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Schliemann S, Müller M, Stadeler M, Elsner P. Doppelblinde, randomisierte repetitive
In‐vivo
‐Wirksamkeitsstudie zu kommerziellen Hautschutzprodukten gegen Natriumlaurylsulfat (SLS). J Dtsch Dermatol Ges 2021; 19:545-553. [PMID: 33861011 DOI: 10.1111/ddg.14359_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
HINTERGRUND In der Primär- und Sekundärprävention von Berufsdermatosen werden Hautschutzprodukte eingesetzt, die eine präexpositionelle Schutzwirkung aufweisen sollen. Insbesondere finden sich auf dem Markt zahlreiche Produkte, die zum Einsatz bei Feuchtarbeit ausgelobt werden. Eine objektive Qualitätsbeurteilung dieser Produkte für Anwender ist auf Grund fehlender vergleichender Wirksamkeitsstudien oft nicht möglich. MATERIAL UND METHODIK In einer doppelblinden, randomisierten und kontrollierten In-vivo-Studie wurden sechs kommerzielle Hautschutzexterna in einem repetitiven Irritationsmodell untersucht. Sie wurden hinsichtlich ihrer präexpositionellen Schutzwirkung vor dem durch Natriumlaurylsulfat (SLS) induzierten irritativen Kontaktekzem mittels hautphysiologischer Methoden getestet. Es wurde ein Wirkindex anhand des transepidermalen Wasserverlustes (TEWL) gemäß des Protokolls der multizentrischen Studie des Forschungsprojektes FP 275 der Deutschen Gesetzlichen Unfallversicherung DGUV berechnet. ERGEBNISSE Die untersuchten Externa zeigten eine Schutzwirkung gegen SLS im Vergleich zum unbehandelten Kontrollfeld, wiesen allerdings signifikante Wirkunterschiede auf. Die Auswertung der Nebenparameter Corneometrie und visueller Score erbrachte ebenfalls Unterschiede zwischen den Externa. SCHLUSSFOLGERUNGEN Die zwischen den untersuchten Externa festgestellten Unterschiede hinsichtlich der Wirkgüte ermöglichten eine Einteilung der Produkte, welche als Grundlage für die Auswahl geeigneter Schutzpräparate dienen kann.
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Affiliation(s)
| | - Maren Müller
- Abteilung Gesundheitsschutz, GB Prävention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe, Erfurt
| | - Martina Stadeler
- Abteilung Gesundheitsschutz, GB Prävention, Berufsgenossenschaft Nahrungsmittel und Gastgewerbe, Erfurt
| | - Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
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Schliemann S, Müller M, Stadeler M, Elsner P. Double blind randomized repetitive efficacy test of various occupational skin protection preparations against sodium lauryl sulphate. J Dtsch Dermatol Ges 2021; 19:545-552. [PMID: 33768641 DOI: 10.1111/ddg.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin protection products, formerly named as barrier creams, are being used as primary and secondary prevention measures against occupational dermatoses. Many of these cosmetic products are claimed by manufacturers to be efficacious against wet work-induced skin barrier impairment if applied prior to exposure. However, results of validated and standardized in vivo efficacy tests allowing the comparison of different products are lacking. MATERIAL AND METHODS Efficacy of six skin protection products against sodium lauryl sulphate-induced irritant contact dermatitis was investigated in a double blind, randomized and controlled repetitive irritation study in healthy volunteers using skin physiological methods. Transepidermal water loss (TEWL) results were used to calculate an efficacy index of protection by mathematical/statistical means according to a protocol developed in a German Statutory Accident Insurance (DGUV) multicenter study (research project FP 275). RESULTS All tested products had a demonstrable, protective effect against SLS compared to controls, but their relative efficacy varied significantly. Differences were also seen upon evaluation of other parameters such as corneometry and clinical irritation score (visual score). CONCLUSIONS Product ranking as a result of the established differences allows improved selection of appropriate skin protection products based on objective parameters, as compared to heterogenous product claims.
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Affiliation(s)
| | - Maren Müller
- Department of Health Protection, Prevention Division, Employer's Liability Insurance Association for the Food and Hospitality Sector (BGN), Erfurt
| | - Martina Stadeler
- Department of Health Protection, Prevention Division, Employer's Liability Insurance Association for the Food and Hospitality Sector (BGN), Erfurt
| | - Peter Elsner
- Department of Dermatology, Jena University Medical Center
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Elsner P. [The "dermatologist's procedure" after the abolition of the obligation to refrain from risky work activities in occupational disease law]. Hautarzt 2021; 72:509-515. [PMID: 33630116 PMCID: PMC8169502 DOI: 10.1007/s00105-021-04776-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/18/2022]
Abstract
Die Berufskrankheit (BK) Haut Nr. 5101 war bisher definiert als „schwere oder wiederholt rückfällige Hauterkrankungen, die zur Unterlassung aller Tätigkeiten gezwungen haben, die für die Entstehung, die Verschlimmerung oder das Wiederaufleben der Krankheit ursächlich waren oder sein können“. In einer weitreichenden Reform des Berufskrankheitenrechts, die zum 01.01.2021 in Kraft trat, hat der Gesetzgeber beschlossen, den „Unterlassungszwang“ als Voraussetzung für die Anerkennung einer Berufskrankheit abzuschaffen. Dieser Unterlassungszwang sollte mit dem 1972 eingeführten Hautarztverfahren und den dort etablierten Präventionsinstrumenten (dermatologische Behandlung, Sanierung des Arbeitsplatzes, Hautschutzmaßnahmen, gesundheitspädagogische Maßnahmen) verhindert werden, was in einem Großteil der Fälle auch gelang. Während die Abschaffung des Unterlassungszwangs die Anerkennung von schweren oder wiederholt rückfälligen Hauterkrankungen als Berufskrankheiten erleichtert, wird das Hautarztverfahren jedoch weiterhin Bedeutung behalten für die beruflichen Hauterkrankungen, insbesondere Handekzeme, die primär nicht die Kriterien der Schwere und/oder der wiederholten Rückfälligkeit erfüllen und die durch geeignete Behandlungs- und Präventionsmaßnahmen beherrscht werden können. Um bei einer BK-Anzeige wegen der Schwere oder wiederholten Rückfälligkeit einer Hauterkrankung Verzögerungen in der Sekundärprävention zu vermeiden, sollte gleichzeitig über einen Hautarztbericht zur BK-Anzeige der Unfallversicherungsträger die für zeitnahe Präventionsmaßnahmen und einen dermatologischen Behandlungsauftrag erforderlichen Informationen erhalten. Ein Anhaltspunkt für die Schwere könnte der Erfolg oder der Misserfolg des Hautarztverfahrens sein.
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Affiliation(s)
- Peter Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Erfurter Str. 35, 07743, Jena, Deutschland.
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Occupational Contact Dermatitis: Chefs and Food Handlers. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Occupational Contact Dermatitis: Chefs and Food Handlers. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_44-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Angelova-Fischer I, Hoek AK, Dapic I, Jakasa I, Kezic S, Fischer TW, Zillikens D. Barrier function and natural moisturizing factor levels after cumulative exposure to a fruit-derived organic acid and a detergent: different outcomes in atopic and healthy skin and relevance for occupational contact dermatitis in the food industry. Contact Dermatitis 2015; 73:358-63. [DOI: 10.1111/cod.12464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 07/21/2015] [Accepted: 07/25/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Irena Angelova-Fischer
- Department of Dermatology; University of Lübeck; 23538 Lübeck Germany
- Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein; 23538 Lübeck Germany
| | - Anne-Karin Hoek
- Department of Dermatology; University of Lübeck; 23538 Lübeck Germany
| | - Irena Dapic
- Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry; Faculty of Food Technology and Biotechnology, University of Zagreb; 10000 Zagreb Croatia
| | - Ivone Jakasa
- Laboratory for Analytical Chemistry, Department of Chemistry and Biochemistry; Faculty of Food Technology and Biotechnology, University of Zagreb; 10000 Zagreb Croatia
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre; 1100 AZ Amsterdam The Netherlands
| | - Tobias W. Fischer
- Department of Dermatology; University of Lübeck; 23538 Lübeck Germany
| | - Detlef Zillikens
- Department of Dermatology; University of Lübeck; 23538 Lübeck Germany
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Antonov D, Kleesz P, Elsner P, Schliemann S. Impact of glove occlusion on cumulative skin irritation with or without hand cleanser-comparison in an experimental repeated irritation model. Contact Dermatitis 2013; 68:293-9. [DOI: 10.1111/cod.12028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Holness DL, Kudla I. Workers with occupational contact dermatitis: workplace characteristics and prevention practices. Occup Med (Lond) 2012; 62:455-7. [PMID: 22837331 DOI: 10.1093/occmed/kqs115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There are many gaps in knowledge related to prevention practices in place for workers who subsequently develop occupational contact dermatitis (OCD). AIMS To describe the workplace characteristics and the prevention practices in workplaces where workers developed hand dermatitis. METHODS Consecutive cases of probable OCD were enrolled from a specialist occupational health clinic. At the time of the initial assessment, questionnaires were administered to collect information about clinical presentation, workplace characteristics and prevention practices at work. RESULTS 100 workers with hand dermatitis were enrolled in the study and 78 were considered to have OCD. Two-thirds of these had had some occupational health and safety or Workplace Hazardous Materials Information System (WHMIS) training in their workplace, however, training related to glove use and skin care was less common. Unionized workers were more likely to have received training. Workers involved in wet work were less likely to report training. CONCLUSIONS These findings suggest that there are gaps in prevention programs for work-related skin disease. Research is needed on effective strategies that are sustainable in the workplace.
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Affiliation(s)
- D L Holness
- Department of Occupational and Environmental Health, St. Michael's Hospital Toronto, Ontario, Canada.
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Halioua B, Bensefa-Colas L, Bouquiaux B, Crépy M, Assier H, Billon S, Chosidow O. Occupational Contact Dermatitis in 10,582 French Patients Reported between 2004 and 2007: A Descriptive Study. Dermatology 2012; 225:354-63. [DOI: 10.1159/000342175] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 07/06/2012] [Indexed: 11/19/2022] Open
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Weistenhöfer W, Baumeister T, Drexler H, Kütting B. An overview of skin scores used for quantifying hand eczema: a critical update according to the criteria of evidence-based medicine. Br J Dermatol 2009; 162:239-50. [DOI: 10.1111/j.1365-2133.2009.09463.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kaatz M, Ladermann R, Stadeler M, Fluhr JW, Elsner P, Bauer A. Recruitment strategies for a hand dermatitis prevention programme in the food industry. Contact Dermatitis 2008; 59:165-70. [DOI: 10.1111/j.1600-0536.2008.01415.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tertiary individual prevention of occupational skin diseases: a decade's experience with recalcitrant occupational dermatitis. Int Arch Occup Environ Health 2008; 81:1059-64. [PMID: 18239930 DOI: 10.1007/s00420-008-0300-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE If employees are threatened to loose their job due to a severe occupational skin disease (OSD), intensive interdisciplinary measures of tertiary individual prevention (TIP) are required. TIP comprises 2-3-weeks in-patient treatment plus intensive health-pedagogic counseling, and consecutive 3-weeks out-patient treatment by the local dermatologists. Each patient (pt) will stay off work for a total of usually 6 weeks to allow full barrier-recovery. METHODS All 1,486 TIP-pts from various high-risk-professions, treated in our institution in the period 1994-2003, were followed up 1 year after the TIP by a standardised questionnaire, which was returned by 1,164 (78%) pts. RESULTS Seven hundred and sixty-four (66%) of the responding 1,164 TIP-pts had successfully remained in their (risk-)professions. It could be demonstrated that to remain in the workplace was dependent on the individual motivation to use skin protection (P < 0.001), the provision of skin protection by the employer (P < 0.001), (higher) age of pt (P < 0.001) and the duration of continued out-patient-treatment by the local dermatologist (P < 0.001). However, there were no significant differences concerning the likelihood of successful job-continuation in the various high-risk-professions, e.g. hairdressers, nurses, metal-workers, food handlers, construction-workers. CONCLUSION The obtained data from TIP reveal remarkable pertinent options for interdisciplinary pt-management in severe OSD in all risk-professions.
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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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Rycroft RJ, Frosch PJ. Occupational Contact Dermatitis. Contact Dermatitis 2006. [DOI: 10.1007/3-540-31301-x_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kartono F, Maibach HI. Irritants in combination with a synergistic or additive effect on the skin response: an overview of tandem irritation studies. Contact Dermatitis 2006; 54:303-12. [PMID: 16787451 DOI: 10.1111/j.0105-1873.2006.00792.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sodium lauryl sulfate (SLS) has often been chosen as a model for irritant contact dermatitis (ICD) to study the effect of irritants in combination (1-14). Recently 'tandem', or sequential, exposures with SLS have been performed to study the mechanism of skin barrier impairment in ICD (1-6, 15). The assessment of reactions have been documented with visual scoring, transepidermal water loss (TEWL), skin colour reflectance measurements, skin blood flow; among which TEWL has been noted as the most sensitive value (16). The matched control groups were treated with either a single exposure to a single irritant or in tandem with the same irritant repeatedly. Synergistic and additive effects have been reported for various tandem pairs of irritants, however, the mechanism for both remains unclear. The results of tandem irritation studies were evaluated to define and investigate the responses produced and deduce a possible mechanism of action. Clinical ramifications, albeit complex, are discussed.
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Affiliation(s)
- Francisca Kartono
- Department of Dermatology, UCSF, School of Medicine, San Francisco, CA 94143, USA
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Schliemann-Willers S, Fuchs S, Kleesz P, Grieshaber R, Elsner P. Fruit acids do not enhance sodium lauryl sulphate-induced cumulative irritant contact dermatitis in vivo. Acta Derm Venereol 2005; 85:206-10. [PMID: 16040403 DOI: 10.1080/00015550410025444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Combined exposure to different irritants in the workplace may lead to irritant contact dermatitis, which is the main type of occupational dermatitis among bakers and confectioners. Following previous work on "tandem irritation", a panel of healthy volunteers was exposed twice daily for 4 days to the organic fruit acids: citric, malic, and lactic acid, either alone or in tandem application with 0.5% sodium lauryl sulphate (SLS) in a repetitive irritation test. Irritant cutaneous reactions were quantified by visual scoring and non-invasive measurement of transepidermal water loss and skin colour reflectance. Twice daily application of either citric or malic acid alone did not induce a significant irritant reaction. Combined exposure to one of the fruit acids and SLS caused marked barrier disturbance, but the latter irritant effect was smaller than that obtained by combined exposure to SLS and water. Thus, combined exposure to the above-mentioned fruit acids and SLS did not enhance cumulative skin irritation.
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Fluhr JW, Praessler J, Akengin A, Fuchs SM, Kleesz P, Grieshaber R, Elsner P. Air flow at different temperatures increases sodium lauryl sulphate-induced barrier disruption and irritation in vivo. Br J Dermatol 2005; 152:1228-34. [PMID: 15948986 DOI: 10.1111/j.1365-2133.2005.06531.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Combined exposure to dry climatic conditions and local heat sources together with detergents represents a common workplace situation. These conditions may support the induction of chronic barrier disruption leading subsequently to irritant contact dermatitis (ICD). OBJECTIVES To test the irritant and barrier disrupting properties of air flow at different temperatures and velocities. METHODS Using noninvasive biophysical measurements such as transepidermal water loss (TEWL) (TM 210; Courage & Khazaka, Cologne, Germany) we assessed the effects of short-term exposure to air flow at different temperatures (24 degrees C and 43 degrees C) in combination with sodium lauryl sulphate (SLS) 0.5% on the skin of 20 healthy volunteers in a tandem repeated irritation test. Chromametry was used to control the accuracy of the SLS irritation model. RESULTS In our study air flow alone did not lead to a significant increase in TEWL values. Sequential treatment with air flow and SLS led to an impairment of barrier function and irritation stronger than that produced by SLS alone. The two different air flow temperatures led to different skin temperatures but had no influence on permeability barrier function. CONCLUSIONS Warm air flow has an additional effect on the SLS-induced barrier disruption in a tandem irritation test with sequential exposure to SLS/air flow. This combination is suspected to promote ICD in workplace and household situations, especially in short-term applications as tested in our model.
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Affiliation(s)
- J W Fluhr
- Skin Physiology Laboratory, Department of Dermatology, Friedrich-Schiller-University, Erfurter Str. 35, 07740 Jena, Germany.
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Fluhr JW, Bornkessel A, Akengin A, Fuchs S, Norgauer J, Kleesz P, Grieshaber R, Elsner P. Sequential application of cold and sodium lauryl sulphate decreases irritation and barrier disruption in vivo in humans. Br J Dermatol 2005; 152:702-8. [PMID: 15840102 DOI: 10.1111/j.1365-2133.2004.06309.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD) is one of the most frequent types of occupational dermatitis. Different factors are involved in the development of contact dermatitis. In the food-processing industry, the combined exposure to different irritants may be involved in the development of ICD. Few data have been published regarding the irritant potential of sodium lauryl sulphate (SLS) in combination with cold. OBJECTIVES The present study was intended to analyse whether cold exposure and low skin temperature influence the development of ICD. METHODS Twenty (part I) and 12 (part II) healthy volunteers were exposed twice daily for 4 days to SLS alone, different low temperatures alone (4 degrees C six times for 90 s with an interval of 20 s or 15 degrees C for 10 min) or a combination of cold and SLS (19.6 microL SLS 1% cm(-2), part I; or 52.6 microL SLS 0.5% cm(-2), part II) using the tandem repetitive irritation test. Irritant cutaneous reactions were measured by noninvasive biophysical methods with transepidermal water loss as a parameter for permeability barrier function and skin colour reflectance together with visual scoring as parameters for inflammatory reactions. RESULTS Cold alone caused no significant skin reaction compared with untreated control. Exposure to SLS alone and SLS together with cold (independent of the applied temperature of 4 or 15 degrees C) twice daily induced a clear irritant reaction and barrier disturbance. Reactions did not differ whether SLS was applied before or after cold. Furthermore, 'tandem application' of cold and SLS diminished the barrier disruption and irritant reaction compared with SLS alone. CONCLUSIONS We conclude that the application of cold may have a protective effect on the development of ICD, at least in our short-term model.
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Affiliation(s)
- J W Fluhr
- Skin Physiology Laboratory, Department of Dermatology, Friedrich-Schiller-University Jena, Erfurter Str. 35, 07740 Jena, Germany
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Jungbauer FHW, Van Der Harst JJ, Schuttelaar ML, Groothoff JW, Coenraads PJ. Characteristics of wet work in the cleaning industry. Contact Dermatitis 2005; 51:131-4. [PMID: 15479201 DOI: 10.1111/j.0105-1873.2004.00421.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Wet work is the main cause of occupational contact dermatitis in the cleaning industry. Dermatologists and occupational physicians need to base their primary and secondary prevention for workers in the cleaning industry on the characteristics of wet work exposures. We quantified the burden of wet work in professional office cleaning activities with a continuous standardized observation by trained observers of 41 office cleaners. Duration and frequency of wet work exposure and of different cleaning activities were assessed. Wet work made up 50% of such cleaning work. Within a typical 3-hr shift, a mean frequency of 68 episodes of wet work was observed, which classifies office cleaning as wet work. Skin exposure to irritants was markedly different among cleaners who did the same cleaning activities. Reduction in skin irritation can be achieved by training the workers. Because this group of workers, who have a low level of education, has a high risk of developing irritant hand dermatitis, a special effort on training and instruction should be made. A reduction of exposure can be achieved by: using gloves more often; using gloves for a shorter period of time; using gloves while doing activities that otherwise cause the skin to be in contact with water and cleaning substances and washing hands with water only, reserving soap for when the hands are visibly dirty.
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Affiliation(s)
- F H W Jungbauer
- Department of Dermatology, Groningen University Hospital, Groningen, the Netherlands.
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Fluhr JW, Bankova L, Fuchs S, Kelterer D, Schliemann-Willers S, Norgauer J, Kleesz P, Grieshaber R, Elsner P. Fruit acids and sodium hydroxide in the food industry and their combined effect with sodium lauryl sulphate: controlled in vivo tandem irritation study. Br J Dermatol 2004; 151:1039-48. [PMID: 15541082 DOI: 10.1111/j.1365-2133.2004.06169.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cutaneous exposure to a variety of irritants has been extensively studied in recent years. Nevertheless, knowledge of the induction of irritant dermatitis, especially by mild irritants at low doses and for a short duration of exposure, is still incomplete. OBJECTIVES To quantify the irritant effects and barrier disruption properties of ascorbic acid (ASC), acetic acid (ACA) and sodium hydroxide (NaOH), particularly in combination with an anionic detergent, sodium lauryl sulphate (SLS). METHODS In a tandem repeated irritation test, the irritants were applied for 30 min twice daily for 4 days to the skin of the mid-back of 19 healthy volunteers of both sexes. We used bioengineering techniques for measurement of transepidermal water loss (TEWL) and skin colour reflectance, as well as visual scoring. RESULTS Repeated application of ASC and ACA caused a moderate increase in TEWL and erythema. The sequential application of ASC or ACA and SLS enhanced these effects. NaOH induced a strong reaction when applied both occlusively and nonocclusively as well as in combination with SLS, with an early onset of the inflammatory signs, leading to discontinuation of the application on the third day in most of the test fields. Notably, the irritant effect of NaOH was not as marked when applied sequentially with SLS. CONCLUSIONS Our results demonstrate that concurrent application of an anionic detergent and a mild acidic irritant can lead to disruption of the barrier function which, although not additive, is still considerable. The combined application of SLS and mild acids does not prevent SLS-induced irritation. Furthermore, we showed that NaOH in low concentrations may also act as a potent irritant but that its effect is not enhanced by SLS. The necessity of adequate skin protection and reduction of contact with substances that are potentially barrier disruptive and irritant, e.g. in the food industry, is emphasized, not only when handling detergents, but also when processing food products.
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Affiliation(s)
- J W Fluhr
- Skin Physiology Laboratory, Department of Dermatology, Friedrich-Schiller-University, Erfurter Str. 35, 07740 Jena, Germany.
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Kelterer D, Fluhr JW, Elsner P. Application of protective creams: use of a fluorescence-based training system decreases unprotected areas on the hands. Contact Dermatitis 2003; 49:159-60. [PMID: 14678214 DOI: 10.1111/j.0105-1873.2003.0185b.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- D Kelterer
- Department of Dermatology and Allergology, University of Jena, Erfurter Strasse 35, 07740 Jena, Germany.
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Dickel H, Kuss O, Schmidt A, Kretz J, Diepgen TL. Importance of irritant contact dermatitis in occupational skin disease. Am J Clin Dermatol 2002; 3:283-9. [PMID: 12010073 DOI: 10.2165/00128071-200203040-00006] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD), provoked by work materials or workflows, is believed to be a frequent cause of occupational skin disease (OSD). Data of incidence rates of ICD within different occupations are inadequate. OBJECTIVE We conducted a population-based study to identify occupational groups at risk for irritant and allergic contact dermatitis (ACD). METHODS The data are based on all workers' compensation claims reported to our register of OSDs in Northern Bavaria [Berufskrankheitenregister Haut-Nordbayern (BKH-N)], Germany. RESULTS From 1990 to 1999, 5285 patients had their cases completely assessed and recorded by government-employed physicians. We calculated the incidence rates of ICD and ACD in various occupations, divided into 24 occupational groups, in co-operation with the German State Institute of Labor and Occupation; there were a known total number of employees in each of the occupations. In these groups 3097 (59%) patients with OSD were observed, with an overall annual incidence rate of 4.5 patients per 10,000 workers for ICD, compared with 4.1 patients per 10,000 workers for ACD. The highest ICD annual incidence rates were found in hairdressers (46.9 per 10,000 workers per year), bakers (23.5 per 10,000 workers per year), and pastry cooks (16.9 per 10,000 workers per year); at the same time ICD was the main diagnosis of OSD in pastry cooks (76%), cooks (69%), food processing industry workers and butchers (63%), mechanics (60%), and locksmiths and automobile mechanics (59%). The results of a questionnaire showed frequent skin contact with detergents (52%), disinfectants (24%), and acidic and alkaline chemicals (24%) in the workplace. CONCLUSION Based on the incidence data of the BKH-N, this study identified occupational groups with a high risk of ICD. Different frequencies of ICD and ACD within a single group are demonstrated. The frequent usage of detergents is being addressed because of the introduction of German legislation of recent date (the Approved Code of Practice 531 on 'wet work').
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Affiliation(s)
- Heinrich Dickel
- Department of Clinical Social Medicine, Center of Occupational and Environmental Dermatology, University Hospital of Heidelberg, Heidelberg, Germany
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Abstract
Occupational contact dermatitis (OCD) represents 90 to 95% of all occupational dermatoses. The incidence rate of OCD is estimated to be around 0.5 to 1.9 cases per full-time worker per year. However, epidemiologic data are lacking and incidence is probably underestimated, especially in the US. Over the past 20 years, OCD has been the most frequently reported occupational disorder to German social insurance institutions. Critical factors in the management of OCD are recognition of clinical features, knowledge of allergens and irritants present in different occupational fields, knowledge of suitable protection, interpretation of patch test results, and awareness of medicolegal aspects. Management of OCD should be carried out by dermatologists and patch test clinics in cooperation with physicians specialized in industrial medicine. Individuals at high risk of OCD are hairdressers, dental laboratory technicians, other healthcare workers, construction industry workers, metal workers, leather and shoe manufacturers, florists and gardeners, and bakers, caterers, confectioners and cooks.
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Affiliation(s)
- P Koch
- Department of Dermatology, University of Saarland, Homburg/Saar, Germany.
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Dickel H, Bruckner T, Bernhard-Klimt C, Koch T, Scheidt R, Diepgen TL. Surveillance scheme for occupational skin disease in the Saarland, FRG. First report from BKH-S. Contact Dermatitis 2002; 46:197-206. [PMID: 12081697 DOI: 10.1034/j.1600-0536.2002.460403.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Occupational skin disease (OSD) is a significant public health concern. To keep OSDs under surveillance, a register of OSDs (BKH-S) was implemented in 1999 in the Saarland, FRG. We conducted a population-based register study to analyse all initial reports of OSDs reported to the BKH-S. 336 cases were prospectively assessed from July 1999 to June 2001. In 78% (n = 263) of the cases an occupational cause for the skin disease was stated, 91% (n = 240) of which fell within 16 occupational groups. This is equivalent to 6.8 cases per 10,000 workers per year within these occupational groups. Notably, young age groups (median age 35 years) were affected with a female predominance. The most frequent final diagnosis was irritant contact dermatitis (75%) followed by allergic contact dermatitis (34%) and atopic dermatitis (19%). The overall prevalence of occupationally relevant delayed-type reactors was 21% and of immediate-type reactors 17%. Work-related delayed-type sensitizations to potassium dichromate (n = 8) and immediate-type sensitizations to natural rubber latex (n = 11) were the most frequently observed. Questionnaire results showed frequent occupational skin contact with wet work (59%), detergents (48%), and disinfectants (38%). The second valid surveillance scheme for OSD in the FRG has been introduced and can be made available for further analysis.
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Affiliation(s)
- H Dickel
- Department of Clinical Social Medicine, Centre of Occupational and Environmental Dermatology, University Hospital of Heidelberg, Heidelberg, Germany
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Abstract
The spectrum of occupational diseases most commonly seen in the food industry includes occupational asthma, rhinitis, conjunctivitis, dermatitis, and hypersensitivity pneumonitis. Occupational asthma represents between 3% and 20% of all asthma cases and is the most common form of occupational lung disease. Occupational skin diseases may represent between 10% and 15% of all occupational diseases, and they have significant economic impact. Hypersensitivity pneumonitis affects the food industry, with farmer's lung representing a common form of the disease. Each of these diseases may have serious and potentially irreversible effects on the health of a farmer, food processor, or food preparer, even after removal of the offending exposure.
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Affiliation(s)
- Matthew Aresery
- Department of Medicine, Section of Clinical Immunology, Allergy & Rheumatology, Tulane University Health Sciences Center, 1700 Perdido Street (SL-57), New Orleans, LA 70112, USA.
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