Factors related to skin health in hairdressing apprentices from two Croatian regions

Biomonitoring of hand and forearm transepidermal water loss and skin pH among nursing apprentices

BACKGROUND

Measurements of transepidermal water loss (TEWL) and stratum corneum (SC) pH can help indicate work-related skin barrier damage, but sensitivity to confounding personal and ambient factors limits their potential as biomonitoring tools.

OBJECTIVES

To evaluate the difference between hand and forearm skin barrier conditions as a tool for early recognition of workers with occupational contact dermatitis.

PARTICIPANTS AND METHODS

The participants were nursing apprentices (N = 238, median age 19 years) from Zagreb, Croatia. They filled out a questionnaire based on the Nordic Occupational Skin Questionnaire, underwent a clinical examination of skin on the hands, and were evaluated for their TEWL and SC pH on the dorsum of the hand and volar part of the forearm.

RESULTS

We found that the difference between hand and forearm TEWL values (ΔTEWL) greater than 7 g/m2/h, or >50%, or the difference in SC ΔpH >0.50, predicted visible skin changes found on clinical examination. However, only the association with ΔpH >0.50 retained statistical significance when controlled for sex, age, ambient temperature, and relative humidity in a multiple regression model.

CONCLUSIONS

The difference between hand and forearm SC pH values is suggested as a reliable biomonitoring tool in recognition of damaged skin barrier conditions in occupational settings.

Low sensitivity of a self-report questionnaire for hand eczema in hairdressing apprentices

BACKGROUND

The validity of the self-report questionnaire for hand eczema (HE) among Croatian hairdressers was not investigated previously, leading to uncertainty in the prevalence estimated from self-reported data.

OBJECTIVES

To (1) investigate the validity of the self-report questionnaire for HE in hairdressing apprentices and (2) examine the differences between apprentices who recognised their HE symptoms and those who did not.

METHODS

Clinical examination for HE signs on hands and wrists was performed by the Osnabrueck Hand Eczema Severity Index for 408 apprentices at four visits covering the entire schooling period. Self-report HE was based on the Nordic Occupational Skin Questionnaire.

RESULTS

Low sensitivity (7%-37%) with high specificity (≥95%) was observed, with both measures improving from baseline to last visit. The severity of HE signs was the only factor associated with the correct identification of HE signs in analyses adjusted for previous HE signs, health-related quality of life, and atopic dermatitis (adjusted odds ratios of 1.58 with 95% confidence interval [1.06-2.35] and 1.74[1.38-2.19] at second and third follow-up visit, respectively).

CONCLUSIONS

Self-report questionnaire for HE showed low sensitivity in hairdressing apprentices, especially at the beginning of training and in those with mild symptoms. Further validation studies following questionnaire modifications aimed at adolescent population are advised.

Difference between hand and forearm transepidermal water loss and skin pH as an improved method to biomonitor occupational hand eczema: our findings in healthcare workers

The aim of this cross-sectional field study was to establish the condition of hand and forearm skin barrier among dentists and physicians and how it may be associated with personal and work-related factors. The study consisted of an occupational questionnaire, clinical examination of skin on hands, and transepidermal water loss (TEWL) and pH measurements on hands and forearms. The participants were divided in the following groups (N=37 each, N=148 in total): physicians, medical surgeons, dentists, and dental surgeons. We calculated the difference between hand and forearm TEWL and pH (ΔTEWL and ΔpH, respectively) and divided it by the forearm values (ΔTEWL% and ΔpH%, respectively). There was a clear trend of increasing median ΔTEWL%, starting from physicians with non-surgical specialisation (56 %) to medical surgeons (65 %), dentists (104 %), and dental surgeons (108 %), with the latter two groups showing particularly worrisome signs of work-related skin barrier impairment, since they had double the TEWL on hands than on forearms. Although less prominent, the same worsening trend was noted for skin pH, with dental surgeons having on average a 0.3 points higher skin pH on hands than on forearms. These findings were mainly associated with prolonged glove use and male sex. Our findings also suggest that comparing TEWL and pH between hands and forearms can better establish occupational skin barrier impairment on hands.

Hand Eczema in Apprentice Nurses during the COVID-19 Pandemic after a Skin Prevention Program

BACKGROUND

Healthcare workers, particularly nurses and apprentice nurses, are at high risk of the development of hand eczema due to daily exposure to wet work. This study aimed to assess the occurrence of hand eczema in a group of first-, second-, and third-year apprentice nurses at the University Hospitals of Trieste (northeastern Italy) during the COVID-19 pandemic.

METHODS

Two hundred forty-two Nursing School students were recruited. Data were collected using a standardized questionnaire based on the Nordic Occupational Skin Questionnaire, and all patients underwent a medical examination to evaluate their skin condition based on standard scores. Transepidermal water loss was also measured. The factors associated with hand eczema were investigated using univariate and multivariate logistic regression analyses.

RESULTS

The prevalence of hand eczema was low in students both before and after the traineeship (17.9 and 21.5%, respectively), but clinical signs of mild skin damage, mainly skin dryness, were present in 52.3 and 47.2%, respectively. The factor associated with hand eczema was a personal history of atopic eczema (odd ratios 2.61, 95% confidence intervals 1.18-5.80), while exposure to irritants and glove use did not reach statistical significance.

CONCLUSIONS

Our findings might be explained by the preventive measures adopted for skin protection among healthcare workers in Trieste since the apprenticeship.

A cross-sectional study of Chinese women facial skin status with environmental factors and individual lifestyles

Geographical, environmental and pollution conditions affect facial skin health, but their effects on skin appearance have not been elucidated. This study aimed to describe the skin barrier and skin tone characteristics of Chinese subjects according to lifestyle and environmental conditions using in vitro measurements. In total, 1092 women aged 22-42 years were recruited from 7 representative Chinese cities. Eight skin parameters (hydration, sebum, pH, transdermal water loss, individual type angle, melanin index, erythema index, yellowness) were measured using noninvasive instruments; individual lifestyle data were also collected. Data on four meteorological factors (air temperature, relative humidity, sunshine duration, wind speed) and seven air pollution indicators (air quality index, fine particulate matter, breathable particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide and ozone) were collected in each city from the China Meteorological Administration. Facial skin characteristics differed significantly between cities. Facial skin barrier characteristics and skin tones showed regional differences, with a better skin barrier associated with the western region, as indicated by high skin hydration and sebum secretion and a low pH value. According to the value of transdermal water loss, lighter and darker skin tones were found in the western and southern regions, respectively. Environmental conditions affected facial skin status. Air pollution induced facial skin issues, with fine particulate matter and nitrogen dioxide contributing the most. Individual lifestyles affected the facial skin barrier and skin tone.

Characteristics of hand eczema in final-year apprentice nurses during the COVID-19 pandemic

BACKGROUND

Apprentice nurses are considered at high risk to developing occupational skin diseases.

OBJECTIVES

This study assessed the frequency and origin of hand eczema, and work-related risk factors in apprentice nurses.

METHODS

The study involved 240 final-year apprentice nurses (females 75%, median age 19 years) from vocational schools in Zagreb, Croatia. The study was performed in 2020/2021 and included a questionnaire and clinical examination by means of the Osnabrück Hand Eczema Severity Index (OHSI). Skin prick test (SPT) with natural rubber latex (NRL) allergen, and patch test with the basic series of allergens, and disinfectants, were performed in 42 apprentice nurses with hand eczema that lasted more than 3 months.

RESULTS

Clinically observed and self-reported hand eczema were found in 49% and 46% of apprentice nurses, respectively. Those with observed changes were older and reported more days per month spent on practical work than those with healthy skin (P = .001). Median OHSI was 4 (interquartile range 2-6). There were no positive SPTs to latex, and 11 (26%) apprentice nurses had positive patch test reactions to one or more tested allergens, mostly nickel.

CONCLUSIONS

Hand eczema was common in final-year apprentice nurses during the COVID-19 pandemic. It was mostly of irritative origin, associated with the duration of practical training, confirming cumulative effect of hazards on skin barrier.

Comparison of beautician and hairdressing apprentices with regard to skin health and skin barrier function

Hairdressing and beautician apprentices are at high risk of occupational skin diseases. Our objective was to compare the prevalence of skin symptoms and the condition of skin barrier between them at the end of vocational training. We recruited 101 hairdressing and 76 beautician apprentices (overall median age 17 years), who reported their history of skin symptoms through the Croatian translation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) and had their hand skin clinically examined and evaluated with the Osnabrück Hand Eczema Severity Index (OHSI). Transepidermal water loss (TEWL) was measured following the standard procedure. Hairdressing apprentices reported significantly higher prevalence of hand/wrist eczema or urticaria than beautician apprentices (35 % vs 25 %, respectively; P=0.041) and higher severity of current hand eczema [median (range) 1.5 (0-8) vs 0.5 (0-4), respectively; P<0.001] and had higher hand TEWL values in those who washed their hands >20 times a day [median (interquartile range): 24.4 (19.7-33.7) vs 18.8 (15.4-23.2) g/ m2/h, respectively; P<0.001). Hairdressing apprentices had more severe clinical symptoms on the hands, and 83 % of those who reported eczema also reported that exacerbation occurred during practical training in comparison to 38 % of beautician apprentices. Our study is the first to report occupational hand and forearm skin issues in the beautician apprentices and also suggests that more effort is needed to improve training about safety at work, which should be specifically tailored for these two trades.