Hand eczema and lifestyle factors in the Dutch general population:Evidence for smoking, chronic stress, and obesity

Background Several risk factors, among other lifestyle factors, have been suggested for hand eczema (HE). Objectives To investigate a possible association between HE and lifestyle factors, including smoking, alcohol consumption, stress, body mass index (BMI), waist circumference, physical activity, diet, and amount of sleep in the Dutch general population. Methods Data from the large population-based LifeLines Cohort Study was used. Individuals with HE in the past year were identified by a cross-sectional questionnaire in 2020. At baseline, information on lifestyle factors was collected. Results In total 57 046 individuals were included in the present analysis. Smoking >= 8 cigarettes/day, and smoking >= 15 pack years showed a positive association with HE in the past year. In addition, chronic stress, a BMI >30 kg/m(2), and a waist circumference of >90 cm were positively associated with HE in the past year. Conclusions The current study indicates that lifestyle factors are associated with HE. Advice regarding lifestyle factors might contribute to enhance overall health, of which HE might possibly benefit in conjunction. Further studies should also focus on the association between lifestyle factors and the severity and prognosis of HE rather than on occurrence alone

Association between moderate to severe atopic dermatitis and lifestyle factors in the Dutch general population

Background Studies on the association between severity of atopic dermatitis (AD) and lifestyle factors in adults have not been conducted in the Netherlands to date. Aim To explore the association between moderate to severe AD and lifestyle factors in adults in the Dutch general population. Methods We conducted this cross-sectional study within the Lifelines Cohort Study by sending a digital AD questionnaire to 135 950 adults in 2020. We extracted data on lifestyle factors from baseline, collected between 2006 and 2013. We analysed the association between lifestyle factors and presence of AD of any severity and of moderate to severe AD, using binary logistic regression and linear regression models. Results We enrolled 56 896 participants (mean age 55.8 years, 39.7% males). The lifetime prevalence of self-reported physician-diagnosed AD was 9.1%, and the point prevalence of any AD and of moderate to severe AD was 3.3% and 2.3%, respectively. We found that moderate to severe AD was associated with smoking habit of > 15 pack-years, alcohol consumption of > 2 drinks per day, chronic stress, Class I obesity, and both shorter and longer sleep duration. Moreover, we found dose-response associations with increases in smoking pack-years and level of chronic stress. We observed no associations with abdominal obesity, physical activity, diet quality or a vegetarian/vegan diet. Conclusion We found associations between moderate to severe AD and some modifiable lifestyle factors. Our findings indicate that more screening and counselling for lifestyle factors, particularly smoking, alcohol use, stress, obesity and sleep disturbances, appears warranted in patients with moderate to severe AD. Further longitudinal studies are required to better characterize the direction of these associations and to develop strategies for prevention

Interpretability of the Quality Of Life in Hand Eczema Questionnaire

The Quality Of Life in Hand Eczema Questionnaire (QOLHEQ) is used to measure impairment of health-related quality of life in hand eczema. Here, we prospectively studied the interpretability of international QOLHEQ scores at three time points: baseline, after 1–3 days (T1), and after 4–12 weeks (T2). Adult patients with hand eczema completed the QOLHEQ and anchor questions for overall assessment of health-related quality of life impairment. Interpretability of single scores was assessed at baseline by defining severity bands based on agreement with the anchor questions. Smallest detectable change was calculated at T1. Minimally important change of improvement was calculated at T2 using three methods: mean cut-off, receiver operating characteristic, and 95% limit. A total of 294 adult patients were included (160 males, mean age 44.9 years). The final proposed severity band of overall QOLHEQ single scores (κ-coefficient of agreement, 0.431) was not at all, 0–10; slightly, 11–39; moderately, 40–61; strongly, 62–86; and very strongly, ≥87. Separate overall severity bands were proposed for males and females and the four subscales of the QOLHEQ. The smallest detectable change in 166 unchanged patients was 18.6 points. The preferred minimally important change, obtained with the receiver operating characteristic method, was 21.5 points. An overall QOLHEQ score of ≥22 is recommended as cut-off for a minimally important, real change

Presenteeism in a Dutch hand eczema population-a cross-sectional survey

Background: Presenteeism (attending work despite complaints and ill health, which should prompt rest and absence) has been overlooked in the field of hand eczema. Objectives: To examine the 1-year prevalence of presenteeism related to hand eczema in a population of hand eczema patients who visited a tertiary referral centre. Secondary objectives: to identify intrinsic/extrinsic reasons for presenteeism and to evaluate associated factors. Methods: This was a cross-sectional questionnaire study. Presenteeism was defined as "going to work despite feeling you should have taken sick leave because of hand eczema". Respondents answered questions about socio-demographic factors, clinical features, occupational characteristics, and hand eczema related to occupational exposure. Results: Forty-one per cent (141/346) of patients who had both worked and had hand eczema during the past 12 months reported presenteeism. The most often reported reasons were: "Because I do not want to give in to my impairment/weakness" (46%) and "Because I enjoy my work" (40%). Presenteeism was associated with: mean hand eczema severity; absenteeism because of hand eczema; improvement of hand eczema when away from work; and high-risk occupations. Conclusions: In this study, presenteeism was common and predominantly observed in patients with more severe hand eczema and occupational exposure. The most frequently reported reasons for presenteeism were of an intrinsic nature

Efficacy and safety of dupilumab in patients with severe chronic hand eczema with inadequate response or intolerance to alitretinoin:a randomized, double-blind, placebo-controlled phase IIb proof-of-concept study

BACKGROUND: Effective treatment options for patients with chronic hand eczema (CHE) are scarce. Dupilumab is licensed for the treatment of moderate-to-severe atopic dermatitis and has shown promising results on hand eczema in other studies.OBJECTIVE: To evaluate the efficacy and safety of dupilumab in adult patients with severe CHE (subtypes recurrent vesicular HE or chronic fissured HE) with an inadequate response/intolerance to alitretinoin, or when alitretinoin is medically inadvisable.METHODS: In this 16-weeks, randomized, double-blind, placebo-controlled, proof-of-concept phase IIb trial, patients with severe CHE were randomized 2:1 to dupilumab 300mg or placebo subcutaneously every two weeks. Patients visited the outpatient clinic at initiation of the study drug, and every 4 weeks until 16 weeks of treatment. The primary end point was the proportion of patients achieving at least 75% improvement on the Hand Eczema Severity Index score (HECSI-75) at week 16. Adverse events were monitored during each visit. The study was registered on ClinicalTrials.gov (identifier NCT04512339).RESULTS: In total, 30 patients were randomized, and 29 patients received the assigned study drug (dupilumab N = 20, placebo N = 9). At week 16, more patients achieved HECSI-75 in the dupilumab group than in the placebo group (95.0% [95% confidence interval (CI), 73.1%; 99.7.0%] versus 33.3% [95% CI, 9.0%; 69.1%]). Dupilumab also showed greater least square mean percentage change from baseline to week 16 in peak pruritus numerical rating scale than placebo (-66.5 ±10.7 [95% CI, -88.6; -44.5] versus -25.3 ±17.0 [95% CI, -60.1; 9.4]). Adverse events were similar between dupilumab and placebo groups and were mostly mild. There were no serious adverse events, nor did any of the adverse events lead to discontinuation of the study drug.CONCLUSION: Dupilumab was efficacious and well tolerated. Larger studies of longer duration, are needed to provide more evidence on the efficacy of dupilumab in CHE. Moreover, larger studies could also enable comparisons between clinical subtypes or etiological diagnoses.</p