The Challenge of Hand Eczema:Pathogenesis, Treatment, and Burden of Disease

Hand eczema is a common condition in the general population. The pathogenesis is largely unknown. The first part of this thesis studied the pathogenesis of hyperkeratotic hand eczema. This subtype has a typical presentation with thick hyperkeratosis of the palms and differs from other subtypes of hand eczema. Immunofluorescence showed that multiple proteins (e.g. filaggrin) had different staining patterns. It is still questionable if hyperkeratotic hand eczema is a subtype of hand eczema or an own entity and future research is necessary. Part two focuses on different systemic treatments in severe hand eczema by drug survival studies. Drug survival is an outcome measure to evaluate long term potency of a treatment. Daily practice data of alitretinoin, acitretin, cyclosporine, methotrexate and azathioprine was retrospectively collected. Cyclosporine was, besides alitretinoin, the most valuable treatment option in severe chronic hand eczema. Furthermore showed these data that current systemic treatments are often limited by side effects and ineffectiveness. Part three explores the burden of disease in terms of health-related quality of life, treatment satisfaction and treatment adherence in chronic vesicular hand eczema. Severity affected both, quality of live as treatment satisfaction. Patients with systemic treatment had a higher treatment satisfaction compared with those using only topical treatment. Systemic treatment should therefore be more accessible in severe vesicular hand eczema. The last chapter of this thesis is a review about cost of illness. Total costs in hand eczema varies between €1311-€9742 per patient per year. Occupational costs formed the largest component of total costs