Mahler Vera
Department of Dermatology, University Hospital Erlangen, Erlangen, Germany.
J Dtsch Dermatol Ges. 2016 Jan;14(1):7-26; quiz 27-8. doi: 10.1111/ddg.12922.
The pathogenesis of hand dermatitis is multifactorial, and includes factors such as genetic predisposition and exposure. A high incidence rate is associated with female gender, contact allergy, atopic dermatitis, and wet work. The most important risk factors for the persistence of hand dermatitis include its extent, contact allergic or atopic etiology, childhood dermatitis, and early onset (before the age of 20). The cost of illness of hand dermatitis corresponds to this seen in moderate to severe psoriasis. The diagnostic workup of hand dermatitis and its differential diagnoses requires a detailed assessment of occupational and recreational exposure. In case of possible work-related triggers, early notification of the accident insurer should be sought (via the dermatologist's report). Exposure to a contact allergen is a contributing factor in one-half of all cases of hand dermatitis. It is therefore imperative that all patients with hand dermatitis persisting for more than three months undergo patch testing. Successful and sustainable treatment of hand dermatitis starts with the proper identification and elimination of individual triggers, including the substitution of identified contact allergens and irritants, as well as optimizing preventive measures. Graded therapy taking the clinical severity into account is essential. Validated instruments may be used to monitor therapeutic efficacy.
手部皮炎的发病机制是多因素的，包括遗传易感性和接触等因素。女性、接触性过敏、特应性皮炎和湿作业等因素与高发病率相关。手部皮炎持续存在的最重要危险因素包括其范围、接触性过敏或特应性病因、儿童期皮炎以及发病早（20岁之前）。手部皮炎的疾病成本与中度至重度银屑病相当。手部皮炎的诊断检查及其鉴别诊断需要对手部职业和娱乐接触情况进行详细评估。如果可能存在与工作相关的触发因素，应尽早通知事故保险公司（通过皮肤科医生的报告）。接触性变应原暴露是所有手部皮炎病例中一半病例的一个促成因素。因此，所有持续超过三个月的手部皮炎患者都必须进行斑贴试验。手部皮炎的成功且可持续的治疗始于正确识别并消除个体触发因素，包括替换已确定的接触性变应原和刺激物，以及优化预防措施。考虑临床严重程度的分级治疗至关重要。可使用经过验证的工具来监测治疗效果。
