The Morphological Features Of Nails In The Various Kind Of Hand Eczema

BackgroundHand eczema (HE) is a common skin disease which is easy to relapse and difficultto treat. It is higher incidence and much more women involed. The etiology of that iscomplicated. HE is multifactorial skin disease. Both exogenous and endogenous factorsplay a significant role. The results of many studies are shown that the irritant contactdermatitis is of the most common subtype of HE. There is no universal classifation ofHE. The most important classification is based on etiological factors. According toetiological classification, HE can be defined into four subtypies, such as IHE, ACD,AHE and HME. With clear contact exposure, the lesions are well circumscribed, thepatients feel burning and sting and the negative patch test are defined as IHE. Thepatients have allergy history, the feeling itching and the lesions are not limited as whilethe patch test is positive are defined as ACD. With a history of AD are defined as AHEwhile HME have positive fungi tests. In our daily clinical work, we found that whenpatients can’t provide the accurate exposure or when we doubt HME but fungi test fornegative, another added diagnosis to clear the etiology of HE are much important.Different subtypes of the HE have different treatment, prevention and prognosis. It isneeded for our dermatologists to diagnosis the HE clearly.The main component of the nail at the distal portion of the finger is the deck,which arises from the angle of epithelial skin. In addition to protecting the skin fromphysical and chemical damage, the deck also assists in the completion of fine fingermovement. The nails are more prone to irritation and this is supported by previous workthat has demonstrated that nail tissue nail is1000times more permeable to water than skin. Damage to the nails in patients may occur much earlier than noticeable damage tothe skin. What features of nails will be in the HE? Can these features as asupplementary role in the etiology of the diagnosis of eczema?Objectives1. To understand the clinical characteristics of the HE2. To verify the skin ultrasound B to exceed the deck measurement applications3. To clear the characteristics and the patch test instrument and detect feature of allkinds of HE4. To measure the levels of UCA in the SC of all subtypies of HE using the HPLCMethods1. The clinical characteristics of the HEHE patients are collected from our hospital, which the diagnosis and phenol typing ofHE was made by experienced dermatologists. All subjectes have read the informedconsent carefully and assigned it. We carried on the questionnaire survey whichincluding medical history, the site, the clinical expression and the objective feelings.And then we take pictures of their both hands, middle finger and thumb nails. After thedermatological check, the HE patients will have the mycotic check (smear and training)in our laboratory. We classified the each questionnaire and collected the informationswhat we wanted.2. To verify the skin ultrasound to exceed the deck measurement applicationsWe recruited the volunteers from the outpatient service (50in IHE subtype,52innormal group). Hand washing for30seconds, after waiting for20minutes,they go intothe measurement room (temperature18-22℃, relative humidity40-60%) and collected the thumb deck pictures with VC98and UC22. We made the clinical score and used theinstrument software to analysis each image and get parameter data.3. The patch test and the non-invasive instrument measurements of all subtypies ofHE. Patch test (PT) is the gold standard method for the diagnosis of contact allergy. Ithas been available for over100years. In our study we used the T.R.U.E. Test. At first,the Finn chambers equipped with antigen S-1000was attached closely with the back ofevery patients for at lest48hours. We removed the patches gently and evaluated thereactions after the0.5h,24h and48h. We take pictures of the back and positiveantigen.2. We Used the non-invasive instrument (VC98, skin ultrasound UC22, imagesystems, Tewameter, Corneometer) to test the hands skin and nails for the biologicalphysical parameters.4. HPLC of strip-derived material to measure the levels of UCA in all subtypies of HE.The levels of UCA of SC were measured using a tape stripping technique from the IS,hand back and TE. Briefly round adhesive tape discs were attached to the those skin.Each tape was applied to the skin for10s using a disc pressure applicator. The tapestrip was gently removed with tweezers and stored in a closed vial at-20℃untilanalysis.50μl of aliquot was introduced into the HPLC system. The statistical softwareSPSS analysis of all kinds of differences between HE.Results1. Detection of nail deck using the skin ultrasoundThere was no difference in the objective parameters between the left and right hands ofsubjects within each subtype (P>0.05). There were significant differences among thesubtypies for the objective parameters (P <0.05), and the left hand was more obviouslydamaged than the right one.2. The clinical epidemiological investigation of the HE The study of questionnaire survey showed that the HE is mostly happened in female,especially in50-59year old age group, and in this age group male and female havesignificant differences.The parts of the index finger, the middle finger and the palm were the most commonsites while the web of the little finger was less happened and it is hardly happened in thelateral margin of the thumb and the little finger.The percentage of all subtypies of HE was IHE24.86%, ACD15.71%, AHE34.29%,HME25.13%. Clinical data analysed are shown: ICD and HME are much more oftenhappened in stomach finger while the ACD and AHE are refers to back finger. The areaof disease happened differently from the primary to the good and the now stages. TheIHE: from the periungual wart of the index to the back of the index finger to the ventralof the index finger. ACD: from the back of the ring finger to the center of the palm tothe back of the index finger; AHE: all in the back of the index finger. HME: from thefingertip of the index to the web of the finger to the ventral of the index finger. Thepictures score showed that the significant difference between the IHE and the ACDsubtype. The significant difference between the male and female in IHE subtype was in30-39age group and in ACD was in20-29age group while there were no difference inthe other groups at any age.3. The patch test and non-invasive instrument detection of all subtypes of HEPatch test:1. The most common allergen were nickel sulphate followed by aromaticmixture, paraphenylenediamine.2. The positive allergen of all subtypes of HE appeareddifferent, ACD100%, IHE0%, AHE6.9%, HME42.8%. The non-invasive methods:1.The results of TWEL and CORNE showed there is no significant difference among allsubtypes of the HE(P>0.05).2. The results of VC98and skin ultrasound B are shownthat there are significant differences in three categories (P <0.05).3. The results ofFluorescence image analysis are shown that there are significant differences in threesubtypes (P <0.05).4. We can see a lot of the cracks, ditch crest, smoothless in the IHE type and with ultrasound we can see the obvious thicked depth and the surfacesmoothness is mostly uneven.5. On the nails of the ACD subtype, we can see themorphological features of nails are easy to appear insect damage change.6. Themorphological features of the nails in the AHE subtype HE. We can see the deckmorphological is more rules, level off, without apparent fracture and ditch crests. Withskin ultrasound, we can see the highest density, the minimum of thickness and flatness.In the fluorescent picture, the nails are with the lowest value of fluorescence.4. HPLC of strip-derived material to measure the levels of UCA in all subtypes of HEThe level of UCA in IHE subtype showed significant difference compared to theACD and AHE subtype. We can see the level of the UCA decreased from the exposurepart to non-exposure part.Conclusions1. Clinical score is a very practical evaluation method and easy to operate.2. The skin ultrasound B can be used to detect nails, with the advantages ofrepeatability, easy to master and it is worthy to be popularized.3. HE is commonly occur in50-59years old female, the common site showed in theindex finger, middle finger and the palm site multiple and less happened in the littlefingers and almost not happened in the the lateral margin of the thumb and the littlefinger. Of all subtypes of HE, Nails’ pictures score showed significant differencesbetween the IHE and ACD. The nail are easy appear more insect damage in ACDgroup.4. VC98and skin ultrasound can be used very well in the diagnosis of IHE subtype.The patch test have good diagnosis function for ACD subtype. TEWL, skin ultrasonicand fluorescence value play a useful role in supplementary diagnosis of AHE subtype.5. HPLC of tape-derived material is an efficient way to measure the levels of the UCA of HE. We can see the level of the UCA are different in distinct parts.