Atopy, Nickel Sensitivity, Occupation, and Clinical Patterns in Different Types of Hand Dermatitis

BACKGROUND: The etiologic diagnosis of hand dermatitis (HD) is often difficult. Knowledge of the relationship between atopy and nickel sensitivity as risk factors for HD is limited. OBJECTIVE: To compare irritant contact dermatitis, allergic contact dermatitis, and dyshidrotic eczema relative to personal atopy, patch-testing results, occupation, and clinical patterns. METHODS: From patients referred for patch testing, 714 consecutive individuals with HD were retrospectively studied. RESULTS: Half of the patients had eczema confined to the palms. The dorsal pattern was more prevalent in atopic patients, compared to nonatopic patients. Irritant contact dermatitis was the most frequent diagnosis (55.3%), followed by allergic contact dermatitis (24.4%) and dyshidrotic eczema (20.3%). Among housewives, health workers, and mechanics, irritants were of much greater importance than allergens whereas among hairdressers and bricklayers, the opposite was found. The prevalence of personal atopy did not differ significantly between different types of HD. Nickel sensitivity was much less frequent in irritant contact dermatitis than in allergic contact dermatitis or dyshidrotic eczema. The distribution of clinical patterns was similar. CONCLUSION: This study suggests that different etiologic diagnoses of HD cannot be distinguished by clinical pattern, prevalence of personal atopy, or nickel-sensitivity.