Hand Eczema Extent and Morphology Association and Influence on Long-Term Prognosis

By Birgitta Meding, M.D., Karin Wrangjo & Bengt Jarvholm, M.D., PhD
Published in J Invest Dermatol 2007, 127;9:2147–2151

Introduction

Throughout the last decade scientist have strived to come together and standardize a measurement for determining the severity of hand eczema. In a previous 15 year follow-up study of hand eczema in the general population, an extent of hand eczema was scored along with a detailed morphology.

This study categorized groups from low extent (LoEx) to high extent (HiEx), which was also broken into subgroups based on the morphological signs of eczema. One goals of the study was to determine the association between the degree and composition of hand eczema, and what improved the prediction of a long-term diagnosis.

Another goal was to study whether registering of both extent and morphology improved the prediction of the long-term prognosis.

Results

In 1983, 6 different morphological signs were registered consisting of erythema, papules, vesicles/pustules, scaling, fissures, and edema/infiltration along with the subgroups LoEx and HiEx. The follow-up questionnaire in the 1997-1998 association between the extent and morphology was presented into LoEx and HiEx along with low morphology (LoMo) and high morphology (HiMo). There was a tendency for an individual to be in a low group and also be present in a high group. In 1983, association on 68% of individuals with a visible sign of eczema were found and when all individuals were integrated, 81% was achieved.

The follow-up date of 1997-1998, resulted in 44% reported hand eczema during the past 12 months. In 1983 it was cataloged with individuals of visible hand eczema, vesicles were 25% and erythema was 74%.

Discussion

The first aim of this study was the relation between hand eczema extent and morphology. A clear alliance was found between the two and expressed as clinical polymorphism such as LoEx and HiEx.

The second aim was to determine whether registering both the extent and morphology would improve the prediction of the long-term prognosis. Studies found that the morphology did not add any significant findings to the long term prognosis creating an almost negative prognostic factor.

In an objective assessment in determining the severity of hand eczema, the study found that preference should be given to the extent in the assessment of eczema. As presented in 1996 by Finlay, recommending that the severity assessment method should be simple enough to use in a clinical setting. It supported that when you are monitoring treatment outcomes of hand eczema, measurements of the extent have been useful.

Reprint requests to: Birgitta Mending, M.D., National Institute for Working Life, SE-11391 Stockholm, Sweden.