eczema Severity Index score as well as significant improvements in their quality-of-life scores and self-evaluated disease severity. They also reported an increase in skin-protective behaviors, including the routine use of protective gloves teamed with cotton under-gloves, frequent application of emollients, and less hand-washing at work.
Dr. Ibler declared having no financial conflicts.