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Trên lâm sàng, điều kiện được đặc trưng bởi các dấu hiệu đỏ, túi (mụn nước nhỏ), sẩn, rộng, vết nứt và tăng sừng (nhẫn tâm như dày lên), tất cả đều có thể có mặt tại các điểm khác nhau trong thời gian. Ngứa, đôi khi nghiêm trọng, là một tính năng phổ biến. | 16 Hand eczema Pieter-Jan Coenraads A Marco van Coevorden and Thomas Diepgen Figure 16.1 One of the several manifestations of chronic hand eczema Background Definition The term hand eczema implies an inflammation of the skin dermatitis that is confined to the hands. Clinically the condition is characterised by signs of redness vesicles tiny blisters papules scaling cracks and hyperkeratosis callous-like thickening all of which may be present at different points in time. Itch sometimes severe is a common feature. Microscopically the disease is characterised by spongiosis with varying degrees of acanthosis and a superficial perivascular infiltrate of lymphocytes and histiocytes. Incidence prevalence Hand eczema is considered a common condition with a point prevalence of 1-5 among adults in the general population and a 1-year prevalence of up to 10 depending on whether the disease definition includes more pronounced or mild cases. The prevalence may be higher in some countries. Recently a decreased prevalence was stipulated attributed to decreased occupational exposure to irritants. Hand eczema is twice as common in women than in men with the highest prevalence in young women. Reasons for this sex difference are unknown although greater exposure of women to wet work is probably contributory. Reliable data on incidence are scarce and are mainly confined to estimates in particular occupational groups. Estimates vary from 0-5 per 1000 in the general population to 7 per 1000 per year in high-risk occupations such as bakers and hairdressers. Aetiology Aetiology is multifactorial. Contact irritants are the commonest external causes. Hand eczema caused by such irritants or mild toxic agents is called irritant contact dermatitis. Causal factors that are less common than irritants are contact allergens. Hand eczema caused by skin contact with allergens is called allergic contact dermatitis. Ingested allergens for example nickel may also provoke hand eczema. Water is a contact
