Aspects on the hand eczema and the current health care system : the possibility of health related quality of life measure as a tool for follow-up patients

Contact eczema is the most common occupational skin disease, and it predominantly affects the hands. Hand eczema is a chronic and fluctuating disease with a multidimensional impact on the patient and society, resulting in an increased consumption of health care, long term sick leave, in voluntary change of occupation, and a risk of early retirement and impaired healthrelated quality of life. A meta-analysis was conducted to determine the magnitude of the association between occupations and the risk of hand eczema. An increased risk of hand eczema was quantified among hairdressers, as well as nurses, metal workers and office workers (paper I). Currently, patients with chronic hand eczema are referred to a dermatology clinic for further treatment and investigation. Patch testing is a well established procedure for confirming or excluding the role of causative allergen that comes in contact with the hands. After patch testing, a majority of patients are referred back to primary health care without follow-up. In a questionnaire study, 1-10 years after patch testing, we found that many patients forgot their patch test results, and still reported concerns with aspects of their work (papers II-III). In addition, there was no association between patch test results and reporting a better health-related quality of life (paper III). For hand eczema and/or atopic dermatitis patients, we evaluated the change of health-related quality of life (HRQoL) at every three months, and the need for health care. An impairment in health-related quality of life, corresponding to a significant clinical value, can predict the worsening of eczema and the need of health care to re-evaluate its treatment (paper IV). Our study suggests the importance of the adoption of long-term management for hand eczema patients, and regularly using HRQoL measure,as the dermatology life quality index, to discover which patients require further adjustment of treatment