Skin protection in the metal industry

In the metal industry, workplaces with a high skin risk used to be frequent. This has changed in recent years in big plants, where technological progress and automatization have eliminated many hazards. However, in many small and middle-sized companies without supervision by an occupational physician, high-risk workplaces may still prevail. Therefore skin protection plays an important role in this industry, with its focus on irritant exposures. From our own studies and campaigns, the following conclusions can be drawn: prework occupational examination and counselling of high-risk groups, especially workers with a history of hand eczema, are essential; skin protection plans have to be simple and should be communicated clearly; the use of skin protection seems to depend more on the endogenous skin risk factors of the individual than on the objective hazards at the workplace; the support of the management and the involvement of production teams are essential for the success of skin protection campaigns.

High-performance liquid chromatography analysis of rubber allergens in protective gloves used in health care

A high-performance liquid chromatography (HPLC) method developed for analysis of zinc dithiocarbamates was validated and used to perform a survey of disposable medical gloves used in southern Sweden. The gloves were extracted with acetone at room temperature for 10 min by shaking. The extracts were injected into a polyether ether ketone lined HPLC column, and peaks were analysed by a diode-array detector. The survey shows that of 19 gloves analysed, 10 contained zinc diethyldithiocarbamate (0.070-3.5 mg/g), 3 contained zinc pentamethylenedithiocarbamate (1.0-4.3 mg/g), 4 contained zinc dibutyldithiocarbamate (0.9-1.1 mg/g), and 2 contained 2-mercaptobenzothiazole (0.005-0.008 mg/g). None of them contained thiurams.

A new sampler to assess dermal exposure during wet working

In the UK, approximately 30% of cases of dermatitis reported to the national surveillance scheme are associated with wet working or exposure to aqueous mixtures. There is evidence that the duration and frequency that hands are wet are key determinants of risk, but there are no objective methods to measure these exposure factors. This research aimed to develop a practical tool to measure the duration and the number of occasions hands are wet. We developed an electronic sensor that is worn on the finger, which detects wetness from evaporative cooling. The output signal is recorded in electronic memory and the frequency and duration of exposure calculated using a simple data processing algorithm. The device has been tested in a variety of environmental conditions and for a standardized wet-work task. Wetting events were detectable in all the standardized tests, with the proportion of time the hands were wet ranging from 15 to 49% (mean 30%). The electronic sensor is slightly affected by abrupt changes in air temperature and rapid air movements, but these do not seem to impose any practical limitations. This IOM Wet-Work sampler has the potential to provide reliable measurements of exposure that may be used to assess the risk of contact dermatitis.

Umweltbedingte Kontaktallergien

Contact allergies are frequent diseases and often lead to social and economic consequences for the patients. The incidence of the clinically manifest allergic contact eczema is between 1.8 and 7 per 1,000 per year, according to the data of the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org). Contact allergies are frequently acquired at the workplace, but a sensitisation and subsequent manifest disease (elicitation) occurs even more often in the private sphere and then poses a special problem. Even if occupational exposure to the allergen is prevented, e. g. by giving up the job, a full remission is only achieved in about half of the cases due to the ubiquitous existence of the responsible allergens. Contact with substances that have a high sensitisation potential can be avoided to a great extent. Prevention can be achieved by personal protective measures, a decrease of the applied concentration of the allergen, or even restrictions concerning certain chemicals. The prerequisite for this is continuous monitoring of the frequency of sensitizations towards known allergens, as well as an understanding of the substances in use in the environment, including newly introduced chemicals, and the education of the public.

A randomized, controlled, double-blind study of the effect of wearing coated pH 5.5 latex gloves compared with standard powder-free latex gloves on skin pH, transepidermal water loss and skin irritation

Hand dermatitis is a common occupational disease. Altered skin pH plays an important role in the development of skin irritation. A glove that maintains tight control over skin pH may reduce hand dermatitis in glove users. The purpose of the study was to characterize the effect of glove wearing on skin pH, investigate the impact of study glove on skin pH compared with standard gloves and determine whether wearing study gloves reduced irritation. 20 healthy volunteers enrolled in a 4-week double-blind comparison of study and control gloves and served as their own controls. Gloves were worn 8 hr per day for 5 days per week. Skin pH and transepidermal water loss were measured during and 2 days after the glove-wearing period. The subject and an observer assessed the skin for irritation. The study glove maintained lower skin pH than the control glove (P < 0.05) and trended towards having less irritation. Observers noted increases in dryness and scale in both hands after 4 weeks but significantly less dryness in the study hand at week 4 (P = 0.006). Glove wearing increased skin pH and dryness. The pH 5.5 glove maintained lower skin pH levels than the control glove and may reduce irritation in long-term glove wearers.

Knowledge of skin hazards and the use of gloves by Australian hairdressing students and practising hairdressers

Occupational contact dermatitis is common amongst hairdressers. In this population-based study, 193 trainee hairdressers and 184 practising hairdressers completed a questionnaire detailing their knowledge of skin hazards, the skills they practised and the frequency of glove use. Knowledge of skin hazards was poor in both groups. While up to 70% of participants correctly identified hairdressing chemicals as potential skin hazards, less than 15% correctly identified the role of wet work. Only a small proportion recognized that hairdressing chemicals could cause allergy. Contrary to findings elsewhere, less-experienced hairdressers often handled chemicals, particularly hair dyes containing p-phenylene diamine. The use of gloves was inadequate, particularly when performing work at the basin, which both junior and senior hairdressers did on a regular basis. Recommended strategies for the prevention of hand dermatitis in hairdressers include improved student education, appropriate glove use and the application of after-work moisturizing creams.

Quality of life and depression in a population of occupational hand eczema patients

Occupational hand eczema (OHE) is the most frequently recognized occupational disease in Denmark, and despite governmental attempts to reduce exposure to harmful occupational allergens, the number of new cases has remained almost unchanged since the mid-1990s. Some studies have indicated that OHE has considerable impact on quality of life (QoL) and may lead to depression. The aims of the study were to determine risk factors for low QoL, the frequency and severity of depression among OHE patients and changes in QoL and depression after 12 months of follow up. The study population, 758 patients, comprised all new recognized cases from the Danish National Board of Industrial Injuries Registry between October 2001 and November 2002. All patients received a questionnaire to determine impairment of QoL and depressive symptoms. A similar follow-up questionnaire was posted after 1 year. The response rate was 82% at baseline and 91% at follow up. The mean Dermatology Life Quality Index total score was 5.5 for all patients and 7.8 for severe OHE cases. Severe OHE cases and lower socioeconomic status were independently associated with low QoL. The prevalence of moderate-to-severe depression was 9%. Only minor changes in QoL and depressive symptoms were found after 12 months of follow up.

Efficacy of an alcohol-based healthcare hand rub containing synergistic combination of farnesol and benzethonium chloride

Healthcare workers are required to disinfect the hands several times a day using hand disinfectants, which leads to chronic hand exposure to high levels of antimicrobials contained in the disinfectants, which could compromise the skin integrity. This problem may be addressed by developing hand disinfectants containing synergistic combinations of small amounts of antimicrobials and other agents. The synergistic effect of farnesol and essential oils with several antimicrobials was studied in vitro to select an effective antimicrobial system in preservative concentration for use in healthcare hand rub. Farnesol and lemon oil showed synergistic activity against S. aureus, in combination with benzalkonium chloride and benzethonium chloride, but not with other antimicrobials studied. All essential oils studied showed synergy with benzethonium chloride against Staphylococcus aureus and Escherichia coli. An alcohol-based healthcare hand rub (ZBF hand rub) containing this unique synergistic combination of farnesol and benzethonium chloride was then developed and its efficacy as a healthcare hand rub was evaluated in human volunteers according to the US FDA-TFM protocol using Serratia marcescens as a marker organism. The ZBF hand rub showed a 3.22 log(10) reduction in the microbial count after the first application and a 5.49 log(10) reduction after the tenth application in vivo and exceeds the US FDA-TFM criteria for healthcare hand rub. The ZBF hand rub did not irritate the hands when tested on human volunteers when applied 10 times everyday for five consecutive days. The ZBF hand rub exhibits more than 5.5 log(10) reduction in the microbial count within 15s and more than 2.8 log(10) reduction in the two types of viruses tested within 30s in vitro. When evaluated in an in vitro pig skin model, the ZBF hand rub shows better prolonged activity (20-35 min post-application) against transient bacteria (S. aureus and E. coli) compared to other alcohol-based hand rubs. These findings suggest that the use of the ZBF hand rub amongst health care workers may lower the risk of chronic hand exposure to high levels of antimicrobials without compromising the efficacy.

A systematic review of contact dermatitis treatment and prevention

BACKGROUND

Contact dermatitis (CD) is a common occupational disease. There have been no systematic reviews of CD treatment or prevention.

METHODS

Multiple databases were systematically searched. Using independent double review and published quality review criteria, articles were rated as good, fair, or poor. Treatment benefit data were tabulated and conclusions were based on the rated strength of published evidence.

RESULTS

In all, 49 studies met inclusion criteria. Barrier creams containing dimethicone or perfluoropolyethers, cotton liners, and softened fabrics prevent irritant CD. Lipid-rich moisturizers both prevent and treat irritant CD. Topical skin protectant and quaternium 18 bentonite (organoclay) prevent rhus dermatitis. Diethylenetriamine pentaacetic acid (chelator) cream prevents nickel, chrome, and copper dermatitis. Potent or moderately potent steroids effectively treat allergic CD. There were no macrolide immunomodulator trials that met inclusion criteria. This review did not include studies of children, animals, or non-English language publications.

CONCLUSIONS

A limited number of interventions effectively prevent or treat irritant and allergic CD, but well-controlled, outcome-blinded studies, particularly in the area of allergic CD prevention are needed.

Intervention development in occupational research: an example from the printing industry

BACKGROUND

Intervention development research is an essential prerequisite of any study that attempts to determine whether specific interventions work to prevent work related injury and illness.

METHODS

Focus groups (n = 5) and direct observational studies (n = 21) of printers were used to elicit key issues that would aid the development of subsequent interventions. Transcripts from these were analysed by standard qualitative methods to identify common and related themes.

RESULTS

The views of managers differed significantly from those of print workers in a number of areas, and working practices did not always follow policy. The majority of printers did not perceive dermatitis to be a major problem, although many complained of dry hands. Other key results included: the lack of skin care policy in most companies; poor understanding of the nature, causes, and treatment of dermatitis; low priority of dermatitis within health and safety concerns; little or no provision of occupational health services, particularly skin checks; variability in provision of and access to appropriate skin protection; and lack of accessible washing facilities.

CONCLUSIONS

As a result it was decided to evaluate the implementation of four

INTERVENTIONS

provision of (1) skin checks and treatment advice; (2) gloves of the correct type and size, and use of an after-work cream; (3) information on dermatitis within the printing industry; and (4) development of best practice skin care policy.

Educational and dermatological aspects of secondary individual prevention in healthcare workers

Healthcare workers (HCW) have an increased risk of suffering from occupational skin diseases (OSDs). Therefore, we established special prevention and skin protection courses for HCW. Medical aims are to optimize diagnostic procedures and individual therapy, educational aims are to improve individual skin protection/skin care habits of the patient and also to influence the participants' attitudes towards health. Participants are patients that have been suspected to suffer from an OSD and are insured with the German Accident Prevention Insurance Association for Health Care Workers (BGW). Teaching units mainly focus on the texture and functioning of the skin, general aspects of OSDs, general information concerning skin protection, instructions about the correct use of skin cleansing and skin protection products. Besides, every participant is clinically examined by a dermatologist and a precise patient's history is obtained. Individually adapted skin protection strategies are developed. Patients can ask the dermatologist questions in confidence. 504 patients (mean age: 36.9 years, SD = 11.7) participated in the skin protection courses. 94.6% (n = 477) suffered from hand eczema frequently caused by a mixture of atopic, irritant and allergic contact dermatitis, but irritant contact dermatitis was the most frequent diagnosis (55.4%, n = 279). The participants rated the course as good to excellent. Health education and advisory services in occupational dermatology are still fragmentary. Prevention of OSD and maintenance of health through education are important complementary measures for dermatological care. In the future, similar educational programmes should be offered for employees of other professions with an increased risk for OSD.

Skin care in occupational contact dermatitis of the hands

A survey of patients attending an occupational dermatology clinic with suspected occupational contact dermatitis affecting the hands was undertaken to determine if optimal skin care treatment had been instituted prior to referral for patch testing. Appropriate treatment for contact dermatitis of the hands was defined as concurrent use of a soap substitute, use of a lipid-rich moisturizer, and if appropriate, use of a topical corticosteroid in an ointment vehicle. Patients were asked about the use of a particular soap substitute, the name and type of any moisturizer used and the name and type of topical corticosteroids currently used. The products were examined where possible. Only one-third of all patients were using the complete package at the time of their clinic appointment. Nearly all of these patients had seen a dermatologist prior to this appointment. Of the group of patients with work-related diseases who reported having seen a dermatologist prior to the clinic appointment, only 38% were using the complete skin care routine.

Women's Occupational Dermatologic Issues

With almost 65 million women in the workforce, their representation in various occupational sectors is crucial, as is their health and safety. Female-dominated occupations in health care and cosmetology along with their potential cutaneous exposures are reviewed. Proper evaluation and management are necessary to minimize the disability that can result from these illnesses.

Primary prevention in health care employees: a prospective intervention study with a 3-year training period

Irritant contact dermatitis is a mayor problem in health care employees. Because educational programs have shown convincing success in certain occupations (e.g. in hairdressers), this study investigates the effect of a special training program in health care trainees. 521 trainees from 14 nursing schools in Central Germany were randomly divided in 2 groups, (i) an intervention group with a regular teaching protocol regarding all aspects of primary prevention and (ii) a control group without any further teaching. Morphological changes of the hands, use of hand care creams and knowledge regarding skin care were evaluated regularly during their 3 years lasting training period (1999-2002). In the intervention group, we found at the end of the 3-year training period a significant better skin condition of the hands than in the control group: a 3-year prevalence of morphological skin changes of 66.7% versus 89.3%. The unteached trainees (control group) had an odds ratio (OR) of 4.8 [95% confidential interval (CI): 2.9-7.8] for developing any skin changes on the hands after 3 years. Besides the effect of the teaching, the history of hand dermatitis before the study start was an independent risk factor for development of further hand dermatitis [OR 1.9, 95% CI: 1.0-3.6). Age and sex showed no influence on the skin condition. Atopic constitution had an influence on the development of skin changes only at the evaluation after 18 month. The observed effect in the intervention group may best be explained by different behaviour of the trainees, e.g. the amount of hand washing was reduced, while procedure of hand disinfection remained unchanged compared with the control group. However, the amount of used skin care cream did not differ between the both groups. This study shows that primary prevention of skin disease by regularly teaching during the training period of medical employees can effectively reduce the risk of development of irritant skin changes of the hands. Therefore, teaching and continuous motivation regarding preventive individual and collective measures during the training of medical staff should be an obliged part of the curriculum.

Regular use of a hand cream can attenuate skin dryness and roughness caused by frequent hand washing

BACKGROUND

Aim of the study was to determine the effect of the regular use of a hand cream after washing hands on skin hydration and skin roughness.

METHODS

Twenty-five subjects washed hands and forearms with a neutral soap four times per day, for 2 minutes each time, for a total of two weeks. One part of them used a hand cream after each hand wash, the others did not (cross over design after a wash out period of two weeks). Skin roughness and skin hydration were determined on the forearms on days 2, 7, 9 and 14. For skin roughness, twelve silicon imprint per subject and time point were taken from the stratum corneum and assessed with a 3D skin analyzer for depth of the skin relief. For skin hydration, five measurements per subject and time point were taken with a corneometer.

RESULTS

Washing hands lead to a gradual increase of skin roughness from 100 (baseline) to a maximum of 108.5 after 9 days. Use of a hand cream after each hand wash entailed a decrease of skin roughness which the lowest means after 2 (94.5) and 14 days (94.8). Skin hydration was gradually decreased after washing hands from 79 (baseline) to 65.5 after 14 days. The hand wash, followed by use of a hand cream, still decreased skin hydration after 2 days (76.1). Over the next 12 days, however, skin hydration did not change significantly (75.6 after 14 days).

CONCLUSION

Repetitive and frequent hand washing increases skin dryness and roughness. Use of a hand cream immediately after each hand wash can confine both skin dryness and skin roughness. Regular use of skin care preparations should therefore help to prevent both dry and rough skin among healthcare workers in clinical practice.

[Skin protection and skin disease prevention courses for secondary prevention in health care workers: first results after two years of implementation]

BACKGROUND

Healthcare workers have an increased risk of occupational dermatoses. In January 2002, the Department of Social Medicine, Occupational and Environmental Dermatology of the University of Heidelberg started organizing special prevention courses for this group of employees in cooperation with the Accident Prevention & Insurance Association for Health Care Workers (BGW). The major aims are to improve individual skin protection and skin care habits, as well as to optimize diagnostic procedures and therapy.

PATIENTS AND METHODS

The two-day course has up to 14 participants. Teaching units mainly focus on skin structure and function, general aspects of occupational skin diseases, general information concerning skin protection and practical exercises emphasizing the correct use of skin cleansing and skin protection products. Additionally, every participant undergoes a dermatological examination including a detailed history and skin inspection. Individual skin protection strategies are developed, and the participants are provided with the opportunity to ask the dermatologist questions in confidence.

RESULTS

Most of the 355 participants have been female (87.3%) with a mean age of 36.9 years. 95% had hand eczema, predominantly dyshidrotic morphology. In many cases, there was a mixture of atopic, irritant and allergic contact dermatitis but irritant contact dermatitis was most common (43%). Atopy was present in 68% of the patients. The participants rated the course as good to excellent. Other benefits are the exchange of experience between patients working in the same or similar occupations and transfer of the new knowledge to colleagues, family and friends.

CONCLUSIONS

Examinations and advisory services in occupational dermatology are still fragmentary. Skin barrier creams and moisturizers are not sufficiently utilized in daily practice. In the future, similar courses should be offered for employees in other professions with an increased risk of occupational skin diseases.

High-fat petrolatum-based moisturizers and prevention of work-related skin problems in wet-work occupations

The study presented is a randomized, controlled intervention study with the purpose of implementing an evidence-based skin disease prevention programme. The hypothesis explored in this article is whether a high-fat petrolatum-based moisturizer can be an alternative to protective gloves in wet-work occupations. The study population was all gut cleaners in Danish swine slaughterhouses, and data were collected by telephone interviews using a standardized questionnaire - The Nordic Occupational Skin Questionnaire (NOSQ-2002). At baseline, 644 (88%) gut cleaners responded and at 1-year follow-up 622 (72%). 135 gut cleaners in the intervention and 277 in the comparison group responded at both telephone interviews. In the intervention group, the eczema frequency was reduced significantly. Detailed analyses revealed that protective gloves are the overall most effective protective means and did not indicate that a high-fat moisturizer could be an alternative. Furthermore, the most extensive improvements could not be explained by combinations of protective behaviour but was found among those who had received information on, and was having discussions on prevention of skin problems. This only applied to the intervention group. A continuous focus on prevention of skin problems with information and discussions on the shop floor therefore seemed to be most important for reducing skin problems.

Occupational Contact Urticaria

Among contact dermatosis, irritant contact dermatitis and allergic eczema are by far the most frequent. Nevertheless, concerning occupational dermatosis, contact urticaria should be not neglected. Allergy to natural rubber latex is well-known; however, many other substances found in catering jobs and in jobs involving close contact with animals or vegetables can cause allergies. Discrete forms are not rare and should be remembered during questioning of the patient, as well as during a clinical examination. Accordingly, a physician should perform the appropriate cutaneous tests--particularly prick tests--and the relevance of these tests then needs to be assessed.