Conflict of interest: SM has acted as speaker and consultant for and received travel grants and honoraria from Basilea Pharmaceutica. TD has acted as a principal investigator for and has received lecture and consultancy fees from Basilea Pharmaceutica. TR has acted as a principal investigator, speaker and consultant for Basilea Pharmaceutica.
Clinical dermatology • Original article
Diagnosing chronic hand eczema by an algorithm: a tool for classification in clinical practice
Article first published online: 20 JUL 2011
© The Author(s). CED © 2011 British Association of Dermatologists
Clinical and Experimental Dermatology
Volume 36, Issue 6, pages 595–601, August 2011
How to Cite
Molin, S., Diepgen, T. L., Ruzicka, T. and Prinz, J. C. (2011), Diagnosing chronic hand eczema by an algorithm: a tool for classification in clinical practice. Clinical and Experimental Dermatology, 36: 595–601. doi: 10.1111/j.1365-2230.2010.04001.x
- Issue published online: 20 JUL 2011
- Article first published online: 20 JUL 2011
- Accepted for publication 4 October 2010
Background. Diagnostic classification of chronic hand eczema (CHE) represents a major clinical and taxonomic challenge because of its wide aetiological and clinical heterogeneity.
Aim. To develop an algorithm for the diagnosis and classification of CHE.
Methods. Well-defined aetiological, clinical and morphological criteria of CHE were arranged graphically in a diagnostic hierarchy, and validated in 137 German patients with hand eczema.
Results. The algorithm distinguished chronic hand eczema due to contact allergy, irritant damage or a combination of the two, each either with or without atopy, and also atopic hand eczema and idiopathic hand eczema lacking obvious causative factors. Foot involvement helped to distinguish idiopathic from irritant hand eczema. Each subtype could occur either with a hyperkeratotic–rhagadiform, dyshidrotic or mixed morphology, but certain hand eczema subtypes had clear morphological preferences.
Conclusions. By providing a more precise clinical definition this diagnostic algorithm could improve the classification and taxonomy of hand eczema subtypes, facilitating more rational treatment decisions and allowing better treatment outcome analysis.