Prognosis of occupational hand eczema: a follow-up study

Abstract

Objective: To identify prognostic risk factors in patients with occupational hand eczema (OHE).

Design: Cohort study with 1-year follow-up.

Setting: Danish National Board of Industrial Injuries Registry.

Patients: All patients with newly recognized OHE (758 cases) from October 1, 2001, through November 10, 2002.

Interventions: Participants received a questionnaire covering self-rated severity, sick leave, loss of job, depression, and health-related quality of life. One year after the questionnaire was returned, all responders (N = 621) received a follow-up questionnaire, and 564 (91%) returned it.

Main outcome measures: Persistently severe or aggravated OHE, prolonged sick leave, and loss of job after 1-year follow-up.

Results: During the follow-up period, 25% of all patients with OHE had persistently severe or aggravated disease, 41% improved, and 34% had unchanged minimal or mild to moderate disease. Patients with atopic dermatitis fared poorly compared with other patients. Patients younger than 25 years fared clearly better than older groups. Furthermore, severe OHE, age 40 years or greater, and severe impairment of quality of life at baseline appeared to be important predictors of prolonged sick leave and unemployment. Patients with lower socioeconomic status also had a high risk of prolonged sick leave, job change, and loss of job. Contact allergy was not found to be a risk factor for poor prognosis.

Conclusions: Atopic dermatitis, greater age, and low socioeconomic status may be reliable prognostic factors in early OHE. Quality of life and standardized severity assessment may also be valuable tools to identify patients at high risk of prolonged sick leave and unemployment.