Duarte I, Terumi Nakano J, Lazzarini R
Sector of Allergy/Dermatology, Department of Clinical Medicine, Santa Casa de São Paulo, São Paulo, Brasil.
Am J Contact Dermat. 1998 Dec;9(4):216-23.
Hand eczema (HE) is a chronic multifactorial dermatosis with the presence of endogenous and exogenous factors in its pathogenesis. The etiologic diagnosis of hand eczema is often difficult.
The objectives of this study were (1) to detect clinical history and clinical examination data capable of differentiating HE types; (2) to determine the importance of patch tests for the etiologic diagnosis of HE; and (3) on the basis of the definitive diagnosis of HE type with the aid of patch tests, to obtain relevant data for appropriate patient guidance for the control of HE.
A total of 250 patients with HE were studied over a period of 3 years (1993 to 1995). All patients were submitted to the battery of patch tests.
The results obtained led to the following conclusions: (1) Women are more predisposed to HE. (2) Work under moist conditions favors HE. (3) With respect to the regional location of HE, any region may be involved in any type of HE; however, involvement of the dorsal region is more common in allergic contact dermatitis (ACD), followed by contact dermatitis owing to primary irritation (ICD) and atopic dermatitis (AD). Location of HE on the dorsal surface of the fingers was mainly observed in ACD, followed by ICD and AD. (4) Patch tests should be part of the investigative routine of HE etiology. (5) The presence of allergy to metals in the clinical history of the patient is a relevant feature, because patch tests confirmed sensitization to nickel in 89% of cases. (6) Rubber components have high sensitization frequency in patients with HE. (7) When the patient reports worsening of HE after the use of rubber gloves, this indicates a probable sensitization to rubber components, mainly in patients with AD.
手部湿疹（HE）是一种慢性多因素皮肤病，其发病机制涉及内源性和外源性因素。手部湿疹的病因诊断往往很困难。
本研究的目的是：（1）检测能够区分手部湿疹类型的临床病史和临床检查数据；（2）确定斑贴试验在手部湿疹病因诊断中的重要性；（3）在借助斑贴试验明确手部湿疹类型诊断的基础上，获取相关数据以便为手部湿疹的控制提供适当的患者指导。
在3年时间（1993年至1995年）内对总共250例手部湿疹患者进行了研究。所有患者均接受了一系列斑贴试验。
所获得的结果得出以下结论：（1）女性更容易患手部湿疹。（2）在潮湿条件下工作易引发手部湿疹。（3）关于手部湿疹的区域分布，任何区域都可能出现于任何类型的手部湿疹中；然而，背部区域受累在过敏性接触性皮炎（ACD）中更为常见，其次是原发性刺激性接触性皮炎（ICD）和特应性皮炎（AD）。手指背侧出现手部湿疹主要见于ACD，其次是ICD和AD。（4）斑贴试验应成为手部湿疹病因调查常规的一部分。（5）患者临床病史中对金属过敏是一个相关特征，因为斑贴试验证实89%的病例对镍致敏。（6）橡胶成分在手部湿疹患者中致敏频率较高。（7）当患者报告使用橡胶手套后手部湿疹加重时，这表明可能对橡胶成分致敏，主要见于AD患者。
