Tove Agner

Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial

Objective To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Design Randomised, observer blinded parallel group superiority clinical trial. Setting Three hospitals in Denmark. Participants 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual. Main outcome measures The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up. Results Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted −3.56 (95% confidence interval −4.92 to −2.14); adjusted −3.47 (−4.80 to −2.14), both P<0.001 for difference. The mean score on the dermatology life quality index was also significantly lower (improved) in the intervention group at follow-up: difference of means: unadjusted −0.78, non-parametric test P=0.003; adjusted −0.92, −1.48 to −0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema. Conclusion A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves. Trial registration ClinicalTrials.gov NCT01012453.

Contact allergy to common ingredients in hair dyes

p‐Phenylenediamine (PPD) is the primary patch test screening agent for hair dye contact allergy, and approximately 100 different hair dye chemicals are allowed.

Clinical severity and prognosis of hand eczema

Background  Hand eczema (HE) is a frequent, long‐lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms.

Transonychial water loss: relation to sex, age and nail-plate thickness

The transonychial water loss (TOWL) was measured in 21 healthy volunteers with an evaporimeter, to establish the usefulness of this technique and study the influence of sex, age and nail‐plate thickness. The median TOWL was 19.4 g/m2h−1 and it decreased with increasing age (R = 0.5I, P < 0.018). The median transepidermal water loss (TEWLHAND) from the back of the hand was 16.0 g/m2 h−1 and from the dorsal side of the underarm (TEWLARM) it was 5.6 g/m2h−1. The TEWLARM was significantly less than from any of the two other points studied (P < 0.01), while there was no significant difference between the values obtained on the hand and the nail. TEWLARM had a median value of 6.4 g/m2 h−1 in men and 4.3 g/m2 h−1 in women (P < 0.05) in this study. No significant correlation between nail‐plate thickness, as measured by ultrasound 20 MHz A‐scan, and TOWL was found. Measurements of TOWL are of interest and should be age‐related. Further studies are needed to determine TOWL in various forms of nail pathology.

Skin reactions to irritants assessed by polysulfide rubber replica

Skin damage after application of experimental irritants was evaluated under blind conditions and by the use of polysulfide rubber replica. Closed pateh tests with 7 different irritants, solvents and empty chambers were applied to 16 volunteers, and the skin damage was evaluated visually and by a replica technique after 24, 48 and 96 h. We found that 3 of the irritants (sodium lauryl sulphate, hydrochloric acid and croton oil) were capable of causing specific and significantly different patterns of skin damage. The patterns could he divided into papular (hydrochloric acid, croton oil) and non‐papular (sodium lauryl sulphate, sapo kalinus, sodium hydroxide) types. Nonanoik acid caused a non‐paular pattern, but propanol, used as a solvent by itself also produced a non‐papular pattern. The time between application of the irritant and appearance of the characteristic alteration in the skin surface differed, depending on the irritant applied.

In vivo studies of aquaporins 3 and 10 in human stratum corneum.

Aquaporins (AQPs) constitute one family of transmembrane proteins facilitating transport of water across cell membranes. Due to their specificity, AQPs have a broad spectrum of physiological functions, and for keratinocytes there are indications that these channel proteins are involved in cell migration and proliferation with consequences for the antimicrobial defense of the skin. AQP3 and AQP10 are aqua-glyceroporins, known to transport glycerol as well as water. AQP3 is the predominant AQP in human skin and has previously been demonstrated in the basal layer of epidermis in normal human skin, but not in stratum corneum (SC). AQP10 has not previously been identified in human skin. Previous studies have demonstrated the presence of AQP3 and AQP10 mRNA in keratinocytes. In this study, our aim was to investigate if these aquaporin proteins were actually present in human SC cells. This can be seen as a first step toward elucidating the possible functional role of AQP3 and AQP10 in SC hydration. Specifically we investigate the presence of AQP3 and AQP10 in vivo in human SC using “minimal-invasive” technique for obtaining SC samples. SC samples were obtained from six healthy volunteers. Western blotting and immunohistochemistry were used to demonstrate the presence of AQP3 as well as AQP10. The presence of AQP3 and AQP10 was verified by Western blotting, allowing for detection of proteins by specific antibodies. Applying immunohistochemistry, cell-like structures in the shape of corneocytes were identified in all samples by AQP3 and AQP10 antibodies. In conclusion, identification of AQP3 and AQP10 protein in SC in an in vivo model is new. Together with the new “minimal-invasive” method for SC collection presented, this opens for new possibilities to study the role of AQPs in relation to function of the skin barrier.

Staphylococcus aureus colonization in atopic eczema and its association with filaggrin gene mutations

Atopic dermatitis (AD) is a prevalent disease with significant impact on physical health and quality of life. Staphylococcus aureus has been directly correlated to disease severity, and may also be a contributing causal factor in the pathogenesis of AD.

Omalizumab for atopic dermatitis: case series and a systematic review of the literature

Omalizumab is a recombinant humanized monoclonal antibody targeting the high‐affinity Fc receptor of IgE, registered for the treatment of chronic spontaneous urticaria and severe allergic asthma. We present a case series of nine patients with atopic dermatitis (AD) treated off‐label with omalizumab and a systematic review of the existing literature. Patients were selected consecutively from a tertiary dermatological referral center during a 5‐year period. All patients were treated with omalizumab at a starting dose of 300 mg subcutaneously every 4 weeks. Systematic literature searches were performed in PubMed, Web of Science, EMBASE, and ClinicalTrials.gov to identify any study (case reports, case series, and controlled trials) evaluating the effect of treatment with omalizumab in AD. Based on physicians’ assessment, 50% of our patients had a good or excellent response to treatment with omalizumab; a further 12.5% had a moderate response, while 37.5% experienced no response or deterioration of symptoms during treatment. Treatment was generally well tolerated. Twenty‐six studies with a median of four patients each (range 1–21), comprising 174 patients, were included in the systematic review. Summed over all studies, a total of 129 patients (74.1%) experienced a beneficial effect of treatment ranging from little to complete response. Omalizumab appears to be a safe and well tolerated, however expensive, treatment with some clinical benefit in patients with severe recalcitrant AD. Recommendation for use in clinical practice awaits evidence from larger randomized controlled trials.

Evidence‐based training as primary prevention of hand eczema in a population of hospital cleaning workers

Skin disorders accounted for one third of all recognised occupational diseases in Denmark in 2010. Wet work is a risk factor for the development of occupational hand eczema. The consequences of occupational hand eczema include sick leave, loss of job and impaired quality of life.

International Comparison of Legal Aspects of Workers’ Compensation for Occupational Contact Dermatitis

The recognition of contact dermatitis as “occupational” depends on the legislation of state institutions and varies considerably among nine European countries, Australia and the USA. Furthermore, claims for compensation after surrender of the occupation are handled in a very different way. Details of management are described based on three typical examples (bricklayer, nurse and surgeon). In most countries, financial compensation is granted if the patient is unable to continue with his/her work and receives retraining for a different occupation. A general shortcoming is the lack of detailed information on the workplace (irritants, allergens and co-factors). For the future, with an increase in workers’ migration, harmonization in regard to procedures for diagnosis, therapy, prevention, recognition and compensation should be pursued with high priority.