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Atopy and vitamin D in chronic hand eczema

Hand eczema is an inflammatory skin disease with a prevalence of 10 to 15%. The clinical picture is dominated by redness, vesicles, skin thickening and painful fissures. Chronic hand eczema (CHE) is defined by duration of more than 3 months or more than 2 recurrences over the course of a year. This disease significantly impairs the quality of life, mainly affecting middle-aged people, with multiple implications for working ability. Exogenous factors in the development of CHE are “wet work” environment or contact allergens. In a proportion of patients, no exogenous factors are identified, implicating the role of genetic factors or immune dysregulation. Moreover, CHE may be a sole manifestation of atopic dermatitis (atopic CHE), thus difficult to diagnose. Vitamin D has been shown to influence allergen-induced pathways in the immune system and several studies reported an inverse relationship between vitamin D levels and severity of atopic dermatitis and chronic urticaria, but its role in CHE has not been explored so far. The aim of this pilot study was to examine the frequency of atopy in patients with CHE who were monitored at Clinical Hospital Center Rijeka over the last year. An additional goal was to examine the incidence of hypovitaminosis D in the same group of patients. Atopic diathesis was considered positive in patients with elevated immunoglobulin E, history of allergic asthma and/or rhinoconjunctivitis or positive skin prick test to inhaled or food allergens. The diagnosis of contact allergy was examined by patch test. The study included 59 patients with CHE, most of whom (79.7%) were women. Atopic diathesis was present in 32.2% of patients. Atopy and contact hypersensitivity were concomitantly demonstrated in only 11.9% of patients. Positive patch test result was shown in a similar proportion of atopic (36.8%) and non-atopic (42.5%) patients. Lower than normal levels of serum vitamin D were detected in 66.7% of patients with CHE, more frequently in non-atopic (73.9%) than in atopic (50%) ones, although this difference was not significant. However, vitamin D insufficiency (<50 nmol/L) and deficiency (<30 nmol/L) were detected only in non- atopic CHE, which difference was significant (p=0.015). The main limitation of this study is small sample size. However, the results indicate that about one third of patients with CHE may actually represent patients with atopic dermatitis present exclusively on their hands (atopic CHE), which bares relevant implications for appropriate treatment of this patient subpopulation. Furthermore, the frequency of hypovitaminosis D in non-atopic CHE patients indicates its possible role in the etiopathogenesis, but additional studies on a larger number of patients will be necessary to determine the exact significance of this finding, as well as the role of vitamin D supplementation for the prevention or treatment of non-atopic CHE.

Eczema ; vitamin D ; contact dermatitis ; atopic dermatitis

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