A broad vision on hand eczema:pathogenesis, epidemiology and patient care

Hand eczema is a prevalent skin disease, which can significantly impact several aspects of life in terms of daily activities, social activities, psychological well-being, work-related aspects, and quality of life. This thesis was divided into three parts, with a focus on the pathogenesis of hyperkeratotic hand eczema in the first part, followed by the prevalence, severity and risk factors for hand eczema in the second part. It was found that among the Dutch general population, the lifetime prevalence of hand eczema was 15.0% and the 1-year prevalence 7.3%. The prevalence of severe to very severe hand eczema at worst ever was 1.9%. It was found that the majority of subjects with hand eczema in the past year had chronic hand eczema. Several lifestyle factors, such as smoking, obesity and stress, were associated with hand eczema. The last part of this thesis included different aspects of patient care with some first promising results of the use of dupilumab (biologic) and the use of baricitinib (JAK inhibitor) as treatment for hand eczema. Besides focusing on the treatment, it is also important to focus on its impact on the patient according to patients with hand eczema. Lastly, a substantial proportion of subjects with hand eczema reported limited health literacy. This emphasizes the need for more awareness of limited health literacy among clinicians treating this patient population. The three parts together encompass very diverse aspects of hand eczema, resulting in a thesis with a broad vision on hand eczema, which is hopefully also what you, as reader of my thesis, will remember; keep a broad vision when counseling patients with hand eczema to cover all related aspects that are necessary to provide optimal personalized care.