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Water exposure on the skin of the hands has previously been studied in adults. The aim of this study was to investigate self-reported water exposure in adolescents in the BAMSE cohort in Stockholm, Sweden. A questionnaire including a question on daily water exposure on the hands was answered by 3,091 adolescents at age 16 years. Exposure > 10 times/day was reported by 28.7% and > 20 times/day by 3.1%; boys had somewhat higher exposure than girls (p = 0.03). In a multivariate analysis, adolescents with dry skin reported higher exposure (adjusted odds ratio (ORadj) 1.4; 95% CI 1.2-1.7), while no statistically significant exposure differences were found in relation to hand eczema or atopic dermatitis. Reported exposure may be considered as baseline exposure during a period of life with limited occupational and domestic duties. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound is emerging as an important imaging modality for characterizing soft-tissue infections and provides advantages over physical examination and magnetic resonance imaging (MRI). Case Report: A 30-year-old man presented to the emergency department with extensive left upper extremity cellulitis. Magnetic resonance imaging of the left arm was preliminarily interpreted as soft-tissue swelling without evidence of deep-space infection. Point-of-care ultrasound revealed pockets of fluid with sonographic fluctuance tracking along the tendon sheath that were concerning for deep abscesses. Based on the ultrasound findings, the patient was taken emergently to the operating room, where multiple left hand and wrist loculated deep-space abscesses were decompressed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights the significant advantages and easy-to-learn findings present in point-of-care ultrasound of musculoskeletal infections. [ABSTRACT FROM AUTHOR]

Unilateral simian crease (USC) is a single transverse crease that extends from across the palm of one of the hands. The presence of a single transverse palmar crease or the simian crease (SC) can be seen in normal individuals. The significance of USC lies in the fact that it can also be associated with abnormal medical conditions. Literature review indicates that there is strong coincidence with the presence of a SC and presence of genetic or chromosomal abnormalities in these subset of patients. USC is seen in 10% of the population. In this case report, a three year old child was detected to have a SC, especially an USC in one of his palms. [ABSTRACT FROM AUTHOR]

Sweet's syndrome is characterized by erythematous tender nodules and plaques over face and extremities. Fever, leukocytosis with neutrophilia, and a neutrophilic infiltrate in the dermis are characteristic features. Neutrophilic dermatosis of dorsal hands is a rare localized variant of Sweet's syndrome occurring predominantly over dorsa of hands. Various degrees of vascular damage may be observed on histopathology of these lesions. Both Sweet's syndrome and its dorsal hand variant have been reported in association with malignancies, inflammatory bowel diseases, and drugs. We report a patient with neutrophilic dermatoses of dorsal hands associated with erythema nodosum. He showed an excellent response to corticosteroids and dapsone. [ABSTRACT FROM AUTHOR]

Process data give important insights into how an intervention is implemented. The aim of the present study is to conduct a process evaluation, alongside a randomised controlled trail, on the implementation of recommendations for the prevention of hand eczema. The intervention was carried out in healthcare workers' departments and consisted of working groups and role models. The role models were selected based on their representativeness, their influence on colleagues, and their motivation. The focus of the working group was to implement recommendations for hand eczema at the department by choosing solutions to overcome barriers for implementation. Out of the 104 solutions, 87 were realised. Solutions regarding moisturisers and use of cotton under gloves, were used by 90.9% and 30.8% of the employees, respectively. Of all participants, 58.2% actively engaged with the role models. This process evaluation showed that the intervention was executed according to protocol and that the solutions were implemented well. However, the role model component in the intervention should be improved. [ABSTRACT FROM AUTHOR]

Background Hand eczema ( HE) is a common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not yet been studied. Objectives To evaluate relations between smoking status, severity and prognosis of occupational HE in patients taking part in an interdisciplinary tertiary individual prevention programme ( TIP). Methods In a prospective, multicentre, cohort study 1608 patients with occupational HE taking part in a TIP were recruited and followed up for 3 years. The clinical and self-reported outcome data of smokers and nonsmokers were compared. Results Nonsmokers and smokers were equally distributed. During the TIP, the average self-reported daily cigarette consumption and the severity of HE decreased significantly ( P < 0·01). However, at all time points HE was significantly more severe in smokers than in nonsmokers. This association was not dependent on the self-reported number of cigarettes smoked daily. Smokers had significantly more days of absence from work due to occupational HE than nonsmokers in the year before the TIP ( P < 0·01) and in the following year ( P = 0·02). After the TIP, smokers reported significantly more often that they had to give up their occupation ( P = 0·02) than nonsmokers. Conclusions The severity of occupational HE is increased in smokers. Tobacco smoking is associated with a higher number of days of absence from work and with not staying in the workforce owing to occupational HE. Thus, smoking confers a worse prognosis and interferes with the outcome of prevention programmes. [ABSTRACT FROM AUTHOR]

Background BAMSE is a Swedish population-based birth cohort. Objectives To estimate prevalence proportions and the incidence rate of hand eczema in Swedish adolescents, and to compare information given by adolescents and parents. Further aims were to study sex distribution, age at onset and extension of hand eczema. Methods At 16 years of age, 2927 adolescents were included in this study; both adolescent and parental questionnaires were used, as well as clinical examination. Results The 1-year prevalence of hand eczema was 5·2% ( n = 152) and 4·0% ( n = 116) ( P < 0·03), and lifetime prevalence was 9·7% ( n = 284) and 7·0% ( n = 206) ( P < 0·01), respectively, when adolescents and parents reported. The incidence rate was 573/100 000 person-years according to the adolescent report. The level of agreement between adolescents and parents was fair for 1-year and lifetime prevalence (κ = 0·56 and κ = 0·49, respectively). According to the Hand Eczema Extent Score, 27·0% ( n = 36) had moderate-to-severe hand eczema. Conclusions At the age of 16 years, the 1-year prevalence of hand eczema was substantial, with an incidence rate of the same magnitude as in adults. Female predominance was seen in adolescence. It is preferable that the occurrence of hand eczema is reported by adolescents themselves, as they are the ones most aware of their symptoms. [ABSTRACT FROM AUTHOR]

Background A series of cases of symmetrical acral keratoderma have been described recently in China. However, no studies about its demographic information and epidermal barrier function have been documented. Objectives To describe the clinical manifestation, demographic information and clinicopathological features of 71 cases with symmetrical acral keratoderma. Patients and methods Seventy-one cases with symmetrical acral keratoderma were retrospectively reviewed. Their demographic information, clinical manifestations, histopathology and epidermal barrier function were analysed. Results Among these patients, there were 64 males and seven females, ranging in age from 4 to 53 years with an average age at onset of 27 ± 8·9 years. Clinical manifestation was characterized by brown hyperkeratotic patches over the dorsum of the hands, palms and feet, dorsal digits and wrists, elbows, knees and ankles. The lesions became dramatically whitish with mild swelling immediately after soaking in water and resolved spontaneously in winter. In patients, a moderate increase of transepidermal water loss ( TEWL) from 16·16 ± 6·15 to 9·9 ± 4·21 g m−2 h−1 ( P = 0·0054) and a moderate decrease of skin hydration from 65·9 ± 5·06 to 42·58 ± 10·73 ( P < 0·01) in comparison with the control group were observed. Histopathological examination revealed epidermal hyperkeratosis, acanthosis and papillomatous hyperplasia as well as dermal infiltration with a few lymphocytes. Conclusions Symmetrical acral keratoderma is characterized by symmetry, acra, keratinization and marked seasonal changes. The epidermal barrier function of the skin was negatively affected. [ABSTRACT FROM AUTHOR]

Background Chronic hand eczema is a common disease that may impact quality of life and have occupational and social consequences. Self-management is pivotal, both in handling acute eruptions and avoiding relapses. However, little is known about how people with hand eczema self-manage and integrate their disease into everyday life. Objectives To explore the knowledge, attitudes and everyday life behaviours of patients with chronic hand eczema in order to generate insights about barriers in self-management. Methods Qualitative, semistructured, focus group interviews were carried out. Twenty-three people with hand eczema participated in the four group sessions. The content of the interviews was analysed according to a template of concepts, categories and codes. Results Patients felt they lacked knowledge about the causes of eczema and how best to manage it. They perceived it as a complex condition, yet only simple solutions were offered. The patients found it difficult to apply preventive strategies in everyday life. They wanted to take an active role in their course of illness, but experienced barriers such as discomfort from emollient treatment or feelings of stigmatization. The patients stated that the need to focus constantly on prevention was energy-consuming. Conclusion Self-management support in chronic hand eczema needs to be individualized in order to provide specific knowledge relevant to the patient, so that the patient has realistic expectations concerning the course of disease and can adopt new habits that minimize effort in preventive behaviour. [ABSTRACT FROM AUTHOR]

Background Several instruments for the assessment of the severity of hand eczema and health-related quality of life (HR-QoL) related to hand eczema have been developed. Objectives The aim of the present study was to evaluate the correlation between frequently used methods. Methods Consecutive patients with current hand eczema from three different centres participated in the study. Severity of hand eczema was assessed with the Hand Eczema Severity Index (HECSI), the Physician Global Assessment (PGA), the Clinical Photo Guide, and the Dermatology Life Quality Index (DLQI). Results One hundred and nineteen patients with hand eczema were included in the study. All six pairwise correlation coefficients between the tested methods were highly statistically significant. Correlation was highest between the HECSI and the PGA (r = 0.82), and weakest, although still statistically significant, between the DLQI and the other three severity scores ( r between 0.30 and 0.45). Age and frequency of eruptions did not influence the correlations. With respect to sex, there was a tendency for correlation between methods to be higher for men than for women. Conclusion We found an overall positive correlation between the four severity assessments applied. As the weakest correlation was found between the DLQI and the other methods, it is suggested that measurement of HR-QoL should be included for assessment of the severity and consequences of hand eczema, but the finding also indicates that a disease-specific tool for evaluation of HR-QoL in hand eczema patients is needed. [ABSTRACT FROM AUTHOR]

Background Physicians need a simple, disease-specific tool with which to assess disease severity and the effect of therapeutic intervention in patients with chronic hand eczema. The currently available clinical scoring systems include numerous items, which makes them laborious to complete and limit their use in daily practice. Objective To develop a simple tool with which to assess disease severity of patients with chronic hand eczema. Methods We evaluated two tools, the Hand Eczema Severity Index (HECSI) and the Hand Eczema Area and Severity score, to determine their ability to predict the Investigator's Global Assessment (IGA) of disease severity in patients with moderate to severe hand eczema. We used a stepwise reduction analysis to determine a minimal set of significantly contributing items for predicting IGA. Results A three-item score, based on the highest observed value of induration, fissuring, and scaling, predicted IGA with a correlation of 0.667. The HECSI predicted the IGA with a correlation of 0.675. Conclusion On the basis of this analysis, we propose a simple tool for clinical decision-making and evaluation of therapeutic intervention in daily practice. [ABSTRACT FROM AUTHOR]

Background: Hand eczema is a common disease seen in dermatological practice comprising of a spectrum ranging from mild disease to a severe distressing and chronic course with a negative impact on the quality of life. Aim: To assess the impact of hand eczema severity on quality of life. Materials and Methods: Patients with hand eczema were enrolled in a prospective study. Disease severity was assessed by hand eczema severity index (HECSI) score and quality of life by dermatology life quality index (DLQI) questionnaire. Results: Forty-six patients participated of which 22 (47.8%) were males and 24 (52.2%) females. The commonest age group affected among men and women was 50-59 years (31.8%) and 40-49 years (41.7%) respectively. History of atopy was found in 23.9% and 63% had persistent disease. In 28 (60.9%), the trigger was washing soaps and detergents of which 21 (87.5%) were housewives. Of those employed, 27.7% reported loss of work days. The mean HECSI score was 14.46 (S.D = 20.98) and mean DLQI score was 9.54 (S.D = 5.62). Gender, age, occupation and duration of disease did not significantly affect the quality of life or disease severity. Increased episodes of eczema (>4 episodes/year) showed a statistically significant correlation with DLQI (P value = 0.021). There was no significant correlation between HECSI score and DLQI in this study. Conclusion: Majority of the patients with hand eczema had a significant impairment of their quality of life. The impairment of quality of life in this study was mainly dependent on increased frequency of the eruptions and not on hand eczema severity. [ABSTRACT FROM AUTHOR]

Background. Protein contact dermatitis was originally defined in 1976 by Hjorth and Roed-Petersen as a distinct kind of dermatitis seen in patients with occupational food contact. Even though occupational skin diseases are frequent in Denmark, little attention has been paid to protein contact dermatitis, and the frequency is unknown. Objectives. To evaluate the frequency of occupational food-related hand dermatoses and test results in patients occupationally exposed to foods. Materials and Methods. This was a retrospective study based on examinations, including skin prick testing and patch testing, performed at the Department of Dermato-Allergology, Gentofte University Hospital, Denmark between 2001 and 2010. Results. Of all patients (n = 372), 57.0% had irritant contact dermatitis, 22.0% had protein contact dermatitis, 2.4% had contact urticaria, and 1.8% had allergic contact dermatitis. A suggestion for diagnostic criteria is presented. Frequent risk occupations were cooking in restaurants, baking, and kitchen work. Substantially more patients reacted in skin prick testing with fresh foods than with food extracts. Conclusion. Protein contact dermatitis is a frequent disorder among patients who professionally handle foods, and should be considered to be a distinct clinical entity. When diagnosing protein contact dermatitis and in other food-related skin prick testing procedures, it is important to include fresh foods. [ABSTRACT FROM AUTHOR]

Summary [ABSTRACT FROM AUTHOR]

The article presets information on various alternatives for the treatment of Chronic Hand Eczema (CHE). It informs that Hand Eczema is a skin disorder which affects the hands. It states that the education about the skin protection helps prevent allergies and skin diseases. It is stated that another treatment for CHE can be done with the help of potent topical corticosteroids. It is also stated that the oral treatment with alitretinoin treatment is also beneficial in curing CHE.

The article discusses the clinical cases of two Chinese pediatric patients who were diagnosed with Mal de Meleda (MDM), an autosomal recessive palmoplantar keratoderma characterized with erythema and hyperkeratosis of the palms and soles. The clinical presentations of the patients are described, along with information on MDM.

Background and objectives: The aim of this cross-sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany. Methods: 1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians. Results: Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86). Conclusions: Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease. [ABSTRACT FROM AUTHOR]

Background: Occupational hand dermatitis (OHD) is a common and often chronic condition. Usage of topical corticosteroids is limited in long-term therapy because of potential side-effects. New treatment options are highly appreciated. Objective: To study efficacy and safety of tacrolimus in patients suffering from OHD. Patients and Methods: In a prospective, open, multicentre study, 29 patients with OHD of predominantly mild-to-moderate severity were treated with tacrolimus ointment (Protopic® 0.1%) during a 4-week active treatment period with twice daily application followed by a 2-month optional treatment period. Efficacy was evaluated by the use of a standardized hand eczema score and by clinical severity rating, conducted on all study visits (screening, baseline and weeks 2, 4, 6, and 12). Adverse events were recorded for safety evaluation. Results: The hand eczema score declined significantly after 2 weeks of treatment compared with baseline and further declined until the end of the study. Finally, 12 (44%) patients were clear of hand eczema. Worsening of the dermatitis occurred in 2 patients (7%). Clinical grading indicated improvement too. Overall tolerability was good. Conclusion: Topical tacrolimus might be an efficacious treatment option for chronic OHD. Blinded and randomized controlled studies are necessary to confirm the results of this pilot study. [ABSTRACT FROM AUTHOR]

Summary: Epidermodysplasia Verruciformis is a rare skin disease due to human papillomavirus (HPV) infection. We report here a male patient of 39 years with severe giant lesion of hands and feet leading to disability for 20 years. The function of the hands was almost lost. We treated the case with the shaving technique and a satisfactory result without recrudescence in the following two years. No apparent scarring resulted. [Copyright &y& Elsevier]

Population-based studies on contact allergy with retesting of individuals are infrequently performed. Variable degrees of persistence are reported when individuals with contact allergy are retested with years in between. The patch test results of 270 individuals tested in 2005–2006 are presented and the pattern and frequency of sensitization discussed. Persistence when compared with patch test results from 1997–1998 is reported. 270 twin individuals with and without hand eczema underwent patch testing with the TRUE Test® (Mekos Laboratories AS, Hilleroed, Denmark) in 1997–1998 and again in 2005–2006 as part of a larger study. In 2005–2006, a total of 74 (27.4%) of the 270 individuals had at least 1 positive patch test and 20 (7.4%) of the 270 had 2. The frequency in men and women was 9/90 (10%) and 65/180 (36.1%), respectively. The frequency of contact allergy in individuals with and without hand eczema was 59/185 (31.3%) and 15/85 (17.6%), respectively. The most prevalent contact allergies were to nickel, thiomersal, and fragrance mix I. All together, 74% of the positive reactions were reproduced. The frequency of contact allergy in this population-based cohort with hand eczema was comparable with previous reports. Persistence of contact allergy after many years was confirmed. [ABSTRACT FROM AUTHOR]

Background In clinical practice or trials on hand eczema the severity of this disease can be ‘measured’ in different ways: by means of a physician-rated clinical severity score, a patient-rated clinical severity score or by an indicator of the burden of disease. We assume that the patient-rated severity score corresponds more with the (change in) burden of disease than with the physician-rated severity score. Objectives To demonstrate how physicians and patients differ in their assessment of the severity of hand eczema as seen in a physician-rated severity score, patient-rated severity score and a burden of disease questionnaire. Methods We used data from an open-label randomized controlled trial which was set up in two university hospital dermatology departments in the Netherlands, specializing in hand eczema. One hundred and fifty-eight patients with moderate to severe chronic hand eczema were included. The main outcome measures were the physician-rated severity score, based on five visible aspects of hand eczema (desquamation, erythema, vesicles, infiltration, fissures), the patient-rated severity score (a self-rating scale), a burden of disease questionnaire (the Dermatology Life Quality Index, DLQI) and the correlations between these parameters, both at inclusion and over time. Results Only desquamation and infiltration were significantly correlated with patient-rated severity score. Patient-rated severity score correlated with seven of 10 DLQI items, but it did not correlate with the items regarding influence on clothes worn, impairment of sporting activities, and problems associated with treatment of the skin. The majority of patients showed improvement in all parameters after treatment. However, the improvement in patient-rated severity score was not clearly correlated with changes in physician-rated severity score. Except for DLQI item 1 (itch, soreness, pain, stinging), none of the changes in burden of disease was correlated with changes in patient-rated severity score. For each DLQI item, change over time correlated weakly with decreases in several, but not all, components of the physician-rated severity score. Conclusions Disease severity can be expressed by different scores; these scores are not clearly correlated, and measure different aspects. Patient satisfaction is not guaranteed when treatment is focused solely on the visible aspects of hand eczema. Instead, burden of disease has a greater impact. [ABSTRACT FROM AUTHOR]

The article comments on the clinical case of a fifteen-year-old white male with recurrent hand, foot, and mouth disease (HFMD). The patient presented to a clinic with a two-day history of multiple perioral and intraoral blisters and an erythematous maculopapular rash on the dorsum of the hands extending up to his forearms. Based on clinical findings, a diagnosis of HFMD was established. The patient was treated symptomatically for his pain and scheduled for a follow up appointment. Coxsackie B virus type 3 IgG antibody levels remained elevated one year following the patient's final episode of infection. The recurrent episodes in this case might be explained by the subsequent infection with a different strain of virus.

Colloid milium is a rare cutaneous deposition disorder that frequently occurs in areas of chronic sun exposure such as the face, neck and backs of the hands and is characterized by multiple small, discrete, usually amber-colored, dome-shaped papules that cluster to form large plaques. A 50-year-old white woman with esophageal squamous cell carcinoma was referred to us with asymptomatic, slowly spreading lesions localized to the dorsa of her hands which had been present for 4 years. The condition was diagnosed histopathologically as pigmented colloid milium associated with exogenous ochronosis (EO). Colloid milium associated with EO is very rarely reported in the published work. We think that a possible interaction between sunlight and exposure to chemical fertilizers may have played a role in the pathogenesis of both of the disorders in our case. [ABSTRACT FROM AUTHOR]

Presents a case of a patient with eczematous changes on the hands. Case report of a 59-year-old nurse from Mauritius presented with a four-year history of exertional dyspnea, arthralgia, and malaise; Results of physical examination.

Presents a case of Mechanic's hands as part of the antisynthetase syndrome. Eczematous changes on the hands; Histologic examination of the biopsy specimen; Improvement in the patient's skin, joint, and muscle problems after therapy with systemic prednisolone and azathioprine; Main differential diagnosis of mechanic’s hands.

The purpose of the study was to evaluate the incidence of hand dermatitis, the impact of potential risk factors and the efficacy of skin bioengineering in a prospectively followed cohort of apprentice nurses. 104 participants were prospectively followed for 3 years. Before the start of training, after about 1 year and in the third year of occupational exposure, a standardized questionnaire was distributed, and a clinical examination with skin bioengineering of the dorsum of hand and forearm was performed. The 12-month period prevalence of self-reported symptoms of hand dermatitis was 36.5%[95%-confidence interval (CI) 27.3–46.6] at intermediate follow-up and 43.3% (95%-CI 33.6–53.3) at the final examination. Apprentices with self-reported symptoms at the final examination showed a significant increase of transepidermal water loss (TEWL) at the dorsal hand from 10.15 g/m2h to 13.55 g/m2h. TEWL at this site did, at the initial examination, not differ significantly between persons who later reported symptoms of hand dermatitis at the final examination and those who did not (10.50 g/m2h versus 10.15 g/m2h, respectively). Our results do not support the notion that an increased basal TEWL is a good indicator for hand dermatitis risk. [ABSTRACT FROM AUTHOR]

Presents clinicians' notes on several investigative dermatology articles featured in various dermatology journals. Notes on risk factors associated with striae gravidarum; Atopic dermatitis, stinging and effects of chronic stress; Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne; Use of aromatherapy products and increased risk of hand dermatitis in massage therapists.

The purpose of this longitudinal study was to examine a cohort of secondary school pupils, aged 16-19 years (47 females and 18 males) with a 1-year prevalence of hand dermatosis. The study deals with the pupils' history of atopy, self-reported symptoms, exacerbating factors, protection habits, choice of education programme, self-rated health and impact on everyday life. The results showed that 61.5% of the pupils had a history of atopic dermatitis; 78% did not use protective gloves. Females reported use of corticosteroids more often than males. In all, 60% had not been given information at school about future occupational risks, when choosing education. The cohort changed education programme significantly more often than pupils reporting not having hand dermatosis. However, the cohort estimated their health as being as good as that of adolescents in the general population. The neglect of risks in choosing a future profession may cause not only suffering for the individual, but also costs for society. [ABSTRACT FROM AUTHOR]

Presents a case of a 66-year old man with a solitary subcutaneous nodule on the dorsum of his left hand. Enlargement of the nodule; Performance of a skin examination and removal of the nodule through surgery; Other changes observed in the skin infected with the disease.

Reports on a case of untreated congenital hyperkeratotic papules in an African American girl. Examination of the multiple crateriaform hyperkeratotic papules located primarily at the boundary of the dorsal and planar surfaces of the patient's hands and feet.

Hand dermatitis is an eczematous inflammation of the hands that is related to occupation or to routine activities. It often becomes chronic, and in some patients may become severe and disabling. Topical corticosteroids are effective treatment, particularly for milder forms, but they often lose effectiveness with time and can produce skin atrophy. To evaluate bexarotene gel topical therapy for safety, tolerability and efficacy in patients with chronic hand dermatitis. A phase I–II open-label randomized clinical study of bexarotene gel, alone and in combination with a low- and a mid-potency steroid, was conducted in 55 patients with chronic severe hand dermatitis at two academic clinics. Patients using bexarotene gel monotherapy reached a 79% response rate for ≥ 50% clinical improvement and a 39% response rate for ≥ 90% clearance of hands. Adverse events possibly related to treatment in all patients were stinging or burning (15%), flare of dermatitis (16%) and irritation (29%). Thirteen patients (24%) withdrew early, including two for related adverse events and five for inadequate response. Bexarotene gel appears to be safe, tolerated by most patients, with useful therapeutic activity in chronic severe hand dermatitis. [ABSTRACT FROM AUTHOR]

Isolated or predominantly hand involvement in Sweet's syndrome, pyoderma gangrenosum, or pustular vasculitis is a rare presentation in the spectrum of neutrophilic dermatoses and is often associated with an occult malignancy or other systemic inflammatory disorder. When these disorders occur on the hands, they are often clinically indistinguishable, but they can sometimes be separated histologically by the presence of papillary dermal edema (Sweet's syndrome), ulceration and necrosis (pyoderma gangrenosum), or vasculitis (pustular vasculitis). These distinctions may be arbitrary, however, and reflect differences in the temporal course of the disease and in the degree of inflammation at the time of biopsy. We report four cases of neutrophilic dermatosis affecting the hands and a review of the literature for similar cases. Of the four patients presented, two had associated carcinomas and one had myelodysplasia in transition to leukemia. The cutaneous symptoms preceded the finding of an occult malignancy. Thirty-two reported cases of neutrophilic dermatoses presenting on the hands showed clinicopathologic features similar to those in our series. Taken together, the mean age at diagnosis was 60.5 years, and 58% of the patients were female. Twenty-five per cent (nine patients) also had myelodysplasia or leukemia, 14% (five patients) ulcerative colitis, 6% (two patients) carcinoma, 6% (two patients) Crohn's disease, and 6% (two patients) seropositive arthritis. These cases illustrate the importance of recognizing that neutrophilic dermatoses may present uniquely or predominantly on the hands. This presentation is distinctive, and prompt diagnosis may prevent unnecessary medical or surgical therapy and may lead to the earlier diagnosis and treatment of an associated malignancy or other systemic disorder. [ABSTRACT FROM AUTHOR]

The potential effect of barrier creams or emollients in the prevention of work-related hand eczema has mostly been documented in a laboratory setting on experimentally damaged skin. Publications on real intervention studies of barrier creams or emollients in a workplace setting are scarce: only four such studies could be identified. The relatively short follow-up of most studies, and the small numbers of subjects enrolled, may reflect the organisational complexity of such studies. The observed effect is a combination of the intervention effect to be measured, and a number of disturbing variables. These disturbing variables are not just measurement error, but also phenomena such as the course of the disease, confounding and effect modification. In hand-eczema studies, the outcome parameters that should form the basis of the intervention effect are ill defined. Moreover, the study itself (i.e. the investigators) influences the results because there is rarely a single intervention: unknowingly, there are improvements in glove wearing, hand-washing habits or occupational hygiene in general. The performance of a blind study is often difficult or impossible. Large numbers of subjects have to be enrolled if a meaningful reduction in incidence of hand eczema is to be detected. One can demonstrate this by calculating the required enrolment in a study among employees in a nursing home. [ABSTRACT FROM AUTHOR]

In parallel with a coronary risk factor survey in northern Norway, 14.667 men and women answered questions concerning health, life style. and soda] background. The occurrence of hand dermatoses varied only slightly within groups with different educational level and groups with different physical activity at work. Women with housework as their main occupation had a somewhat higher frequency of hand dermatoses than employed women. Sick leave due to hand dermatoses was 4-5 times more frequent in both sexes in less educated compared to highly educated individuals, and more frequent in men and women with physically active jobs. These differences may partly reflect differences in the over-all frequency of sick leave. [ABSTRACT FROM AUTHOR]

An 85-year-old women was referred to the dermatology department in December 1993 for evaluation of slightly painful masses over the dorsum of her left hand for 1 week. She was unaware of any antecedent trauma. The optimal dosage and duration of itraconazole treatment have not been determined. Factors that may influence the treatment outcome include the immune competence of the host, the site and extent of involvement, the disease responsiveness, and the causative organism. An insufficient duration of treatment may cause relapse of phaeohyphornycosis.

Thirty two adult patients who presented with a sharply marginated, hyperkeratotic dermatitis of the palms (HDP), but with no skin lesions elsewhere, have been re-examined approximately 10 years later. Topical treatments had had limited effect. The morphological appearance and localization had remained unchanged, except in two individuals who were free from symptoms. One had developed psoriasis. The incidence of atopic disease and psoriasis in first degree relatives did not differ from that in control subjects. Mycological cultures and patch tests were negative. Serum IgE was normal. Skin biopsies in nine patients all revealed a chronic spongiotic dermatitis. HDP emerges as a distinct and separate disease entity. [ABSTRACT FROM AUTHOR]

Although epidermoid cysts of the palms and soles have long been assumed to develop following implantation of an epidermal fragment as a result of a penetrating injury, the pathogenic mechanism is still controversial, and the discovery of a more common aetiological agent is awaited. Clinical, histological, immunohistochemical and molecular biological studies were performed on 119 epidermoid cysts of palmoplantar location, in order to examine the role of the eccrine ducts, and human papillomavirus (HPV). in the pathogenesis of this disorder. Characteristic histological features were found, including intracytoplasmic eosinophilic bodies (ICB: in 14 cases. 12%) in the cyst wall, vacuolar structures (V: in 28 cases, 24%). or parakeratotlc nuclei (P: in 85 cases. 71%) within the keratinous mass in the cyst cavity. Ductal structures suggesting eccrine ducts (E: in 63 cases, 53%) were also found in the cyst wall or in the cyst cavity. Either ductal structures or carcinoembryonic antigen expression (66 cases. 55%) were noted in a total of 73 cases (61%). Papillomavirus common antigens were detected in 36 cases (30%) showing one or more of the three distinct histological features, i.e. ICB, V and P. Subsequently, hybridization experiments to detect HPV DNA were performed in 47 cases, revealing an association between cysts showing ICB or V and the presence of HPV 60 DNA sequences. On the basis of our results, we propose that epidermoid cysts in the palmoplantar regions may develop from eccrine ducts, and that HPV and injury may play a role in their pathogenesis. [ABSTRACT FROM AUTHOR]

The article discusses about aquagenic palmoplantar keratoderma (APPK) or aquagenic wrinkling of the palms. Topics include heterozygotes and homozygous cystic fibrosis (CF), CF in children, and skin disease in children. The risk of exposure to seawater or warm water and APPK's association to hyperhidrosis and eczema are also mentioned.

Ridged skin occurs on the volar surfaces of the hands and feet of all primates. It also occurs on the distal part of the tail of some New World monkeys and on the paws of certain other mammals. The term "dermatoglyphics," literally "skin-carvings," is used not only as a collective name for all features of ridged skin but also as a description of its study. Although the ridged skin itself is formed in the early fetal period, the configurations are determined by morphologic events in the embryonic hand and foot. Like other features of limb development, the ridges form on the hands at a somewhat earlier period than on the feet. From the time the primary ridges have been formed midway through the fifth month, no further change is apparent either in the structure of the ridges or in the configurations they form.

The article discusses cases of Sybert's keratoderma. The case involved a family of five siblings in which 3 of the siblings have a history of thickening and scaling over the palms and soles since their birth. Results of the examination showed the presence of hyperkeratosis of the palms and soles which reached the dorsum of the hands and feet. An overview of the distinct patterns of palmoplantar keratodermas is provided.

Ichthyosis vulgaris is an autosomal dominant inherited, keratinization disorder and characterized by diffuse scaling. Acrokeratosis verruciformis is also an autosomal dominant, rare keratinization disorder and characterized by warty, brownish to skin colored papules on the dorsa of the hands and feet. We present a case of ichthyosis vulgaris coexisted with acrokeratosis verruciformis in a 24-year-old woman. (Turkderm 2008; 42: 134-6). [ABSTRACT FROM AUTHOR]

The article discusses a study on treatment of Acquired Aquagenic Papulotranslucent Acrokeratoderma (APA). APA is distinguishable by the presence of translucent-to-white papules in bilateral, symmetric patterns on the feet and hands. Although the condition can be treated with salicylic acid, recurrence of the lesions will still occur.

Olmsted syndrome is a rare disorder characterized by the combination of periorificial, keratotic plaques and bilateral palmoplantar keratoderma. New associated features are being reported. Olmsted syndrome is particularly rare in a female patient, and we report such a case in a six year-old Indian girl, who presented with keratoderma of her soles since birth and on her palms since the age of two years along with perioral and perinasal hyperkeratosis. She had sparse, light brown, thin hair. Although the psychomotor development of the child was normal until 18 months of age, the keratoderma plaques had restricted the child's mobility after that stage. [ABSTRACT FROM AUTHOR]

Psoriasis has been recognized as a familial disease with a polygenic inheritance. A case is reported of a father and four of his seven children with plaque psoriasis localized to the hands. The other three children are not afflicted by psoriasis. All patients developed psoriasis at 5 years of age. Only one member of this family has involvement in an area other than the hands. This case illustrates some of the complexities of the genetics of psoriasis. [ABSTRACT FROM AUTHOR]

SUMMARYA 49-year-old woman presented with an asymptomatic indurated linear plaque extending from the medial surface of the right thumb along the junction of the dorsal and palmar skin of the hand onto the lateral aspect of the index finger. The left hand showed a similar but less extensive plaque. A skin biopsy showed an acellular zone in the reticular dermis composed of thickened bundles of collagen haphazardly arranged, some perpendicular to the epidermis, admixed with elastic fibres and amorphous basophilic elastotic material. Granular calcium deposits were identified, particularly within degenerate collagen bundles. These clinical and histological features are diagnostic of collagenous and elastotic marginal plaques of the hands, a slowly progressive but largely asymptomatic condition. Actinic degeneration and chronic pressure have been proposed as aetiological agents, but our patient did not exhibit marked actinic degeneration and had no history of chronic occupational pressure. [ABSTRACT FROM AUTHOR]

Treatment of hand deformities in a long-term survivor with dermolytic bullous dermatosis-recessive is described. An "open method" is sufficient for dealing with volar skin defects. There is still no effective treatment for perfect control of blister formation. But appropriate surgery, followed by careful post-operative rehabilitation can give reasonable hand function. [ABSTRACT FROM AUTHOR]

Evaluates the effectiveness of two gentle cryosurgery regimens in 20 female Caucasian patients with solar lentigines on the back of the hands. Vulnerability of melanocytes to cold; Production of substantial lightening of the lesions due to both regimens; Correlation between chromametric measurements with the classification of the clinical response; High cure rates and cosmetic results.