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Background Recurrent vesicular hand eczema frequently has a chronic course and needs long-term treatment. Objectives To evaluate health-related quality of life (HRQoL), treatment satisfaction, and adherence in patients with vesicular hand eczema. Methods Patients using one main treatment for at least three months were included. Data on HRQoL (Quality of Life in Hand Eczema Questionnaire [QOLHEQ]), treatment satisfaction (Treatment Satisfaction Questionnaire for Medication, version II), and treatment adherence (4-item Morisky Medication Adherence Scale) were collected. Univariate and multivariate regression analysis were used to predict variables associated with HRQoL. Results HRQoL was moderately impaired, with the highest impact in the QOLHEQ subdomain symptoms. Female sex, more severe hand eczema, and lower treatment satisfaction were associated with more impairment in HRQoL. Patients with severe/very severe hand eczema had significant lower "global satisfaction" scores compared with the other severity groups. The "global satisfaction" and treatment adherence in patients using systemic treatment were significantly higher compared with those with only topical treatment. Conclusions In patients with vesicular hand eczema disease severity affects both HRQoL and treatment satisfaction. Systemic treatment of severe hand eczema could improve the severity and as a result also HRQoL, treatment satisfaction, and medication adherence.

Hand eczema (HE) is a prevalent inflammatory skin disease(1). Staphylococcus aureus (S. aureus) is cultured from >50% of all HE cases, and its presence has been associated with disease severity(2-5), although the causal relationship remains unresolved. Topical corticosteroids (TCS) serve as the first-line medical treatment of HE (6).

It is observed that adequate iron intake and status can limit nickel absorption from the diet in the human body. Chronic vesicular hand eczema (CVHE) due to nickel sensitivity is a common dermatological condition where the dietary nickel acts as a provocating factor. Such patients are usually treated with low nickel diet (LND). The present study was conducted to observe the result of addition of oral iron with LND in the treatment of CVHE in patients due to nickel sensitivity. 23 patients with CVHE due to nickel sensitivity were taken for this study. Study group (12 patients) were advised LND with oral iron for a period of 12 weeks. Control group (11 patients) were advised LND alone for a period of 12 weeks. Fast improvement noted in the skin lesions of the study group patients; 10 (83.33%) patients had complete clearance of their hand eczemas at the end of 12 weeks. There were significant reductions in the blood level of nickel in those patients. Moderate improvement noted in the skin lesions of the control group patients; 5 (45.45%) patients showed complete clearance of hand eczema at the end of 12 weeks. This study showed that oral iron helped to reduce nickel absorption from the diet. The study also showed that combination of LND and oral iron can bring a faster reduction in the severity of clinical symptoms of CVHE in a nickel sensitive individual.

Chromium is an essential trace element found in soil, water, air, and in the biosphere. It is the fourth most common element in the earth's crust, mostly used to manufacture stainless steel and other alloys. Chromate allergy is not uncommon and its prevalence rate is reported to be 6%. Once developed, it tends to persist for a long time. Chromate is present in most of the dietary items. Chromate content in food often varies considerably from place to place. However, certain foods are routinely high in chromate content. Chromate in the diet of a chromate-sensitive person can provoke dermatitis. Careful selection of food with relatively low chromate concentration can bring a reduction in the total dietary intake of chromate per day. This can influence outcome of the disease, especially chronic vesicular hand eczema due to chromate sensitivity, and can benefit a chromate-sensitive patient.

Acute and recurrent vesicular hand eczema is an eczematous eruption on the palmar skin of patients for whom no external contactants can be identified as the cause of the eruptions.

5 patients with dermatitis or stomatitis related to the use of orthodontic appliances are described. All the patients were patch tested with the European standard series. One had a ++ reaction to potassium dichromate, one a ++ reaction to nickel, and the remaining 3 no positive patch tests. 3 of the patients had recurrent vesicular hand eczema, which flared after oral challenge with 1 of the metals used in their orthodontic appliances. 2 of these 3 patients had negative patch tests. The dermatitis of 4 of the 5 patients cleared completely upon the removal of their metal orthodontic appliances or their replacement with appliances made of acrylics.

Blastomycosis-like pyoderma, also known as pyoderma vegetans, is an uncommon disease characterized by vegetating skin lesions mimicking blastomycosis or warty tuberculosis, often associated with staphylococcal and streptococcal infections. It is more commonly observed in elderly patients with impaired immunological capacity, and is often unresponsive to various therapeutic modalities. We describe a case of BLP that occurred on the palmar aspect of the left hand in an elderly female, affected with recurrent vesicular hand eczema. The disease resolved completely following the administration of oral acitretin 25 mg/day for 10 weeks.

Oral challenge with nickel sulphate indicated that vesicular hand eczema in nickel-sensitive patients may be exacerbated by nickel occurring naturally in the diet. Twelve nickel-sensitive females with vesicular hand eczema were challenged with a supplementary high nickel diet for 4 days in a single-blind cross-over study. The diet had about five times the average nickel content of the daily Danish diet. An aggravation of the hand eczema was observed in six out of 12 patients on day 4 after the start of the challenge. By day II, the hand eczema was worse in 10 out of 12 patients, and remained unchanged in two.

Ten women with vesicular hand eczema and delayed hypersensitivity to nickel were given 0.5 mg nickel supplements to their diets. The double-blind controlled supplements were given on Monday and Tuesday of each week for at least 1 month. The nickel supplement was lower than that used in previous studies, and only one subject had reproducible flaring of her vesicular dermatitis. We conclude that dietary restriction of nickel is not warranted based on nickel supplement studies, but nickel's role in hand eczema could be clarified by depleting nickel from body stores with chelating agents.

202 patients, 68 males and 134 females, with patch-test-negative, symmetrical vesicular hand eczema were challenged orally in a controlled study with 2.5 mg nickel, 2.5 mg chromium and 1 mg cobalt given as salts of the respective metals. Initially a mixture of the 3 metal salts was given, and if this produced a flare of the eczema, the salts were administered individually at 1 week intervals. 55 patients reacted to the mixture of salts as well as to 1 or 2 of the individual salts. 3 other patients were challenged openly with nickel alone. Male patients reacted primarily to chromate and cobalt, while female patients more commonly reacted to nickel and cobalt. 56 patients were instructed to follow diets planned to reduce the daily intake of the respective metals. The dermatitis of 36 patients cleared or improved markedly after 1 month of dieting. Responses to a questionnaire sent to these 36 patients indicated that 28 of them had followed the prescribed diet rigorously or intermittently for at least a year, because they experienced recurrence of the dermatitis if they stopped dieting. 6 noted no long-term benefit and 2 did not respond.