Occupational Contact Dermatitis: An Update

Occupational skin diseases among bricklayers and brick masons in a resource poor setting, Southwest Nigeria: prevalence and correlates - a case-control study

OBJECTIVES

Cement and most other materials used by bricklayers and brick masons for construction purposes could heighten the risk for occupational skin diseases (OSDs) which mostly include occupational contact dermatitis (OCD) and others. The activities of the bricklayers or brick masons are essentially manual as they work as artisans involving mixing sands and gravels with cement and water for building and block moulding, respectively. This can lead to a significant decline in the quality of life and psychosocial function. We determined the prevalence of OSDs and their correlates among bricklayers and brick masons.

DESIGN

This was a comparative case-control study which involved 200 bricklayers/brick masons and 200 healthy non-bricklayers/non-brick masons.

SETTINGS

This study was carried out in two local governments (LGAs) in Ogbomoso community.

METHODS

Respondents were selected using a multistage random sampling technique. Interviewer-administer semi-structured questionnaire was used to collect data. Data were analysed using descriptive statistics, the prevalence of OCD and other OSD were determined, χ2 test and logistic regression were obtained. A p<0.05 was considered as statistically significant.

RESULTS

The mean age of the bricklayers/brick masons was 39.74±17.03 years, while that of the control group was 40.04±17.24 years. The prevalence of OCD was significantly higher in the bricklayers/brick masons (43.0%) than controls (5.5%), p<0.001. Other dermatological conditions were more common among the cases (8.5%) than the controls (5.0%), p=0.04. Bricklayers/brick masons not using personal protective equipment (PPE, hand gloves) were three times more likely to develop OCD compared with those who used them (OR=3.38, 95% CI 0.12 to 0.72, p=0.007). A family history of allergy is also a predictor of OCD (OR=2.69, 95% CI 1.30 to 5.60, p=0.008).

CONCLUSION

OSD are common in bricklayers/brick masons, especially among those without the use of PPE. Regular educational programmes emphasizing the need to reduce direct contact with cement including the proper and regular use of PPE among this population group are advised.

Update on occupational dermatitis: reviewing toxic substances from OSHA standards

Occupational dermatitis (OD) is an inflammatory skin disease stemming from exposure to specific substances within a work setting. As the second most prevalent occupational health concern in 2020, affecting 1.8 per 10,000 workers, OD poses a significant challenge to workforce well-being and imposes a substantial economic burden through lost wages, decreased productivity, and increased healthcare spending. Dermatologists emerge as pivotal figures in recognizing risk factors and delivering essential care to individuals with OD. This review focuses on chemical hazards and toxic substances regulated by the Occupational Safety and Health Administration across general industry, maritime, and construction sectors. It explores the background of each hazard, pathophysiology to dermatitis, and human cases reported between 2017 and 2023 for formaldehyde, chromium, vinyl chloride, and cadmium.

Comorbid Scenarios in Contact Dermatitis: Atopic Dermatitis, Irritant Dermatitis, and Extremes of Age

Contact dermatitis (allergic and irritant) occurs when the skin encounters haptens that elicit a T cell-mediated hypersensitivity reaction (allergic) or a nonimmunologic, toxic reaction (irritant). Patch testing is the reference standard for diagnosing allergic contact dermatitis (ACD), although positive results are not always relevant. Therefore, the definitive diagnosis of ACD requires an astute clinician able to connect the results of patch testing appropriately with the clinical history and the cutaneous examination findings. Comorbid conditions such as atopic dermatitis can confound the accurate diagnosis of ACD because of the similarities in clinical presentation. Furthermore, both extremes of age can further challenge the diagnostic specificity of ACD owing to the maturing immune system and the space limitations present when the very young are patch tested. The goal of this Continuing Medical Education article is to discuss the challenges of diagnosing ACD in patients with unique comorbidities such as atopic dermatitis, given the morphologic similarities, and when to patch test these patients. Diagnosis of ACD will also be discussed in very young patients with a focus on patch test allergen selection despite the limited geographic space. The most common allergens reported in very young and old patients will also be discussed.

Occupational contact dermatitis caused by sodium tetradecyl sulfate in a healthcare worker: A case report

Healthcare workers are known to be at a higher risk of experiencing occupational contact dermatitis and attention should be paid to new materials that cause contact dermatitis. Sodium tetradecyl sulfate is widely used in the treatment of small varicose veins of the legs and venous malformations. We report the case of a 42-year-old woman, a healthcare worker, who presented with contact dermatitis caused by sodium tetradecyl sulfate. The contact dermatitis induced by sodium tetradecyl sulfate resolved completely after sodium tetradecyl sulfate avoidance at the last follow-up. Thus, we recommend increased protective measures when handling this substance.

The Characteristics of Allergic Contact Dermatitis in Military and Civilian Populations: A Multicenter Cross-Sectional Study

Background: Contact dermatitis is a common condition in the general population, with a global prevalence of 20%. It is an inflammatory skin disease that is classified as irritant contact dermatitis (80%) and allergic contact dermatitis (ACD) (20%). In addition, it is the most common presentation of occupational dermatoses and is one of the primary reasons for seeking medical attention among military personnel. Only few studies have compared the characteristics of contact dermatitis in soldiers and civilians. Objective: To compare the characteristics of ACD between civilians and soldiers. Methods: This large retrospective study was conducted in Israel and involved 1800 civilians and 750 soldiers with suspected ACD. All patients underwent relevant patch tests based on their clinical presentation and medical history. Results: At least 1 positive allergic reaction was found in 382 civilians (21.22%) and 208 soldiers (27.73%) (nonsignificant). Moreover, 69 civilians (18.06%) and 61 soldiers (29.32%) had at least 1 positive occupational allergic reaction (P < 0.05). Widespread dermatitis was significantly more common among soldiers. The most frequent occupations among civilians with positive allergic reactions were hairdressers/beauticians. "Professional, technical, and managerial occupations" were the most frequent categories among soldiers (24.6%), with computing professionals being the most common occupation (46.67%). Conclusion: Military personnel and civilians have different characteristics associated with ACD. Therefore, considering these characteristics before placement in a workplace can help prevent ACD.

Work-related and personal risk factors for occupational contact dermatitis: A systematic review of the literature with meta-analysis

The objective of this review is to identify work-related and personal risk factors for contact dermatitis (CD), and assess their association with this frequently occurring occupational disease. A systematic review of the literature from 1990 to June 2, 2020, was conducted using Medline and Embase. Prospective cohort and case-control studies were included, and meta-analyses were conducted when feasible. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Twenty-nine studies were identified, comprising 26 study populations and with a total of 846 209 participants investigating 52 risk factors for CD. Meta-analyses were performed for five risk factors, all of them for irritant contact dermatitis (ICD). Moderate-quality evidence was found for associations between wet work and ICD (OR: 1.56, 95%CI: 1.21-2.01). High-quality evidence was found for the association between atopic dermatitis and ICD (OR: 2.44, 95%CI: 1.89-3.15). There was no evidence for an association between ICD and sex or history of hand dermatitis, respiratory and mucosal atopy. In conclusion, several work-related and personal risk factors associated with CD were identified. Our data emphasize the need for the assessment of both, work-related and personal, risk factors to prevent occupational CD.

Occupational Hand Dermatitis

PURPOSE OF REVIEW

Occupational hand dermatitis is a common work-related disorder of the skin. Prevention and management of this disease is critical to improving workers' quality of life and for occupation-specific retention.

RECENT FINDINGS

This is a critical review of the current literature on occupational hand dermatitis. Occupational dermatitis continues to have a high prevalence among workers although the overall incidence may be slowly decreasing. Irritant contact dermatitis due to wet work exposure is the most common cause of occupational hand dermatitis. Healthcare workers, hairdressers, and metal workers are at particularly high risk for this disease. While some prevention programs have been ineffective in mitigating occupational hand dermatitis, other more resource-intensive initiatives may have benefit. Continued research is needed on ways to manage wet work exposures and on scalable, effective prevention programs for occupational hand dermatitis. The spectrum of culprit contact allergens continues to evolve, and vigilance for potential occupation-specific allergens remains important.

Presentations to emergency departments in Melbourne, Australia diagnosed as allergic contact dermatitis

BACKGROUND

This study investigated cases diagnosed as allergic contact dermatitis (ACD) in emergency departments (EDs) and management.

METHODS

A multisite retrospective study of patients attending EDs in metropolitan Melbourne between July 2017 and June 2018 was performed. Using International Statistical Classification of Disease-10 (ICD-10) codes, the Victorian Agency for Health Information generated a list of cases of contact dermatitis (CD). Demographic and clinical data were analysed.

RESULTS

Two hundred twenty-eighty patients from 14 different sites were diagnosed with ACD. Hair dyes caused the most cases, and one such case was admitted to hospital. It was apparent from the specified causes that cases of irritant CD were misdiagnosed as ACD. There were significant differences in management with dermatology input, with dermatologists more often advising oral corticosteroids (33.3% vs. 14.5%, P = 0.004) topical corticosteroids (92.9% vs. 38.7%, P < 0.01), emollients (38.1% vs. 20.4%, P = 0.01) and less often advising antihistamines (16.7% vs. 44.6%, P < 0.001). With dermatology input, potent or very potent steroids were more likely to be prescribed (69.3% vs. 11.1%, P < 0.001); without, a mild potency steroid was more likely to be prescribed (63.9% vs. 4%, P = 0.01).

CONCLUSION

Improved understanding, diagnosis and management of CD are needed in EDs.

Comparison of product safety data sheet ingredient lists with skin irritants and sensitizers present in a convenience sample of light-curing resins used in additive manufacturing

Material jetting and vat photopolymerization additive manufacturing (AM) processes use liquid resins to build objects. These resins can contain skin irritants and/or sensitizers but product safety data sheets (SDSs) might not declare all ingredients. We characterized elemental and organic skin irritants and sensitizers present in 39 commercial products; evaluated the influence of resin manufacturer, system, color, and AM process type on the presence of irritants and sensitizers; and compared product SDSs to results. Among all products, analyses identified 23 irritant elements, 54 irritant organic substances, 22 sensitizing elements, and 23 sensitizing organic substances; SDSs listed 3, 9, 4, and 6 of these ingredients, respectively. Per product, the number and total mass (an indicator of potential dermal loading) of ingredients varied: five to 17 irritant elements (8.32-4756.65 mg/kg), one to 17 irritant organics (3273 to 356,000 mg/kg), four to 17 sensitizing elements (8.27-4755.63 mg/kg), and one to seven sensitizing organics (15-382,170 mg/kg). Median numbers and concentrations of irritants and sensitizers were significantly influenced by resin system and AM process type. The presence of undeclared irritants and sensitizers in these resins supports the need for more complete information on product SDSs for comprehensive dermal risk assessments.