Glove-related skin symptoms among operating theatre and dental care unit personnel (I). Interview investigation

Allergic contact dermatitis: From pathophysiology to development of new preventive strategies

As the body's first line of defense, the skin is the organ most frequently exposed to chemicals present in personal hygiene products, household products, or materials used in the work environment. In this context, skin disorders account for more than 40 % of all occupational and work-related diseases, constituting a significant public health burden. Among skin disorders, allergic contact dermatitis (ACD) is the most prevalent occupational disease and the most common form of immunotoxicity in humans. ACD is a T-cell-mediated skin inflammation resulting from the priming and expansion of allergen-specific CD4⁺ and CD8⁺ T cells. The clinical condition is characterized by local skin rash, itchiness, redness, swelling, and lesions, being mainly diagnosed by the patch test. Upon ACD diagnosis, avoiding the exposure to the triggering allergen is the mainstay of treatment to prevent future flares. In cases where avoidance is not possible, the use of a standard of care interim treatments such as steroid creams or ointments, barrier creams, and moisturizers are strongly recommended to alleviate symptoms. In this review, we sought to provide the reader with an overview of the pathophysiology of ACD as well as the currently available pharmacological treatment options. Furthermore, a comprehensive outline of several preventive strategies is also provided.

Interventions for preventing occupational irritant hand dermatitis

BACKGROUND

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

OBJECTIVES

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

SEARCH METHODS

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

SELECTION CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

MAIN RESULTS

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

AUTHORS' CONCLUSIONS

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

Interventions for preventing occupational irritant hand dermatitis

BACKGROUND

Occupational irritant hand dermatitis (OIHD) is an important cause of discomfort in the working population. Different preventive measures are in place but it is not clear how effective these are.

OBJECTIVES

To assess the effect of interventions for preventing OIHD in healthy people who work in occupations where the skin is at risk of damage.

SEARCH STRATEGY

In May 2010, we searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLlNE and EMBASE. Conference proceedings, and ongoing trials registers were also searched.

SELECTION CRITERIA

Randomised controlled trials (RCTs) studying the effectiveness of barrier creams, moisturisers, gloves, complex educational interventions, and other interventions for the prevention of OIHD.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the trials and extracted data.

MAIN RESULTS

Four RCTs involving 894 participants from different occupations were included. The primary outcome was numbers of new cases.One large RCT of 708 print and dye workers compared 2 barrier creams (containing silicone or hydrocarbon) versus no intervention. Fewer workers using barrier creams developed OIHD than those who did not (39.9% versus 45%, (OR 0.75, 95% CI 0.53 to 1.07. P = 0.11) but this was not statistically significant.In 1 RCT of 54 metal workers less developed OIHD when using an after work emollient or a barrier cream compared to no intervention. There was no statistical difference between the groups at different times of follow-up.One RCT of 111 cleaners and kitchen workers compared a moisturiser (Locobase) versus no intervention using a cross-over design. While using the moisturiser no participant developed OIHD. During the control period with no skin treatment, 19 (20.4%) out of 93 participants developed OIHD.One RCT of 21 hairdressers compared a barrier cream containing aluminium chlorohydrate (Excipial protect) versus its vehicle. No participant developed OIHD while the products were used.Only limited side-effects such as transient itching, stinging, and dryness were reported for the interventions.

AUTHORS' CONCLUSIONS

Although the findings of this review were generally positive, no statistical significance was reached. We conclude that at present there is insufficient evidence for the effectiveness of most of the interventions used in the primary prevention of OIHD. This does not mean that current measures are necessarily ineffective, as the limited studies to date have been rather small and of poor quality. Larger well designed RCTs are now needed in different workplaces to establish the effectiveness of various preventative strategies.

A randomized, controlled, double-blind study of the effect of wearing coated pH 5.5 latex gloves compared with standard powder-free latex gloves on skin pH, transepidermal water loss and skin irritation

Hand dermatitis is a common occupational disease. Altered skin pH plays an important role in the development of skin irritation. A glove that maintains tight control over skin pH may reduce hand dermatitis in glove users. The purpose of the study was to characterize the effect of glove wearing on skin pH, investigate the impact of study glove on skin pH compared with standard gloves and determine whether wearing study gloves reduced irritation. 20 healthy volunteers enrolled in a 4-week double-blind comparison of study and control gloves and served as their own controls. Gloves were worn 8 hr per day for 5 days per week. Skin pH and transepidermal water loss were measured during and 2 days after the glove-wearing period. The subject and an observer assessed the skin for irritation. The study glove maintained lower skin pH than the control glove (P < 0.05) and trended towards having less irritation. Observers noted increases in dryness and scale in both hands after 4 weeks but significantly less dryness in the study hand at week 4 (P = 0.006). Glove wearing increased skin pH and dryness. The pH 5.5 glove maintained lower skin pH levels than the control glove and may reduce irritation in long-term glove wearers.

Adverse reactions to protective gloves used in the dental profession: experience of the UK Adverse Reaction Reporting Project

The Adverse Reaction Reporting Project (ARRP) was set up to measure the extent and severity of adverse reactions to dental materials in the UK. Further analysis into the use of protective gloves has been carried out to establish the degree to which gloves are having a deleterious effect on the dental profession. In addition the survey aimed to establish the techniques used to manage adverse reactions and their effectiveness. In a 23-month period, 369 reports were received concerning adverse reactions to protective gloves used in dental practices. Reporters were contacted for further information, and a 92% response rate was achieved. The 330 reports analysed showed dentists to be the largest group to report adverse reactions, whilst dental technicians reported the fewest. The referral rate for staff and patients was similar with a third of adverse reactions being referred (n=110) to a specialist for diagnosis. A confirmed diagnosis was received in 65% of referred cases (n=72), but the symptoms reported suggested a larger degree of Type I reactions occurring than diagnosed. The use of non-powdered gloves appeared to be favoured over powdered gloves in 42% of glove changes, and nitrile gloves were used as an alternative to latex in 39% of changes. In conclusion, the results from this survey showed that wearing gloves in dental practices in the UK caused a range of adverse reactions. In 79% (n=330) of cases reported and analysed, these reactions were readily resolved or improved by self-medication, prescribed medication and/or changing to a different type of protective glove.

Epidemiology of latex sensitization and allergies in health care workers

Although it is often claimed that health care workers are at increased risk of latex sensitization and type I allergies, there has been no systematic analysis of the epidemiologic studies that are relevant to this conclusion. A systematic analysis of the epidemiologic literature found that, in the past 14 years, there have been 48 epidemiologic studies of type I latex allergy among health care workers. Of these, 2 cohort studies estimated the incidence of latex sensitization by skin prick testing at between 1% and 2.5% per year. Neither compared the risk to that in the general population. The prevalence of sensitization in health care workers varied between 0% and 30%, yet this large variation was unexplained. Increased risk of sensitization was not clearly associated with the duration of work in health care, the time spent wearing latex gloves, the frequency of exposure, the specific job categories, the use of powdered versus nonpowdered latex gloves, the use of latex versus nonlatex gloves, or any measurements of ambient exposure to latex proteins. The epidemiologic studies do not support a conclusion that health care workers are at clearly increased risk of latex sensitization or type I allergies compared to other occupations in the United States. The role of latex gloves in causing latex sensitization and type I allergic symptoms remains poorly defined because of the inconsistent results across studies. Future epidemiologic studies are needed that include measured exposures to latex antigens, that compare health care workers to appropriate referent groups, and that address confounding by atopy, age, sex, and race.

Changes in rates of natural rubber latex sensitivity among dental school students and staff members after changes in latex gloves

BACKGROUND

A high rate of sensitization and clinical allergy to natural rubber latex (NRL) gloves has been reported in dental students and staff members.

OBJECTIVE

The purpose of this study was to determine whether a change in glove use from high-protein/powdered to low-protein/powder-free latex gloves at a previously surveyed dental school reduced the prevalence of NRL sensitivity among students and staff members.

METHODS

A cross-sectional study was performed through use of a questionnaire and skin prick testing to low ammoniated NRL extract; the method was similar to that used in a study conducted in 1995. Analyses were performed on the entire groups as well as on a subset of senior students.

RESULTS

A total of 97 subjects (61 students and 36 staff members) completed the questionnaire and underwent skin prick testing; this compared with 131 subjects in 1995. Percentages of subjects reporting asthma symptoms, rhinitis or conjunctivitis, urticaria, or pruritus within minutes of NRL exposure were 4%, 7%, 6%, and 8%, respectively; the corresponding percentages in the 1995 survey were 7% (P = not significant), 13% (P = not significant), 20% (P =.004), and 22% (P =.005). Results were similar for the subset of senior students, but in addition there were also significantly fewer complaints of rhinoconjunctivitis in 2000 than in 1995 (0% and 12%, respectively; P =.007). Of 97 subjects who underwent skin prick testing, 3 (3%) had positive skin prick test responses of 2+ or greater to NRL; this compared with 13 (10%) of 131 subjects in 1995 (P =.03). There were 3 positive skin test responses among staff members in 2000; there were none among students.

CONCLUSIONS

Our results suggest a preventive effect on NRL allergy in dental students from the change to low-protein/powder-free NRL gloves in the dental school.

Protective gloves in Swedish dentistry: use and side-effects

BACKGROUND

During the 1980s routine wearing of gloves in dentistry was recommended by health authorities in several countries. However, prolonged glove use is associated with side-effects of irritant and allergic origin.

OBJECTIVES

To investigate the extent of glove use and self-reported glove intolerance reactions among Swedish dentists, and to examine how far IgE-mediated allergy to natural rubber latex (NRL) occurs in subjects who report rapid itching when in contact with protective gloves.

SUBJECTS/METHODS

A postal questionnaire was answered by 3083 of 3500 licensed dentists, a response rate of 88%. Of the dentists who reported rapidly occurring itching of the hands from gloves, 131 of 170 attended a clinical examination including a skin prick test (SPT) and a serological examination (RAST) for IgE-mediated allergy.

RESULTS

Seventy-three per cent of the dentists reported daily glove use of more than 2 h, 48% more than 6 h a day, and 6% reported no use. NRL gloves were used most frequently (P < 0.001) and were the main material that elicited symptoms (P < 0.001). Female dentists reported more frequent glove use than males, as did young dentists (P < 0.001) compared with older ones. Females also preferred vinyl gloves. Glove intolerance reactions were reported by 723 (23%) dentists, [females 28%, males 21% (P < 0.001)] and were more common in younger dentists. Of the 417 dentists with reported hand eczema during the previous year, 54% reported glove intolerance, compared with 20% of the dentists without hand eczema (P < 0.001). A logistic regression analysis including hand eczema, age, sex and atopy showed that all these factors contributed significantly to the risk of glove intolerance, and that hand eczema was a stronger factor than atopy. In 15 of 131 (11%) dentists examined for reported glove-related itch, latex allergy was verified by SPT and/or RAST. Glove-related conjunctivitis, rhinitis and asthma, in contrast to skin symptoms, showed a significant association with IgE-mediated allergy to NRL.

CONCLUSIONS

Swedish dentists show good compliance with the recommendations for routine glove use. Intolerance reactions are frequently reported, especially by dentists with hand eczema, which emphasizes the need for preventive skin care programmes. Glove-related symptoms from mucous membranes showed a higher association with IgE-mediated allergy to NRL than reported itching of the skin, a fact that should be considered when composing screening questionnaires for NRL sensitization

Sensitisation to natural rubber latex: an epidemiological study of workers exposed during tapping and glove manufacture in Thailand

OBJECTIVES

To estimate the prevalence of sensitisation to natural rubber latex in latex tappers and latex glove factory workers, and to relate this to airborne exposure to latex.

METHODS

Five hundred workers employed in three latex glove factories, 314 tappers, and 144 college students (control group) were studied. The workers in the glove factories were classified into three exposure groups; high, moderate, and low. Personal exposures to natural rubber latex aeroallergens were measured by immunoassay. Symptom questionnaires and skin prick tests with latex allergens (Stallergènes 1:200 w/v) and other common environmental allergens were performed. The criterion for positivity was a wheal reaction at least 3 mm in diameter greater than that to a diluent control.

RESULTS

The geometric mean (GM) concentration of latex in air was 15.4 microg/m(3) for those employed in glove stripping, glove inspections, and packing of powdered gloves. The moderate exposure glove manufacturing group and the tappers had GM concentrations of 2.3 and 2.4 microg/m(3) respectively, compared with United Kingdom users of latex powdered gloves,who had GM concentrations of 0.5 microg/m(3). The prevalence of sensitisation to latex in the tappers and latex glove factory workers was 1.3% and 1.7% respectively. No positive cases were found among the college students. Workers who showed a positive skin prick test to latex were more likely to be atopic. Work related respiratory and dermatological symptoms were found in about 20% of each population studied, but were not related to the presence of positive latex prick tests.

CONCLUSIONS

This study suggests that in the Thai latex industries, latex sensitisation is rare despite high concentrations of airborne exposure and is less prevalent than in the healthcare sector in Europe where skin exposure is greater.

Prevention of work-related skin problems in student auxiliary nurses: an intervention study

The present study was designed as an intervention study to investigate whether an educational programme was efficient in preventing work-related skin problems on the hands. 107 student auxiliary nurses (61 in the intervention group and 46 in the control group) were followed during the first 10 weeks of their initial practical training in county hospitals. The intervention group was given an educational programme before the practical training started. For evaluation the participants had questionnaires, clinical examination of the hands, measurement of transepidermal water loss (TEWL) and patch testing. The use of hand disinfectants, which was discouraged in the educational programme, was significantly lower in the intervention group as compared to the control group (p=0.002). 48% of the intervention group and 58% of the control group had aggravation of skin problems during practical training (p>0.05). Use of hand disinfectant agents was significantly associated with aggravation of skin problems (p=0.016). A significant increase in TEWL for the control group (p<0.005), but not for the intervention group, was seen after 10 weeks of practical training. In conclusion, the present intervention study shows promising results from the use of an educational programme.

Glove powder affects skin roughness, one parameter of skin irritation

Most patients with immediate-type-hypersensitivity to natural rubber latex (NRL) give a history of hand eczema. Susceptibility to allergens is increased by irritant hand eczema due to damage to the skin barrier. Therefore, especially for employees in medical or paramedical professions, reduction in skin irritation is of importance. The present study reports the effect of glove powder on skin roughness, one feature of skin irritancy. Skin replicas, performed before and after wearing different types of gloves, were evaluated by laser profilometry. Significant alteration of skin roughness was evident and determined by different factors. Use of unpowdered Biogel gloves on prepowdered hands results in an increase in skin roughness, in contrast to the use of Biogel gloves on hands without any pre-application. On the other hand, powdered Manex neoderm gloves show no influence on the skin structure, whereas powdered Peha taft gloves also increase the roughness of the skin. Other potential candidates causing skin morphology alteration could be the glove pH, rubber chemicals with irritant potential and other characteristics of gloves, which are already under investigation.

Latex allergy

Coined the next major health concern of the decade, allergy to natural rubber latex affects people routinely exposed to rubber products. Groups at highest risk include health care workers, rubber industry workers, and persons who have undergone multiple surgical procedures, especially those with spina bifida. Allergy to latex is a type I, immediate, IgE-mediated reaction, which can lead to anaphylaxis and death. Much of latex research is published in allergy journals. Dermatologists may not be aware of the prevalence, symptoms, risks, diagnosis, and treatment of latex allergy. These topics are the subject of this review. Research concerning antigenic proteins, as well as sources of latex alternatives, is also summarized. (J Am Acad Dermatol 1998;39:1-24.)

LEARNING OBJECTIVE

At the completion of this learning activity, participants should have a clear understanding of the history, biology, epidemiology, mechanism, clinical characteristics, diagnostic work-up, and treatment of latex allergy. Readers should also have a greater understanding of multiple potential allergenic latex proteins and their importance in preventing future latex-sensitization.

Atopy and other risk factors for UK dentists reporting an adverse reaction to latex gloves

A study was conducted to assess the significance of a personal history of atopy and other risk factors for UK dentists reporting an adverse reaction to natural rubber latex (NRL) gloves. 2535 dentists completed a self-administered questionnaire and, of these, 1034 (group 1) reported an adverse reaction to NRL gloves and 1501 (group 2) did not. Risk factors investigated were: sex, years in clinical practice, exposure to gloves and a history of atopy or food allergy. The signs and symptoms reported by group 1 dentists were recorded. Logistic regression analysis was used to identify a set of risk factors that produced the most discrete model for a dentist reporting an adverse reaction to NRL gloves. A personal history of atopy was a significant risk factor. Dentists with a history of eczema and hand eczema in childhood were most likely to report an adverse reaction to NRL gloves.

Prevalence of occupationally related hand dermatitis in dental workers

Occupationally related hand dermatitis has been attributed to frequent hand-washing, exposure to possible sensitizers and latex glove use. The authors conducted a study to determine the prevalence of occupationally related hand dermatitis in dental personnel. They found that 75 (19.2 percent) of 390 subjects self-reported they had a positive history of hand dermatitis. Further testing of 53 of these subjects indicated that only 9.4 percent reacted to the 45 allergens tested, and 3.8 percent had an allergy to latex.

Allergic and Irritant Glove-related Diseases in Health Care Workers and Their Prevention

Because the widespread use of gloves by health care workers has induced an increase of both irritant and type I or type IV allergic glove-related diseases, the Italian Society of Preventive Medicine for Health Care Workers set up a working group to collect information about glove composition and to standardize procedures for the diagnosis and prevention of glove-related disease and job-fitness evaluation of employees who will be wearing gloves. In addition, the group made recommendations for educational programs focusing not only on users but also on purchasers, who presently favor glove selection for economic reasons. The group's recommendations are summarized in a consensus document, but cannot be considered definitive. More research is needed to achieve answers to questions raised by the working group, indicated in the consensus document. In particular, diagnostic criteria must be standardized to plan multicenter studies to verify the real extent of the problem, and further studies are needed to verify whether limit values for substances contained in the gloves (e.g., latex proteins, residual chemicals) can be established.

Effect of glove occlusion on human skin (II). Long-term experimental exposure

Gloves are indispensable in many occupations. Irritant skin reactions from gloves have, however, been reported. In the present study, the effect of long-term glove occlusion on normal skin (6 h/day for 14 days) was studied and, in addition, the effect of a cotton glove worn under the occlusive glove was also studied. 2 studies were performed (studies A and B). Study A: 19 volunteers wore an occlusive glove on normal skin 6 h/day for 14 days. They wore the glove on one hand only, while the other hand served as control. Study B: 18 volunteers wore occlusive gloves on both hands on normal skin. A cotton glove was worn under the occlusive glove on either the left or the right hand. Skin barrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter), skin hydration by electrical capacitance (Corneometer) and inflammation by erythema index (Derma-Spectrometer). The gloves used were hypoallergenic non-latex gloves. Results. Study A: glove occlusive on normal skin 6 h/day for 14 days had a significant negative effect on skin barrier function, as measured by TEWL. Study B: the negative effect on skin barrier function from occlusive gloves was prevented by the use of a cotton glove. It is concluded that gloves may be a substantial factor in the pathogenesis of cumulative irritant contact dermatitis, and that recommendations as to their use are important.

Effect of glove occlusion on human skin. (I). short-term experimental exposure

Skin barrier function was studied after use of occlusive gloves on normal and compromised skin. 2 studies were performed (Study A and B), and the effects were evaluated by non-invasive methods. Participants in the studies were instructed to wear an occlusive glove on one hand, while the other hand served as control. The gloves used were hypoallergenic, non-latex. Study A: 20 volunteers wore a glove on normal skin 6 h/day for 3 days. Study B: 20 volunteers wore a glove on sodium lauryl sulfate(SLS)-compromised skin 6 h/day for 3 days. Skin barrier function was evaluated by measurement of transepidermal water loss (TEWL) (Evaporimeter), skin hydration by electrical capacitance (Corneometer) and inflammation was evaluated by erythema index (DermaSpectrometer).

RESULTS

Study A. Glove occlusion on normal skin 6 h/day for 3 days caused no significant influence on the water barrier function. Study B: Glove occlusion on SLS-compromised skin for the same period of time had a significantly negative effect on the water barrier function. It is concluded that occlusion may be an additional factor in the pathogenesis of cumulative irritant contact dermatitis.

Glove-related skin symptoms among operating theatre and dental care unit personnel (II). Clinical examination, tests and laboratory findings indicating latex allergy

Following interviews on glove-related skin symptoms, 202 subjects, 56 hospital workers at an operating theatre and 146 workers at dental care centres, were skin prick tested with different latex extracts. Also, in 193 cases, blood samples were RAST-analysed, using the CAP system. Sensitization to latex diagnosed by positive skin prick test and/or by demonstration of specific antibodies in serum analyses was found in 3.5% of the subjects investigated. 4 cases (2%) showed 1 or more positive skin tests, and 4 cases (2%) had positive RAST to latex antigens. Further work on the diagnostic tools is still needed, as are prognostic studies.