Perceived stress, disease burden and quality of life in patients with chronic hand eczema: A French national study

Abstract

Chronic hand eczema (CHE) is defined as hand eczema that persists for more than 3 months or relapses at least twice per year.1 Data on the burden of CHE and effect on quality of life (QoL) of patients in France are lacking. The objective of this study was to characterize perceived stress, disease burden and QoL of patients with CHE in France with validated scores and assess the association of QOL with demographics, self-reported-severity, symptoms and clinical signs found on examination. Between October 2022 and January 2023, we sent an online questionnaire to all patients ≥18 y.o in the ‘French Eczema Patient Association’. Patients were asked to answer a questionnaire regarding sociodemographics. The following information on CHE clinical features were collected: location on hands (wrists, back of the hands, palms, fingers), hand appearance (dry, cracked, swollen red, thickened, greyish) and symptoms (pruritus, pain, stinging and pulling, burning and unpleasant sensations). Clinical severity was assessed by the patient using the Patient-Oriented Eczema Measure (POEM), the QoL using the dermatology life quality index (DLQI), perceived stress using the PSS score and the burden of HE using the BoHEM2 score. In total, 409 patients responded. There were 326 women (79.7%), and the mean age was 36 ± 11. Results of PSS and DLQI scores are represented in Table 1. Regarding BoHEM, the mean score was 23.1 ± 18. The BoHEM mean score was proportional to the POEM score (mild POEM: 15.6 ± 15.2, moderate POEM: 22.8 ± 17.6, severe POEM: 30 ± 18.4, p < 0.0001). It was also proportional to the self-diagnosed severity of HE (mild: 12.6 ± 13.4, moderate: 21 ± 14.4, severe: 34.6 ± 20.9). Males had significantly higher BoHEM scores (male: 29.5 ± 19.2 vs. females: 21.5 ± 17.4, p- 0.0008). Moreover, those with unilateral involvement also had higher BoHEM scores (unilateral: 28.4 ± 20.2 vs. bilateral: 21.2 ± 16.9, p < 0.0001). The impact of specific localizations, clinical signs of hands and symptoms on the DLQI is represented in Table 2. The higher the severity of the disease in the POEM score is, the higher the burden of the disease (BoHEM) and the impact on QoL (DLQI) are. The same applies to the self-diagnosed severity. Contrary to previous studies that show no difference in DLQI between males and females,3-5 our study showed that DLQI was significantly higher in males. This is in contrast to atopic dermatitis which seems to have a higher DLQI in females. Disease burden measured by BOHEM score was also significantly higher in males. Association of DLQI or BOHEM with the number of affected hands has not been studied yet. Our results showed that impact on QoL and disease burden measured by DLQI and BoHEM scores, respectively, are both higher in patients who have one hand affected compared with those who have both hands affected. Who have one hand affected had a QoL more decreased than those who have both hands affected. This can be explained by the fact that these patients, by worry of having their other hand affected, might limit their daily tasks or leisure activities, which ends up affecting their QoL. Another explanation can be that unilateral involvement is usually more visible, which can result in a higher social impact. Contrary to dryness, cracking, thickening and greyish appearances, swollen red hands were more likely to be associated with higher DLQI. Special attention should be given to these patients, as they are at higher risk for lower QoL and possible social exclusion. Unlike localization on wrists, back of hands and nails, localization on fingers and palms was associated with higher DLQI. This is possibly because skin damage to these parts hamper daily activities. CHE is a severely distressing dermatosis that adversely influences the psychological, occupational, and sex life of patients.6-10 Our study assessed two different tests for the same patients at the same time. Disease severity was associated with a higher BoHEM and a higher DLQI. Moreover, our study demonstrated for the first time that male patients and those with unilateral involvement had higher BoHEM and DLQI scores. To better meet the needs of patients, future studies should investigate the possible reasons behind these associations, in particular the role of the patients' occupations on the severity and burden of the disease. The authors acknowledge the participation of the 409 subjects in this study. This study was granted by the Leo Pharma. None. A favourable opinion was obtained from CPP. The data that support the findings of this work are available from the corresponding author upon reasonable request.

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