Prevalence of contact sensitisation among patients with hand eczema and factors associated with contact sensitisation and disease severity.

INTRODUCTION: Chronic hand eczema is a debilitating skin disease. The aetiology of hand eczema can be due to irritant contact, allergic contact or a manifestation of endogenous eczema. Identification of sensitisers and subsequent avoidance of relevant sensitisers may improve care of chronic hand eczema patients. We aimed to study the prevalence and pattern of sensitisation, factors associated with sensitisation and severity of hand eczema. MATERIALS AND METHODS: A cross sectional study was conducted over a six month period between January to June 2025 at the Department of Dermatology in a tertiary hospital located in the capital of Selangor. Patients with predominantly hand eczema aged above 18 years old were interviewed, examined and patch tested with Standard European Baseline Series from Chemotechnique Diagnostics. Patients with contraindications for patch test and uncertain diagnosis were excluded. Hand eczema morphology was classified according to the Danish Contact Dermatitis Group classification. Hand eczema severity was determined using Hand Eczema Severity Index (HECSI). Patch test results were interpreted according to International Contact Dermatitis Research Group (ICDRG) guidelines. RESULTS: A total of 54 patients aged 44± 15.29years old participated. Female to male ratio was 2.6:1 and 79.6% had positive patch test. The most common sensitisers were nickel sulphate (29.63%), fragrance mix 1 (25.93%), potassium dichromate (14.8%) and formaldehyde (14.8%). Polysensitisation was seen in 41.6%. Sensitisation was not associated with age, history of atopy, hand washing >10 times/day, hand wetting activities > two hours/day, use of non-permeable gloves, hand sanitiser use, fragrances and smoking. Cosmetic use showed seven times increased odds of polysensitisation (p=0.033). Hand eczema morphology was not associated with sensitisation. HECSI was significantly higher with use of non-permeable gloves. HECSI was not associated with atopy, frequency of hand washing and duration of wet hands. CONCLUSION: Patch test sensitisation was common in hand eczema patients. Polysensitisation was associated with use of cosmetics. Use of non-permeable gloves may worsen hand eczema.