The association between atopic dermatitis and hand eczema: a systematic review and meta-analysis

Background Atopic dermatitis (AD) and hand eczema (HE) are common chronic and relapsing inflammatory skin conditions that often co-occur. Objectives While several studies have addressed their relationship, the exact association estimate is unknown. Methods We systematically reviewed published literature on the association between AD and HE in PubMed, Embase and Web of Science using the following search terms: (atopic dermatitis OR atopic eczema) AND (hand dermatitis OR hand eczema). Meta-analyses were then performed to examine the association between AD and the point, 1-year and lifetime prevalence of HE, respectively. Results We identified 35 relevant studies, of which 26 were included in the metaanalyses. AD was associated with an increased prevalence of HE with regard to point [odds ratio (OR) 2 +/- 35; 95% confidence interval (CI) 1 +/- 47-3 +/- 76], 1-year (OR 4 +/- 29; 95% CI 3 +/- 13-5 +/- 88) and lifetime prevalence (OR 4 +/- 06; 95% CI 2 +/- 726 +/- 06). Furthermore, positive associations between AD and occupational HE were identified when assessing the 1-year (OR 4 +/- 31; 95% CI 2 +/- 08-8 +/- 91) and lifetime prevalence (OR 2 +/- 81; 95% CI 2 +/- 08-3 +/- 79). Similar positive associations were found in the general population studies, i. e. OR 4 +/- 19 (95% CI 3 +/- 46-5 +/- 08) and OR 5 +/- 69 (95% CI 4 +/- 41-7 +/- 36). Conclusions Important study limitations include the wide use of questionnaire studies, and lack of prospective studies as well as poor clinical phenotype descriptions. In conclusion, our systematic review and meta-analysis showed that patients with AD had a strongly increased prevalence of HE. Clinicians should continue to guide patients with AD away from occupations with a high risk of HE.