Occupational skin disease in the construction industry

Causal associations between fluid intake patterns and dermatitis risk: a Mendelian randomization study

Background

Dermatitis is one of the most common skin disorders across the world. Atopic dermatitis (AD) and contact dermatitis (CD) are its two primary types. Few studies have focused on the causal relationship between fluid intake and dermatitis. With an Mendelian Randomization (MR), this study investigated the potential causal effects of alcohol, coffee, tea, and water intake on the risk of AD and CD.

Methods

Utilizing genetic variants as instrumental variables (IVs), a two-sample MR analysis was implemented based on data from the UK Biobank and FinnGen r9 consortium. Fluid intake was categorized into alcohol, coffee, tea, and water intake. Causal estimates were analyzed through Inverse Variance Weighted (IVW), MR-Egger, and weighted median methods. Cochran's Q, MR-Egger intercept, and MR-PRESSO tests were conducted to assess potential heterogeneity and pleiotropy.

Results

Water intake exhibited a significant causal effect on raised CD risk (IVW OR = 2.92, 95% CI: 1.58-5.41, p = <0.01). Coffee intake was associated with increased CD risk (IVW OR = 2.16, 95% CI: 1.19-3.91, p = 0.01). Conversely, tea intake demonstrated a protective effect on AD risk (IVW OR = 0.71, 95% CI: 0.56-0.91, p = <0.01).

Conclusion

This MR study suggests a potential association where water and coffee intake may be linked to an elevated risk of CD, while tea intake may potentially have a mitigating effect on AD risk. Modifying fluid intake patterns could be a targeted approach for dermatitis prevention, emphasizing the need for additional longitudinal studies to validate and expand upon these findings.

Toll-Like Receptors and Contact Dermatitis

Contact dermatitis (CD) is a common cutaneous inflammatory condition that affects millions of people worldwide. Xenobiotic agents are frequently encountered in substances used in everyday life, making it difficult to avoid personal and occupational exposure. Toll-like receptors (TLRs) are transmembrane receptors that modulate the innate immune system in response to tissue injury or infection. TLRs play a key role in the pathophysiology of contact dermatitis. TLR signaling is involved in three major forms of CD: protein CD, allergic contact dermatitis (ACD), and irritant CD. Of the 10 TLRs found in humans, three play an important role in ACD. This makes TLRs a useful potential therapeutic target to consider against CD. In this review, we discuss the role of TLRs in CD and summarize current and emerging treatments for CD that target TLRs.

Metal reactivity is present in dogs with tibial plateau leveling osteotomy and total hip replacement implants

OBJECTIVE

Determine whether dogs with well-functioning orthopedic metal implants can develop metal reactivity.

SAMPLE

Client-owned dogs that had tibial plateau leveling osteotomy (TPLO) or total hip replacement (THR) implants for 12 months or more and control dogs with no implants.

PROCEDURES

Lymphocyte transformation testing was performed by exposing peripheral blood lymphocytes to nickel (Ni), chromium (Cr), cobalt (Co), or a combination of these metals. Lymphocyte proliferation was assessed with flow cytometry. Lymphocyte stimulation indexes (SIs) were calculated. A SI > 2 was considered reactive. Median SIs of dogs in response to metal exposure were compared statistically.

RESULTS

Samples from 10 dogs with TPLO, 12 dogs with THR, and 7 control dogs were analyzed. Six dogs out of 22 with metal implants had a reactive SI to 1 or more metals, while 2 of 7 control dogs had a SI > 2 when exposed to nickel only. When all metals were considered, no differences in metal reactivity were found between TPLO, THR, and control groups.

CLINICAL RELEVANCE

Metal reactivity is present in dogs and can be identified using lymphocyte transformation testing. Reactivity to Ni is present in dogs with and without metal implants. Reactivity to Co and Cr occurs in some dogs with metal implants.

Occupational Skin Diseases among Building Construction Workers in Dar es Salaam, Tanzania

Background:

Amongst established growing industries worldwide, the construction industry contributes about 7.5% of the world labor force and 16.4% of global occupational diseases and accidents. A variety of activities are practiced in construction work, such as masonry, painting, welding, carpentry, plastering, concrete and cement mixing. These may eventually lead to exposures that can subject the workers to risks of developing occupational skin diseases. Most studies done on the construction industry in Tanzania have focused on effects such as injuries, respiratory problems and ergonomics; very little research has been done on skin diseases.

Objectives:

The study aimed at assessing the prevalence of occupational skin diseases, associated factors and preventive measures among building construction workers in Dar es Salaam, Tanzania.

Methods:

Construction sites and participants were selected using simple random sampling. The Nordic Occupational Skin Questionnaire (NOSQ) was adapted and used for assessing the development of skin diseases among constructions workers. Analysis of categorical variables, associated factors and skin preventive measures was done using Chi-square tests. Bivariate and multivariate logistic regression analyses were performed to determine odds ratio and adjusted odds ratio for factors indicating an influence on the occurrence of skin diseases.

Findings:

The study consisted of 420 building construction workers from different sites with a mean age of 32.7 years. The participants were masons, assistant masons and carpenters. The mean work duration was 6 years. Occupational Skin diseases were prevalent in 228 (54%) workers. Carpenters had a higher prevalence of skin diseases 12(67%), followed by assistant masons 43 (64%). Timely provision of safety trainings and of PPE utility, training and guidance lowered the occurrence of skin diseases.

Conclusion:

A high number of construction workers experienced skin diseases, especially those who have worked for more than 4 years. Workers who received safety training before the work shift had lesser prevalence of skin diseases compared to those who did not. Receiving proper information on PPE usage and proper wearing of gloves had a protective effect.

Occupational contact allergy of construction workers in Greece: Trends during 2009-2018

BACKGROUND

Recent trends in the sensitization of construction workers show a decrease in potassium dichromate and an increase in epoxy resin sensitization.

OBJECTIVES

To present the trends of occupational contact allergy of construction workers in Greece from 2009 to 2018.

METHODS

We retrospectively reviewed the files of patients with eczema patch tested in our Contact Dermatitis Clinic who were construction workers.

RESULTS

A total of 191 construction workers initially reported contact dermatitis. Of these, 138 had occupation-relevant allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD). All patients were men. After being patch tested, 98 (71.0%) were diagnosed with ACD and 40 with ICD. Median duration of occupation till onset of ACD was 2 years (interquartile range [IQR] 0.8-7). The hands were the most common location for ACD (73.5%), followed by the trunk (39.8%), the legs (38.8%), and the face (11.2%). Of the patients, 74.6% had lesions affecting multiple body sites. Potassium dichromate (67%) was the most frequent allergen, followed by thiuram mix (37.4%) and cobalt chloride (31.8%). Sensitization to epoxy resins was lower (12.1%).

CONCLUSION

The sensitization pattern of Greek construction workers does not follow the trends in Central or Northern Europe, rather sharing attributes with less industrialized countries.

Clinical, Occupational and Allergological Profile of 455 Patients with Occupational Contact Dermatitis: A 5-Year Study from a Tertiary Care Center of North India

Objectives:

To evaluate clinical and occupational profile and common allergens in patients with occupational contact dermatitis (OCD).

Materials and Methods:

The records of 455 (M:F 2:1) patients aged 18-85 years with allergic contact dermatitis were analyzed retrospectively. The diagnosis of OCD and patterns of dermatitis were defined by standard criteria. Indian standard series comprising 20 allergens and when suspected patient's own products were patch tested by Finn chamber method as per European Society of Contact Dermatitis guidelines and relevance of positive results was defined clinically.

Results:

Airborne contact dermatitis (27.7%), acral dermatitis (14.1%), hand dermatitis (12.9%), acrofacial dermatitis (12.7%), and facial dermatitis (10.5%) were the common patterns. Agriculturists (51.2%), homemakers (27.9%), office workers (24.6%), and construction workers (4.6%) comprised the majority. Positive patch test results in 58% cases were from parthenium (31.7%), p-paraphenylenediamine (PPD) (22.9%), nickel (16%), fragrance mix (11%), potassium dichromate (10.7%), cobalt (7.6%), and mercaptobenzothiazole (4.9%). Hair colorants, shoe chips, and shaving cream also produced relevant positive reactions. Parthenium, PPD, fragrance mix, and potassium dichromate in agriculturists; nickel, parthenium, PPD, fragrance mix, and potassium dichromate in women, and potassium dichromate and parthenium in construction workers elicited the most positive reactions. PPD and hair colorants elicited positive reaction mainly in office workers.

Conclusions:

The agriculturists, homemakers, and construction workers have OCD most frequently. Parthenium in farmers, potassium dichromate in construction workers, nickel in women, and PPD in office workers were the major contact allergens. The study is limited by its retrospective design, small number of patients, and limited number of patch test allergens.

Occupational allergic contact dermatitis: A 24-year, retrospective cohort study from Turkey

BACKGROUND

Limited data exist on occupational allergic contact dermatitis (OACD) in Turkey.

OBJECTIVES

To investigate the epidemiologic profile of OACD in Turkey.

METHODS

A retrospective cohort study on 294 patients with OACD among 2801 consecutively patch-tested patients in the Allergy Unit of the Dermatology Department of İstanbul Faculty of Medicine between 1996 and 2019.

RESULTS

The overall prevalence of OACD was 10.5%, showing a male predominance. OACD was most frequently seen in construction workers (45.2%), followed by hairdressers, metalworkers, health care workers, and miscellaneous. The main relevant allergens were chromium in cement, thiurams in rubber gloves, hairdressing chemicals, resins/glues/plastics, metals, isothiazolinones, and fragrances. Hands were the mainly involved site (95.6%). Airborne eczema was observed in 21.4%. Hand and foot eczema and co-sensitizations to chrome and thiuram and chrome and cobalt were significantly associated with being a construction worker. Sensitizations to isothiazolinones in house painters, ammonium persulfate and p-phenylenediamine in hairdressers, and colophonium increased after 2010.

CONCLUSION

This was the largest group of data on OACD from Turkey, reflecting the importance of rubber glove allergy in all occupations and the striking increase in ammonium persulfate allergy among hairdressers. Chrome and cobalt were still the main cement allergens in Turkey, where the cement directive is not yet in force.

Heavy metals and the skin: Sensitization patterns in Lithuanian metalworkers

BACKGROUND

Metalworkers are exposed to many sensitizing and irritant substances. There are no published data on contact allergy in this population in the Baltic countries.

OBJECTIVES

To detect skin symptoms related to occupational exposure and to describe the reactivity pattern to the European baseline series in workers from two metal plants in Lithuania.

METHODS

In this cross-sectional study 185 metalworkers (154 production workers and 31 office staff) filled an interviewer-administered questionnaire. Patch testing was performed in 135 metalworkers and office staff, as a control group.

RESULTS

Metalworkers younger than 40 years complained statistically significantly more often of skin symptoms, especially on the hands and face, than older workers. Physician-diagnosed skin diseases were reported in 1.7% of cases. Metalworkers, working <20 years in the factory, more often had skin symptoms. Contact with chemicals at the workplace was suspected as the main factor provoking skin symptoms. Metalworkers were sensitized mainly to cobalt, and nickel was the most prevalent allergen among office staff.

CONCLUSION

Younger metalworkers more often had skin symptoms suspected of being work-related compared to older ones. Sensitization to cobalt was more prevalent in the metalworkers than in the control group.

Trace elements and oxidative stress status in patients with psoriasis

Introduction

Psoriasis is a common, inflammatory skin disease of which etiopathogenesis is still not explained clearly, however in which trace elements and oxidative stress are considered to play a role.

Aim

To evaluate the serum trace element and oxidative stress levels in patients diagnosed with psoriasis.

Material and methods

A total of 87 psoriasis patients and 60 healthy subjects were included in the study. Serum sodium (Na), potassium (K), calcium (Ca), phosphorus (P), magnesium (Mg), iron (Fe), selenium (Se), zinc (Zn), copper (Cu) levels, oxidative stress parameters, ischemia-modified albumin (IMA), catalase (CAT), myeloperoxidase (MPO) and ferroxidase (FOX) activity and an inflammatory marker, C-reactive protein (CRP), were examined in all participants.

Results

IMA, IMA/Albumin (IMA/Alb), CAT, Cu, FOX and CRP levels were found to be significantly higher; Se, Zn and albumin levels were significantly lower in the patient group as compared to the control group. No significant difference was found between groups with regard to Na, K, Ca, P, Mg, Fe and MPO levels.

Conclusions

Some trace element levels and oxidant-antioxidant balance were changed in psoriasis patients.

Evaluate the effect of cadmium on levels of zinc in scalp hair and blood samples of smoker and nonsmoker psoriatic patients at different stage

Psoriasis, a skin inflammatory disease, originates from dysregulated interactions of the immune system and environmental factors. In the present study, cadmium (Cd) and zinc (Zn) were analyzed in biological samples (blood and scalp hair) of smoker and nonsmoker males who have mild and severe psoriasis. The patients were evaluated according to criteria based on the standard clinical diagnosis and classified into mild and severe psoriasis groups using the Psoriasis Area Severity Index (PASI) score. Both elements were determined by atomic absorption spectrometry after matrix oxidation. In smoker psoriatic patients, the level of Cd in biological samples was significantly increased. The Zn was significantly decreased in smoker mild and severe psoriatic patients as related to nonsmokers' referents and patients. The resulted data indicated that the levels of Zn in smoker referents were about 5.0% lower than nonsmoker's referents. While the concentrations of Zn in blood samples of nonsmoker's mild and severe psoriatic patients have 17.8 to 33.3% lower than nonsmoker's referents. The results indicate that the level of Cd in blood samples of referent smokers has ≥ 25% than nonsmokers, whereas the psoriatic patients at different stages have two- to threefold higher Cd in both biological samples.

FAKTOR YANG BERHUBUNGAN DENGAN DERMATITIS KONTAK AKIBAT KERJA PADA PEKERJA PROYEK BANDARA

The incidence of contact dermatitis in Indonesia varies greatly and affects most workers. Epidemiological studied showed the incidence of Occupational Contact Dermatitis (OCD) was 0.5–1.9 cases/1000 workers/year. Aircarft Filling Depot Project at Juanda Airport is a construction project that is working on hydrant system and topping up development. This study was aimed at identifying risk factors of OCD among the project workers. A cross sectional design was used on 47 workers whom randomly selected during period May-June 2017. Data was collected using a questionnaire with the researcher’s guide. Occupational Contact Dermatitis is diagnosed by general practitioner that located in Naval Hospital (RUMKITAL) dr. Soekantyo Jahja Surabaya. Occupational contact dermatitis risk factors were analyzed using Chi-square test, followed by multiple logistic regression test. Of 47 workers, 21 (43.8%) experienced OCD. The use of personal protective equipment (PPE), duration of contact, personal hygiene, and history of skin diseases were associated with OCD (p < 0.01), whereas the type of work was not related to OCD (p = 0.491). The most dominant factor causing OCD was personal hygiene (OR = 9.659), followed by duration of contact (OR = 8.576), and history of skin disease (OR = 3.420). In conclusion, factors of use of PPE, length of contact, personal hygiene, and history of skin relationship with DKAK, while the type of work is not related to DKAKKeywords: aircraft filling depots project, occupational contact dermatitis, risk factor

Chromium(III), chromium(VI) and cobalt release from leathers produced in Nicaragua

BACKGROUND

Leather exposure has been associated with chromium (Cr) and cobalt (Co) contact dermatitis. Cr(VI) in leather is now restricted to <3 mg/kg in the EU. Cr(III) is not restricted.

OBJECTIVES

To analyse 29 differently coloured Cr-tanned leather samples from two Nicaraguan tanneries, and to compare their release of Cr, Cr(VI) and Co with that of leathers produced in Europe.

METHODS

Cr, Cr(VI) and Co were extracted in phosphate buffer for 3 hours at 25°C according to EN ISO 17075. Atomic absorption spectroscopy and spectrophotometry were used for detection of the metals in phosphate buffer.

RESULTS

There was no difference in total Cr or Cr(VI) release between European and Nicaraguan leathers. There was no association between Cr(VI) and total Cr release. Co was released primarily from leathers of one tannery. Cr(III) was released in significantly higher amounts than Cr(VI).

CONCLUSIONS

Future investigations and regulations should focus on Cr(III) and Co as well as on Cr(VI).

Prevalence of self-reported work-related illness and injuries among building construction workers, Shiraz, Iran

The construction industry is one of the largest and most hazardous industries in the world, which has a direct role in the development of countries. The purpose of this study was to investigate the prevalence of self-reported work-related illness and injuries among construction workers in Shiraz, Iran. 850 randomly selected workers from 2450 construction sites completed a self-statement questionnaire regarding the prevalence of self-reported work-related illness and injuries (WRIIs), in Shiraz, Iran. The association of WRII with demographic variables were studied. The overall prevalence rate of occupational injuries was 31 %. Musculoskeletal disorders (53.3 %), eye diseases (34.1 %) and skin diseases (30.1 %) have been the most prevalent work-related illnesses among construction workers, respectively. The prevalence of WRIIs among construction workers was significantly associated with age, education, marriage, work experience, safety training programs and number of workers in the workplace as well as employment status. Considering the high prevalence of WRIIs among construction workers, more stringent occupational safety and health interventions are recommended in construction workplaces.

Cement-Induced Chromate Occupational Allergic Contact Dermatitis

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.

Concentration of selenium, zinc, copper, Cu/Zn ratio, total antioxidant status and c-reactive protein in the serum of patients with psoriasis treated by narrow-band ultraviolet B phototherapy: A case-control study

BACKGROUND

Psoriasis is a common, an inflammatory skin disease. Trace elements may play an active role in the pathogenesis of psoriasis.

OBJECTIVE

The aim of this study was to estimate the concentration of selenium (Se), zinc (Zn), copper (Cu) and Cu/Zn ratio as well as total antioxidant status (TAS) and c-reactive protein (CRP) in the serum of patients with psoriasis.

METHODS

In this case-control study sixty patients with psoriasis and fifty-eight healthy people were examined. Serum levels of Se, Zn and Cu were determined by atomic absorption spectrometry. Cu/Zn ratio was calculated. TAS was measured spectrophotometrically. CRP was analyzed by immunoturbidimetric method. Clinical activity of psoriasis was evaluated using Psoriasis Area and Severity Index (PASI).

RESULTS

Serum concentration of Se in patients with psoriasis (71.89±16.90μg/L) was lower as compared to the control group (79.42±18.97μg/L) and after NB-UVB. Cu level of patients was higher (1.151±0.320mg/L) as compared to controls (1.038±0.336mg/L), but Zn level did not differ. We observed higher Cu/Zn ratio (p<0.05) in examined patients than in the control group and after NB-UVB. We found decrease TAS before and after NB-UVB. CRP levels was found to be normal range. A significant correlation coefficient between CRP and Cu/Zn was observed.

CONCLUSIONS

The study showed some disturbances in the serum levels of trace elements and TAS in psoriatic patients.

Occupational contact allergy in bricklayers, tile setters etc. - Current spectrum of sensitization and recent time trends

Background: Occupational exposure of bricklayers, construction workers, tile setters etc. has changed during the last years. For some years now, all manually handled cement in the European Union and in Switzerland is chromate-reduced. Epoxy resin systems are being used in more and more fields of application. Improved worker’s protection, especially wearing protective gloves, is promoted. These changes influence the spectrum of occupational contact sensitization. Objective: Description of the current allergen spectrum in patients working in the building trade who suffer from occupational contact dermatitis. Material and methods: Retrospective analysis of data of the Information Network of Departments of Dermatology (IVDK), 2009 – 2011. Results: During the study period, 245 bricklayers, construction workers, tile setters etc. with occupational dermatitis have been patch tested. Potassium dichromate was the most frequent allergen, yielding 15.1% positive reactions, followed by epoxy resin with 13.7% positive reactions. Beyond that, there were 8 additional components of epoxy resin systems (5 reactive diluents and 3 amine hardeners), as well as 9 rubber ingredients, mainly thiurams, among the 30 most frequent allergens. In the course of time, a decline of chromate sensitization could be noted, paralleled by a decline of cobalt sensitization. In contrast, sensitization to epoxy resin has increased. Conclusion: Thanks to the usage of chromate-reduced cement, chromate sensitization continues to decline in the building trade. The increase of epoxy resin sensitization must prompt intensified prevention efforts. When recommending protective gloves, thiuram-free products should be preferred. The most important allergens are covered by the following test series recommended by the German Contact Dermatitis Research Group (DKG): DKG baseline series, DKG test series “building trade”, DKG rubber series.

Civil construction work: The unseen contributor to the occupational and global disease burden

Background:

Construction industry is the second largest employment giving industry in India with many semi-skilled or unskilled workers taking up the occupation for livelihood without any training and proper guidance.

Aim:

To evaluate the pathogenic association of cement exposure to occupational contact dermatoses as evidenced by immune markers and to correlate their pulmonary functions with years of exposure to cement.

Setting and Design:

This was a cross-sectional study conducted among randomly selected cement workers. Methods and material: Evaluation of socioeconomic status (SES) and years of exposure of cement workers was done using a questionnaire. Clinical examination of skin lesions and strip patch test with application of potassium dichromate on unexposed skin was performed. Results were interpreted after 48 hours. Absolute eosinophil count (AEC) and IgE levels measured, and spirometric evaluation was performed.

Statistical Analysis:

Analysis of variance and Pearson's correlation test were used for data analysis. P < 0.05 was considered to be statistically significant.

Results:

Clinically, skin lesions were noticed in 51%, elevated AEC in 47%, and raised Anti IgE in 73%. Two participants developed positive reactions to the skin strip patch test. Duration of exposure to cement and SES were compared with clinical skin lesions. Spirometry result was normal in 81%, obstruction in 8%, restriction in 10%, and mixed pattern in 1%. Forced expiratory volume at 1.0 second, forced expiratory flow (25–75%), and  (PEFR) Peak Expiratory Flow Rate were markedly reduced with years of exposure. Workers who had greater skin lesions and with increase in exposure had increased AEC and IgE levels, although statistically not significant.

Conclusions:

Exposure to cement and poor SES is strongly correlated to increased prevalence of skin lesions and reduced pulmonary functions.

Chromium-induced skin damage among Taiwanese cement workers

Little research has been done on the relationships between chromium exposure, skin barrier function, and other hygienic habits in cement workers. Our purpose was to investigate chromium-induced skin barrier disruption due to cement exposure among cement workers. One hundred and eight cement workers were recruited in this study. Urinary chromium concentration was used to characterize exposure levels. The biological exposure index was used to separate high and low chromium exposure. Transepidermal water loss (TEWL) was used to assess the skin barrier function. TEWL was significantly increased in workers with high chromium exposure levels than those with low chromium exposure levels ( p = 0.048). A positive correlation was also found between urinary chromium concentration and TEWL ( R = 0.28, p = 0.004). After adjusting for smoking status and glove use, a significant correlation between urinary chromium concentrations and TEWL remained. Moreover, workers who smoked and had a high chromium exposure had significantly increased TEWL compared to nonsmokers with low chromium exposure ( p = 0.01). Skin barrier function of cement workers may have been disrupted by chromium in cement, and smoking might significantly enhance such skin barrier perturbation with chromium exposure. Decreased chromium skin exposure and smoking cessation should be encouraged at work.

Contact dermatitis in the construction industry: the role of filaggrin loss-of-function mutations

BACKGROUND

A high prevalence of contact dermatitis (CD) and respiratory symptoms has been observed in the construction industry, probably due to widespread exposure to irritants and allergens. It is unknown whether carriers of loss-of-function mutations in the gene encoding filaggrin (FLG), a known risk gene for eczema and asthma, are at increased risk.

OBJECTIVES

To investigate associations of FLG mutations with CD and respiratory symptoms in Dutch construction workers.

METHODS

A questionnaire including items on dermal and respiratory symptoms such as wheeze, shortness of breath and asthma was administered to construction workers. Total and specific serum IgE was analysed by enzyme immunoassays. Four FLG loss-of-function mutations were genotyped. CD was diagnosed by a team of a dermatologist and a clinical occupational medicine specialist using photographs of the subjects' hands and self-reported questionnaire data.

RESULTS

Of the 506 participating workers, 6·3% carried at least one FLG mutation. Mild CD was diagnosed by the specialists in 34·0%, and severe CD in an additional 24·3%. CD was considered work related in 282 of 295 subjects (95·6%). Carriers of FLG variants had an increased risk of CD compared with subjects carrying wild-type alleles [mild CD: odds ratio (OR) 5·71, 95% confidence interval (CI) 1·63-20·06; severe CD: OR 8·26, 95% CI 2·32-29·39]. FLG variants and the presence of CD were not associated with respiratory symptoms and atopy.

CONCLUSIONS

Contact dermatitis prevalence in construction workers is high. FLG loss-of-function mutations increase the risk of CD even further. FLG mutations were not associated with respiratory symptoms or atopy.

Hexavalent and trivalent chromium in leather: What should be done?

Trivalent chromium compounds are used for leather tanning, and chromium may be released during use of leather goods. In certain instances, small amounts of hexavalent chromium can be formed and released. Both trivalent and hexavalent chromium can elicit allergic skin reaction in chromium sensitised subjects, the latter being significantly more potent. Induction of sensitisation only occurs after exposure to hexavalent chromium. A minority of subjects are sensitised to chromium, and in a fraction of these subjects allergic skin reaction have been described after wearing leather shoes or, less frequently, other leather goods. The evidence that in all these cases the reaction is related to hexavalent chromium is not always strong. The content of hexavalent chromium in leather is regulated in European Union, but rate of release rather than content is relevant for allergic skin reaction. The role of trivalent chromium appear much less relevant if at all. Modern tanning procedure do not pose significant risk due to either hexavalent or trivalent chromium. Dismissing bad quality and worn-off leather goods is relevant in reducing or eliminating the skin reaction. It should also be pointed out that shoe components or substances other than chromium in leather may cause allergic/irritative skin reactions.

Clinical profile and quality of life of patients with occupational contact dermatitis from New Delhi, India

BACKGROUND

Data regarding occupational contact dermatitis (OCD) and its effect on quality of life (QOL) in India are limited.

OBJECTIVES/AIMS

To evaluate patients with OCD and record the outcome of treatment.

PATIENTS/MATERIALS/METHODS

All patients with OCD were evaluated for severity of disease (by the use of physician global assessment) and its effect on QOL (by use of the Dermatology Life Quality Index) questionnaire) at the first visit and after 3 months of treatment.

RESULTS

Among 117 patients with OCD, hand eczema was present in 81.2%. Positive patch test reactions were found in 76%. The most common allergens were Parthenium hysterophorus and potassium dichromate. The most frequent diagnosis was occupational allergic contact dermatitis (OACD) (57%), caused by farming and construction work, followed by occupational irritant contact dermatitis (OICD) (24%), caused by wet work. Severe psychosocial distress was recorded in 62.5% of patients. After 3 months of treatment, 83% improved significantly, and 54% had improvement in QOL.

CONCLUSIONS

Farmers were most frequently affected, followed by construction workers and housewives. OACD was found at a higher frequency than OICD. The most frequent allergens were Parthenium hysterophorus in farmers, potassium dichromate in construction workers, and vegetables in housewives. OCD has a significant impact on QOL. Patch testing, in addition to standard treatment, improves the outcome considerably.

Occupational sensitization to epoxy resins in Northeastern Italy (1996-2010)

BACKGROUND

One of the main health concerns of epoxy resins is their role as skin sensitizer. This sensitization is not uncommon, because the prevalence ranges around 1-12% of the general population.

OBJECTIVES

Perform a cross sectional study in a patch test population from Northeastern Italy to investigate the prevalence of epoxy resins sensitization among patients with suspected contact dermatitis. Subsequently, relate findings to patients' occupation and evaluate time trend of prevalence.

METHODS

The final study database included 19 088 consecutive patients, tested from 1996 to 2010 in Northeastern Italy.

RESULTS

The overall prevalence of epoxy resins sensitization was 0·89%. Dermatitis most frequently involved hands (40·25%). In both sexes, we find a significant correlation in mechanics, woodworkers, and chemical industry workers; and in males only, among farmers and fishers, construction workers, and unemployed. We found significant increase of sensitization in construction workers in the analyzed period.

CONCLUSIONS

The overall prevalence of sensitization to epoxy resins in Northeastern Italy is in line with other European countries, but we found an increased risk of sensitization in some professions and an increasing trend of prevalence in construction workers. Better preventive actions are strongly advised in higher risk professions, with particular attentions towards building sector.

Occupational contact dermatitis in blue-collar workers: results from a multicentre study from the Danish Contact Dermatitis Group (2003-2012)

BACKGROUND

Blue-collar workers have a high risk of occupational contact dermatitis, but epidemiological studies are scarce.

OBJECTIVES

To investigate allergic contact dermatitis in blue-collar workers with dermatitis registered by the Danish Contact Dermatitis Group.

METHODS

A retrospective analysis of patch test data from 1471 blue-collar workers and 1471 matched controls tested between 2003 and 2012 was performed. A logistic regression was used to test for associations.

RESULTS

The blue-collar workers often had occupational hand dermatitis (p < 0.001). Atopic dermatitis was less commonly observed among blue-collar workers (19.6%) than among controls (23.9%) (p = 0.005). Allergens with a statistically significant association with the occupational group of blue-collar workers were epoxy resins, methyldibromo glutaronitrile, 2-bromo-2-nitro-1,3-propanediol, potassium dichromate, and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI). The following occupations were additionally identified as risk factors for contact sensitization to MCI/MI and MI, epoxy resins, and potassium dichromate, respectively: painting, construction work, and tile setting/terrazzo work.

CONCLUSION

Contact allergy is a major problem among blue-collar workers. The data indicate a healthy worker effect among blue-collar workers diagnosed with dermatitis, as blue-collar workers were diagnosed significantly less often with atopic dermatitis than were controls.

Skin symptoms in the construction industry: occurrence and determinants

BACKGROUND

In the construction industry, a relatively high hand eczema prevalence can be expected due to exposure to irritating and allergenic agents.

METHODS

As part of a regular program of voluntary medical examinations, a questionnaire including items on health symptoms and working circumstances is administered to construction industry personnel. We studied 152,200 male workers (response rate 52%). Associations between possible risk factors and self-reported skin symptoms and skin hypersensitivity were assessed using log-binomial regression analysis.

RESULTS

Prevalence of skin symptoms on the hands was 25.4% among construction workers, 14.6% among office personnel. Nuisance due to dust exposure was the most important work-related determinant for skin symptoms [Prevalence Ratio (PR) 1.59, 95% confidence interval (CI): 1.55-1.63]. Cross-sectional findings were supported by longitudinal analyses in a study population subset.

CONCLUSIONS

Skin symptoms are common among construction workers. Nuisance due to dust exposure was associated with higher prevalences of skin symptoms.

Self-reported skin symptoms and skin-related quality of life among Latino immigrant poultry processing and other manual workers

BACKGROUND

Manual labor employment occurs in environments with exposures likely to impact skin-related quality of life (SRQOL).

OBJECTIVES

The objectives of this paper are to (1) document the dimensions of SRQOL, (2) examine its association with skin symptoms, and (3) identify the predictors of SRQOL in Latino manual workers.

METHODS

A population-based survey of 733 Latino manual workers obtained Dermatology Life Quality Index (DLQI) and skin symptoms in the prior year.

RESULTS

Two-thirds of workers were employed in production. Skin symptoms in prior year were reported by 23%. Impaired SRQOL was reported by 23%. In multivariate analyses, reduced SRQOL was associated with age, occupation, childhood indigenous language use, and experience of skin symptoms in the prior year.

CONCLUSIONS

Despite overall high SRQOL exposures in some immigrant occupational groups produce reduce SRQOL. This rural, immigrant population faces significant obstacles to obtaining dermatological care; efforts are needed to improve their SRQOL.

Improving occupational health care for construction workers: a process evaluation

Background

To evaluate the process of a job-specific workers’ health surveillance (WHS) in improving occupational health care for construction workers.

Methods

From January to July 2012 were 899 bricklayers and supervisors invited for the job-specific WHS at three locations of one occupational health service throughout the Netherlands. The intervention aimed at detecting signs of work-related health problems, reduced work capacity and/or reduced work functioning. Measurements were obtained using a recruitment record and questionnaires at baseline and follow-up. The process evaluation included the following: reach (attendance rate), intervention dose delivered (provision of written recommendations and follow-up appointments), intervention dose received (intention to follow-up on advice directly after WHS and remembrance of advice three months later), and fidelity (protocol adherence). The workers scored their increase in knowledge from 0–10 with regard to health status and work ability, their satisfaction with the intervention and the perceived (future) effect of such an intervention. Program implementation was defined as the mean score of reach, fidelity, and intervention dose delivered and received.

Results

Reach was 9% (77 workers participated), fidelity was 67%, the intervention dose delivered was 92 and 63%, and the intervention dose received was 68 and 49%. The total programme implementation was 58%. The increases in knowledge regarding the health status and work ability of the workers after the WHS were graded as 7.0 and 5.9, respectively. The satisfaction of the workers with the entire intervention was graded as 7.5. The perceived (future) effects on health status were graded as 6.3, and the effects on work ability were graded with a 5.2. The economic recession affected the workers as well as the occupational health service that enacted the implementation.

Conclusions

Programme implementation was acceptable. Low reach, limited protocol adherence and modest engagement of the workers with respect to the intervention were the most prominent aspects that influenced the intervention process. The increase in the workers’ knowledge about their health status and work ability was substantial, and the workers’ satisfaction with the intervention was good. The perceived effect of the advised preventive actions on health status was sufficient.

Trial registration

Netherlands Trial Register: http://NTR3012

Allergic contact dermatitis among construction workers detected in a clinic that did not specialize in occupational dermatitis

BACKGROUND: Contact dermatitis is one of the common work-related dermatoses. Among bricklayers, cement can cause both allergic contact dermatitis and primary contact irritative dermatitis. The personal protective equipment (rubber gloves) may favor the development of allergic contact dermatitis. OBJECTIVES: 1) to evaluate the frequency of allergic contact dermatitis among construction workers between January 2005 and December 2009; 2) to determine the major sensitizing agents in the study group; and 3) to compare the data obtained from the construction workers to that of a group of patients who were not construction workers. METHODS: A retrospective analysis of patch tests. Patients were separated into two groups: 1) bricklayers and 2) non-bricklayers. RESULTS: Of the 525 patch tests analyzed, 466 (90%) were from non-bricklayers and 53 (10%) from bricklayers. The hands were affected in 38 (61%) of them. 13 patients (24%) had irritative contact dermatitis and 40 (76%) had allergic contact dermatitis. The group of construction workers had a high frequency of sensitization to cement, and 29 (54.7%) had sensitization to rubber vulcanizing agents. 23 patients (43.4%) had sensitization to both cement and rubber. CONCLUSIONS: Among the bricklayers the presence of allergic contact dermatitis to rubber and cement in the same patient is common and demonstrates the importance of the patch test.

Concurrent sensitization to metals and occupation

BACKGROUND

Cosensitization to nickel, cobalt and chromium occurs in the general population and in some occupational groups.

OBJECTIVES

To estimate the isolated and concurrent occurrence of nickel, cobalt and chromium contact sensitization and their association with individual and occupational risk factors.

PATIENTS/METHODS

Twelve thousand four hundred and ninety-two patients were patch tested with the European baseline series between 1997 and 2004 in north-eastern Italy. The associations between patch test results and patient characteristics and occupations were investigated by means of multinomial logistic regression analysis.

RESULTS

Of the patients, 34.7% (4334 patients) had one or more positive patch test reactions to metals. As compared with those with negative reactions to all three metals, nickel sensitization was significantly higher in females than in males, not only as monosensitization, but also as cosensitization with cobalt, with chromium, or with both metals. Building and related trades workers showed positive reactions to chromium + nickel [odds ratio (OR) 1.99; 95% confidence interval (CI) 1.05-3.76) and chromium + cobalt (OR 2.61; 95% CI 1.46-4.67]. Cleaning workers showed a high prevalence of nickel, chromium, nickel + chromium and nickel + cobalt + chromium cosensitization (ORs 1.29, 1.66, 2.11, and 1.79, respectively). An excess risk for cosensitization to all three metals was found in textile and leather workers (OR 2.19; 95% CI 1.10-4.33), and in bartenders (OR 2.10; 95% CI 1.03-4.26).

CONCLUSIONS

Some occupational groups are more likely to develop nickel, cobalt and chromium cosensitization.

Contact allergy to epoxy resin: risk occupations and consequences

BACKGROUND

Epoxy resin monomers are strong skin sensitizers that are widely used in industrial sectors. In Denmark, the law stipulates that workers must undergo a course on safe handling of epoxy resins prior to occupational exposure, but the effectiveness of this initiative is largely unknown.

OBJECTIVES

To evaluate the prevalence of contact allergy to epoxy resin monomer (diglycidyl ether of bisphenol A; MW 340) among patients with suspected contact dermatitis and relate this to occupation and work-related consequences.

PATIENTS/METHODS

The dataset comprised 20 808 consecutive dermatitis patients patch tested during 2005-2009. All patients with an epoxy resin-positive patch test were sent a questionnaire.

RESULTS

A positive patch test reaction to epoxy resin was found in 275 patients (1.3%), with a higher proportion in men (1.9%) than in women (1.0%). The prevalence of sensitization to epoxy resin remained stable over the study period. Of the patients with an epoxy resin-positive patch test, 71% returned a questionnaire; 95 patients had worked with epoxy resin in the occupational setting, and, of these, one-third did not use protective gloves and only 50.5% (48) had participated in an educational programme.

CONCLUSION

The 1% prevalence of epoxy resin contact allergy is equivalent to reports from other countries. The high occurrence of epoxy resin exposure at work, and the limited use of protective measures, indicate that reinforcement of the law is required.

Study of the frequency of allergens in cosmetics components in patients with suspected allergic contact dermatitis

BACKGROUND: Contact dermatitis to cosmetics is a common dermatosis, especially in adults and professionals who handle them. OBJECTIVE: The objective of this study was to evaluate the frequency of sensitization to cosmetics' components in patients with suspected allergic contact dermatitis and to identify the main sensitizers related to occupational contact dermatitis. METHODS: During the period of January 2008 to June 2010, all the patients with a presumptive diagnosis of allergic contact dermatitis to cosmetics were selected. The patients were submitted to the patch tests of cosmetics series, composed by ten substances. RESULTS: Among the 147 patients studied sensitization to cosmetics components occurred in 31,29% of the cases, 14 of those (19,18%) equally corresponding to BHT and triethanolamine substances, 13 (17,81%) to ammonium thioglycolate, 09 to sorbic acid (12,33%), 08 to tosilamida (10,95%), 06 to germall (8,22%). The other elements tested showed indices of 5% or less. A higher frequency of contact dermatitis to cosmetics was observed in women and the age most affected was concordant with the age range of greatest professional activity of the population. CONCLUSION: Allergic contact dermatitis was more frequently associated with Triethanolamine, BHT and ammonium thioglycolate, and the relation with occupational contact dermatitis was discreet.