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Zagrodney KAP, King EC, Mohammed ETCL, Nichol KA, Holness DL. Occupational Hand Dermatitis in Health Care: Development and Evaluation of an Online Training E-Module. Dermatitis 2023; 34:413-418. [PMID: 37158786 DOI: 10.1089/derm.2023.0012] [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: 05/10/2023]
Abstract
Background: Occupational hand dermatitis (OHD) is an important health concern for health care workers (HCWs), yet there is a lack of accessible training materials on this topic. Objectives: The objective of this study was to develop and evaluate an OHD training e-module for HCWs. Methods: The e-module was created in collaboration with an expert advisory committee and tested by Ontario HCWs through pre- and post-training OHD knowledge tests, a usability survey, and a survey about intent to change work skin care practices. Analyses of survey results included means and paired t-tests. Results: The 10-minute OHD training e-module for HCWs was tested by 254 HCWs and found to be highly usable, to increase OHD knowledge immediately and sustainably, and to change workplace skin care practices. Average OHD knowledge test scores significantly improved by 19% between the pretest (64.50%) and post-test (83.50%). Most 6-month follow-up survey respondents reported changing their skin care work practices (76.69%). Conclusions: This research addresses the previous lack of accessible OHD training for workers in health care settings. The creation and evaluation of a no-cost accessible OHD training e-module for workers in health care settings showed promising results across knowledge increase, knowledge retention, skin care behavior changes, and usability.
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Affiliation(s)
- Katherine A P Zagrodney
- From the VHA Home HealthCare, Toronto, Canada
- Canadian Health Workforce Network (CHWN), University of Ottawa, Ottawa, Canada
| | - Emily C King
- From the VHA Home HealthCare, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Emmelie T C L Mohammed
- From the VHA Home HealthCare, Toronto, Canada
- Faculty of Arts and Science, Queen's University, Kingston, Canada
| | - Kathryn A Nichol
- From the VHA Home HealthCare, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine and MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, Canada
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Lejding T, Persson L, Andersen KE, Bruze M, Derevyanko L, Elsner P, Goh CL, Gonçalo M, Goossens A, Gülgün MA, Isaksson M, Ljubojevic Hadzavdic S, Maibach H, Matsunaga K, Mowitz M, Nixon R, Pailin P, Pratt M, Schuttelaar MLA, Sukakul T, Verma K, Zimerson E, Özkaya E, Svedman C. Analysis of Hexavalent Chromium in Cement Samples From Countries Within and Outside the EU: A Study From the International Contact Dermatitis Research Group. Dermatitis 2023; 34:323-328. [PMID: 37001151 DOI: 10.1089/derm.2022.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Background: Allergic contact dermatitis (ACD) caused by hexavalent chromium (Cr(VI)) is often severe and difficult to treat. The content of Cr(VI) in cement can be reduced by, for example, addition of iron(II) sulfate. Since 2005 the content of Cr(VI) in cement is regulated in the EU Directive 2003/53/EC and must not exceed 2 ppm. Since this regulation came into force, ACD caused by cement has markedly been reduced. Objective: To investigate Cr(VI) and total chromium content in samples of cement from countries within and outside the EU. Methods: The members of the International Contact Dermatitis Research Group (ICDRG) were invited to participate in the study with the aim to collect cement samples from geographically different areas. The content of Cr(VI) in the samples was estimated by the diphenyl carbazide spot test, atomic absorption spectroscopy was used to assess the total chromium content. Results: Forty-five cement samples were analyzed, containing amounts of Cr(VI) from <0.1 to >70 ppm. Twenty-one samples contained >2 ppm Cr(VI), 24 contained less. Four of 17 samples from within the EU contained >2 ppm Cr(VI), that is, higher amounts than stipulated in the EU directive, as compared with 17 samples from countries outside the EU. Conclusion: In countries outside the EU, significantly more cement samples contained >2 ppm Cr(VI).
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Affiliation(s)
- Tina Lejding
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Lena Persson
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Klaus Ejner Andersen
- Department of Dermatology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Magnus Bruze
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ludmyla Derevyanko
- Department of Dermatovenereology, Kyiv Medical University, Kyiv, Ukraine
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | | | - Margarida Gonçalo
- University Hospital and Faculty of Medicine University of Coimbra, Coimbra, Portugal
| | - An Goossens
- Department of Dermatology, KU Leuven, Leuven, Belgium
| | - Mehmet Ali Gülgün
- Sabancı University, Faculty of Engineering and Natural Sciences Materials Science and Nano Engineering, Tuzla-Istanbul, Turkey
| | - Marléne Isaksson
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Suzana Ljubojevic Hadzavdic
- Department of Dermatovenereology, University Hospital Center Zagreb, University of Zagreb, School of Medicine, Kišpatićeva, Zagreb, Croatia
| | - Howard Maibach
- Department of Dermatology, University of California Medical Center, San Francisco, California, USA
| | - Kayoko Matsunaga
- Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Nagoya, Japan
| | - Martin Mowitz
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Carlton, Melbourne, Victoria, Australia
| | | | - Melanie Pratt
- University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | | | - Thanisorn Sukakul
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Kaushal Verma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Erik Zimerson
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Esen Özkaya
- Department of Dermatology and Venereology, Istanbul University, Istanbul Faculty of Medicine, Çapa-Istanbul, Turkey
| | - Cecilia Svedman
- From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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3
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Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Kajal Patel
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Level 1/80 Drummond Street, Carlton, 3053 Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Level 1/80 Drummond Street, Carlton, 3053 Australia
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4
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Garrido AN, House R, Lipszyc JC, Liss GM, Holness DL, Tarlo SM. Cleaning agent usage in healthcare professionals and relationship to lung and skin symptoms. J Asthma 2021; 59:673-681. [PMID: 33402006 DOI: 10.1080/02770903.2021.1871740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Healthcare workers have an increased risk of respiratory symptoms and dermatitis, likely related to cleaning/disinfecting agents. The aim of this study was to identify work tasks and cleaning/disinfecting agents associated with respiratory symptoms and hand dermatitis among healthcare workers in a tertiary hospital. METHODS Cleaning agent usage, respiratory symptoms and skin symptoms were recorded by participants using a questionnaire in a cross-sectional study. Age and sex adjusted odds ratios (OR) were used to examine associations between job tasks, exposures, respiratory, and skin outcomes. RESULTS Two hundred and thirty healthcare workers who were exposed to cleaning agents were compared with 77 who had no, or minimal, exposure. Exposed workers had an increased risk of respiratory symptoms (adjusted OR = 2.17; 95% CI: 1.18-4.14) and skin symptoms (adjusted OR = 1.77; 95% CI: 1.00 - 3.17). Washing instruments manually, using aerosol products, cleaning operating rooms, cleaning sanitary rooms, preparing disinfectants, and filling devices with cleaning products were cleaning tasks associated with various respiratory symptoms. Bleach was the only cleaning agent associated with a respiratory symptom: tightness in the chest (unadjusted OR = 2.46; 95% CI: 1.01-6.89) but statistical significance did not persist after adjustment for age and sex. Hand dermatitis was associated with actual disinfecting tasks (adjusted OR = 2.19; 95% CI: 1.10-4.66). Bleach was the only cleaning agent significantly associated with hand dermatitis (adjusted OR = 2.54; 95% CI: 1.32-5.13). CONCLUSIONS This study provides insight into possible work tasks that need interventions to reduce or prevent respiratory and skin symptoms in healthcare workers.
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Affiliation(s)
- Ameth N Garrido
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Respiratory Division, Toronto Western Hospital, UHN, Toronto, ON, Canada
| | - Ronald House
- Occupational Medicine Division, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joshua C Lipszyc
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gary M Liss
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dorothy Linn Holness
- Occupational Medicine Division, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan M Tarlo
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Respiratory Division, Toronto Western Hospital, UHN, Toronto, ON, Canada.,Occupational Medicine Division, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Dear K, Toholka R, Nixon R. Occupational skin disease in mining: an Australian case series. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:504-510. [PMID: 33372583 DOI: 10.1080/19338244.2020.1857674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The mining industry has one of the highest rates of occupational disease across all industries. However, occupational skin disease (OSD) is not commonly reported in this industry, although has been estimated to affect up to 51 people per 100,000 workers, with contact dermatitis accounting for the majority of cases. It often has a poor prognosis and leads to days lost from work. There have been relatively few reports regarding the specific forms of OSD encountered by miners worldwide. We report our experience of miners attending our Occupational Dermatology Clinic and our investigations at two Australian mines. We compare our findings with other reports of OSD in the mining population. The most commonly observed skin condition was irritant contact dermatitis, but miliaria and allergic contact dermatitis were also observed. It is not surprising that most cases of OSD appear to be related to harsh working conditions and exposures to multiple skin irritants, however, specific exposures causing ACD should not be forgotten. Our findings are consistent with previous studies of OSD in miners.
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Affiliation(s)
- Kate Dear
- Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia
| | - Ryan Toholka
- Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia
| | - Rosemary Nixon
- Skin Health Institute - Occupational Dermatology Research and Education Centre, Carlton, VIC, Australia
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6
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Dear K, Palmer A, Nixon R. Allergic chromate dermatitis to cement in Australia: an ongoing problem. Occup Environ Med 2020; 77:658. [PMID: 32404532 DOI: 10.1136/oemed-2020-106639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Kate Dear
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia
| | - Amanda Palmer
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Victoria, Australia
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Nichol K, Copes R, Kersey K, Eriksson J, Holness DL. Screening for hand dermatitis in healthcare workers: Comparing workplace screening with dermatologist photo screening. Contact Dermatitis 2019; 80:374-381. [DOI: 10.1111/cod.13231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/31/2018] [Accepted: 01/21/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Kathryn Nichol
- Collaborative Academic PracticeUniversity Health Network Toronto Ontario Canada
- Dalla Lana School of Public HealthUniversity of Toronto Toronto Ontario Canada
- Centre for Research Expertise in Occupational Disease Toronto Ontario Canada
| | - Ray Copes
- Dalla Lana School of Public HealthUniversity of Toronto Toronto Ontario Canada
- Environmental and Occupational HealthPublic Health Ontario Toronto Ontario Canada
| | - Karon Kersey
- Occupational Health and SafetyUniversity Health Network Toronto Ontario Canada
| | - Jonas Eriksson
- Collaborative Academic PracticeUniversity Health Network Toronto Ontario Canada
| | - Dorothy L. Holness
- Dalla Lana School of Public HealthUniversity of Toronto Toronto Ontario Canada
- Centre for Research Expertise in Occupational Disease Toronto Ontario Canada
- Division of Occupational Medicine, Department of MedicineUniversity of Toronto Toronto Ontario Canada
- Division of Occupational MedicineSt Michael's Hospital Toronto Ontario Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge InstituteSt Michael's Hospital Toronto Ontario Canada
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8
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Effect of Patch Testing on the Course of Allergic Contact Dermatitis and Prognostic Factors That Influence Outcomes. Dermatitis 2019; 30:135-141. [DOI: 10.1097/der.0000000000000452] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nichol K, McKay SM, Ruco A, Holness DL. Testing the Hand Dermatitis Screening Tool in the Home Health Care Sector. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318780012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Workers exposed to wet work are at an increased risk for occupational contact dermatitis and may benefit from screening to detect early disease. The objective of this study was to assess the prevalence of hand dermatitis in home care workers, identify factors that influence presence of disease, and explore feasibility and importance of workplace screening in the home care sector. Following institutional ethics approval, nurses, personal support workers, and rehab therapists at one large home care provider in Ontario, Canada, self-screened for hand dermatitis using the Hand Dermatitis Screening Tool and accompanying photo guide and completed a short feasibility evaluation. Of the 220 participants, 18% had a positive screen for hand dermatitis and 77% reported exposure to wet work. In all, 93% of participants reported using the tool took less than 2 minutes and 84% reported screening for hand dermatitis is important. In conclusion, prevalence of hand dermatitis in home care workers is higher than reported in the general population. Workplace screening for hand dermatitis was deemed important, and the tool was feasible to use in the home care sector.
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Affiliation(s)
- K. Nichol
- VHA Home HealthCare, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
- Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
| | - S. M. McKay
- VHA Home HealthCare, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - A. Ruco
- VHA Home HealthCare, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | - D. L. Holness
- University of Toronto, Ontario, Canada
- Centre for Research Expertise in Occupational Disease, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
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10
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Carøe T, Ebbehøj N, Bonde J, Vejlstrup S, Agner T. Job change facilitates healing in a cohort of patients with occupational hand eczema. Br J Dermatol 2018; 179:80-87. [DOI: 10.1111/bjd.16095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- T.K. Carøe
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - N.E. Ebbehøj
- Department of Occupational and Environmental Medicine; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - J.P.E. Bonde
- Department of Occupational and Environmental Medicine; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - S.G. Vejlstrup
- Department of Occupational and Environmental Medicine; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
| | - T. Agner
- Department of Dermatology; University of Copenhagen; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen Denmark
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11
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Abstract
BACKGROUND Hexavalent chromium in cement is a common cause of occupational allergic contact dermatitis (OACD). METHODS Analysis of patch test data during 1999 to 2013 was done. Patients with cement-induced chromate OACD filled the Dermatology Life Quality Index, graded 1 to 5. RESULTS Of 4846 consecutive patients who were patch tested, 146 (3%) were chromate-sensitive. Of 46 (31.5%) who presented with chromate OACD, 27 (59%) had cement-induced chromate OACD. The proportion of chromate-sensitive patients with clinically relevant cement exposure increased from 7.7% in 2002 to 2004 to 28.7% in 2011 to 2013 (P = 0.04). The median age of presentation was younger than for other chromate-sensitive patients (32 vs 42 years). Hand eczema (88.9%) was the most frequent clinical presentation. Of the 27 with cement-induced chromate OACD, 21 (77.8%) had ongoing dermatitis at the time of the review. Although 14/27 (51.9%) changed their occupation to avoid exposure to cement, symptoms persisted in 9/14 (64.3%). Prolonged exposure to cement before development of symptoms was associated with chronicity. All the symptomatic patients experienced at least a moderate effect on their quality of life (grade 3 or higher on the Dermatology Life Quality Index). CONCLUSIONS We recommend the adoption of the European legislation in Israel, to reduce the prevalence of chromate OACD from cement.
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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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Occupational Contact Dermatitis: Workers' Compensation Patch Test Results of Portland, Oregon, 2005-2014. Dermatitis 2016; 26:276-83. [PMID: 26551607 DOI: 10.1097/der.0000000000000142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Workers are exposed to potential irritants and allergens with constant introduction of new industrial chemicals in the workplace. OBJECTIVE Characterize the final diagnoses, demographics, occupations, exposures, clinical presentations, patch test results, dermatologic histories, and risk factors of workers evaluated for suspected work-related allergic contact dermatitis (ACD). METHODS A retrospective chart review of 310 workers' compensation independent medical examinations evaluated for suspected work-related ACD was performed. Workers were seen in a community dermatology clinic in Portland, Oregon, from 2005 to 2014. Evaluation included history, physical examination, patch testing, and further diagnostic workup when indicated. RESULTS Hand dermatitis was the most common presentation (n = 148, 47.7%). Prevalent occupations included health care workers (n = 51, 16.5%), custodial staff (n = 41, 13.2%), and machinists (n = 36, 11.6%). Allergic contact dermatitis (47.5%) was more common than irritant contact dermatitis (ICD) (38.9%) in those diagnosed as having occupational skin disease (n = 185). The highest-frequency work-related allergens were thiuram mix (21 of 88, 23.9%), carba mix (20 of 88, 22.7%), potassium dichromate (9 of 88, 10.2%), and epoxy resin (9 of 88, 10.2%). CONCLUSIONS Allergic contact dermatitis and ICD are common occupational skin disorders. In this population of workers' compensation referrals, ACD was more common, with 73.3% of those cases work related, compared with 86.7% of ICD. Blue collar work and wet work were risk factors for the development of ACD and ICD.
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14
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Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermatitis 2016; 75:213-22. [PMID: 27436328 DOI: 10.1111/cod.12616] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Healthcare workers (HCWs) are at risk of developing occupational skin disease (OSD). OBJECTIVES To ascertain the causes of OSD in Australian HCWs in a tertiary referral clinic. METHODS A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne from 1993 to 2014. RESULTS Of 685 HCWs assessed in the clinic over a period of 22 years, 555 (81.0%) were diagnosed with OSD. The most common diagnosis was irritant contact dermatitis (ICD) (79.1%), followed by allergic contact dermatitis (ACD) (49.7%). Natural rubber latex allergy was also relatively frequent (13.0%). The major substances causing ACD were rubber glove chemicals (thiuram mix and tetraethylthiuram disulfide), preservatives (formaldehyde, formaldehyde releasers, and isothiazolinones), excipients in hand cleansers, which are hard-to-avoid weak allergens, and antiseptics. ACD caused by commercial hand cleansers occurred more frequently than ACD caused by alcohol-based hand rubs (ABHRs). Occupational ICD was mostly caused by water/wet work and hand cleansers, and environmental irritants such as heat and sweating. CONCLUSIONS Understanding the causes of OSD in HCWs is important in order to develop strategies for prevention. We suggest that skin care advice should be incorporated into hand hygiene education. The use of ABHRs should be encouraged, weak allergens in skin cleansers should be substituted, and accelerator-free gloves should be recommended for HCWs with OSD.
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Affiliation(s)
- Claire L Higgins
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia.
| | - Amanda M Palmer
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
| | - Jennifer L Cahill
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria, 3053, Australia
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16
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Al-Otaibi ST, Alqahtani HAM. Management of contact dermatitis. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2015. [DOI: 10.1016/j.jdds.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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17
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Clemmensen KKB, Carøe TK, Thomsen SF, Ebbehøj NE, Agner T. Two-year follow-up survey of patients with allergic contact dermatitis from an occupational cohort: is the prognosis dependent on the omnipresence of the allergen? Br J Dermatol 2015; 170:1100-5. [PMID: 24359102 DOI: 10.1111/bjd.12795] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin diseases are the most frequently recognized occupational diseases in Denmark. The prognosis for occupational contact dermatitis is often poor. OBJECTIVES To investigate the prognosis, assessed by eczema, job status and skin-related quality of life, among patients allergic to rubber chemicals and latex (ubiquitous allergens) and epoxy (nonubiquitous allergen), 2 years after recognition of occupational allergic contact dermatitis. METHODS From a cohort of all patients recognized as having occupational dermatitis by the Danish National Board of Industrial Injuries in 2010, 199 patients with relevant rubber allergy (contact allergy to rubber chemicals or contact urticaria from latex) or epoxy allergy were identified. Follow-up consisted of a questionnaire covering current severity of eczema, employment, exposure and quality of life. RESULTS The response rate was 75%. Clearance of eczema was reported by 11% of patients and 67% reported improvement. Overall 22% of patients with allergy to a nonubiquitous allergen had total clearance of eczema compared with 10% of cases allergic to ubiquitous allergens and 0% of those with contact urticaria (P = 0·116). Improvement was significantly more frequent in those who had changed jobs compared with those who had not (P = 0·01). CONCLUSIONS At follow-up, patients with contact urticaria had significantly poorer prognosis than those with contact allergy, and there was a trend towards a poorer prognosis for those with contact allergy to rubber chemicals than those with allergy to epoxy. A significant positive association between job change and improvement was found.
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Affiliation(s)
- K K B Clemmensen
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, 2400, Copenhagen, Denmark
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Wong CC, Gamboni SE, Palmer AM, Nixon RL. Occupational allergic contact dermatitis to chromium from cement: Estimating the size of the problem in Australia. Australas J Dermatol 2014; 56:290-3. [DOI: 10.1111/ajd.12238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Celestine C Wong
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation; Melbourne Victoria Australia
| | - Sarah E Gamboni
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation; Melbourne Victoria Australia
| | - Amanda M Palmer
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation; Melbourne Victoria Australia
| | - Rosemary L Nixon
- Occupational Dermatology Research and Education Centre; Skin and Cancer Foundation; Melbourne Victoria Australia
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19
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Petersen A, Johansen J, Hald M. Hand eczema - prognosis and consequences: a 7-year follow-up study. Br J Dermatol 2014; 171:1428-33. [DOI: 10.1111/bjd.13371] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A.H. Petersen
- National Allergy Research Centre; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
| | - M. Hald
- Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; Kildegaardsvej 28 DK-2900 Hellerup Denmark
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Choi YY, Kim MH, Lee JY, Hong J, Kim SH, Yang WM. Topical application of Kochia scoparia inhibits the development of contact dermatitis in mice. JOURNAL OF ETHNOPHARMACOLOGY 2014; 154:380-385. [PMID: 24751363 DOI: 10.1016/j.jep.2014.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 03/04/2014] [Accepted: 04/04/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Kochia scoparia (Chenopodiaceae) has been reported to have anti-nociceptive, anti-inflammatory, anti-allergic, and anti-pruritic actions. This study investigated the anti-inflammatory effects of externally applied Kochia scoparia water extract (KSW) in 2,4-dinitrochlorobenzene (DNCB)-induced contact dermatitis mouse model. MATERIALS AND METHODS To develop atopic dermatitis-like skin lesions, 100μL of 1% DNCB in acetone/olive oil (4:1) had been applied for three days on shaved dorsal skin. 1% KSW was topically applied to DNCB-induced mice. After KSW treatment, histological analysis was measured by hematoxylin eosin staining. The cytokine and pro-inflammatory expressions were examined using reverse transcription polymerase chain reaction and western blotting analysis. RESULTS Histological studies showed that hyperplasia of the epidermis and dermis in the KSW treated group was markedly decreased as compared with the DNCB group. The expression levels of pro-inflammatory cytokine such as IL-1β, and TNF-α mRNA were significantly reduced by topical application of KSW, whereas these cytokines were increased in DNCB-induced dorsal skin. In addition, NF-κB expression was inhibited by KSW treatment in DNCB-induced mice. Similarly, KSW treatment significantly suppressed the expression of several MAP kinases, including ERK1/2, p38, and JNK compared to their expression in DNCB-induced mice. CONCLUSIONS These findings indicated that KSW ameliorates contact dermatitis via inhibition of the production of several inflammatory mediators. Therefore, external application of KSW may be used for the treatment of contact dermatitis as an alternative therapy.
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Affiliation(s)
- You Yeon Choi
- College of Korean Medicine and Institute of Korean Medicine, Kyung Hee University, Seoul 130-701, South Korea
| | - Mi Hye Kim
- College of Korean Medicine and Institute of Korean Medicine, Kyung Hee University, Seoul 130-701, South Korea
| | - Ji Ye Lee
- College of Pharmacy, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Jongki Hong
- College of Pharmacy, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Sung-Hoon Kim
- Cancer Preventive Material Development Research Center, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Woong Mo Yang
- College of Korean Medicine and Institute of Korean Medicine, Kyung Hee University, Seoul 130-701, South Korea.
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21
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Holness DL. Occupational skin allergies: testing and treatment (the case of occupational allergic contact dermatitis). Curr Allergy Asthma Rep 2014; 14:410. [PMID: 24408535 DOI: 10.1007/s11882-013-0410-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Occupational contact dermatitis, including occupational allergic contact dermatitis, is one of the most common occupational diseases. Making a timely and accurate diagnosis is important to improving the outcome. Taking a work history and patch testing are essential elements in the diagnostic process. Management, based on an accurate diagnosis, must include both medical treatment to address the disease and workplace modifications as appropriate to reduce exposure the causative agents.
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Affiliation(s)
- D Linn Holness
- Department of Occupational and Environmental Health, St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada,
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22
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Evaluation of structured patient education in occupational skin diseases: a systematic assessment of the disease-specific knowledge. Int Arch Occup Environ Health 2014; 87:861-9. [DOI: 10.1007/s00420-014-0926-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
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23
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Landeck L, Visser M, Skudlik C, Brans R, Kezic S, John SM. Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy. Br J Dermatol 2013; 167:1302-9. [PMID: 22962861 DOI: 10.1111/bjd.12035] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Filaggrin loss-of-function mutations and atopy may alter the clinical course of irritant contact dermatitis (ICD). OBJECTIVE To investigate the clinical course of patients with occupational ICD according to loss-of-function mutations in the filaggrin gene (FLG) and atopy. METHODS In a prospective cohort study, the clinical course, use of topical corticosteroids, sick leave, recovery rate and job continuation were investigated in 459 inpatients treated for occupational ICD of the hands. Patients were genotyped for four FLG mutations, examined for atopy and followed for up to 3 years after discharge. RESULTS Our study included 327 (71·2%) atopic individuals and 132 nonatopic individuals. Overall, 68 patients showed a mutation in the FLG alleles R501X, R2447X, S3247X and 2282del4 (60 atopic and eight nonatopic). Nonatopic patients with ICD responded well to therapeutic approaches, while atopy status made subjects more resistant to therapy, resulting in lower rates of recovery and job continuation and higher use of topical corticosteroids. Carriage of FLG loss-of-function mutations in combination with atopy worsened the course. The risk of abandoning one's profession in this group was significantly increased when compared with 'pure' ICD (odds ratio 3·1) after 3 years. CONCLUSIONS Patients with atopy are a special risk population for ICD. In the presence of atopy, FLG mutations seem to be a modifier of the severity of the clinical course in ICD. Early-stage identification of this subgroup may result in additional emphasis to these patients regarding the importance of adherence to specific therapeutic interventions.
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Affiliation(s)
- L Landeck
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.
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Landeck L, Visser M, Kezic S, John SM. Impact of tumour necrosis factor-α polymorphisms on irritant contact dermatitis. Contact Dermatitis 2012; 66:221-7. [PMID: 22404198 DOI: 10.1111/j.1600-0536.2011.02045.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Genetic variations in genes coding for cytokines involved in skin inflammation may alter their expression, thus changing the susceptibility to irritant contact dermatitis (ICD). OBJECTIVES To determine the prevalence of polymorphisms in the cytokine genes TNFA-238 and TNFA-308 in patients with occupational ICD, and to compare it with that in controls. METHODS In a case-control study, 478 patients with occupational ICD of the hands were genotyped for TNFA-238 and TNFA-308 polymorphisms. The results were compared with those for 393 apprentices from the same high-risk occupations (controls). RESULTS For a carrier of a variant TNFA-238A allele, the odds ratio (OR) of acquiring ICD was 0.57 [95% confidence interval (CI) 0.34-0.97], suggesting a protective effect of the A allele. The genotype distributions were 94.4% wild type (G/G), 5.6% heterozygous (G/A) and 0% homozygous for variant allele (A/A) in patients, and 90.9%, 8.5%, and 0.6%, respectively in controls. In contrast, carriers of the variant TNFA-308A allele had an increased risk of ICD [OR 1.33; 95% CI 1.05-1.74; G/G 66.4%, G/A 31.2%, and A/A 2.4% (patients) versus 73.5%, 24.6%, 1.9% in controls]. CONCLUSIONS Individuals with a TNFA-238 polymorphism are less prone and those with a TNFA-308 polymorphism are more prone to develop ICD of the hands, suggesting a protective versus a detrimental effect of the A allele respectively.
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Affiliation(s)
- Lilla Landeck
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, 49090 Osnabrück, Germany.
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Visscher MO, Randall Wickett R. Hand hygiene compliance and irritant dermatitis: a juxtaposition of healthcare issues. Int J Cosmet Sci 2012; 34:402-15. [DOI: 10.1111/j.1468-2494.2012.00733.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/05/2012] [Indexed: 12/14/2022]
Affiliation(s)
| | - R. Randall Wickett
- The James L. Winkle College of Pharmacy; University of Cincinnati; Cincinnati; OH; 45267; U.S.A
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27
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Wilke A, Gediga G, Schlesinger T, John SM, Wulfhorst B. Sustainability of interdisciplinary secondary prevention in patients with occupational hand eczema: a 5-year follow-up survey. Contact Dermatitis 2012; 67:208-16. [DOI: 10.1111/j.1600-0536.2012.02132.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schnuch A, Geier J, Lessmann H, Arnold R, Uter W. Surveillance of contact allergies: methods and results of the Information Network of Departments of Dermatology (IVDK). Allergy 2012; 67:847-57. [PMID: 22563651 DOI: 10.1111/j.1398-9995.2012.02834.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2012] [Indexed: 11/28/2022]
Abstract
Contact allergy (CA) surveillance networks provide information to a multitude of stakeholders, which is indispensable for evidence-based decision-making in the field of prevention. Methods and results of the German surveillance system on CA are reviewed and discussed with reference to other systems. The German network structure comprises 56 departments of dermatology and includes all patients who are patch-tested for suspected CA. Data analysis considers the results of patch testing and further pertinent information for each patient. Following aspects are addressed: (i) the description of the clinical population, (ii) evaluation of patch test reactions, (iii) relationship between patch test results and population characteristics. Trend analyses on chromate (decreasing), epoxy resin (increasing) and nickel (heterogeneous) served as examples for surveillance system analyses, with the identification of sentinel events, as well as proof of success or failure of prevention. In addition, external data sources can be used such as sales data of patch test preparations to estimate frequencies of sensitization on a population level. National prescription data of drugs and statistics of labelling of preservatives on cosmetics can be included, the latter two approaches allowing for risk estimates conferred by specific allergens.
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Affiliation(s)
- A. Schnuch
- Information Network of Departments of Dermatology; University of Göttingen; Göttingen; Germany
| | - J. Geier
- Information Network of Departments of Dermatology; University of Göttingen; Göttingen; Germany
| | - H. Lessmann
- Information Network of Departments of Dermatology; University of Göttingen; Göttingen; Germany
| | - R. Arnold
- Information Network of Departments of Dermatology; University of Göttingen; Göttingen; Germany
| | - W. Uter
- Department of Medical Informatics, Biometry and Epidemiology; University Erlangen-Nürnberg; Erlangen; Germany
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Wilke A, Gediga K, Weinhöppel U, John SM, Wulfhorst B. Long-term effectiveness of secondary prevention in geriatric nurses with occupational hand eczema: the challenge of a controlled study design. Contact Dermatitis 2011; 66:79-86. [DOI: 10.1111/j.1600-0536.2011.01976.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Duarte I, Rotter A, Lazzarini R. Frequency of occupational contact dermatitis in an ambulatory of dermatologic allergy. An Bras Dermatol 2011; 85:455-9. [PMID: 20944905 DOI: 10.1590/s0365-05962010000400006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 03/19/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Occupational contact dermatitis (OCD) corresponds to 80% of the cases of skin diseases related to work. OBJECTIVES To determine: the frequency of OCD in an ambulatory of allergy not specific for occupational dermatosis; the profile of these patients according to age, gender, color, profession, atopic history, duration and localization of the dermatosis; the diagnosed types of contact dermatitis; the main allergens and to compare the frequency of the main antigens with the results obtained from patients examined in the same period of time, without DCO. METHODS During the three-year period from 2003 to 2006, 630 patients were examined and submitted to a battery of standardized contact patch tests and those who were diagnosed with OCD were selected. RESULTS Sixty-nine out of the 630 patients were diagnosed with OCD. The average age was 44.5 years. Forty-eight patients (70%of the cases) presented the disease on the hands. The most prevalent activities of patients suffering from the disease were household tasks (39%) and building construction (33%). The allergic contact dermatitis (ACD) occurred in 48 cases which represent 70% of the total number of cases and irritant contact dermatitis in 21 cases corresponding to 30% of the total number of cases. The main allergens were potassium dichromate 28 (41%), nickel sulfate 16 (23%) and carba-mix 16 (23%). CONCLUSION OCD was present in 10.9% of the patients. Concerning age the group in which the disease was more commonly found corresponded to the most productive group of the population. ACD corresponded to 48 cases, probably influenced by the long period of evolution of the dermatosis. Metal and rubber chemicals were the commonest allergens.
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Affiliation(s)
- Ida Duarte
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
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31
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Davis JA, Visscher MO, Wickett RR, Hoath SB. Role of TNF-α polymorphism -308 in neurosensory irritation. Int J Cosmet Sci 2011; 33:105-12. [DOI: 10.1111/j.1468-2494.2010.00597.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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32
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van Gils RF, Boot CR, van Gils PF, Bruynzeel D, Coenraads PJ, van Mechelen W, Riphagen II, Anema JR. Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature. Contact Dermatitis 2011; 64:63-72. [DOI: 10.1111/j.1600-0536.2010.01825.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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34
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Hald M, Agner T, Blands J, Johansen J. Delay in medical attention to hand eczema: a follow-up study. Br J Dermatol 2009; 161:1294-300. [DOI: 10.1111/j.1365-2133.2009.09402.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Carlsen BC, Andersen KE, Menné T, Johansen JD. Characterization of the polysensitized patient: a matched case-control study. Contact Dermatitis 2009; 61:22-30. [PMID: 19659961 DOI: 10.1111/j.1600-0536.2009.01573.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Polysensitization ( >or= 3 contact allergies) may be regarded as a special entity in patients with contact allergies. However, this group of polysensitized patients is poorly characterized. Filaggrin mutations are associated with atopic eczema and lead to impaired skin barrier which may predispose to contact allergy. Therefore, it is of interest to consider atopic eczema and contact allergies, especially in patients with multiple allergies. OBJECTIVE To characterize polysensitized patients regarding occurrence, duration and course of dermatitis, and examine potential risk factors for polysensitization, including atopic eczema. METHODS A questionnaire case-control study of 562 polysensitized and 1124 single/double-sensitized individuals was performed. RESULTS The results show that 45% of polysensitized and 31% of single/double-sensitized patients had or had had atopic eczema, and atopic eczema was identified as a risk factor for polysensitization. Patients with leg ulcer constituted only a minor part of the polysensitized group and leg ulcers were not identified as a risk factor for polysensitization in this study. The influence of contact allergies on duration and course of disease diverged between the group of patients with atopic eczema and the group without atopic eczema. CONCLUSION Patients with atopic eczema were overrepresented in the group of polysensitized patients and polysensitized patients should be viewed in the light of occurrence or lack of atopic eczema.
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Affiliation(s)
- Berit Christina Carlsen
- Department of Dermatology and Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, 2900 Hellerup, Denmark.
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Kezic S, Visser MJ, Verberk MM. Individual susceptibility to occupational contact dermatitis. INDUSTRIAL HEALTH 2009; 47:469-478. [PMID: 19834255 DOI: 10.2486/indhealth.47.469] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Occupational Contact Dermatitis (OCD) is one of the most common work-related diseases. High risk occupations are in health care, hairdressing, food sector and metal industry. OCD tends to become chronic; persistent OCD often results in impaired quality of life and loss of work ability. The purpose of this article is to review the present knowledge on the factors which determine individual susceptibility to acquire OCD. Recent discoveries regarding genes involved in the skin barrier, inflammatory response and biotransformation of xenobiotics provide more insight in the individual susceptibility for OCD. Knowledge of the factors which predispose to OCD is useful in occupational health practice for the application of preventive measures and for career guidance for apprentices and workers in high risk occupations.
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Affiliation(s)
- Sanja Kezic
- Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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Hald M, Agner T, Blands J, Ravn H, Johansen JD. Allergens associated with severe symptoms of hand eczema and a poor prognosis. Contact Dermatitis 2009; 61:101-8. [DOI: 10.1111/j.1600-0536.2009.01577.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Hald M, Agner T, Blands J, Veien N, Laurberg G, Avnstorp C, Menné T, Kaaber K, Kristensen B, Kristensen O, Andersen K, Paulsen E, Thormann J, Sommerlund M, Nielsen N, Johansen J. Clinical severity and prognosis of hand eczema. Br J Dermatol 2009; 160:1229-36. [DOI: 10.1111/j.1365-2133.2009.09139.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Apfelbacher CJ, Soder S, Diepgen TL, Weisshaar E. The impact of measures for secondary individual prevention of work-related skin diseases in health care workers: 1-year follow-up study. Contact Dermatitis 2009; 60:144-9. [DOI: 10.1111/j.1600-0536.2008.01505.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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41
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Apfelbacher CJ, Radulescu M, Diepgen TL, Funke U. Occurrence and prognosis of hand eczema in the car industry: results from the PACO follow-up study (PACO II). Contact Dermatitis 2008; 58:322-9. [DOI: 10.1111/j.1600-0536.2008.01329.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Genetic factors presumably play a role in contact allergy (CA). There is, however, a lack of conclusive evidence from clinical studies. This may be on account of the strongly competing or modifying impact of exogenous factors, namely the potency of allergens and the intensity of exposure, and the fact that - in principle - everybody can be sensitized. Regarding phenotype, in contrast, polysensitization (PS) seems to indicate a subset of individuals at greater risk. In human sensitization experiments with dinitrochlorobenzene, induction was facilitated in PS, and elicitation enhanced. Recent clinical epidemiological data, taking confounders for PS, such as age, sex, and other skin diseases into account, demonstrated the following: (i) PS was the greatest risk factor to be sensitized to a number of (even weak) index allergens, indicating higher susceptibility on the level of induction; (ii) patch test reactions in PS patients were generally stronger indicating higher susceptibility on the level of elicitation. These findings are complemented by reports on polymorphisms of TNF-alpha and IL-16 in PS patients. Future studies on the genetics of CA should be performed in subgroups with PS, focussing on polymorphisms relevant for CA-specific and nonspecific (inflammatory) processes.
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Affiliation(s)
- A Schnuch
- Center of the Information Network of Department of Dermatology, Institute at University of Göttingen, Göttingen, Germany
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43
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Li LF, Liu G, Wang J. Etiology and prognosis of hand eczema in a dermatology clinic in China: a follow-up study. Contact Dermatitis 2007; 58:88-92. [DOI: 10.1111/j.1600-0536.2007.01260.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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44
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Keegel T, Erbas B, Cahill J, Noonan A, Dharmage S, Nixon R. Occupational contact dermatitis in Australia: diagnostic and management practices, and severity of worker impairment. Contact Dermatitis 2007; 56:318-24. [PMID: 17577372 DOI: 10.1111/j.1600-0536.2007.01114.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
The aims of this study were to compare treatment and referral practices between general practitioners (GPs) and dermatologists and to evaluate predictors for occupational contact dermatitis (OCD) disease severity measured in terms of worker impairment. Data were collected from 181 patients recruited for a larger study of OCD. Information about treatment recommendations and usual referral practices are reported for 123 patients. Data from patients, diagnosed with work-related skin disease, were modelled for severity of worker impairment. GPs were more likely to treat a patient independently, referring if the patient did not improve, whereas dermatologists were more likely to refer for patch testing on initial presentation. Dermatologists were more likely to recommend gloves and GPs were more likely to recommend soap avoidance/substitution. 2 GPs and no dermatologists reported recommending the best practice combination of moisturizers, topical corticosteroids and soap substitutes. When adjusted for all variables including age, sex, duration and diagnostic subgroup, workers with atopy as a cofactor had the most severe impairment. This study suggests that in Australia, patients with suspected OCD are initially managed within general practice, few clinicians recommend best practice treatments for OCD, and that atopy is associated with severity. These findings have implications for health resource allocation, clinician education, and the pre-employment counselling of atopic patients.
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Affiliation(s)
- Tessa Keegel
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Melbourne, Australia
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45
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Abstract
The aim of this study was to investigate the occurrence of hand eczema after 20 years in women patch tested to nickel during childhood. In 1982-1983, 960 schoolgirls were patch tested for nickel allergy; its prevalence was found to be 9%. 20 years later, the same individuals received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. 735 of 908 women (80.9%) answered the questionnaire. In total, 17.6% of respondents reported hand eczema after the age of 15 years, and the 1-year prevalence was 12.8%. There was no statistically significant difference in the occurrence of hand eczema between the groups who had previously tested positive and negative for nickel allergy. 38.3% of the respondents considered themselves to be nickel sensitive at the time they answered the questionnaire; in this group, the reported prevalence of hand eczema after age 15 was 22.5%. 31.4% of those with a history of atopic dermatitis reported hand eczema after age 15, compared with 10.6% of those without (P < 0.001). In conclusion, contact allergy to nickel in childhood did not seem to increase the prevalence of hand eczema later in life.
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Affiliation(s)
- Anna Josefson
- Department of Dermatology, Orebro University Hospital, 701 85 Orebro, Sweden.
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46
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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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Nixon R, Roberts H, Frowen K, Sim M. Knowledge of skin hazards and the use of gloves by Australian hairdressing students and practising hairdressers. Contact Dermatitis 2006; 54:112-6. [PMID: 16487284 DOI: 10.1111/j.0105-1873.2006.00790.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: 11/29/2022]
Abstract
Occupational contact dermatitis is common amongst hairdressers. In this population-based study, 193 trainee hairdressers and 184 practising hairdressers completed a questionnaire detailing their knowledge of skin hazards, the skills they practised and the frequency of glove use. Knowledge of skin hazards was poor in both groups. While up to 70% of participants correctly identified hairdressing chemicals as potential skin hazards, less than 15% correctly identified the role of wet work. Only a small proportion recognized that hairdressing chemicals could cause allergy. Contrary to findings elsewhere, less-experienced hairdressers often handled chemicals, particularly hair dyes containing p-phenylene diamine. The use of gloves was inadequate, particularly when performing work at the basin, which both junior and senior hairdressers did on a regular basis. Recommended strategies for the prevention of hand dermatitis in hairdressers include improved student education, appropriate glove use and the application of after-work moisturizing creams.
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Affiliation(s)
- Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation, Monash University, Melbourne, Victoria, Australia.
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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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