Klaziena Politiek: The challenge of hand eczema. Pathogenesis, Treatment, and Burden of Disease
Hand eczema is a common condition in the general population, but its pathogenesis is largely unknown.
Part one of this thesis studied the pathogenesis of hyperkeratotic hand eczema, a subtype which has a typical presentation with thick hyperkeratosis of the palms, and differs from other subtypes of hand eczema. Immunofluorescence showed that multiple proteins (e.g. filaggrin) had different staining patterns. Whether hyperkeratotic hand eczema is a subtype of hand eczema or a separate entity is still unclear; future research is necessary.
Part two focuses on different systemic treatments of severe hand eczema, using drug survival studies. Drug survival is an outcome measure to evaluate long-term potency of treatments. Retrospectively, we collected daily-practice data regarding alitretinoin, acitretin, cyclosporine, methotrexate and azathioprine. Besides alitretinoin, cyclosporine was the most valuable treatment option for severe chronic hand eczema. Our data also showed that current systemic treatments are most often limited by side effects.
Part three explores the burden of disease in terms of health-related quality of life, treatment satisfaction, and treatment adherence in chronic vesicular hand eczema. Severity affected both quality of life and treatment satisfaction. As patients receiving systemic treatment had higher treatment satisfaction than those using only topical treatment, systemic treatment should be more accessible for severe vesicular hand eczema. The last chapter discusses costs of illness for hand eczema. Per patient, yearly totals vary between €1311 and €9742, the largest component of which is occupational costs.