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Michaels BS, Ayers T, Brooks-McLaughlin J, McLaughlin RJ, Sandoval-Warren K, Schlenker C, Ronaldson L, Ardagh S. Potential for Glove Risk Amplification via Direct Physical, Chemical, and Microbiological Contamination. J Food Prot 2024; 87:100283. [PMID: 38679200 DOI: 10.1016/j.jfp.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
This review focuses on the potential direct physical, chemical, and microbiological contamination from disposable gloves when utilized in food environments, inclusive of the risks posed to food products as well as worker safety. Unrecognized problems endemic to glove manufacturing were magnified during the COVID-19 pandemic due to high demand, increased focus on PPE performance, availability, supply chain instability, and labor shortages. Multiple evidence-based reports of contamination, toxicity, illness, deaths, and related regulatory action linked to contaminated gloves in food and healthcare have highlighted problems indicative of systemic glove industry shortcomings. The glove manufacturing process was diagramed with sources and pathways of contamination identified, indicating weak points with documented occurrences detailed. Numerous unsafe ingredients can introduce chemical contaminants, potentially posing risks to food and to glove users. Microbial hazards present significant challenges to overall glove safety as contaminants appear to be introduced via polluted water sources or flawed glove manufacturing processes, resulting in increased risks within food and healthcare environments. Frank and opportunistic pathogens along with food spoilage organisms can be introduced to foods and wearers. When the sources and pathways of glove-borne contamination were explored, it was found that physical failures play a pivotal role in the release of sweat build-up, liquefaction of chemical residues, and incubation of microbial contaminants from hands and gloves. Thus, with glove physical integrity issues, including punctures in new, unused gloves that can develop into significant rips and tears, not only can direct physical food contamination occur but also chemical and microbiological contamination can find their way into food. Enhanced regulatory requirements for Acceptable Quality Limits of food-grade gloves, and the establishment of appropriate bioburden standards would enhance safety in food applications. Based on the information provided, together with a false sense of security associated with glove use, the unconditional belief in glove chemical and microbiological purity may be unfounded.
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Affiliation(s)
- Barry S Michaels
- B. Michaels Group Inc., 487 West River Road, Palatka, FL 32177, USA.
| | - Troy Ayers
- Eurofins Microbiology Laboratories Inc., Des Moines, IA 50321, USA
| | | | | | | | | | - Lynda Ronaldson
- Eagle Protect PBC, South Lake Tahoe, CA 96150, USA; Eagle Protect Ltd. Christchurch 8011, New Zealand
| | - Steve Ardagh
- Eagle Protect PBC, South Lake Tahoe, CA 96150, USA; Eagle Protect Ltd. Christchurch 8011, New Zealand
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2
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Wilke A, Fischer AK, Brans R, Sonsmann F. [Patient education in work-related hand eczema : Importance and challenges in health care practice]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05137-2. [PMID: 37103553 DOI: 10.1007/s00105-023-05137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 04/28/2023]
Abstract
Patient education can help patients with work-related hand eczema to cope with their skin disease in an informed and responsible manner and to improve their personal skin protection behavior in everyday working and private life. Skin protection education in centers specialized in occupational dermatology is a pivotal component of outpatient and inpatient individual prevention programs for individuals with work-related skin diseases provided by the statutory accident insurance institutions in Germany. Patient education should be patient-oriented and promote learning, e.g., through interactive, activating discussions and design, references to everyday life, and methodically and didactically well-prepared media and materials in clear, understandable language. Challenges may arise in educational practice, e.g., due to subjective illness perceptions, participants with a lack of motivation, language barriers, functional illiteracy, or heterogeneous patient groups. In this article, different challenges are presented and educational and health psychological perspectives are discussed to meet these challenges in order to provide an optimal, patient-oriented individual prevention measure.
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Affiliation(s)
- Annika Wilke
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
- Institut für Gesundheitsforschung und Bildung (IGB), Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
| | - Ann-Kristin Fischer
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
| | - Richard Brans
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
- Institut für Gesundheitsforschung und Bildung (IGB), Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
| | - Flora Sonsmann
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
- Institut für Gesundheitsforschung und Bildung (IGB), Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
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3
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Heichel T, Brans R, John SM, Nienhaus A, Nordheider K, Wilke A, Sonsmann FK. Effects of impermeable and semipermeable glove materials on resolution of inflammation and epidermal barrier impairment after experimental skin irritation. Contact Dermatitis 2023. [PMID: 37015218 DOI: 10.1111/cod.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Semipermeable membranes might be suitable for glove liners or comfort gloves in individuals with irritant contact dermatitis (ICD). OBJECTIVES To evaluate the effects of different glove materials on inflammation and epidermal barrier impairment after experimental skin irritation. METHODS Nine test areas on the volar forearms of 24 healthy volunteers were irritated with sodium lauryl sulfate (1%) and afterward covered for 6 days (6 or 8 h/day) with semipermeable Sympatex (SYM), vinyl (OCC), combinations of vinyl with Sympatex (SYM/OCC) or cotton (COT/OCC), or left uncovered (CON). Up to day 10, measurements of transepidermal water loss (TEWL), erythema (a*), skin humidity (SH) and visual scoring (VS) were applied. RESULTS No significant differences in skin parameters were found between COT/OCC and SYM/OCC as well as between each of the combinations and CON. SYM, COT/OCC and SYM/OCC led to better results for most skin parameters than OCC alone. CONCLUSIONS Occlusive material has a negative impact on skin barrier recovery and inflammation after skin irritation whereas SYM is not inferior to uncovered areas indicating good tolerability. Altogether, the data suggest that SYM is a useful alternative to COT as material for glove liners and comfort gloves in ICD patients.
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Affiliation(s)
- Theres Heichel
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany
| | - Swen M John
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Service Research in Nursing (CVcare), Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Annika Wilke
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany
| | - Flora K Sonsmann
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
- Lower-Saxonian Institute of Occupational Dermatology at the University of Osnabrück, Osnabrück, Germany
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4
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. S1-Leitlinie Kontaktekzem. J Dtsch Dermatol Ges 2022; 20:711-734. [PMID: 35578429 DOI: 10.1111/ddg.14734_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster
| | - Vera Mahler
- Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Langen
| | | | | | | | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Johannes Geier
- Zentrale des IVDK, Universitätsmedizin Göttingen, Göttingen
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. German S1 guideline: Contact dermatitis. J Dtsch Dermatol Ges 2022; 20:712-734. [DOI: 10.1111/ddg.14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Heinrich Dickel
- Department of Dermatology Venereology and Allergology St. Josef Hospital University Medical Center of the Ruhr University Bochum Bochum Germany
| | - Andrea Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - Randolf Brehler
- Department of Dermatology University Hospital Münster Münster Germany
| | - Vera Mahler
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Hans F. Merk
- Department of Dermatology RWTH Aachen University Aachen Germany
| | - Irena Neustädter
- Department of Pediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | | | - Thomas Werfel
- Department of Dermatology Allergology and Venereology Hannover Medical School Hannover Germany
| | - Margitta Worm
- Department of Dermatology Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Johannes Geier
- Center of IVDK University Medical Center Göttingen Göttingen Germany
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6
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Allergic contact dermatitis to rubber accelerators in protective gloves: Problems, challenges, and solutions for occupational skin protection. Allergol Select 2021; 5:335-344. [PMID: 34734158 PMCID: PMC8561832 DOI: 10.5414/alx02265e] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
Protective gloves are an elementary component of personal protective equipment in many occupations and are intended to protect the hands from various hazards (e.g., wetness, chemicals, mechanical forces, or thermal stress). This is particularly important when other occupational safety measures (e.g., technical-organizational measures) cannot be implemented or are insufficient. However, it is not uncommon for protective gloves themselves to become a problem, as some of their ingredients (e.g., rubber accelerators) can cause allergic reactions. Accelerators in rubber gloves include thiurams, dithiocarbamates, thiazoles, guanidines, and thioureas. If no alternative means of protection are available, this may even result in abandoning the profession. This article is about rubber accelerators, which are often contained in protective gloves made of different rubber materials (e.g., natural rubber (latex) and nitrile rubber) and may cause delayed-type allergies, as well as related challenges, problems, and solutions for occupational skin protection.
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7
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Heichel T, Brans R, John SM, Nienhaus A, Nordheider K, Wilke A, Sonsmann FK. Acceptance of semipermeable glove liners compared to cotton glove liners in health care workers with work-related skin diseases: Results of a quasi-randomized trial under real workplace conditions. Contact Dermatitis 2021; 85:543-553. [PMID: 34232510 DOI: 10.1111/cod.13929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Glove liners (GLs) made of cotton (COT) are worn under impermeable gloves to prevent occlusion effects. Semipermeable GLs made of Sympatex (SYM) might be an alternative. OBJECTIVES To evaluate the acceptance of GLs (COT/SYM) in health care workers (HCWs) with work-related skin diseases (WRSDs). METHODS One hundred sixty-one HCWs with WRSDs were asked to wear GLs in combination with occlusive gloves for 10 ±2 weeks under workplace conditions. A questionnaire was applied to compare acceptance and usability of the respective glove combinations and previously used protective gloves (PUGs). RESULTS A total of 120 data sets were available (SYM: n = 65, 77.4%; COT: n = 55, 71.4%). Both GLs provided a significantly lower sweating sensation, more pleasant climate, comfortable wearing experience, and moist or dry feeling on the skin compared to PUGs. SYM-GLs performed significantly better than COT-GLs regarding mobility of hands, sensitivity, and sense of touch. COT-GLs were significantly better than SYM-GLs in the categories fit, donning and doffing, and material contact. CONCLUSIONS Both GLs did not impair work performance, were applicable in various areas of health care activities, and were preferred over PUGs. Our results indicate that SYM-GLs are an alternative to COT-GLs and thus may contribute to current prevention strategies.
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Affiliation(s)
- Theres Heichel
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Service Research in Nursing, Institute for Health Service Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
| | - Flora K Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany.,Lower-Saxonian Institute of Occupational Dermatology, University of Osnabrück, Osnabrück, Germany
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8
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Herloch V, Elsner P. Die (neue) Berufskrankheit Nr. 5101: „Schwere oder wiederholt rückfällige Hauterkrankungen“. J Dtsch Dermatol Ges 2021; 19:720-742. [PMID: 33979060 DOI: 10.1111/ddg.14537_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
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9
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Herloch V, Elsner P. The (new) occupational disease no. 5101: "Severe or recurrent skin diseases". J Dtsch Dermatol Ges 2021; 19:720-741. [PMID: 33938626 DOI: 10.1111/ddg.14537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
Occupational dermatoses are among the most common occupational diseases, with BK 5101 accounting for the largest proportion. Historically, the latter was also the most frequently reported group of occupational diseases within the working age population. More than 80,000 suspected cases of occupational diseases were notified in 2019, of which 19,883 related to BK 5101. In Germany, work-related hand eczema accounts for 90 % of all BK 5101 diseases, and consists mainly of contact eczema. Especially young people working in the hairdressing sector, health care, metal, food or construction industries belong to the high-risk group. Diagnosis, therapy and prevention of BK 5101 play an important role, since advanced skin diseases are usually accompanied by a poor prognosis and long periods of inability to work, which can have considerable socio-economic consequences. On January 1st , 2021, with the "Seventh Act amending the Fourth Book of the German Social Code (SGB) and other Laws", an amendment to the Occupational Diseases Law came into force, with which the obligation to cease work was abolished, thereby fulfilling a decades-long requirement for recognition of BK 5101. As of this year, only the "severe or repeated recurrences" of a skin disease remain as a criterion for the occurrence of an insured event, which will likely result in an increased number of notifications and acknowledged cases of occupational skin diseases.
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Affiliation(s)
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
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10
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11
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Allergic Reactions to Rubber Components. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_87-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Abstract
Apart from endogenous factors, hand eczema is often caused by irritant or allergic contact dermatitis related to occupational or non-occupational exposure to skin hazards. This enables several complementary approaches on the level of primary, secondary and tertiary prevention. A high priority is set on identification and subsequent reduction or elimination of causative exposures. Important preventive approaches include legal regulations, technical and organizational measures as well as correct use of adequate personal protective equipment (e.g. protective gloves). Interventions based on health education are conducted to improve individual protective behaviour. Even though evidence-based proof of effectiveness is limited, preventive measures are considered of particular importance for avoidance of occupational hand eczema and its adverse sequelae. Therefore, a complex, step-wise approach to occupational skin diseases has been established in Germany. In recent years, the positive impact of secondary and tertiary preventive measures of this approach has been demonstrated.
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Affiliation(s)
- R Brans
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
| | - C Skudlik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
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13
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Rocholl M, Ludewig M, Skudlik C, Wilke A. [Occupational skin cancer : Prevention and recommendations for UV protection as part of the treatment approved by the public statutory employers' liability insurance]. Hautarzt 2019; 69:462-470. [PMID: 29704211 DOI: 10.1007/s00105-018-4171-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In Germany, approximately 2 to 3 million employees work in outdoor professions. They are exceptionally exposed to solar ultraviolet (UV) radiation for a large part of their daily working time. Cumulative UV exposure is associated with a significantly increased risk of skin cancer for outdoor workers from various occupational groups (e. g. landscape and horticulture, agriculture and forestry, fisheries and seafaring, construction and trade, as well as sports teachers, lifeguards and mountain guides). Since 1 January 2015, squamous cell carcinoma and multiple actinic keratosis due to natural UV radiation can be recognised as occupational disease No. 5103 by the German statutory social accident insurance. Reducing cumulative UV exposure is the main prevention aspect of this type of skin damage. Therefore, technical, organisational and personal UV protection measures should be implemented in the professional and private environment. Moreover, they have to be regularly used in an appropriate way. In addition to guideline-oriented therapy, training and counselling of patients with already existing actinic skin damage or a recognised occupational disease No. 5103 is therefore of particular importance. The focus should be on improving the individual UV protection behaviour. This article gives an overview of current recommendations for UV protection in the professional environment. It outlines possible solutions for patient counselling in terms of UV protection in everyday practice.
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Affiliation(s)
- M Rocholl
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland. .,Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
| | - M Ludewig
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
| | - C Skudlik
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
| | - A Wilke
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.,Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
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