Delay in medical attention to hand eczema: a follow-up study

BACKGROUND: Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis.

OBJECTIVES: To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis.

METHODS: Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6-month follow up using a self-administered photographic guide. Additional information was obtained by self-administered questionnaires.

RESULTS: Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1.5-8.0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1-8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1.11 [95% confidence interval (CI) 1.02-1.21] per month of patient delay and by 1.05 (95% CI 1.00-1.10) per month of healthcare delay.

CONCLUSIONS: A poorer prognosis of hand eczema was associated with longer delay before medical attention.