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Assessment of Comorbidities Associated With Allergic Contact Dermatitis in the United States: A Retrospective Claims-Based Study. Dermatitis 2022; 33:421-428. [PMID: 36255394 DOI: 10.1097/der.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allergic contact dermatitis (ACD) is a common dermatologic disease. Patch testing remains the criterion standard for diagnosis. In clinical practice, avoidance may be limited by patient occupation or noncompliance, the pervasive nature of the culprit agent, or barriers to expert care because of socioeconomic, cultural, or geographic factors. Thus, ACD is frequently chronic and/or recurrent; however, the comorbidities associated with ACD are not well characterized. OBJECTIVE The aim of the study is to identify associations between ACD and psychiatric, sleep health, cardiovascular, and infectious conditions. METHODS In this study, we used a large US claims database to identify comorbidities associated with ACD diagnosed after patch testing, including psychiatric, sleep health, cardiovascular, and infectious conditions. We also stratified these associations by chronicity of disease. RESULTS We identified associations between ACD and psychiatric, sleep-related, cardiovascular, and infectious comorbidities. We also found that more chronic ACD was associated with more infectious comorbidities. All of these associations remained significant on further subanalysis when patients with AD and venous stasis were excluded. CONCLUSIONS Allergic contact dermatitis is associated with multiple comorbidities. Further study is required to corroborate these findings, determine causality, and to explore the impact of possible interventions in the workup and management of this common and often debilitating disease.
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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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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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Waked IS, Ibrahim ZM. Beneficial Effects of Paraffin Bath Therapy as Additional Treatment of Chronic Hand Eczema: A Randomized, Single-Blind, Active-Controlled, Parallel-Group Study. J Altern Complement Med 2020; 26:1144-1150. [PMID: 33196289 DOI: 10.1089/acm.2020.0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Chronic hand eczema (CHE) is a common inflammatory skin disease with a major psychological and socioeconomic impacts on patients' quality of life (QoL) and work ability. To the best of knowledge, this study is the first randomized-controlled trial conducted to evaluate the effect of paraffin bath therapy in management of hand eczema and its related symptoms. Design: This study was a parallel-group, active-control, randomized clinical trial with measures at pretreatment, 6th week, and 12th week of treatment. Settings: The study took place at the Outpatient Clinic of Faculty of Physical Therapy, Cairo University, and some licensed rehabilitation centers in Cairo for a 1-year period. Subjects: Sixty patients with moderate to severe CHE were randomly assigned into two groups of equal number; the paraffin bath therapy group and the control group. Interventions: The paraffin group received paraffin bath therapy for 5 days a week for 12 weeks, in addition to the routine skin care program, while the control group only received the routine skin care program. Outcome measures: SCORing Atopic Dermatitis (SCORAD) was used to assess the severity of atopic dermatitis and dermatology life quality index (DLQI) to assess the effect of CHE on quality of patients' life. All measurements were obtained before, at the 6th week, and at the 12th week of treatment. Results: Marked improvement in the severity of the disease symptoms was observed, reflected by a highly decrease in objective SCORAD score in the paraffin group over time more than the control group. The percentage of reduction was 28.6% in paraffin group versus 0.41% in control group. Subjective item score (itching and sleepiness) was reduced in the paraffin group more than the control group with a percentage of improvement (47% and 5.5%), respectively. Regarding QoL measure, there were highly positive changes in DLQI in paraffin group more than the control group. The percentage of improvement was 60% in paraffin group and 3.8% in control group. Conclusions: Paraffin bath therapy applied for a 12-week duration seems to be effective, both in reducing severity of eczema symptoms and improving QoL in patients with CHE.
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Affiliation(s)
- Intsar S Waked
- Professor at Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Zizi M Ibrahim
- Associate Professor at Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia.,Assistant Professor at Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Topal Y, Agner T, van der Heiden J, Ebbehøj NE, Clemmensen KKB. Hand eczema patients’ knowledge of skin protection following a guided talk—A retrospective study with a follow‐up questionnaire. Contact Dermatitis 2019; 81:117-123. [DOI: 10.1111/cod.13264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Yasemin Topal
- Department of DermatologyBispebjerg University Hospital Copenhagen Denmark
| | - Tove Agner
- Department of DermatologyBispebjerg University Hospital Copenhagen Denmark
| | | | - Niels E. Ebbehøj
- Department of Occupational and Environmental MedicineBispebjerg University Hospital Copenhagen Denmark
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6
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Douwes J, Slater T, Shanthakumar M, McLean D, Firestone RT, Judd L, Pearce N. Determinants of hand dermatitis, urticaria and loss of skin barrier function in professional cleaners in New Zealand. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2018; 23:110-119. [PMID: 29359638 DOI: 10.1080/10773525.2018.1427307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study assessed the risk of dermatitis, urticaria and loss of skin barrier function in 425 cleaners and 281 reference workers (retail workers and bus drivers). Symptoms, atopy and skin barrier function were assessed by questionnaire, skin prick tests, and measurement of transepidermal water loss. Cleaners had an increased risk of current (past 3 months) hand/arm dermatitis (14.8% vs. 10.0%; OR = 1.9, p < 0.05) and urticaria (11% vs. 5.3%; OR = 2.4, p < 0.05) and were more likely to have dermatitis as adults (17.6% vs. 11.4%; OR = 1.8, p < 0.05). The risk of atopy was not increased, but associations with symptoms were more pronounced in atopics. Transepidermal water loss was significantly higher in cleaners. Wet-work was a significant risk factor for dermatitis and hand washing and drying significantly reduced the risk of urticaria. In conclusion, cleaners have an increased risk of hand/arm dermatitis, urticaria and loss of skin barrier function.
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Affiliation(s)
- Jeroen Douwes
- a Centre for Public Health Research , Massey University , Wellington , New Zealand
| | - Tania Slater
- a Centre for Public Health Research , Massey University , Wellington , New Zealand
| | | | - Dave McLean
- a Centre for Public Health Research , Massey University , Wellington , New Zealand
| | - Ridvan Tua Firestone
- a Centre for Public Health Research , Massey University , Wellington , New Zealand
| | - Lissa Judd
- b Anwyl Specialist Medical Centre , Wellington , New Zealand
| | - Neil Pearce
- a Centre for Public Health Research , Massey University , Wellington , New Zealand.,c Department of Medical Statistics , London School of Hygiene and Tropical Medicine , London , UK
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Augustin M, Thaçi D, Kamps A. Der Einfluss von Alitretinoin auf die Lebensqualität bei Patienten mit schwerem chronischen Handekzem: FUGETTA - Beobachtungsstudie unter Praxisbedingungen. J Dtsch Dermatol Ges 2016; 14:1261-1272. [PMID: 27992125 DOI: 10.1111/ddg.12870_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
HINTERGRUND UND ZIELE Alitretinoin ist die einzige zugelassene Behandlung für schweres chronisches Handekzem (CHE), das refraktär gegenüber potenten topischen Corticosteroiden ist. Bei dieser Studie (FUGETTA) wurde die Wirksamkeit von leitliniengerecht angewendetem oralem Alitretinoin sowie dessen Einfluss auf die Lebensqualität (LQ) bei Patienten mit schwerem refraktärem CHE beurteilt. PATIENTEN UND METHODEN Multizentrische, offene, nichtinterventionelle Beobachtungsstudie, durchgeführt in Deutschland. Die Patienten wurden nach Ermessen ihres behandelnden Arztes mit Alitretinoin 10 mg oder 30 mg einmal täglich über maximal 24 Wochen behandelt. Die Wirksamkeit wurde anhand des Physician Global Assessment (PGA) und des Dermatology Life Quality Index (DLQI) bewertet. Zudem wurden unerwünschte Ereignisse (UE) erfasst. ERGEBNISSE Die Studienpopulation bestand aus 658 Patienten (30 mg: n = 581; 10 mg: n = 77). Bei Beobachtungsbeginn litten die meisten Patienten (83 %) gemäß PGA an einem schweren CHE. Bei Beobachtungsende war das Handekzem bei 48 % der Patienten gemäß PGA vollständig oder fast vollständig abgeheilt (30 mg: 49 %; 10 mg: 43 %). Die mittlere Verbesserung des DLQI-Scores in Woche 24 betrug 58 % (30 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,4 [8,04]) und 70 % (10 mg: mittlere [SD] Veränderung gegenüber dem Ausgangswert -10,8 [7,29]). Die Gesamtinzidenz von NW war niedrig und in den beiden Gruppen ähnlich. SCHLUSSFOLGERUNGEN Alitretinoin führte zu einer schnellen, deutlichen Verbesserung der LQ bei Patienten mit schwerem CHE.
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Affiliation(s)
| | - Diamant Thaçi
- Zentrum für Entzündungsmedizin, Universität zu Lübeck, Deutschland
| | - Anja Kamps
- Stiefel, ein GSK-Unternehmen, München, Deutschland
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8
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Augustin M, Thaçi D, Kamps A. Impact on quality of life of alitretinoin in severe chronic hand eczema: FUGETTA real-world study. J Dtsch Dermatol Ges 2016; 14:1261-1270. [DOI: 10.1111/ddg.12870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine; University of Luebeck; Germany
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9
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:53-64. [PMID: 27545662 PMCID: PMC5434821 DOI: 10.1111/jdv.13851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
Contact dermatitis is one of the most common occupational diseases, with serious impact on quality of life, lost days at work and a condition that may be chronically relapsing. Regular prophylactic skin cream application is widely acknowledged to be an effective prevention strategy against occupational contact dermatitis; however, compliance rates remain low. To present a simple programme for skin cream application in the workplace with focus on implementation to drive down the rate of occupational irritant contact dermatitis, an expert panel of eight international dermatologists combined personal experience with extensive literature review. The recommendations are based on clinical experience as supported by evidence-based data from interventional studies. The authors identified three moments for skin cream application in the work place: (i) before starting a work period; (ii) after washing hands; and (iii) after work. Affecting behaviour change requires systematic communications, monitoring and reporting, which is proposed through Kotter's principles of organizational change management. Measurement tools are provided in the appendix. Interventional data based on application of this proposal is required to demonstrate its effectiveness.
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Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, UK
| | | | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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10
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Hauber AB, Mohamed AF, Gonzalez JM, Otteson Fairchild A, Zelt SC, Graff O. Benefit-risk tradeoff preferences for chronic hand eczema treatments. J DERMATOL TREAT 2016; 28:40-46. [PMID: 27160959 DOI: 10.1080/09546634.2016.1177161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hand eczema affects approximately 16% of the US population. The long-term prognosis is poor, and 5-7% experience severe chronic hand eczema (sCHE) that interferes with daily activities. Treatments for CHE may be ineffective or associated with adverse events (AEs) that may dissuade patients from pursuing or continuing treatment. For quantification of patient experiences and benefit-risk preferences for outcomes associated with CHE treatments, a web-based discrete choice experiment survey was administered to patients in the United States with a self-reported physician diagnosis of CHE and severe symptoms not resolved with topical agents. Respondents answered a series of treatment choice questions, each requiring evaluation of a pair of hypothetical profiles of medications for sCHE defined by efficacy and risk of several AEs. Improvement in CHE clearing of 25-50% was rated from 1.5 to 3.1 times as important as eliminating a 5% risk of permanent bone problems. The mean maximum acceptable risk of permanent vision problems in exchange for an improvement in CHE clearing of 25-50% ranged from 3.4% to 4.8%. This study demonstrated that patients with CHE rated efficacy improvements associated with treatment of sCHE as more important than eliminating the risks of specific AEs.
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Affiliation(s)
- A Brett Hauber
- a RTI Health Solutions , Research Triangle Park , NC , USA
| | | | | | | | - Susan C Zelt
- b Steifel, a GSK Company , Research Triangle Park , NC , USA
| | - Ole Graff
- b Steifel, a GSK Company , Research Triangle Park , NC , USA
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11
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Morris M, Schifano L, Fong R, Graff O. Safety of alitretinoin for severe refractory chronic hand eczema: Clinical studies and postmarketing surveillance. J DERMATOL TREAT 2015; 27:54-8. [DOI: 10.3109/09546634.2015.1034080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Scalone L, Cortesi P, Mantovani L, Belisari A, Ayala F, Fortina A, Bonamonte D, Borroni G, Cannavò S, Guarneri F, Cristaudo A, De Pità O, Gallo R, Girolomoni G, Gola M, Lisi P, Pigatto P, Satta R, Giannetti A. Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: results from Italy. Br J Dermatol 2014; 172:187-95. [DOI: 10.1111/bjd.13220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Scalone
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - P.A. Cortesi
- Research Centre on Public Health (CESP); University of Milan-Bicocca; Villa Serena Via Pergolesi 33 I-20052 Monza Italy
- CHARTA Foundation; Milan Italy
| | - L.G. Mantovani
- CHARTA Foundation; Milan Italy
- Faculty of Pharmacy; University of Naples Federico II; Naples Italy
| | | | - F. Ayala
- Department of Dermatology; University of Naples Federico II; Naples Italy
| | - A.B. Fortina
- Pediatric Dermatology Unit; Department of Medicine; University of Padova; Padova Italy
| | - D. Bonamonte
- Department of Biomedical Science and Human Oncology; Unit of Dermatology; University of Bari ‘Aldo Moro’; Bari Italy
| | - G. Borroni
- Clinical-Surgical, Diagnostic and Pediatric Science; Dermatology Unit; University of Pavia; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - S.P. Cannavò
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - F. Guarneri
- Department of Clinical and Experimental Medicine-Unit of Dermatology; University of Messina; Messina Italy
| | - A. Cristaudo
- Department of Allergological and Occupational Dermatology; San Gallicano Dermatologic Institute, IRCCS; Rome Italy
| | - O. De Pità
- Laboratory of Immunology; Istituto Dermopatico dell'Immacolata (IDI)-IRCCS; Rome Italy
| | - R. Gallo
- Section of Dermatology; DISSAL - Department of Health Sciences; University of Genoa; Genoa Italy
| | - G. Girolomoni
- Department of Medicine; Section of Dermatology and Venereology; University of Verona; Verona Italy
| | - M. Gola
- Allergological and Occupational Dermatology Unit; Department of Critical Care Medicine and Surgery; University of Florence; Florence Italy
| | - P. Lisi
- Department of Medical and Surgical Specialities and Public Health; Section of Clinical, Allergological and Venereological Dermatology; University of Perugia; Perugia Italy
| | - P.D. Pigatto
- Department of Biomedical Science for Health IRCCS Galeazzi Hospital; University of Milan; Milan Italy
| | - R. Satta
- Institute of Dermatology; University of Sassari; Sassari Italy
| | - A. Giannetti
- Division of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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13
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Jung PK, Lee JH, Baek JH, Hwang J, Won JU, Kim I, Roh J. The effect of work characteristics on dermatologic symptoms in hairdressers. Ann Occup Environ Med 2014; 26:13. [PMID: 25028609 PMCID: PMC4097089 DOI: 10.1186/2052-4374-26-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/28/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives Hairdressers in Korea perform various tasks and are exposed to health risk factors such as chemical substances or prolonged duration of wet work. The objective of this study is to provide descriptive statistics on the demographics and work characteristics of hairdressers in Korea and to identify work-related risk factors for dermatologic symptoms in hairdressers. Methods 1,054 hairdressers were selected and analyzed for this study. Independent variables were exposure to chemical substances, the training status of the hairdressers, and the main tasks required of them, and the dependent variable was the incidence of dermatologic symptoms. The relationships between work characteristics and dermatologic symptoms were evaluated by estimating odds ratios using multiple logistic regression analysis. Results Among the 1,054 study subjects, 212 hairdressers (20.1%) complained of dermatologic symptoms, and the symptoms were more prevalent in younger, unmarried or highly educated hairdressers. The main tasks that comprise the majority of the wet work were strictly determined by training status, since 96.5% of staff hairdressers identified washing as their main task, while only 1.5% and 2.0% of master and designer hairdressers, respectively, identified this as their main task. Multiple logistic regressions was performed to estimate odds ratios. While exposure to hairdressing chemicals showed no significant effect on the odds ratio for the incidence of dermatologic symptoms, higher odds ratios of dermatologic symptoms were shown in staff hairdressers (2.70, 95% CI: 1.32 - 5.51) and in hairdressers who perform washing as their main task (2.03, 95% CI: 1.22 - 3.37), after adjusting for general and work characteristics. Conclusions This study showed that the training status and main tasks of hairdressers are closely related to each other and that the training status and main tasks of hairdressers are related to the incidence of dermatologic symptoms. This suggests that in the future, regulations on working conditions and health management guidelines for hairdressers should be established.
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Affiliation(s)
- Pil Kyun Jung
- Graduate School of Public Health, Yonsei University, Seoul, Korea ; The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
| | - June-Hee Lee
- Graduate School of Public Health, Yonsei University, Seoul, Korea ; The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hye Baek
- Korea Occupational Safety and Health Agency (KOSHA), Service Industry Safety Team, Chungbuk Area Office, Ulsan, Korea
| | - Jungho Hwang
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea ; Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Uk Won
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea ; Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Inah Kim
- Graduate School of Public Health, Yonsei University, Seoul, Korea ; Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Jaehoon Roh
- The Institute for Occupational Health, Yonsei University College of Medicine, Seoul, Korea ; Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Korea
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Saetterstrøm B, Olsen J, Johansen JD. Cost-of-illness of patients with contact dermatitis in Denmark. Contact Dermatitis 2014; 71:154-61. [DOI: 10.1111/cod.12231] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 02/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Bjørn Saetterstrøm
- Centre for Applied Health Services Research and Technology Assessment; University of Southern Denmark; 5000 Odense C Denmark
| | - Jens Olsen
- Centre for Applied Health Services Research and Technology Assessment; University of Southern Denmark; 5000 Odense C Denmark
| | - Jeanne Duus Johansen
- Department of Dermato-Allergology; National Allergy Research Centre, Gentofte Hospital, University of Copenhagen; 2900 Hellerup Denmark
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Surber C, Elsner P, Singh J. Howard I. Maibach: Extraordinary Leadership in Integrating Key Concepts Underpinning Our Understanding of Percutaneous Absorption and Occupational Dermatology. Skin Pharmacol Physiol 2013; 26:190-8. [DOI: 10.1159/000353622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of the present article is to briefly highlight some contributions of Prof. Howard I. Maibach to the field of dermatology. After a few introducing remarks regarding Howard's personal career, the article specifically reviews contributions to the understanding of percutaneous absorption and to occupational dermatology. He and his companions/coworkers established and introduced experimental prerequisites to better study and understand percutaneous absorption - both in vitro and in vivo. Not less influential was his contribution to occupational dermatology acting as a founding member of the International Contact Dermatitis Research Group and coinaugurating the North American Contact Dermatitis Group. These groups have been very active ever since. As an academic teacher, he inspired young colleagues to perform original research work and to establish their own working groups. He has done this most successfully with many fellows who worked with him over the years, and who are now leading departments or companies dedicated to dermatological research all over the world. Probably this is his most important and lasting achievement.
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16
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Graham-Brown R. Clinical pharmacology supplement: Introduction. Clin Exp Dermatol 2011; 36 Suppl 2:1-3. [DOI: 10.1111/j.1365-2230.2011.04030.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Frenzel DF, Weiss JM. Osteopontin and allergic disease: pathophysiology and implications for diagnostics and therapy. Expert Rev Clin Immunol 2011; 7:93-109. [PMID: 21162653 DOI: 10.1586/eci.10.82] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Osteopontin (OPN) is a phosphoglycoprotein that is expressed by various immune cells in a secreted and intracellular form. It has cytokine, chemotactic and cell signaling functions enhancing Th1 and Th17 immunity and protects against apoptosis. Recent studies found OPN to be modulatory in cell-mediated and immediate-type allergic diseases. In allergic asthma, OPN enhances sensitization but downmodulates Th2-driven IL-4-dominated inflammation. The finding that OPN expression is augmented during specific immunotherapy supports a Th2 suppressive effect of OPN. In Th1-driven delayed-type allergy, such as allergic contact dermatitis, OPN supports dendritic cell migration and IL-12 expression and is secreted by T effector cells and keratinocytes, augmenting Th1-mediated allergy and supporting disease chronification. There are numerous missing links as to how OPN variants modulate allergic inflammation through different OPN receptors. OPN research in allergy is an interesting, rapidly expanding field that has high potential for translational research.
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Affiliation(s)
- Denis F Frenzel
- University of Ulm, Department of Dermatology and Allergy, Maienweg 12, D-89081 Ulm, Germany
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Bissonnette R, Diepgen TL, Elsner P, English J, Graham-Brown R, Homey B, Luger T, Lynde C, Maares J, Maibach HI. Redefining treatment options in chronic hand eczema (CHE). J Eur Acad Dermatol Venereol 2010; 24 Suppl 3:1-20. [DOI: 10.1111/j.1468-3083.2010.03615.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seier AM, Renkl AC, Schulz G, Uebele T, Sindrilaru A, Iben S, Liaw L, Kon S, Uede T, Weiss JM. Antigen-specific induction of osteopontin contributes to the chronification of allergic contact dermatitis. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 176:246-58. [PMID: 20008129 DOI: 10.2353/ajpath.2010.090488] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Allergic contact dermatitis is a T cell-mediated immune response, which in its relapsing chronic form is of high socioeconomic impact. The phosphoglycoprotein osteopontin (OPN) has chemotactic and Th1 cytokine functions and in various models is essential for robust T cell-mediated immunity. Here we demonstrate that OPN is abundantly expressed by both effector T cells and keratinocytes in allergic contact dermatitis lesions. T cells from nickel-allergic donors secrete high levels of OPN following antigen-specific stimulation. OPN may substitute for missing IFN-gamma secretion in T effector cells because low IFN-gamma-producing T cell clones secrete high levels of OPN, and OPN down-modulates their interleukin-4 expression. Furthermore, interferon-gamma from T effector cells augments OPN in allergic contact dermatitis by inducing OPN in keratinocytes, which in turn polarizes dendritic cells and attracts inflammatory cells. In the murine contact hypersensitivity (CHS) model for allergic contact dermatitis, OPN is strongly induced in antigen-specific proliferating T cells, and OPN null mice display a reduced chronic CHS inflammatory response due to a decreased influx of effector T cells. Importantly, because of its function for chronic allergic contact dermatitis, OPN may well be a therapeutic target, because anti-OPN antibody treatment in part suppresses established chronic CHS.
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Affiliation(s)
- Anne M Seier
- Department of Dermatology and Allergology, University of Ulm, Ulm 89081, Germany
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Bissonnette R, Worm M, Gerlach B, Guenther L, Cambazard F, Ruzicka T, Maares J, Brown T. Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema. Br J Dermatol 2009; 162:420-6. [DOI: 10.1111/j.1365-2133.2009.09572.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Piggott CDS, Hayes B, Robb CW, Thomas L, Creech CB, Smith ML. Chemical Burn Induced by Cutaneous Exposure to a Concentrated Sodium Hypochlorite and Alkyl Sulfate Solution. Cutan Ocul Toxicol 2008; 26:189-94. [PMID: 17687684 DOI: 10.1080/15569520701502799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Acute irritant contact dermatitis induced by cutaneous exposure to chemicals is a common dermatologic problem in the workplace. In severe cases, irritant contact responses can result in a caustic burn. Chemical burn induced by concentrated sodium hypochlorite (the active ingredient in bleach) has been reported infrequently in the literature, with no previously reported cases of chemical burn due to an alkyl sulfate (a common surfactant in cleaning fluids). Here we describe a chemical burn in a 16-year-old girl resulting from exposure to a solution of concentrated sodium hypochlorite and alkyl sulfate applied as a sanitizer to the interior of roller skates worn at work. OBSERVATIONS The diagnosis was made on the basis of the patient's exposure history, clinical appearance, and laboratory results. On physical examination, the erythematous plaque, located at the site of chemical exposure, had intact skin lines, surrounding edema, and decreased sensitivity to touch. The peripheral white blood cell count was within normal limits and bacterial and fungal cultures from the lesion were negative. CONCLUSIONS The irritant effect of exposure to chemicals, including those that usually are not major irritants, and the possible additive effect of simultaneous exposure to different chemicals, should be considered in the differential diagnosis of acute dermatitis of unknown etiology. Moreover, increased reporting of cases of chemical-induced acute irritant contact dermatitis will help lead to crucial early and appropriate treatment.
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Affiliation(s)
- Caroline D S Piggott
- Department of Medicine, Division of Dermatology, Vanderbilt University Medical Center, 1301 22nd Avenue South, Nashville, TN 37232, USA
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Ruzicka T, Lynde C, Jemec G, Diepgen T, Berth-Jones J, Coenraads P, Kaszuba A, Bissonnette R, Varjonen E, Holló P, Cambazard F, Lahfa M, Elsner P, Nyberg F, Svensson A, Brown T, Harsch M, Maares J. Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol 2008; 158:808-17. [DOI: 10.1111/j.1365-2133.2008.08487.x] [Citation(s) in RCA: 281] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Diepgen TL, Agner T, Aberer W, Berth-Jones J, Cambazard F, Elsner P, McFadden J, Coenraads PJ. Management of chronic hand eczema. Contact Dermatitis 2007; 57:203-10. [PMID: 17868211 DOI: 10.1111/j.1600-0536.2007.01179.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the 'management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidence-based approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity.
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Affiliation(s)
- Thomas L Diepgen
- Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg, Heidelberg 69115, Germany.
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Ma C, Li LF, Zhang BX. Metallothionein I and II gene knock-out mice exhibit reduced tolerance to 24-h sodium lauryl sulphate patch testing. Clin Exp Dermatol 2007; 32:417-22. [PMID: 17362230 DOI: 10.1111/j.1365-2230.2007.02399.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Metallothioneins (MTs) are a group of proteins widely distributed in tissues regulating metal metabolism, scavenging free radicals, and taking part in immunological reactions. Knockout mice for MT genes I and II (MT(-/-)) exhibit reduced tolerance to ultraviolet B injury in vivo. Upregulation of MT proteins can be found at positive allergy patch-test sites; however, the role of MTs in skin irritation has not been investigated. AIM To evaluate the role of MT genes in sodium lauryl sulphate (SLS)-induced skin irritation. SLS is a well-known model irritant in the study of experimental irritant contact dermatitis. METHODS Skin irritation was induced in mice by applying closed-patch testing of 2.5%, 5%, 7.5% and 10% SLS in distilled water on the right dorsal skin of MT(-/-) mice for 24 h. Skin irritation was evaluated visually and by the number of infiltrated inflammatory cells in SLS-irritated skin. Homozygous wild-type mice with intact MT genes (MT(+/+)) tested at the same time served as controls. RESULTS MT(-/-) mice showed a much higher degree of skin inflammation than did MT(+/+) mice. Numbers of infiltrated inflammatory cells were 312.8 +/- 50.9 vs. 136.2 +/- 13.1 for 2.5%, 430.2 +/- 49.3 vs. 242.6 +/- 28.6 for 5%, 540.2 +/- 28.4 vs. 437.6 +/- 22.2 for 7.5%, and 690.6 +/- 31.0 vs. 559.0 +/- 37.8 for 10% SLS in MT(-/-) and MT(+/+) mice, respectively (P < 0.05, Mann-Whitney U test). CONCLUSIONS These results clearly suggest that the MTI and MTII genes may play an important protective role in SLS irritation. It would be valuable to study whether topical MTs can prevent or treat skin irritation.
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Affiliation(s)
- C Ma
- Department of Dermatology, Peking University Third Hospital, Beijing, China
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Anveden I, Wrangsjö K, Järvholm B, Meding B. Self-reported skin exposure -- a population-based study. Contact Dermatitis 2006; 54:272-7. [PMID: 16689812 DOI: 10.1111/j.0105-1873.2006.00823.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim was to study self-reported skin exposure in individuals from the general population with or without hand eczema. In a population-based study in 1996 using postal questionnaires to 3000 individuals, 215 of 2218 (9.7%) reported hand eczema during the past 12 months. 182 (85%) of those with hand eczema and 182 without hand eczema, matched for age and sex, participated in telephone interviews in 1997 regarding exposure to skin irritants at work and in leisure time. No differences were shown in occupational exposure to water, hand washing or chemicals in individuals with or without hand eczema. Women reported more wet exposure than men at work and in leisure time. A correlation was found between occupational wet exposure and wet work at home. Persons in high-risk occupations reported more frequent exposure to skin irritants. However, 53% in high-risk occupations reported exposure to water and detergents for less than half-hour a day and 11% in low-risk occupations for more than half-hour a day. In conclusion, individuals with or without hand eczema seem to have similar exposure to skin irritants. Using job titles as a proxy for exposure gives misclassification, which may result in underestimation of the hand eczema risk.
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Affiliation(s)
- Ingegärd Anveden
- Occupational and Environmental Health, Centre for Public Health, Stockholm, Sweden.
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Lazarov A, Rabin B, Fraidlin N, Abraham D. Medical and psychosocial outcome of patients with occupational contact dermatitis in Israel. J Eur Acad Dermatol Venereol 2006; 20:1061-5. [PMID: 16987258 DOI: 10.1111/j.1468-3083.2006.01697.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the medical, financial and prognostic factors of occupational contact dermatitis (OCD) have been addressed, studies on the social outcome of OCD are sparse. OBJECTIVE To define the medical and psychosocial outcome of patients with OCD. METHODS Workers with OCD were interviewed by telephone using a questionnaire that included questions about the occupation, dermatological disease, sick leave, present working status and disability claims, and questions related to the subjective perceptions of OCD in all areas of psychosocial functioning and quality of life. RESULTS Seventy workers (64.3% males and 35.7% females) were interviewed. Forty per cent had stopped working and one-third had taken sick leave because of OCD. Forty-seven (67.1%) were currently working while 23 (32.8%) were unemployed. Disability compensation was claimed by only 41.4% and was received by 24.3%. Eight workers (11.4%) had persistent postoccupational dermatitis (PPOD). Loss of employment affected the occupational area of the workers' lives (100%), and also interpersonal relationships (45.7%), relationships within the family (18.6%), daily functioning (45.7%) and mental health (24.3%). CONCLUSIONS Considerable working time is lost because of unemployment or sick leave due to OCD. Only a small proportion of eligible patients with OCD apply for disability compensation and an even smaller proportion receive it. Our study demonstrates the significance of OCD to the psychosocial aspects of workers' lives and emphasizes that the assessment of OCD outcome should relate not only to the medical but also to the psychosocial aspect of the disease.
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Affiliation(s)
- A Lazarov
- Contact Dermatitis Clinic, Meir Hospital and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Beltrani VS, Bernstein I, Cohen DE, Fonacier L. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol 2006. [DOI: 10.1016/s1081-1206(10)60811-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Belsito DV. Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability. J Am Acad Dermatol 2006; 53:303-13. [PMID: 16021126 DOI: 10.1016/j.jaad.2005.02.045] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cutaneous irritant and allergic responses account for the vast majority of cases of occupational contact dermatitis (OCD). Although the pathophysiologic responses to these two different exposures are distinct, the clinical differentiation between chronic cumulative irritant contact dermatitis and allergic contact dermatitis can be difficult and frequently requires patch testing. This article reviews the recommended algorithms that clinicians should utilize to assess whether a worker suffers from OCD. The prevalence of OCD, its predisposing factors (both endogenous and exogenous), and prognosis are discussed in depth. Finally, issues surrounding the assessment of impairment and disability resulting from OCD are summarized.
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Affiliation(s)
- Donald V Belsito
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas 66160-7319, USA.
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Meding B, Lantto R, Lindahl G, Wrangsjö K, Bengtsson B. Occupational skin disease in Sweden - a 12-year follow-up. Contact Dermatitis 2005; 53:308-13. [PMID: 16364116 DOI: 10.1111/j.0105-1873.2005.00731.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this project was to study the long-term prognosis of occupational skin diseases in Sweden. In 1999, a questionnaire was sent to 623/655 individuals who in 1987 reported occupational skin disease to the Social Insurance Office. 394 answered the questionnaire, and 123 non-responders were interviewed by telephone, giving 517 participants (83%), 323 females and 194 males. 85% reported skin symptoms after 1987, 70% during the previous year. 28% considered themselves recovered, of those with nickel allergy only 12%. In a logistic regression model, skin atopy was the strongest unfavourable factor for the prognosis followed by contact allergy and female sex. 66% had consulted a doctor after 1987 and the majority, 82%, had performed occupational changes - most common was change of jobs, 44%. Those who had changed jobs reported less sick leave. The conclusion is that occupational skin diseases have a clear tendency to end up as chronic conditions with a majority reporting symptoms at a 12-year follow-up. The skin disease had influenced the occupational situation for the majority (82%) and for 15% resulted in exclusion from the labour market through unemployment or disability pension.
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Affiliation(s)
- B Meding
- Occupational Dermatology, National Institute for Working Life, Stockholm, Sweden.
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Abstract
Hand dermatitis is a common diagnosis seen in dermatologic and general practice. It can present with typical morphology, but uncommon manifestations are possible. This review reports on common and uncommon presentations of irritant and allergic hand dermatitis focusing on uncommon localizations, time course, and morphology such as follicular, pustular, bullous, ulcerous, exudative erythema multiforme-like, purpuric, lichenoid, pigmented, and depigmented skin lesions. Clinical diagnosis can be challenging. Even histopathology is not always very helpful. Thorough evaluation of the patient's history and investigation of clinical morphology are the cornerstones of diagnosis.
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Affiliation(s)
- Andrea Bauer
- Department of Dermatology and Allergology, University Hospital, Friedrich-Schiller-University Jena, 07743 Jena, Germany.
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Abstract
BACKGROUND Hand eczema is a skin disease often with a long-lasting and relapsing course. The long-term prognosis in the general population is unknown. OBJECTIVES The aims were to examine the extent to which hand eczema had persisted and the medicosocial consequences of the disease. METHODS In a 15-year follow-up of hand eczema, patients diagnosed in a previous population-based study were sent a questionnaire with 20 questions concerning the persistence and course of the disease, and its occupational and medicosocial consequences. RESULTS Addresses were available for 1115 persons, of whom 868 answered the questionnaire. Sixty-six per cent of the respondents reported periods of hand eczema and 44% reported symptoms during the previous year, with no sex difference. Twelve per cent reported continuous eczema. However, 74% of those reporting symptoms considered that their hand eczema had improved; of these more were women than men (78% vs. 66%, P < 0.01). Twenty people, 3% of those who were gainfully employed in 1983, reported a change to another occupation because of their hand eczema, 15 of these reporting improvement after the job change. A considerable need for medical consultation was reported, as was the influence on psychosocial functions among those who had eczema the previous year, e.g. sleep disturbances (36%) and hampered leisure activities (72%). Job changes related to hand eczema and psychosocial impairment were also reported by individuals who had not sought medical help for their hand eczema. CONCLUSIONS This study demonstrates a variable and poor long-term prognosis for hand eczema in the general population. One-third sought medical care during follow-up, while the vast majority with ongoing hand eczema experienced negative psychosocial consequences. For about 5%, the hand eczema gave far-reaching consequences including long sick-leave periods, sick pension and changes of occupation.
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Affiliation(s)
- B Meding
- Occupational and Environmental Dermatology, Department of Medicine, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
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Abstract
The aim of this study was to identify factors of importance for the long-term prognosis of hand eczema in the general population. In a 15-y follow-up, 868 (78%) individuals with hand eczema, diagnosed and clinically examined in a previous population-based study, answered a postal questionnaire with questions concerning persistence of the disease. In a logistic regression model, the extent of eczema involvement at the initial examination was the strongest negative factor for the prognosis, followed by history of childhood eczema and age below 20 y at onset of hand eczema. These factors significantly influenced both the total time with hand eczema during the 15 y follow-up and occurrence of hand eczema the previous year. The predictive factor for hand eczema 15 y later was doubled for an individual with all three risk factors compared with one without them, 72%vs 35%. Contact allergy to any of the standard allergens also related significantly to current hand eczema. In conclusion, the main determinant for a poor long-term prognosis was widespread hand dermatitis at the initial examination. Other important factors were low age at onset of hand eczema, history of childhood eczema, and contact allergy.
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Affiliation(s)
- Birgitta Meding
- Occupational Dermatology, National Institute for Working Life, Stockholm, Sweden.
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Cahill J, Keegel T, Dharmage S, Nugriaty D, Nixon R. Prognosis of contact dermatitis in epoxy resin workers. Contact Dermatitis 2005; 52:147-53. [PMID: 15811030 DOI: 10.1111/j.0105-1873.2005.00542.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Between January 1993 and February 2002, 40 of 1354 (3%) workers who attended a tertiary referral occupational dermatology clinic were diagnosed with allergic contact dermatitis (ACD) from epoxy resin systems (ER). 20 of these patients were followed up at least 2 years post-diagnosis to establish prognosis. Characteristics collected at diagnosis, including age, atopic status and severity, were compared between the follow-up and not followed-up groups. No significant differences were observed. A clinician contacted patients and administered a telephone questionnaire based on variables identified from the literature, which were considered of importance for prognosis. All patients reported improvement of their skin condition since diagnosis. 12 of the 20 {60%[95% confidence interval (CI) 56-94%]} patients had applied for workers' compensation; all of these claims were successful. 16 had ceased working with ER. Of these, 9 [56% (95% CI 29-80%)] reported complete healing and 7 [44% (95% CI 19-70%)] reported ongoing dermatitis. Although no conclusions could be drawn because of the small sample size, factors that may be associated with a poor prognosis were age, atopy, duration of symptoms and severity at diagnosis. The prognosis of ACD from ER is not always favourable, even if a worker ceases exposure.
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Affiliation(s)
- Jennifer Cahill
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Australia
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Sajjachareonpong P, Cahill J, Keegel T, Saunders H, Nixon R. Persistent post-occupational dermatitis. Contact Dermatitis 2004; 51:278-83. [PMID: 15606653 DOI: 10.1111/j.0105-1873.2004.00473.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Wall and Gebauer (Contact Dermatitis 1991: 24: 241-243) first described persistent post-occupational dermatitis (PPOD) as ongoing dermatitis for which there is no obvious present cause, precipitated by prior occupational contact dermatitis (OCD). We propose that individuals exhibiting PPOD lose the capacity for resolution of their condition upon removal from exposure to causative agents and subsequently develop persistent dermatitis, which can be continual or intermittent. Accordingly, we suggest modification of criterion 6 of the OCD criteria developed by Mathias (J Am Acad Dermatol 1989: 20: 842-848): 'Removal from exposure initially leads to improvement of dermatitis, however, over time there may be incomplete or no improvement, despite removal from exposures at work'. To satisfy the definition of PPOD, individuals must meet at least 4 of the 7 criteria, including the altered criterion 6. We present 6 cases of PPOD exemplifying these scenarios, which met the altered Mathias criteria. In some cases, subsequent failure to recognize the initial work relatedness of their skin conditions resulted in the termination of workers' compensation benefits. This situation is particularly relevant in the Australian context. The diagnosis of PPOD needs to be considered in all individuals with work-initiated dermatitis who present with ongoing endogenous-like eczema.
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Affiliation(s)
- Praneet Sajjachareonpong
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, VIC 3053, Australia
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Abstract
The prognosis of occupational contact dermatitis (OCD) takes into account the extent of healing, effect on quality of life and employment, and financial costs for both the individual and the wider community. We reviewed 15 studies published between 1958 and 2002, reporting the complete clearance of dermatitis (range of 18-72%). 9 of the 15 studies reported a clearance rate of between 18 and 40%. Improvement was reported as an outcome in 3 studies between 1991 and 2002 (range of 70-84%). A number of common variables were identified as of possible influence. These include age, sex, atopy, patient knowledge, disease aetiology, duration of symptoms and job change; clinical, financial and social issues are also described. All of these factors need to be considered when managing a patient with OCD. Improved patient knowledge and early diagnosis may be associated with improved prognosis, whereas job change does not make a significant difference. Some patients will develop persistent post-occupational dermatitis, which has important implications for prognosis and workers' compensation. Only a small proportion of eligible patients receive workers' compensation, even though financially supported healing time soon after diagnosis may result in an improved prognosis.
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Affiliation(s)
- Jennifer Cahill
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, VIC 3053, Australia
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Jungbauer FHW, van der Vleuten P, Groothoff JW, Coenraads PJ. Irritant hand dermatitis: severity of disease, occupational exposure to skin irritants and preventive measures 5 years after initial diagnosis. Contact Dermatitis 2004; 50:245-51. [PMID: 15186383 DOI: 10.1111/j.0105-1873.2004.00347.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Irritant contact dermatitis (ICD) is often chronic; its aetiology frequently being related to occupational exposure. Management of ICD involves persistent reduction in exposure to skin irritants such as water, detergents and prolonged occlusion by gloves. The aim of this study was to determine the severity of hand dermatitis 5 years after initial diagnosis and to find out what factors were related to this outcome. A questionnaire survey was carried out on severity of hand dermatitis, exposure to skin irritants and preventive measures, 5 years after initial ICD diagnosis. Of a cohort of 201 patients with ICD, 172 received the questionnaire and 124 (72%) responded. 5 years after initial diagnosis, 50% still had medium and 32% severe hand dermatitis. Patients with severe ICD and high exposure showed low levels of prevention and difficulty in changing their occupational exposure. Use of emollients was predominantly therapeutic rather than preventive. Occupation was changed in 57% of cases, of which 46% was permanent. In this population, ICD is a chronic disease; implementation of secondary preventive measures appears to fail. In occupations with high exposure to skin irritants, implementation of permanent exposure reduction is more difficult, compared to occupations with a medium level of exposure. High exposures might have led to change of occupation; medium exposures could have been reduced to low levels. In occupations with high exposure, women were overrepresented.
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MESH Headings
- Dermatitis, Allergic Contact/diagnosis
- Dermatitis, Allergic Contact/epidemiology
- Dermatitis, Allergic Contact/etiology
- Dermatitis, Allergic Contact/pathology
- Dermatitis, Allergic Contact/prevention & control
- Dermatitis, Occupational/diagnosis
- Dermatitis, Occupational/epidemiology
- Dermatitis, Occupational/etiology
- Dermatitis, Occupational/pathology
- Dermatitis, Occupational/prevention & control
- Female
- Hand Dermatoses/diagnosis
- Hand Dermatoses/epidemiology
- Hand Dermatoses/etiology
- Hand Dermatoses/pathology
- Hand Dermatoses/prevention & control
- Humans
- Irritants/adverse effects
- Male
- Netherlands/epidemiology
- Occupational Exposure/adverse effects
- Patient Education as Topic
- Severity of Illness Index
- Surveys and Questionnaires
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Affiliation(s)
- F H W Jungbauer
- Department of Dermatology, Groningen University Hospital, PO Box 30.001. 9700 RB Groningen, The Netherlands.
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Diepgen TL. Occupational skin-disease data in Europe. Int Arch Occup Environ Health 2003; 76:331-8. [PMID: 12690490 DOI: 10.1007/s00420-002-0418-1] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2002] [Accepted: 08/21/2002] [Indexed: 02/08/2023]
Abstract
The different occupational health systems and legislations in the countries across Europe makes it difficult for one to sketch a detailed picture for the whole continent. Reporting bias and selection bias have a considerable impact on the perceived prevalence and incidence, while reliable data are hard to extract from official registries. Data from one region in Germany will serve as an example. Comparison with data from other sources yields an estimate of 0.7 to 1.5 cases per 1,000 per year as a gross average, while the problem in specific occupational groups is more pronounced. Reliable data on social and economic impact are very scarce.
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Affiliation(s)
- Thomas L Diepgen
- Department of Social Medicine, Center of Occupational and Environmental Dermatology, University Hospital of Heidelberg, Bergheimer Strasse 58, 99115 Heidelberg, Germany.
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Abstract
Skin reactions are common in the workplace. The skin, which constantly is exposed to chemicals and industrial processes, develops inflammatory reactions, most commonly dermatitis, which may have an allergic or irritant basis. The epidemiology, pathophysiology, and clinical features of common occupational dermatoses are discussed. Irritant, allergic, and urticarial contact reactions are compared, and their clinical features are outlined. Important occupational irritants and allergens, their sources, and the industries in which they most commonly are found are listed. The prognosis and therapy of these occupational reactions are examined.
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Affiliation(s)
- Marc Antezana
- Department of Dermatology, Oregon Health and Science University, 3181 South West Sam Jackson Park Road, OP06, Portland, OR 97201-3098, USA
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van Coevorden MA, Williams HC, Svensson ÅA, Diepgen TL, Elsner P, Coenraads PJ. Interventions for hand eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2002. [DOI: 10.1002/14651858.cd004055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Marco A van Coevorden
- University Medical Center Groningen; Department of Dermatology; P.O. Box 30001 Groningen Netherlands 9700 RB
| | - Hywel C Williams
- The University of Nottingham; Centre of Evidence-Based Dermatology; Queen's Medical Centre Derby Road Nottingham UK NG7 2UH
| | - Åke A Svensson
- University Hospital; Department of Dermatology; Malmö Sweden S 205 02
| | - Thomas L Diepgen
- University Hospital of Heidelberg; Department of Clinical Social Medicine; Thibautstrasse 3 Heidelberg Germany 69115
| | - Peter Elsner
- Friedrich Schiller University; Department of Dermatology and Allergology; Erfurter Strasse 35 Jena Germany D 07743
| | - Pieter-Jan Coenraads
- University Medical Center Groningen ; Department of Dermatology; Groningen Netherlands 9700 RB
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Affiliation(s)
- Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, Rechovot, Israel
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Schliemann-Willers S, Wigger-Alberti W, Kleesz P, Grieshaber R, Elsner P. Natural vegetable fats in the prevention of irritant contact dermatitis. Contact Dermatitis 2002; 46:6-12. [PMID: 11918580 DOI: 10.1034/j.1600-0536.2002.460102.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic irritant contact dermatitis (ICD) is one of the most pressing problems in occupational medicine and is common in the food processing industry. To date, protective creams that fulfil the special requirements in the foodstuffs industry have not been available. Therefore, we studied the efficacy of pre-exposure application of natural vegetable fats in the prevention of experimentally induced ICD. A panel of 20 healthy volunteers was tested with a repetitive irritation test using sodium lauryl sulfate (SLS) as a standard irritant in a randomized study. Application sites were assessed clinically and by the use of bioengineering techniques (evaporimetry, chromametry, and corneometry). Rape seed and palm fats showed significant protective potential. Gas-chromatographic analysis revealed differences in the fatty acid composition of the vegetable. Higher content of linoleic acid and lower content of oleic acid was associated with beneficial effects. Our results are a new approach in the prevention of ICD and towards the development of new protective preparations for workplaces in the foodstuffs industry.
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Affiliation(s)
- S Schliemann-Willers
- Department of Dermatology and Allergology, Friedrich-Schiller-University, Jena, Germany
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Abstract
Primary care physicians will likely see a wide variety of occupational skin diseases in their practices, including allergic contact dermatitis, irritant contact dermatitis, contact urticaria, a variety of infectious diseases, and skin cancers. The ideal role of a medical practitioner involved in occupational dermatology is not only to diagnose and treat patients, but also to determine the cause of the occupational skin disease and to make recommendations for its prevention. Making the diagnosis and offering treatment, determining the cause, and recommending measures can be difficult undertakings.
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Affiliation(s)
- B D Lushniak
- US Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations, and Field Studies, Cincinnati, Ohio, USA
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Abstract
This article reviews the role of dermatologists in occupational dermatologic care by reviewing the types of skin diseases that may be work-related, the diagnostic testing, and evidence of quality of care delivery and outcomes provided by dermatologists.
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Affiliation(s)
- E F Sherertz
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Abstract
Latex sensitivity is becoming epidemic in the health care arena. Providers of health care need to be aware of the signs and symptoms, the treatments, and the consequences of latex sensitive reactions. In this article, I will provide information about latex sensitivities that will enable health care workers and their patients to have a better understanding of the phenomena. Resource information is provided for the latest information pertaining to latex sensitivities to aid in the education of health care providers and their patients.
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Affiliation(s)
- J Bartlett
- CNS Surgical Services, Sparrow Health System, Lansing, MI 48909, USA
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Chapter III: Preventive activities. General aspects and the efficacy of emollients and moisturizers. Contact Dermatitis 1996. [DOI: 10.1111/j.1600-0536.1996.tb06259.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Färm G. Contact allergy to colophony and hand eczema. A follow-up study of patients with previously diagnosed contact allergy to colophony. Contact Dermatitis 1996; 34:93-100. [PMID: 8681565 DOI: 10.1111/j.1600-0536.1996.tb02137.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Colophony is commonly used in many products that we are exposed to both at work and during leisure. At our Department, about 5% of patch tested dermatitis patients show positive reactions to colophony. 83 patients in whom contact allergy to colophony had been diagnosed were followed up after 9-13 years. They were interviewed, examined and retested. At least 30% had current hand eczema on follow-up examination. Among those in whom the dermatitis had started on the hands, there were proportionally more individuals with current hand eczema than among those in whom the onset had been on other parts of the body. 72% of the participants were still patch-test-positive to colophony, and more than 1/2 had additional positive reactions to other allergens. Some of these additional reactions were new compared to the previous test occasion. The degree of exposure to colophony throughout the years was difficult to estimate. Contact allergy to colophony was considered occupational in individuals with, e.g., soldering jobs.
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Affiliation(s)
- G Färm
- Department of Occupational Dermatology, Karolinska Hospital, Stockholm, Sweden
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Rietschel RL. Human and economic impact of allergic contact dermatitis and the role of patch testing. J Am Acad Dermatol 1995; 33:812-5. [PMID: 7593782 DOI: 10.1016/0190-9622(95)91837-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R L Rietschel
- Department of Dermatology, Ochsner Clinic, New Orleans, LA 70121, USA
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Kujala VM, Reijula KE. Glove-induced dermal and respiratory symptoms among health care workers in one Finnish hospital. Am J Ind Med 1995; 28:89-98. [PMID: 7573078 DOI: 10.1002/ajim.4700280108] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To evaluate the prevalence of skin and respiratory symptoms associated with the use of protective gloves in health care workers, an inquiry study was carried out on 534 hospital employees who used protective latex or vinyl gloves on a daily basis at work. The prevalence of skin disorders related to the usage of gloves was 56%. Rhinorrhea or nasal congestion was present in 13% of the workers who used powdered disposable gloves. The prevalence of both skin and respiratory symptoms was significantly higher among the workers who used gloves > 2 hours a day (p < 0.001). The skin disorders were more common in young employees. The findings indicate that most of the symptoms were caused by irritation or an immediate, IgE-mediated allergy. We conclude that there is a positive correlation between the duration of daily glove usage at work and the skin and respiratory symptoms. In order to reduce skin disorders associated with the daily use of gloves, it is necessary to develop safer materials in the glove manufacturing process.
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Affiliation(s)
- V M Kujala
- Department of Public Health Science and General Practice, University of Oulu, Finland
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