Abstract

Background: Atopic dermatitis and hand eczema are common chronic and relapsing inflammatory skin conditions that often co-occur. Many factors like age of onset, personal and family history of atopy and severity atopic dermatitis influence the risk of developing hand eczema.

Aims: To find out the proportion of patch test positivity in atopic individuals with hand eczema and to identify the specific contact allergens in these patients.

Materials & Methods: This was a cross-sectional study involving 56 hand eczema patients conducted between January 2016 and December 2016, at a tertiary care centre in Southern India. After a detailed history and detailed examination, patch test was done on all the patients with hand eczema using the Indian standard series. The readings were interpreted according to International Contact Dermatitis Research Group criteria and noted down. The data collected were analysed in terms of descriptive statistics. The test of association was done using Chi-square test.

Results: A total of 56 patients with hand eczema were studied. Among the 56 patients, 34 participants (60.7%) had positive patch test reaction. 24 patients in the study group had atopy, among whom 70.8% had a positive patch test reaction. Most common allergen yielding positive results were Potassium dichromate (20.8%), Nickel sulphate (17%) and Thiuram mix (15.1%). Patients with atopic dermatitis were more frequently sensitive to Thiuram mix than non atopics. Most of the patients had a non-specific morphological pattern of hand eczema (66.1%) followed by wear and tear dermatitis. A similar pattern was seen in atopic individuals also. No statistical association could be found out between pompholyx and atopy (p=0.659).

Conclusions: Patients with atopic dermatitis should be patch tested when indicated because they also develop contact allergic sensitization to a significant degree. Our observations indicate that patch testing with standard allergens often add valuable information about contact sensitivity in these patients. Clinicians should guide patients with atopic dermatitis away from occupation with a high risk of hand eczema. A specific morphology for hand eczema is not seen in most of the times. There was no increase risk for the development of pompholyx in atopic patients.

Keywords: hand eczema, contact dermatitis, patch test.