Hand eczema

Alex Haga — Tue, 17 Dec 2024 19:23:37 +0000

Date Added:

December 17, 2024

Journal/Publication:

Lancet

Publication Date:

December 14, 2024

Issue:

10470

Volume:

404

Pages:

2476-2486

URL:

Hand eczema

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(24)01810-5

Keywords

eczema

hand

PMID (1):

39615508

MeSH

Dermatitis

Atopic / diagnosis

Eczema*

Hand Dermatoses* / diagnosis

Phototherapy

A review of the recognition and management of hand eczema. James W. Mold, MD, MPH

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Hand eczema is a highly prevalent skin disease and one of the most common work-related disorders. In up to two-thirds of individuals affected by hand eczema, the disease becomes chronic and results in substantial personal and occupational disability. Manifestations of chronic hand eczema vary in severity and appearance over time, and people with eczema typically experience itch, pain, and a burning sensation. The pathophysiology of chronic hand eczema is multifactorial. Major risk factors are current or past atopic dermatitis and excessive or prolonged exposure to irritants or allergens. Based on the suspected main causes, chronic hand eczema is commonly classified into irritant, allergic, and atopic hand eczema. Diagnosis and assessment can be complex, and management is often challenging. Strategies include structured education, avoidance of trigger factors, primary to tertiary prevention, topical anti-inflammatory treatment with glucocorticosteroids, calcineurin inhibitors, or januskinase inhibitors, phototherapy, systemic retinoids, and off-label use of immunosuppressive drugs. Topical and systemic immunomodulatory therapies approved for atopic dermatitis could be used in severe atopic hand eczema and some of them are under clinical development for chronic hand eczema. Additional research is needed to better understand chronic hand eczema subtypes and underlying mechanisms, and the comparative effectiveness and safety of therapies. This Review combines established knowledge with ongoing changes in our understanding of the disease and their implications for prevention, management, and future research.

Author/s:

Stephan Weidinger, Natalija Novak

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years

Brian Desmarais — Mon, 19 Aug 2019 15:00:24 +0000

Date Added:

August 19, 2019

Journal/Publication:

Journal of Pediatrics

Publication Date:

June 25, 2019

URL:

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years

Type:

Clinical Research Results

Format:

Article

Keywords

MeSH

Anemia, Iron-Deficiency

infants

Perhaps we are overprescribing iron fortified formulas for infants without iron deficiency anemia. James W. Mold, MD, MPH

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OBJECTIVES:

To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formulaor low-iron formula as part of an iron deficiency anemia prevention trial.

STUDY DESIGN:

Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified(12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group.

RESULTS:

At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high.

CONCLUSIONS:

Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear.

TRIAL REGISTRATION:

Clinicaltrials.gov: NCT01166451.

Author/s:

Gahagan, S., Delker, E., Blanco, E., Burrows, R., Lozoff, B.