Nickel, Fragrance Top Sensitizers in Patients With Hand Eczema

Nearly 4 in 5 patients with hand eczema at a Malaysian tertiary dermatology clinic tested positive to at least 1 contact allergen, and cosmetic use nearly 7-folded the odds of reacting to multiple allergens at once, according to a study published in the Medical Journal of Malaysia.¹

Sorting Irritants From Allergic Triggers

Chronic hand eczema is a debilitating skin disease that can arise from irritant contact, allergic contact, or an underlying endogenous eczema, and distinguishing among these causes matters because identifying and avoiding relevant allergens can meaningfully improve a patient's disease course. Despite that clinical importance, data on sensitization patterns in hand eczema from Southeast Asian populations have remained limited compared with the larger patch-test registries maintained in Europe.²

Researchers in Malaysia set out to characterize the prevalence and pattern of contact sensitization among patients with hand eczema, along with the clinical and behavioral factors associated with sensitization and disease severity.¹

Patch Testing at a Selangor Tertiary Center

The cross-sectional study was conducted over a 6-month period from January through June 2025 at the Department of Dermatology of a tertiary hospital in Selangor's capital. Patients older than 18 years with predominantly hand eczema were interviewed, examined, and patch tested with the Standard European Baseline Series, with patients who had contraindications to patch testing or an uncertain diagnosis excluded. Hand eczema morphology was classified using the Danish Contact Dermatitis Group system, severity was measured with the Hand Eczema Severity Index (HECSI), and patch test results were interpreted according to International Contact Dermatitis Research Group guidelines.

In total, 54 patients with a mean (SD) age of 44 (15.29) years participated, with a 2.6:1 female-to-male ratio.

Nickel, Fragrance, and a Cosmetic Connection

Overall, 79.6% of patients (n = 43 of 54) had a positive patch test. Of those, 33.3% of all patients (n = 18 of 54) showed polysensitization—reactivity to multiple allergens—while 46.3% (n = 25 of 54) showed oligosensitization to a single allergen and 20.4% (n = 11 of 54) showed no sensitization. The most common sensitizers were nickel sulfate (29.63%), fragrance mix 1 (25.93%), potassium dichromate (14.8%), and formaldehyde (14.8%). Sensitization itself was not significantly associated with age, history of atopy, frequent hand washing, prolonged wet-hand activities, nonpermeable glove use, hand sanitizer use, fragrance exposure, or smoking. Cosmetic use, however, was associated with a 7-fold increase in the odds of polysensitization (OR, 7.07; 95% CI, 1.17-42.85; P = .033). Disease severity, measured by HECSI, was significantly higher among patients who used nonpermeable gloves (mean HECSI score, 24.30 vs 12.82; P = .013), though it was not associated with atopy, hand-washing frequency, or duration of wet-hand exposure.

“Patch test sensitisation was common in hand eczema patients,” the authors wrote. Polysensitization, they noted, was associated with cosmetic use, and use of nonpermeable gloves may worsen hand eczema severity.

A Modest Sample at a Single Center

With only 54 participants drawn from a single tertiary center, the study's statistical power to detect associations with less common exposures was limited, and the findings may not generalize to community dermatology settings or other regions of Malaysia.

The cross-sectional design also cannot establish whether cosmetic use or glove choice preceded sensitization and severity or reflects behaviors adopted in response to existing hand eczema symptoms.

For clinicians managing hand eczema, the findings reinforce the value of routine patch testing and a targeted allergen history that includes cosmetic product use, while the glove-severity association offers a practical, low-cost counseling point: recommending breathable, cotton-lined alternatives to nonpermeable gloves where occupational or hygiene needs allow.

References

1. Liong CS, Jamil A, Ng TG, Mohamad N. Prevalence of contact sensitisation among patients with hand eczema and factors associated with contact sensitisation and disease severity. Med J Malaysia. 2026;81(4):438-446.
2. Thein D, Maul JT, Ribero S, Silverberg JI, Egeberg A, Thyssen JP. Prevalence and Characteristics of Chronic Hand Eczema Among Adults in Denmark: A General Population-Based Study. Contact Dermatitis. 2025;92(5):358-366. doi:10.1111/cod.14732