German Study Explores the Emotional Impact of Work-Related CHE

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Researchers in Europe have investigated the emotional impact of work-related chronic hand eczema (CHE) on patients.¹ They also evaluated the psychometric properties of the Atopic Eczema Score of Emotional Consequences (AESEC) and how it can be applied to CHE.

“A thorough understanding of the emotional consequences is crucial for health care professionals and to ensure comprehensive and patient-centered care; thus, it is necessary to investigate the emotional impact of WRHE separately,” the authors wrote.

The exploratory, cross-sectional study occurred from June 2020 to May 2021. It included 223 adult patients involved in a 3-week tertiary prevention program for work-related hand eczema. Over 50% were female with a mean age of 48.1 years. The mean disease duration was between 8 and 10 years.

Participants self-reported the severity of their disease with the Patient-Oriented Eczema Measure (POEM). Conversely, dermatologists assessed severity using the Osnabrueck Hand Eczema Severity Index (OHSI) and the Erlangen Atopy Score (EAS). A modified version of the 28-item AESEC was also utilized.

The average OHSI of patients ranged from 3.1 to 6.4. With a median POEM score of 14, 45% of patients had moderate CHE and 31.2% had severe CHE. Nearly 60% of participants believed their disease was moderate based on the global self-assessment scores (median = 4.0). The most common occupation groups were health care and elderly care workers, mechanics, food handlers, construction workers, and hairdressers/cosmetologists.

It was determined that patients with work-related CHE had a significant emotional burden. Participants felt sad and worried about life because of their disease. This sense of worry is much higher than what has been reported in patients with atopic dermatitis.² The authors suspect that this is due to a loss of productivity and risk of unemployment or job changes, which can create personal and financial insecurities.

Additionally, patients did not feel in control of their CHE, reporting a feeling of being “trapped” and constrained. They also had severe levels of disturbance due to excessive itching. These findings on emotional burden align with previous studies that have investigated the disease burden of CHE. In fact, the emotional burden may be higher in this patient population, as most in this program had long-lasting, refractory moderate-to-severe work-related hand eczema.

“In addition, the localization of the skin disease on the hands might have an important impact, as the hands, for example, in comparison to the forearms or legs, are more visible to others, which may lead to stigmatization and (therefore) greater emotional burden,” the authors concluded.

The study does have some limitations. Technically, the AESEC and POEM instruments are designated for patients with atopic dermatitis and have not yet been validated in patients with CHE. Further research with longitudinal designs and more diverse patient populations can determine if a new or adapted measurement tool is needed for patients with work-related hand eczema, especially regarding the emotional toll of the disease.

The authors believe that this is the first study to evaluate the psychometric properties of the AESEC in patients with work-related hand eczema and the first to investigate its emotional impact separately. Although more research is needed, it is evident that there is a greater need for personalized psychological support in patients with work-related CHE.

References

1. Rocholl M, Brans R, Wilke A, Meyer J, John SM, Ludewig M. Emotional Burden of Patients With Work-Related Hand Eczema: Results of an Exploratory Study in a Tertiary Individual Prevention Setting in Germany. Contact Dermatitis. Published online June 1, 2025. doi:10.1111/cod.14819

2. Arents, B. W., Mensing, U., Seitz, I. A., Wettemann, N., Fink-Wagner, A. H., de Carlo, G., ... & Ring, J. (2019). Atopic eczema score of emotional consequences—a questionnaire to assess emotional consequences of atopic eczema. Allergo Journal International, 28, 277-288.