Effects of leather industry on health and recommendations for improving the situation in Pakistan

The leather industry and its associated sectors contribute significantly to the Pakistani economy. There are around 600 tanneries in Pakistan that are concentrated in 3 major cities (Kasur, Karachi, Sialkot). Waste discharge from tanneries pollutes the air, soil, and water, causing serious health problems. Exposure to such contaminated environmental milieu has been seen to culminate in a multiple array of disease processes such as asthma, dermatitis, hepatic and neurological disorders, and various malignancies. An overall dearth of research on the occupational hazards of employment in the leather industry as well as its effects on pediatric population was observed during literature review with particular reference to Pakistan. It is recommended that research should be conducted about the health hazards in the leather industry in Pakistan as well as globally to gather data that can be translated into effective prevention programs for both adults as well as pediatric populations.

Interventions for preventing occupational irritant hand dermatitis

BACKGROUND

Occupational irritant hand dermatitis (OIHD) is an important cause of discomfort in the working population. Different preventive measures are in place but it is not clear how effective these are.

OBJECTIVES

To assess the effect of interventions for preventing OIHD in healthy people who work in occupations where the skin is at risk of damage.

SEARCH STRATEGY

In May 2010, we searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLlNE and EMBASE. Conference proceedings, and ongoing trials registers were also searched.

SELECTION CRITERIA

Randomised controlled trials (RCTs) studying the effectiveness of barrier creams, moisturisers, gloves, complex educational interventions, and other interventions for the prevention of OIHD.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the trials and extracted data.

MAIN RESULTS

Four RCTs involving 894 participants from different occupations were included. The primary outcome was numbers of new cases.One large RCT of 708 print and dye workers compared 2 barrier creams (containing silicone or hydrocarbon) versus no intervention. Fewer workers using barrier creams developed OIHD than those who did not (39.9% versus 45%, (OR 0.75, 95% CI 0.53 to 1.07. P = 0.11) but this was not statistically significant.In 1 RCT of 54 metal workers less developed OIHD when using an after work emollient or a barrier cream compared to no intervention. There was no statistical difference between the groups at different times of follow-up.One RCT of 111 cleaners and kitchen workers compared a moisturiser (Locobase) versus no intervention using a cross-over design. While using the moisturiser no participant developed OIHD. During the control period with no skin treatment, 19 (20.4%) out of 93 participants developed OIHD.One RCT of 21 hairdressers compared a barrier cream containing aluminium chlorohydrate (Excipial protect) versus its vehicle. No participant developed OIHD while the products were used.Only limited side-effects such as transient itching, stinging, and dryness were reported for the interventions.

AUTHORS' CONCLUSIONS

Although the findings of this review were generally positive, no statistical significance was reached. We conclude that at present there is insufficient evidence for the effectiveness of most of the interventions used in the primary prevention of OIHD. This does not mean that current measures are necessarily ineffective, as the limited studies to date have been rather small and of poor quality. Larger well designed RCTs are now needed in different workplaces to establish the effectiveness of various preventative strategies.

Propylene glycol dermatitis in the printing industry: the fundamental role of a workplace visit

Workers in the printing industry serve as an example of a working population that is at high risk of developing occupational skin disease. Daily exposures include both irritants and sensitizing agents. While many substances have been associated with occupational contact dermatitis in this population, no detailed cases of allergic contact dermatitis (ACD) from propylene glycol (PG) have been reported to date. We present a case of a printing tradesman who developed work-related ACD from PG and who was subsequently able to return to work after a multidisciplinary team assessment that included a comprehensive worksite visit by a clinical occupational hygienist.

Latex allergy

The prevalence of latex allergy in the general population is low; however, the risk of developing latex allergy is higher in persons with increased latex exposure, such as health care workers or persons who work in the rubber industry. Children with spina bifida and others who undergo multiple surgeries or procedures, particularly within the first year of life, are also at greater risk of latex allergy. Reactions to latex allergy can range from type IV delayed hypersensitivity (e.g., contact dermatitis) to type I immediate hypersensitivity (e.g., urticaria, bronchospasm, anaphylaxis). Latex allergy can be diagnosed with clinical history, skin prick testing, latex-specific serum immunoglobulin E testing, and glove provocation testing. The main goals of latex allergy management are avoidance of exposure to latex allergens and appropriate treatment of allergic reactions. The use of nonlatex products from birth may prevent potentially serious allergic reactions. Widespread adoption of nonlatex or low-latex gloves has decreased the incidence of latex sensitization in health care workers.

Individual susceptibility to occupational contact dermatitis

Occupational Contact Dermatitis (OCD) is one of the most common work-related diseases. High risk occupations are in health care, hairdressing, food sector and metal industry. OCD tends to become chronic; persistent OCD often results in impaired quality of life and loss of work ability. The purpose of this article is to review the present knowledge on the factors which determine individual susceptibility to acquire OCD. Recent discoveries regarding genes involved in the skin barrier, inflammatory response and biotransformation of xenobiotics provide more insight in the individual susceptibility for OCD. Knowledge of the factors which predispose to OCD is useful in occupational health practice for the application of preventive measures and for career guidance for apprentices and workers in high risk occupations.

Methyl methacrylate permeability of dental and industrial gloves

Our study was undertaken to measure the amount and time it took for methyl methacrylate monomer (MMA) to permeate latex, vinyl and industrial neoprene gloves and to compare the results to obtain a rating of the permeability of each of the gloves studied to MMA. The monomer, permeated under static conditions, was measured using a spectrophotometer. Latex and vinyl clinical gloves became permeable to MMA in a very short amount of time. Neoprene industrial gloves remained impervious for 25 minutes. Dentists and dental technicians should be aware of the toxic effects of MMA and understand that clinical gloves do not afford protection from MMA.

Latex hypersensitivity: a closer look at considerations for dentistry

Over the past several decades, latex hypersensitivity has become an increasingly common phenomenon in the dental setting. Exposure to latex via direct skin contact or inhalation of airborne allergens from powdered gloves poses the risk of sensitizing both clinicians and their patients. Adverse reactions to latex range from mild irritant contact dermatitis to potentially life-threatening hypersensitivity. The prevalence of these reactions is higher among medical and dental practitioners, those with prior allergies, patients with a history of multiple surgeries and those with spina bifida. The risk of developing latex hypersensitivity increases with prolonged and repeated exposure. The incidence of latex allergy may be reduced through such simple measures as using latex alternatives and powder-free, low-protein gloves. For patients with confirmed latex allergy or those at risk of hypersensitivity, it is critical for dental personnel to be familiar with the range of possibilities for latex exposure and to employ appropriate preventive procedures.

Using skin models to assess the effects of a pre-work cream. Methodological aspects and perspective of the industry

BACKGROUND

There is a basic necessity to understand the mechanisms of the protective effects of pre-work creams. Additionally a lot of workplace-related irritants cannot be tested with the existing in vivo methods due to their toxicological profile. As a consequence, there is a need for additional in vitro models for testing pre-work creams.

OBJECTIVE

An in vitro skin model test was developed to evaluate the protective mechanism of a pre-work cream.

METHODS

The efficacy of 3 products was assessed by an in vivo test (repetitive occlusive irritation test) and then 3-dimensional skin model tests were carried out.

RESULTS

In vivo test results demonstrate that the best protection against sodium dodecyl sulfate is offered by a multiple emulsion. In the case of a skin model test, sodium dodecyl sulfate led to cell damage, an increase in proinflammatory markers and some barrier lipids. The pre-work cream increased the content of skin lipids, without inducing irritation or cell death.

CONCLUSION

Skin models support the understanding of the interaction of irritants and pre-work creams. Because they are in vitro models, there are no limitations regarding the selection of irritants, which offers numerous opportunities to test a broad range of workplace irritants.

[Chemical resistance of latex gloves]

Dermal chemical risk is represented by the chemicals with irritant, caustic and sensitization properties or that can produce toxic effects after penetration through the skin. During the last few years the interest for the effective protecting ability of gloves progressively is increased in parallel with their use. Penetration of chemicals through the protecting material does not always turn out visible. That has led to the development of test standardizes. In 1989 the EC adopted two Directives in the field of the characteristics of protection devices defining certification procedures (89/686/EEC) and characteristics demanded for the use of protection devices at the workplace (89/656/EEC). When the European Standards are accepted from the CEN they exist in rough draft shape (prEN), losing the prefixed one pr- when they are approved by all the EC member Countries. A number of EN for protection gloves have been proposed by CEN/TC 162 regarding methods for testing the resistance to penetration/permeation of chemicals and other characteristics. However in these protocols some limitations were found, since not necessarily they represent the real using conditions. In general an ideal protecting material against the chemicals does not exist because what is effective to a specific compound does not effectively protect from an other. Latex is not commonly considered a very chemical resistant material and therefore its use in such sense is limited However the low cost and the spread of latex gloves in particular in Public Health often make them easy available at workplace and therefore used in several situations.

Experiences with implementation of evidence-based prevention programs to prevent occupational skin diseases in different occupations

Occupational skin diseases are among the most frequently recognized occupational diseases in many industrialized countries. This paper describes and review experiences with implementation of interventions to prevent occupational skin diseases in different occupational settings representing the food processing industry and a hospital. The study populations were gut cleaners with all participants being exposed to wet work, cheese dairies and a hospital where all employees were included. The effect of implementation of evidence-based prevention programs were tested by questionnaire surveys on baseline and follow-up. A significant reduction in eczema at hands or forearms was observed among gut cleaners. At cheese dairies the eczema frequencies were low except for a comparison dairy where significant changes were seen. At the hospital a non significant reduction in hand eczema was observed. Changes related to use of protective measures and knowledge on prevention of occupational skin diseases were observed. A process evaluation carried out at the gut cleaning departments showed association between the eczema frequency at follow-up, activities related to prevention and implementation of an occupational health management system. In addition to documenting the scientific background for evidence-based prevention programs to prevent occupational skin diseases in different occupations, both the study population and the study design should be considered carefully when testing the implementation of workplace interventions. These aspects may influence the outcome in different directions and either facilitate or hamper the possibilities to provide scientific documentation of the effect of the intervention tested.

[Irritant contact dermatitis. Part I. Epidemiology, etiopathogenesis and clinical manifestation]

Irritant contact dermatitis is a frequent problem in dermatology. It compromises the majority of all occupational skin diseases in most countries. It develops as a result of the environmental or work-related exposure to irritants. Cutaneous reaction depends on the intrinsic properties of the irritant, individual skin susceptibility and environmental conditions. A great morphological variety of irritant contact dermatitis and difficulties in diagnosis may lead to misdiagnosis and inadequate treatment. The prognosis is variable. Preventive measures, including education, individual skin protection and proper skin care may contribute to the reduced incidence of occupational irritant contact dermatitis.

Characteristics of chelation ability of chosen metal ions by protective ointments containing Na2H2EDTA

Allergy contact dermatitis is a common occupational disease and the protective ointments are often used by the sensitized subjects. The efficacy of the chelation ability of the barrier creams containing Na2H2EDTA was evaluated. The in vitro test with the diffusion chamber and artificial membrane was performed. The effect of the Na2H2EDTA concentration (3, 5 or 10%), pH of the buffer for Na2H2EDTA dissolving and the vehicle of the ointment on the chelation of Ni2+ and Co2+ were assessed. The ointment with 10% Na2H2EDTA dissolved in the buffer of pH 7.0 or 7.4 buffer was found as optimal for the protection ability. There was no influence of the formula of the ointements on the efficiency of chelation.

A proposal for guideline for prevention of allergic occupational asthma in conformity with the globally harmonized system of classification and labelling of chemicals (GHS)

The use of chemical products to enhance and improve life is a widespread worldwide practice. Alongside the benefits of these products, there is also the potential of chemicals for adverse effects to people or the environment. As a result, a number of countries or organizations have developed laws or regulations over the years that require information to be prepared and transmitted to those using chemicals, through labels or Safety Data Sheets (SDS). Their differences are significant enough to result in different labels or SDS for the same product in different countries. In July 2003, United Nations (UN) recommended the globally harmonized system of classification and labelling of chemicals (GHS). We, special committee of Japanese Society of Occupational and Environmental Allergy proposed a guideline for prevention of allergic occupational asthma and sensitizers (n=60) causing occupational asthma or contact dermatitis in conformity with respiratory and skin sensitization criteria of GHS. We should propose these 60 sensitizers to the chemical industry association and governments to control, regulate and label them in each country.