Wirksamkeit von Hautschutzprodukten im Vergleich zu Hautpflegeprodukten bei Zahntechnikern - eine kontrollierte Feldstudie. Efficacy of barrier creams in comparison to skin care products in dental laboratory technicians - a controlled trial

Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study)

Objectives

Radiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment.

Design

We conducted a controlled, randomized, double-blind clinical trial.

Setting

Radiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain).

Interventions

Patients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream.

Main outcome measures

The primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed.

Results

Seventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: "My skin condition makes it hard to work or do hobbies" (17.1% in the GTE vs. 2.9% in GTA; p = 0.024).

Conclusions

The higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

Evaluation of Skin Barrier Condition Among Physicians and Dentists

Background: Physicians and dentists are at risk for chronic hand eczema, but their skin barrier condition has rarely been investigated before. Objective: To objectively assess the skin barrier condition among physicians and dentists. Methods: This cross-sectional epidemiological study included an occupational questionnaire, medical examination of hand skin, skin transepidermal water loss (TEWL), and pH measurements, analyzed in 5 groups (N = 37 in each): physicians-nonsurgeons, physicians-surgeons, dentists-nonsurgeons, dentists-surgeons, and control group (unexposed workers). Results: Critical skin condition (TEWL >30 g/[m2·h]) was found in 14% of control workers, 14% physicians nonsurgeons, 22% physicians surgeons, 27% dentists nonsurgeons, and 43% dentists surgeons. The latter had the worst stratum corneum condition indicated by a TEWL median of 25.80 g/(m2·h) (interquartile range [IQR] 19.24-34.31). Hand skin pH was highest among dentists with nonsurgical specializations, with a median of 5.33 (IQR 5.15-5.60), where 38% of them had pH >5.5. Male sex (P < 0.001) and glove use for >1 h/day (P = 0.009) were associated with elevated hand TEWL values, whereas female sex (P < 0.001) and glove use for >4 h/day with elevated pH values (P < 0.001). Conclusions: Prolonged glove usage and dental profession, especially surgical work, significantly affect the skin barrier condition. This study was the first to objectively determine skin barrier condition among dentists and physicians.

Interventions for preventing occupational irritant hand dermatitis

BACKGROUND

Occupational irritant hand dermatitis (OIHD) causes significant functional impairment, disruption of work, and discomfort in the working population. Different preventive measures such as protective gloves, barrier creams and moisturisers can be used, but it is not clear how effective these are. This is an update of a Cochrane review which was previously published in 2010.

OBJECTIVES

To assess the effects of primary preventive interventions and strategies (physical and behavioural) for preventing OIHD in healthy people (who have no hand dermatitis) who work in occupations where the skin is at risk of damage due to contact with water, detergents, chemicals or other irritants, or from wearing gloves.

SEARCH METHODS

We updated our searches of the following databases to January 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLlNE, and Embase. We also searched five trials registers and checked the bibliographies of included studies for further references to relevant trials. We handsearched two sets of conference proceedings.

SELECTION CRITERIA

We included parallel and cross-over randomised controlled trials (RCTs) which examined the effectiveness of barrier creams, moisturisers, gloves, or educational interventions compared to no intervention for the primary prevention of OIHD under field conditions.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane. The primary outcomes were signs and symptoms of OIHD developed during the trials, and the frequency of treatment discontinuation due to adverse effects.

MAIN RESULTS

We included nine RCTs involving 2888 participants without occupational irritant hand dermatitis (OIHD) at baseline. Six studies, including 1533 participants, investigated the effects of barrier creams, moisturisers, or both. Three studies, including 1355 participants, assessed the effectiveness of skin protection education on the prevention of OIHD. No studies were eligible that investigated the effects of protective gloves. Among each type of intervention, there was heterogeneity concerning the criteria for assessing signs and symptoms of OIHD, the products, and the occupations. Selection bias, performance bias, and reporting bias were generally unclear across all studies. The risk of detection bias was low in five studies and high in one study. The risk of other biases was low in four studies and high in two studies.The eligible trials involved a variety of participants, including: metal workers exposed to cutting fluids, dye and print factory workers, gut cleaners in swine slaughterhouses, cleaners and kitchen workers, nurse apprentices, hospital employees handling irritants, and hairdressing apprentices. All studies were undertaken at the respective work places. Study duration ranged from four weeks to three years. The participants' ages ranged from 16 to 67 years.Meta-analyses for barrier creams, moisturisers, a combination of both barrier creams and moisturisers, or skin protection education showed imprecise effects favouring the intervention. Twenty-nine per cent of participants who applied barrier creams developed signs of OIHD, compared to 33% of the controls, so the risk may be slightly reduced with this measure (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.06; 999 participants; 4 studies; low-quality evidence). However, this risk reduction may not be clinically important. There may be a clinically important protective effect with the use of moisturisers: in the intervention groups, 13% of participants developed symptoms of OIHD compared to 19% of the controls (RR 0.71, 95% CI 0.46 to 1.09; 507 participants; 3 studies; low-quality evidence). Likewise, there may be a clinically important protective effect from using a combination of barrier creams and moisturisers: 8% of participants in the intervention group developed signs of OIHD, compared to 13% of the controls (RR 0.68, 95% CI 0.33 to 1.42; 474 participants; 2 studies; low-quality evidence). We are uncertain whether skin protection education reduces the risk of developing signs of OIHD (RR 0.76, 95% CI 0.54 to 1.08; 1355 participants; 3 studies; very low-quality evidence). Twenty-one per cent of participants who received skin protection education developed signs of OIHD, compared to 28% of the controls.None of the studies addressed the frequency of treatment discontinuation due to adverse effects of the products directly. However, in three studies of barrier creams, the reasons for withdrawal from the studies were unrelated to adverse effects. Likewise, in one study of moisturisers plus barrier creams, and in one study of skin protection education, reasons for dropout were unrelated to adverse effects. The remaining studies (one to two in each comparison) reported dropouts without stating how many of them may have been due to adverse reactions to the interventions. We judged the quality of this evidence as moderate, due to the indirectness of the results. The investigated interventions to prevent OIHD probably cause few or no serious adverse effects.

AUTHORS' CONCLUSIONS

Moisturisers used alone or in combination with barrier creams may result in a clinically important protective effect, either in the long- or short-term, for the primary prevention of OIHD. Barrier creams alone may have slight protective effect, but this does not appear to be clinically important. The results for all of these comparisons were imprecise, and the low quality of the evidence means that our confidence in the effect estimates is limited. For skin protection education, the results varied substantially across the trials, the effect was imprecise, and the pooled risk reduction was not large enough to be clinically important. The very low quality of the evidence means that we are unsure as to whether skin protection education reduces the risk of developing OIHD. The interventions probably cause few or no serious adverse effects.We conclude that at present there is insufficient evidence to confidently assess the effectiveness of interventions used in the primary prevention of OIHD. This does not necessarily mean that current measures are ineffective. Even though the update of this review included larger studies of reasonable quality, there is still a need for trials which apply standardised measures for the detection of OIHD in order to determine the effectiveness of the different prevention strategies.

Canadian hand dermatitis management guidelines

BACKGROUND

Hand dermatitis (HD) is one of the most common skin conditions; however, it is not a homogeneous disease entity. The severity of HD may range from very mild cases to severe chronic forms, which may result in prolonged disability and, occasionally, refractory HD. Chronic hand dermatitis (CHD) is associated with a high health- economic burden and significant loss of quality of life.

OBJECTIVE

Although numerous treatment options are available, the management of CHD is often difficult and unsatisfactory. There is a paucity of well-designed, randomized, controlled clinical trials in support of the efficacy of established treatment modalities.

CONCLUSION

These guidelines cover the epidemiology, burden, quality of life, etiology, diagnosis, classification, and prevention of HD and provide guidance on management using an approach that is as evidence based as possible.

Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year

BACKGROUND

We recently found a very low adherence to a generally recommended skin protection regimen in a sample of 1355 metalworkers.

OBJECTIVES

The present study assessed the effectiveness of skin protection as presently recommended, especially the differential contribution of skin care and skin protection, to the prevention of occupational hand eczema. Methods Of 1355 metalworkers screened, 1020 male volunteers, all fit for work, were recruited for a prospective intervention study with four arms (skin care, skin protection, both combined, and control group, i.e. no recommendation). The study was performed from winter 2006/2007 to spring 2008, following each subject for up for 12 months. Both hands were examined using a quantitative skin score, and a standardized personal interview was performed three times. The change of the objective skin score from baseline to 12 months was used as primary outcome measure.

RESULTS

After 12 months 800 subjects were included (78.4% of those recruited). The compliance to follow the randomized measure depended on the recommended measure and ranged from 73.7% to 88.7%. While in the control group a significant deterioration was found, the largest and significant improvement was noted in the group following the generally recommended skin protection programme (skin care + skin protection) followed by skin protection alone as second best.

CONCLUSIONS

The generally recommended skin protection regimen seems to provide effective prevention of occupational skin disease. Therefore, the compliance to follow the skin protection regimen, especially the use of skin protection, should be enhanced.

Occupational skin diseases in cleaning and kitchen employees: Course and quality of life after measures of secondary individual prevention

BACKGROUND

Cleaning and kitchen employees have an increased risk of suffering from occupational dermatoses. Prevention including improving individual skin care and skin protection behavior, health education, optimizing diagnostics and therapy as well as avoidance of occupational skin disease (BK 5101) is important.

PATIENTS AND METHODS

Participants in the courses were patients suspected of having an occupational skin disease. Besides socio-demographic and disease-related data, health-related quality of life (QL) was measured using the SF-36 and Skindex-29. One year later all participants were interviewed by telephone about the course of their skin disease.

RESULTS

Out of 212 participants, 84.0 % were female. The mean age was 41.6 (SD = 10.8) years.168 patients (79.2 %) suffered from hand dermatitis,with irritant contact dermatitis being the predominant diagnosis (46.2 %,n = 98). One year later 65.4 % (n = 85) of the patients interviewed still suffered from hand dermatitis.9.2 % (n = 12) had meanwhile quit their job due to the skin disease. QL was impaired in all age groups being lower with increasing age of the patients.

CONCLUSIONS

The follow-up confirmed the positive impact of the skin protection courses on patients' skin disease and well-being. Occupational skin diseases impair health-related quality of life in these professions but disease severity does not seem to play a key role.

Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees: aims, experiences and descriptive results

OBJECTIVES

Due to increased occupational dermatoses in certain professions such as health care workers (HCW), cleaning and kitchen employees (CKE), measures of prevention and skin protection are of high significance. Skin protection courses focus on educational aims (e.g. improving skin care habits, influencing the participants' attitudes towards health) and medical aims (e.g. optimising diagnostic procedures, complementing individual therapy).

METHODS

Participants are patients who have been suspected to suffer from an occupational skin disease and are insured with the German Accident Prevention & Insurance Association (BGW). Teaching units of the skin protection courses focus on basics of skin functioning and important aspects of occupational skin diseases. Practical parts include information and instructions about the correct implementation of skin protection, skin care and skin cleansing. Every participant is seen by a dermatologist obtaining a precise patient's history and performing a skin examination. All this results in working out individually adapted and professional skin protection strategies.

RESULTS

In total, 791 participants (93 men and 698 women) completed the skin protections courses. Six hundred and sixty-seven patients (mean age: 36.9 years, SD = 11.6) were HCW and 124 patients (mean age: 40.4 years, SD = 10.8) were CKE. In HCW 82.5% (n = 550) and in CKE 86.3% (n = 107) suffered from hand eczema of the atopic, irritant or allergic type. Irritant contact dermatitis as a single diagnosis was the most frequent one in both groups (HCW: 34.5.%, n = 230; CKE: 49.2% n = 61). According to regularly performed evaluations, the participants rated the course as good to excellent. Nearly 80% of the participants had skin lesions while attending the course, in 27% the dermatosis was severe.

CONCLUSIONS

There is a high need for health education, advisory services, diagnostics and additional therapy in occupational dermatology. Prevention of occupational skin diseases and maintenance of health through educational programmes are important complementary measures for dermatological care but still missing in endangered professions.

Educational and dermatological aspects of secondary individual prevention in healthcare workers

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

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

BACKGROUND

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

PATIENTS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Rehabilitation von berufsbedingten Hauterkrankungen

The high incidence rates of occupational contact dermatitis, its poor prognosis, and the high social and economic impact of the disease for the affected individuals as well as for the medical insurance companies indicates a need to strive for the target of "rehabilitation instead of retirement". Here, we highlight the need and effectiveness of rehabilitation measures in individuals with work related skin diseases (mainly contact dermatitis and hand eczema). We discuss the measures for secondary individual prevention as well as tertiary prevention, which have been established in our department together with the state medical insurance companies, mainly the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BWG: Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Service). The results of the multicentre study "Optimisation and Quality Assessment of Tertiary Prevention of Occupational Dermatoses" are presented and discussed. Both, the secondary as well as tertiary prevention measures have been successful, which has resulted in a decrease in the total annual rehabilitation costs to the BGW. A reason for this success story is the fact that in Germany these organisations are, in contrast to the health insurance companies, responsible for both acute treatment and the rehabilitation.