Hand Eczema Significantly Reduces Quality of Life

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A new study showed hand eczema does more than make the skin dry, itchy, and red—the condition has a moderate-to-severe impact on quality of life.¹

“We found a clear correlation between disease severity of [hand eczema] and impact on quality of life emphasizing the importance of [hand eczema] by itself on psychical burden,” wrote investigators, led by Mie Siewertsen, department of dermatology and allergy at Copenhagen University Hospital in Denmark.

This common skin disease has a 1-year prevalence worldwide of 9.1%. Many people get it from occupational exposure, resulting in work absences, reduced productivity, and prolonged sick leave. Some may need to change their profession.

Aside from the disease potentially impacting work, hand eczema may impact a patient’s personal life. In social settings, they may feel embarrassed and try to hide their hands.

Previous literature suggested hand eczema is associated with anxiety, depression, and an impaired quality of life. A 15-year follow-up study found 96% of patients with hand eczema reported psychosocial consequences, such as giving up hobbies and sleep disturbances.²

Despite the discovered links between hand eczema and quality of life, as well as mental health, the extent of the associations was not clear.¹ Investigators sought to assess the psychological burden patients with hand eczema face regarding anxiety, depression, and quality of life.

The team conducted a systematic review and meta-analysis, searching through several databases. They calculated averages for disease severity, quality of life, depression, and anxiety.

The analysis included 81 studies with 17,835 hand eczema patients and 31,541 healthy controls. In total, 79 studies evaluated quality of life (n = 17,591 patients), 8 studies evaluated depression (n = 1354 patients), 4 studies evaluated anxiety (n = 406), and 1 study evaluated suicidal ideation (n = 143).

Investigators observed hand eczema had a moderate-to-large effect on quality of life, with a mean Dermatology Life Quality Index of 10.66. There was also a strong correlation between the Dermatology Life Quality Index and the Hand Eczema Severity Index (95% confidence interval [CI], 0.56 – 0.87). Furthermore, the EuroQoL visual analog scale was significantly lower in patients with hand eczema than in controls (68.03 vs 80.63; P < .00001).

Additionally, compared to controls on the Hospital Anxiety and Depression Scale, patients with hand eczema had a greater anxiety score (7.4 vs 5.8; P = .0008). However, patients with eczema did not have significantly greater depression scores than controls (6.5 vs 5.7; P = .32).

One study in the analysis showed patients with hand eczema had increased odds of anxiety, depression, and suicidal ideation compared with controls.

The team said the analysis was limited by only including a few studies assessing the link between hand eczema and anxiety, depression, and suicidal ideation. Studies also used several measures to evaluate hand eczema severity, quality of life, and depression. They could also not differentiate the etiology or clinical type of hand eczema, assess gender differences, and identify the exact number of patients affected by depression or anxiety as most studies only provided a mean score for the study population.

Nevertheless, a strength of the study was the number of articles included and the various aspects of the psychological burden of hand eczema assessed.

“Patients with hand eczema have an impact on [quality of life] comparable to other chronic diseases when measured with generic [quality of life] scoring systems,” investigators concluded. “This systematic review and meta-analysis emphasize the serious and far-reaching consequences that [hand eczema] may have.”

References

1. ^{Siewertsen M, Näslund-Koch C, Duus Johansen J, et al. Psychological burden, anxiety, depression and quality of life in patients with hand eczema: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol. Published online May 29, 2024. doi:10.1111/jdv.20140}
2. ^{Meding B, Wrangsjö K, Järvholm B. Fifteen-year follow-up of hand eczema: persistence and consequences. Br J Dermatol. 2005;152(5):975-980. doi:10.1111/j.1365-2133.2005.06494.x}
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