Clinical assessment of the severity of chronic hand eczema: correlations between six assessment methods

Abstract

Objective. The severity of hand eczema (HE) can be assessed via numerous methods, however, a standard method remains lacking. Furthermore, correlations between the various methods are not known. The purpose of the study was to evaluate the correlations between six different methods used for assessing the severity of chronic HE. Method. The study included 100 patients with chronic HE. The severity of HE was assessed using the Hand Eczema Severity Index (HECSI), Physician Global Assessment (PGA), Dermatology Life Quality Index (DLQI), Photographic Guide (PG), Osnabrueck Hand Eczema Severity Index (OHSI), and Investigators’ Global Assessment (IGA). Furthermore, correlations between the 6 methods were determined. Results. There was a strong correlation between HECSI, and OHSI, mTLSS, PG, and IGA, and between IGA, and PG and OHSI (P < 0.001). There was a moderate correlation between DLQI and PGA (P < 0.001), whereas correlations between DLQI and the other scales were weak. The females had lower quality of life, although gender was not associated with disease severity according to the other scales. Conclusion. Overall, the six methods used for assessing the severity of HE were significantly positively correlated. Females had lower quality of life, but the severity of HE assessed via the other five scales did not vary according to gender. The weakest correlation was between DLQI and all other scales.

Keywords

• Chronic hand eczema, severity, quality of life

References

1. Cortesi PA, Scalone L, Belisari A, Bonamonte D, Cannavò SP, Cristaudo A, et al. Cost and quality of life in patients with severe chronic hand eczema refractory to standard therapy with topical potent corticosteroids. Contact Dermatitis. 2014;70:158-68.
2. Weistenhöfer W, Baumeister T, Drexler H, Kütting B. An overview of skin scores used for quantifying hand eczema: a critical update according to the criteria of evidence-based medicine. Br J Dermatol. 2010;162:239-50.
3. Apfelbacher C, Molin S, Weisshaar E, Bauer A, Elsner P, Mahler V, et al. Characteristics and provision of care in patients with chronic hand eczema: updated data from the CARPE registry. Acta Derm Venereol. 2014;94:163-7.
4. Held E, Skoet R, Johansen JD, Agner T. The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability. Br J Dermatol. 2005;152:302-7.
5. Skudlik C, Dulon M, Pohrt U, Appl KC, John SM, Nienhaus A. Osnabrueck hand eczema severity index--a study of the interobserver reliability of a scoring system assessing skin diseases of the hands. Contact Dermatitis. 2006;55:42-7.
6. Thaci D, Steinmeyer K, Ebelin ME, Scott G, Kaufmann R. Occlusive treatment of chronic hand dermatitis with pimecrolimus cream 1% results in low systemic exposure, is well tolerated, safe, and effective. An open study. Dermatology. 2003;207:37-42.
7. Ruzicka T, Lynde CW, Jemec GB, Diepgen T, Berth-Jones J, Coenraads PJ, et al. Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol. 2008;158:808-17.
8. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210-216.

9. Charan UP, Peter CV, Pulimood SA. Impact of hand eczema severity on quality of life. Indian Dermatol Online J. 2013;4:102-5.
10. Hongbo Y, Thomas CL, Harrison MA, Salek MS, Finlay AY. Translating the science of quality of life into practice: What do dermatology life quality index scores mean? J Invest Dermatol. 2005;125:659-64.
11. Coenraads PJ1, Van Der Walle H, Thestrup-Pedersen K, Ruzicka T, Dreno B, De La Loge C,et al. Construction and validation of a photographic guide for assessing severity of chronic hand dermatitis. Br J Dermatol. 2005;152:296-301.
12. Mollerup A, Veien NK, Johansen JD. An analysis of gender differences in patients with hand eczema - everyday exposures, severity, and consequences. Contact Dermatitis. 2014;71:21-30.
13. Agner T, Andersen KE, Brandao FM, Bruynzeel DP, Bruze M, Frosch P, et al; EECDRG. Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients. Contact Dermatitis. 2008;59:43-7.
14. Handa S, Kaur I, Gupta T, Jindal R. Hand eczema: Correlation of morphologic patterns, atopy, contact sensitization and disease severity. Indian J Dermatol Venereol Leprol. 2012;78:153-8.
15. Meding B, Swanbeck G. Epidemiology of different types of hand eczema in an industrial city. Acta Derm Venereol. 1989;69:227-33.
16. Suman M, Reddy BS. Pattern of contact sensitivity in Indian patients with hand eczema. J Dermatol. 2003;30:649-54.
17. Agner T, Jungersted JM, Coenraads PJ, Diepgen T. Comparison of four methods for assessment of severity of hand eczema. Contact Dermatitis. 2013;69:107-11.
18. Wallenhammar LM, Nyfjall M, Lindberg M, Meding B. Health-related quality of life and hand eczema – a comparison of two instruments, including factor analysis. J Invest Dermatol. 2004;122:1381-9.
19. Bingefors K, Lindberg M, Isacson D. Quality of life, use of topical medications and socio-economic data in hand eczema: a Swedish nationwide survey. Acta Derm Venereol. 2011;91:452-8.
20. Boehm D, Schmid-Ott G, Finkeldey F, John SM, Dwinger C, Werfel T, et al. Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema. Contact Dermatitis. 2012;67:184-92.