Treatment of hand eczema, any help from classification?

Background: Intervention studies often use unclear definitions of either morphological or aetiological types of hand eczema, or there is no classification at all. These studies are not reproducible or difficult to compare. A generally accepted classification system is essential for clinical trials. Only then evidence based advice can be given on the treatment of well defined types of hand eczema. The multifactorial aetiology makes it challenging to classify hand eczema into aetiological types. A clinical description alone seems insufficient. The Danish Contact Dermatitis Group (DCDG) published a classification of hand eczema according to predefined clinical patterns and aetiological diagnosis. Objectives: Tostudy therelationshipbetweencontact sensitization and the different clinical types of hand eczema. Methods: We included 1680 patients with hand eczema, aged=18 years, which were patch tested from 2002 to 2013 and filed in the ESSCA database of the University Medical Center Groningen. All cases were classified retrospectively into six clinical types according the DCDG: chronic fissured hand eczema, recurrent vesicular hand eczema, hyperkeratotic palmar eczema, pulpitis, interdigital eczema, nummular hand eczema and non-classifiable. Classification was based on data from medical records and our local ESSCA database. Patch test results were collected from the ESSCA database. The sensitization rate in the different clinical types was determined and the relationship between contact sensitization and the different clinical types was analysed. We investigated whether this relationship was modified by an atopic state. Results: Preliminary data indicate that there is yet no clear association pattern between the clinical type of hand eczema and contact sensitization. Conclusions: Proper application of clinical description of hand eczema is needed to investigate the relationship between clinical types of hand eczema and aetiological factors like contact sensitization and an atopic state