Hand eczema: clinical efficacy of interventions, and burden of disease

Hand eczema is considered a common disease. The exact prevalences however, are unknown. Studies estimate a point prevalence of 1 to 5% among adults in the general population, and a one-year prevalence of up to 10%, depending on whether the disease definition includes more pronounced or mild cases. Hand eczema tends to run a long lasting and chronic relapsing course, probably because of the multifactorial origin: atopy, irritant and allergic contact factors all may play a role, alone or in combination. In addition to the obvious itch, the social stigmata associated with a visible skin disease can be a great burden. The skin changes in hand eczema can prevent manual work, leading to significant disability and huge economic loss to both individuals and society. The above-mentioned characteristics of hand eczema make it an important disease to study from an individual and a societal perspective. The aim of this thesis, stimulated by our randomised controlled trial (RCT), is to clinically reflect on the evidence-base for the treatments of hand eczema. The work focuses on the comparative efficacy of interventions for hand eczema and on the burden of disease associated with it.