DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20185081

Clinical evaluation and role of patch testing in identifying the exogenous causes in patients presenting with hand eczema

S. Jyothi Lakshmi, K. Gopalakrishnan

Abstract


Background: Hand eczema is a common dermatological problem resulting from both allergic and irritant contactants. Patch testing helps in both diagnosing and identifying allergens.

Methods: A cross sectional study wherein 110 patients with hand eczema attending Dermatology OPD were included and patch testing was done. Data was collected from April 2015 to July 2016 and was analysed for clinical and epidemiological characteristics.

Results: The mean age of the patients studied was 40.27 years with male preponderance. Housewives were the major occupational group comprising 25.5% followed by masons 21.8% and farmers 10.9%. The commonest morphological type was hyperkeratotic type constituting 51.85%, followed by fingertip eczema 19.1%, discoid eczema 11.8%, wear and tear dermatitis 8.2%, recurrent focal palmar peeling 4.5% and pompholyx 4.5%. In the study group 60% of patients showed positive patch test result. A total 66 patients showed patch test positivity to a total of 69 allergens. Nickel was the most common allergen 27.3% identified followed by potassium dichromate 10.9%. Among female patients with positive patch test 70% reacted to nickel and similarly 83.5% of male patients reacted to potassium dichromate. Parthenium allergy was seen in 41.5% of farmers studied.

Conclusions: Patch testing has a definitive role in diagnosing hand eczema caused by allergens. Identifying the allergen involved helps the clinician in advising the patient regarding further avoidance of contactants.


Keywords


Hand eczema, Morphological type, Patch test, Allergens

Full Text:

PDF

References


Eczema BJ. Lichenification, Prurigo and Erythroderma. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s Textbook of Dermatology, 8th ed. Oxford: Wiley-Blackwell; 2010: 23-51.

Rietschel RL, Fowler JF Jr. Hand dermatitis due to contactants: Special considerations. Fisher’s Contact Dermatitis. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2001: 261-278.

Fisher AA. Contact Dermatitis. 2nd ed. Lea and Febiger: Philadelphia; 1986: 31-108.

Suman M, Reddy BS. Pattern of contact sensitivity in Indian patients with hand eczema. J Dermatol. 2003;30:649-54.

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.

Skoet R, Olsen J, Mathiesen B, Iversen L, Johansen JD, Agner T. A survey of occupational hand eczema in Denmark. Contact Dermatitis. 2004;51:159-66.

Templet JT, Hall S, Belsito DV. Etiology of hand dermatitis among patients referred for patch testing. Dermatitis. 2004;15:25-32.

Kishore NB, Belliappa AD, Shetty NJ, Sukumar D, Ravi S. Hand Eczema-clinical patterns and role of patch testing. Indian J Dermatol Venereol Leprol. 2005;71:207-8.

Laxmisha C, Kumar S, Nath AK, Thappa DM. Patch testing in hand eczema at a tertiary care center. Indian J Dermatol Venereol Leprol. 2008;74:498-9.

Minocha YC, Dogra A, Sood VK. Contact sensitivity in palmar hyperkeratotic dermatitis. Indian J Dermatol Venereol Leprol. 1993;59:60-3.

Christophersen J, Mennè T, Tanghǿj P, Anderson KE, Brandrup F, Kaaber K, et al. Clinical patch testdata evaluated by multivariate analysis, Danish Contact Dermatitis Group. Contact Dermatitis. 1989;21:291-9.

Nielsen GD, Jepsen LV, Jǿrgensen PJ, Grandjean P, Brandrup F, Nickel-sensitive patients with vesicular hand eczema: oral challenge with a diet naturally high in nickel. Br J Dermatol. 1990;122:299-308.

Li LF, Wang J. Contact hypersensitivity in hand dermatitis. Contact Dermatitis 2002;47:206-9.

Agarwal US, Panse GG. Relevance of patch testing in hand eczema-comment. Indian J Dermatol Venereol Leprol. 2010;76:59-60.

Duarate I, Terumi Nakano J, Lazzarini R. Hand eczema: Evaluation of 250 patients. Am J Contact Dermat. 1998;9:216-23.

Uter W, Pfahlberg A, Gefeller O, Geier J, Schnuch A. Risk factors for contact allergy to nickel-results of a multifactorial analysis. Contact Dermatitis. 2003;75:378-80.

Boonstra MB, Christoffers WA, Coenraads PJ, Schuttelaar ML. Patch test results of hand eczema patients: relation to clinical types. J Eur Acad Dermatol Venereol. 2015;29:940-7.