No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Eczema or psoriasis? A special challenge in occupational dermatology
Abstract
In daily dermatological practice as in occupational dermatology, patients with psoriasis vulgaris and atopic eczema are seen frequently. These diseases may appear very similar in terms of morphology. Thus, the differentiation between nummular eczema and psoriatic plaque may form a challenge, equally between hand eczema and psoriasis manuum. So far, diagnostic classification was based on patient and family medical history, comorbidities, onset and course of disease, morphology and localization, and diagnostic tests such as allergy tests and dermatopathology. Especially the latter was not yet able to allow helpful classification. A new molecular disease classifier based on the expression of the genes NOS2 and CCL27 in lesional skin has been developed that improves the diagnostic classification of diseases such as eczema and psoriasis. This test is reliable in classical variations as well as in subtypes of the diseases. Our paper presents first experiences with this molecular classifier in a group of patients attending a clinic for occupational skin diseases. We hope that this classifier may in future be applied as a routine test in diagnostics and may possibly even allow prognostics about clinical course, comorbidities and optimal therapy. Being now a first simple diagnostic test for the differentiation between psoriasis and eczema, this classifier is most likely to achieve an important prospective role in times of personalized medicine in occupational dermatology.
... Resulting from this analysis, two markers, NOS2 and CCL27, were identified that not only correlated with hallmarks of either psoriasis or eczema but also diagnosed psoriasis and eczema with a sensitivity and specificity of >95%. Moreover, the NOS2-and CCL27-based classifier predicted the correct diagnosis, which was in line with therapeutic response to drugs acting specifically on psoriasis or eczema, respectively [39,[92][93][94][95][96]. ...
Characterization of the complex interplay between cytokines, chemokines and microorganisms has led to a better understanding of the pathogenesis of both psoriasis and AD and resulted in new therapeutics targeting distinct immune responses. Psoriasis and AD share many characteristics: they are highly prevalent, chronic, cause primarily skin inflammation, but are associated with comorbidities, and come with a devastating quality of life due to itch and stigmatization. However, the pathogenesis of psoriasis and AD is opposing – psoriasis is dominated by a Th17 immune response that causes neutrophil migration, induction of innate immunity and exaggerated epithelial metabolism. Leading cytokines of this Th17 immune response are IL‐17A and F, IL‐22 and TNF‐a. AD is characterized by Th2 immunity characterized by the signature cytokines IL‐4 and IL‐13 leading to an impaired epidermal barrier, dampened innate immunity and eosinophil migration. This review compares genetics, microbiome and T‐cell infiltrate and resulting epithelial response in psoriasis and AD. Whilst the antagonistic course of psoriasis and AD is confirmed by response to specific biologics targeting the key cytokines of inflammation in psoriasis and AD, respectively, clinically overlapping phenotypes are challenging in our daily clinical practice. We conclude this review by summarizing what is known about these mixed phenotypes and how the identification of clinically relevant endotypes and molecular‐driven decision‐making is the next step in the field of dermato‐immunology.
Abstract
... For further detail see chapter ▶ "Genetics". Psoriasis has long been neglected as an important differential diagnosis of hand eczema [52]. In cases without a positive family history and absent erythematous scaly plaques in typical locations, the primary diagnosis upon first visit is often impossible to make. ...
Chefs and food handlers are at high risk for developing occupational skin diseases. Incidence rates per 10,000 workers per year range from 2.9 (butchers/food processing industries) and 6.6 (cooks) up to 23.9 (pastry cooks) and 33.2 (bakers). Irritant contact dermatitis is the most prevalent occupational disease in chefs and food handlers followed by allergic contact dermatitis (most frequently due to Compositae (foods), thiurams (gloves), and formaldehyde (detergents and disinfectants)). Food-handling occupations are also prone for IgE-mediated protein contact dermatitis and immunological (IgE-mediated) and nonimmunological occupational contact urticaria. Some foods and food additives can trigger several of these mechanisms independently and may induce different clinical pictures. The prerequisite for a successful treatment is the individual identification and exclusion of the disease-eliciting allergen(s) as well as implementation of skin protection.
... For further detail see chapter ▶ "Genetics". Psoriasis has long been neglected as an important differential diagnosis of hand eczema [52]. In cases without a positive family history and absent erythematous scaly plaques in typical locations, the primary diagnosis upon first visit is often impossible to make. ...
Occupational contact dermatitis is the most frequent type of skin diseases caused by occupational factors. The frequency varies considerably among professions and is highest in hairdressers, chefs, food handlers, and healthcare workers. Numerous irritants and contact allergens have to be considered in the pathogenesis and are often highly specific for a particular profession. Therefore, in-depth information on the working environment must be obtained for the diagnostic work-up. Careful patch testing, particularly with the worker’s own materials, must be performed to identify relevant contact allergens. The prognosis depends on the diagnosis: slight forms of irritant contact dermatitis can usually be well improved with gloves and avoidance of major irritants. If an occupational contact allergen cannot be eliminated, or exposure to it be reduced, the worker frequently has to give up this occupation. Combined forms of allergic and irritant contact dermatitis, which are not rare, are the most difficult to treat. A multidisciplinary approach including dermatologists, allergists, technicians, and patient education is necessary.
... For further detail see chapter ▶ "Genetics". Psoriasis has long been neglected as an important differential diagnosis of hand eczema [52]. In cases without a positive family history and absent erythematous scaly plaques in typical locations, the primary diagnosis upon first visit is often impossible to make. ...
In daily dermatological practice, the distinction between eczema and psoriasis in dermatoses of the hands can be difficult. However, a clear diagnosis is necessary to initiate optimal therapy and management. In recent years, the so-called molecular classifier has been developed for optimized differentiation of eczema and psoriasis. An occupational dermatological cohort has been established at Heidelberg University Hospital since 2020. It is funded by the German Statutory Accident Insurance. The aim is to follow-up patients over 3 years where this new diagnostic method is used and to compare the results with a retrospective occupational dermatological cohort. Recruitment ended in December 2022. The current analysis reports participants' occupational activity, insurance status, disease progression, and number of sick days. A total of 287 patients were included; mean age was 50.4 years and 63.5% (n = 181) were undergoing treatment at the expense of the liable statutory accident insurance at the start of the study. About 50% of the patients worked in health professions, metal industry, or construction. The average duration of occupational dermatosis was 6.5 years. In 38.9% of the patients, the clinical diagnosis had been classified as unclear by the treating dermatologist. By using the molecular classifier, the diagnosis could be clarified in 98% of the cases (eczema vs. psoriasis). The first analyses demonstrate that the molecular classifier contributes to improving therapy by optimizing the diagnosis.
Occupational dermatology has become a vibrant and interesting specialty, particularly in recent years. This includes more than hand eczema (HE). The increasing prevalence of atopic dermatitis (AD) has led to an increase of atopic hand eczema which can be worsened in certain occupations. New systemic therapies have improved the range of treatments for HE. The current guideline on hand eczema includes a variety of topical and systemic therapies. Nevertheless, in daily occupational dermatological practice, there are still chronic cases, especially vesicular hand eczema. They can often not be assigned to a clear cause, which is often a problem for those who are affected. In addition, co-factors such as chronic infectious comorbidities and psychological factors/illnesses must be considered. We present challenges in occupational dermatology by reporting special cases.
AbstractA cohort of occupational dermatology patients will be set up at the University Hospital Heidelberg, Germany. In a 3-year prospective cohort study, the so-called molecular classifier will be applied in 262 patients to better differentiate between eczema and psoriasis. A retrospective cohort of 282 occupational health patients with the same suspected diagnosis but no molecular classifier designation was used as a control group. In 5 follow-up visits during 3 years, data will be obtained on diagnoses, disease course and severity, absence from work, occupation and quality of life. The research questions address whether early diagnoses will help to better identify the efficient treatment, disease course, absence from work and continuance of occupation. The study is sponsored by the public statutory employers’ liability insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]).
Background
The pathogenesis of hand eczema is multifactorial. Exogenous factors such as skin irritation and contact sensitization contribute to this as well as an endogenous atopic predisposition.
Objective
This article provides a review of the pathogenetic factors relevant to the development of hand eczema.
Material and methods
An evaluation of the current literature on the pathogenesis of hand eczema was carried out.
Results
Impairment of the epidermal barrier function plays an essential role for the development of hand eczema. The molecular biological basis and the possible significance of a genetic predisposition beyond atopy are not yet fully understood. Immunological processes involved in the pathogenesis of allergic contact dermatitis and atopic eczema are likely to play a role in the development of certain subtypes of hand eczema. This might contribute to an expansion of the therapeutic armamentarium for hand eczema in the future.
Conclusion
The exact understanding of the individual pathogenesis in single hand eczema patients is essential in order to provide specific advice on allergen avoidance, skin protection and basic treatment and to initiate appropriate therapeutic measures.
Background
Using current diagnostic tools for hand eczema, namely clinical picture and histology, differential diagnoses such as psoriasis palmaris usually cannot be ruled out.
Objectives
Discussion of current diagnostic possibilities for hand eczema; presentation and critical evaluation of proposed biomarkers for molecular diagnostics and outlook how diagnostics in dermatology will change in the near future.
Materials and methods
In this article, we discuss basic research and provide a review of the literature.
Results
Molecular diagnostics has the potential to substantially improve diagnosis of hand eczema; prerequisites are prospective validation of proposed markers and availability of valid and cost-effective diagnostics.
Conclusions
In the near future, the diagnosis of hand eczema will be complemented by software algorithms and artificial intelligence on the one hand and simple, precise, and economic molecular diagnostic devices on the other.
ResearchGate has not been able to resolve any references for this publication.