1
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Weisshaar E. Chronic Hand Eczema. Am J Clin Dermatol 2024:10.1007/s40257-024-00890-z. [PMID: 39300011 DOI: 10.1007/s40257-024-00890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2024] [Indexed: 09/22/2024]
Abstract
Chronic hand eczema (CHE) is a complex, challenging, and frequently multifactorial skin disease of the hands. It is very common in the general population, especially in certain professions. When hand eczema (HE) persists for longer than 3 months or has a minimum of two relapses per year after initial manifestation with complete clearance, it is considered chronic. In this case, health-related quality of life and the patient's working life are often impaired. CHE can be considered as an umbrella term because it covers different clinical pictures and etiologies. To date, there is no definite and unique HE classification. Treatment starts with identifying the individual HE etiology paralleled by symptomatic therapy (local and/or systemic and/or ultraviolet phototherapy). Sustainable management of HE requires the identification and avoidance of its triggering factors, from the professional and private environment. This includes ruling out allergic contact dermatitis if any HE persists for more than 3 months despite adequate therapy. Randomized controlled trials investigating the efficacy in HE are lacking for several treatment modalities. Patient education measures of skin protection and prevention complete the multimodal treatment.
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Affiliation(s)
- Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Ruprecht Karls University Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany.
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2
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Claus R, Chu WK, Savory LD, Staelens A, Poels K, Draper M, Creta M, Vanoirbeek JAJ. Comparison of a novel glove connector to chemical tape as a sealing device between gloves and protection suits. JOURNAL OF HAZARDOUS MATERIALS 2024; 476:135186. [PMID: 39029180 DOI: 10.1016/j.jhazmat.2024.135186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Affiliation(s)
- Rani Claus
- Environment and Health, KU Leuven, Leuven, Belgium
| | - Wai Kei Chu
- Environment and Health, KU Leuven, Leuven, Belgium
| | | | | | | | - Mike Draper
- Ansell U.K. Limited, Willerby, Hull, United Kingdom
| | - Matteo Creta
- Environment and Health, KU Leuven, Leuven, Belgium; Unit of Environmental Hygiene and Human Biological Monitoring, Department of Health Protection, Laboratoire National de Santé (LNS), Dudelange, Luxembourg
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3
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Michaels BS, Ayers T, Brooks-McLaughlin J, McLaughlin RJ, Sandoval-Warren K, Schlenker C, Ronaldson L, Ardagh S. Potential for Glove Risk Amplification via Direct Physical, Chemical, and Microbiological Contamination. J Food Prot 2024; 87:100283. [PMID: 38679200 DOI: 10.1016/j.jfp.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
This review focuses on the potential direct physical, chemical, and microbiological contamination from disposable gloves when utilized in food environments, inclusive of the risks posed to food products as well as worker safety. Unrecognized problems endemic to glove manufacturing were magnified during the COVID-19 pandemic due to high demand, increased focus on PPE performance, availability, supply chain instability, and labor shortages. Multiple evidence-based reports of contamination, toxicity, illness, deaths, and related regulatory action linked to contaminated gloves in food and healthcare have highlighted problems indicative of systemic glove industry shortcomings. The glove manufacturing process was diagramed with sources and pathways of contamination identified, indicating weak points with documented occurrences detailed. Numerous unsafe ingredients can introduce chemical contaminants, potentially posing risks to food and to glove users. Microbial hazards present significant challenges to overall glove safety as contaminants appear to be introduced via polluted water sources or flawed glove manufacturing processes, resulting in increased risks within food and healthcare environments. Frank and opportunistic pathogens along with food spoilage organisms can be introduced to foods and wearers. When the sources and pathways of glove-borne contamination were explored, it was found that physical failures play a pivotal role in the release of sweat build-up, liquefaction of chemical residues, and incubation of microbial contaminants from hands and gloves. Thus, with glove physical integrity issues, including punctures in new, unused gloves that can develop into significant rips and tears, not only can direct physical food contamination occur but also chemical and microbiological contamination can find their way into food. Enhanced regulatory requirements for Acceptable Quality Limits of food-grade gloves, and the establishment of appropriate bioburden standards would enhance safety in food applications. Based on the information provided, together with a false sense of security associated with glove use, the unconditional belief in glove chemical and microbiological purity may be unfounded.
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Affiliation(s)
- Barry S Michaels
- B. Michaels Group Inc., 487 West River Road, Palatka, FL 32177, USA.
| | - Troy Ayers
- Eurofins Microbiology Laboratories Inc., Des Moines, IA 50321, USA
| | | | | | | | | | - Lynda Ronaldson
- Eagle Protect PBC, South Lake Tahoe, CA 96150, USA; Eagle Protect Ltd. Christchurch 8011, New Zealand
| | - Steve Ardagh
- Eagle Protect PBC, South Lake Tahoe, CA 96150, USA; Eagle Protect Ltd. Christchurch 8011, New Zealand
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4
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Bauer A, Brans R, Brehler R, Büttner M, Dickel H, Elsner P, Fartasch M, Herzog C, John SM, Köllner A, Maul JT, Merk H, Molin S, Nast A, Nikolakis GD, Schliemann S, Skudlik C, Weisshaar E, Werfel T, Zidane M, Worm M. S2k-Leitlinie Diagnostik, Prävention und Therapie des Handekzems: S2k guideline diagnosis, prevention and therapy of hand eczema. J Dtsch Dermatol Ges 2023; 21:1054-1076. [PMID: 37700403 DOI: 10.1111/ddg.15179_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
ZusammenfassungDie S2k‐Leitlinie „Diagnostik, Prävention und Therapie des Handekzems (HE)“ gibt auf der Grundlage eines evidenz‐ und konsensbasierten Ansatzes konkrete Handlungsanweisungen und Empfehlungen für die Diagnostik, Prävention und Therapie des HE. Die Leitlinie wurde auf der Grundlage der deutschen Leitlinie „Management von Handekzemen“ aus dem Jahr 2009 und der aktuellen Leitlinie der European Society of Contact Dermatitis (ESCD) „Guidelines for diagnosis, prevention and treatment of hand eczema“ aus dem Jahr 2022 erstellt. Allgemeines Ziel der Leitlinie ist es, Dermatologen und Allergologen in der Praxis und Klinik eine akzeptierte, evidenzbasierte Entscheidungshilfe für die Auswahl sowie Durchführung einer geeigneten und suffizienten Therapie für Patienten mit Handekzemen zur Verfügung zu stellen. Die Leitlinie basiert auf zwei Cochrane‐Reviews zu therapeutischen und präventiven Interventionen beim HE. Die übrigen Kapitel wurden überwiegend basierend auf nicht systematischen Literaturrecherchen durch die Expertengruppe erarbeitet und konsentiert. Die Expertenkommission bestand aus Mitgliedern von allergologischen und berufsdermatologischen Fachgesellschaften und Arbeitsgruppen, einer Patientenvertretung und Methodikern. Im Rahmen einer Konsensuskonferenz am 15.09.2022 wurden die Vorschläge für die Empfehlungen und Kernaussagen unter Verwendung eines nominalen Gruppenprozesses konsentiert. Der strukturierte Konsensfindungsprozess wurde professionell moderiert. Die vorliegende Leitlinie hat eine Gültigkeit bis zum 22.02.2028.
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Affiliation(s)
- Andrea Bauer
- Klinik für Dermatologie und Poliklinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Richard Brans
- Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für Interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Randolf Brehler
- Allergologie, Berufsdermatologie und Umweltmedizin an der Hautklinik, Universitätsklinikum Münster, Münster, Deutschland
| | | | - Heinrich Dickel
- Bochum Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Peter Elsner
- Privatpraxis für Dermatologie und Allergologie, SRH Krankenhaus Gera, Gera, Deutschland
| | - Manigé Fartasch
- Institut für Prävention und Arbeitsmedizin der Deutschen Gesetzlichen Unfallversicherung (IPA), Institut der Ruhr-Universität Bochum, Bochum, Deutschland
| | - Claudia Herzog
- Universitätskrebszentrum, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Deutschland
| | - Swen-Malte John
- Fachbereich Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für interdisziplinäre dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Arno Köllner
- Dermatologische Gemeinschaftspraxis, Duisburg, Deutschland
| | | | - Hans Merk
- Professor für Dermatologie und Allergologie, ehemaliger Direktor der Hautklinik, RWTH Aachen, Deutschland
| | - Sonja Molin
- Abteilung für Dermatologie, Fachbereich Medizin, Queen's University, Kingston, Kanada
| | - Alexander Nast
- Klinik für Dermatologie, Venerologie und Allergologie, Abteilung für Evidenzbasierte Medizin (dEBM), Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Georgios D Nikolakis
- Klinik für Dermatologie, Venerologie, Allergologie und Immunologie, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | | | - Christoph Skudlik
- Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland und Institut für Interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück, Osnabrück, Deutschland
| | - Elke Weisshaar
- Berufsdermatologie, Abteilung Dermatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Thomas Werfel
- Klinik für Dermatologie und Allergologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Miriam Zidane
- Klinik für Dermatologie, Venerologie und Allergologie, Abteilung für Evidenzbasierte Medizin (dEBM), Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, korporatives Mitglied der Freien Universität Berlin und der Humboldt-Universität zu Berlin, Berlin, Deutschland
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5
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Bauer A, Brans R, Brehler R, Büttner M, Dickel H, Elsner P, Fartasch M, Herzog C, John SM, Köllner A, Maul JT, Merk H, Molin S, Nast A, Nikolakis GD, Schliemann S, Skudlik C, Weisshaar E, Werfel T, Zidane M, Worm M. S2k guideline diagnosis, prevention, and therapy of hand eczema. J Dtsch Dermatol Ges 2023; 21:1054-1074. [PMID: 37700424 DOI: 10.1111/ddg.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/14/2023] [Indexed: 09/14/2023]
Abstract
The consensus-based guideline "Diagnosis, prevention, and treatment of hand eczema (HE)" provides concrete instructions and recommendations for diagnosis, prevention, and therapy of HE based on an evidence- and consensus-based approach. The guideline was created based on the German guideline "Management von Handekzemen" from 2009 and the current guideline of the European Society of Contact Dermatitis (ESCD) "Guidelines for diagnosis, prevention, and treatment of hand eczema" from 2022. The general goal of the guideline is to provide dermatologists and allergologists in practice and clinics with an accepted, evidence-based decision-making tool for selecting and conducting suitable and sufficient therapy for patients with hand eczema. The guideline is based on two Cochrane reviews of therapeutic and preventive interventions for HE. The remaining chapters were mainly developed and consented based on non-systematic literature research by the expert group. The expert group consisted of members of allergological and occupational dermatological professional associations and working groups, a patient representative, and methodologists. The proposals for recommendations and key statements were consented by using a nominal group process during a consensus conference on September 15, 2022. The structured consensus-building process was professionally moderated. This guideline is valid until February 22, 2028.
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Affiliation(s)
- Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Randolf Brehler
- Department of Allergy, Occupational Dermatology and Environmental Medicine, University Hospital Münster, Münster, Germany
| | | | - Heinrich Dickel
- Bochum Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Medical Center, Ruhr University Bochum, Bochum, Germany
| | - Peter Elsner
- Privat practice for dermatology and allergology, SRH Hospital Gera, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr University Bochum, Bochum, Germany
| | - Claudia Herzog
- University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Swen-Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Sonja Molin
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, Canada
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georgios D Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | | | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany and Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Miriam Zidane
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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6
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. S1-Leitlinie Kontaktekzem. J Dtsch Dermatol Ges 2022; 20:711-734. [PMID: 35578429 DOI: 10.1111/ddg.14734_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Heinrich Dickel
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Bochum
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - Randolf Brehler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster
| | - Vera Mahler
- Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Langen
| | | | | | | | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin
| | - Johannes Geier
- Zentrale des IVDK, Universitätsmedizin Göttingen, Göttingen
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7
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Dickel H, Bauer A, Brehler R, Mahler V, Merk HF, Neustädter I, Strömer K, Werfel T, Worm M, Geier J. German S1 guideline: Contact dermatitis. J Dtsch Dermatol Ges 2022; 20:712-734. [DOI: 10.1111/ddg.14734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Heinrich Dickel
- Department of Dermatology Venereology and Allergology St. Josef Hospital University Medical Center of the Ruhr University Bochum Bochum Germany
| | - Andrea Bauer
- Department of Dermatology University Hospital Carl Gustav Carus Technical University Dresden Dresden Germany
| | - Randolf Brehler
- Department of Dermatology University Hospital Münster Münster Germany
| | - Vera Mahler
- Paul‐Ehrlich‐Institut Federal Institute for Vaccines and Biomedicines Langen Germany
| | - Hans F. Merk
- Department of Dermatology RWTH Aachen University Aachen Germany
| | - Irena Neustädter
- Department of Pediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | | | - Thomas Werfel
- Department of Dermatology Allergology and Venereology Hannover Medical School Hannover Germany
| | - Margitta Worm
- Department of Dermatology Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Johannes Geier
- Center of IVDK University Medical Center Göttingen Göttingen Germany
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8
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Thyssen JP, Schuttelaar MLA, Alfonso JH, Andersen KE, Angelova-Fischer I, Arents BWM, Bauer A, Brans R, Cannavo A, Christoffers WA, Crépy MN, Elsner P, Fartasch M, Larese Filon F, Giménez-Arnau AM, Gonçalo M, Guzmán-Perera MG, Hamann CR, Hoetzenecker W, Johansen JD, John SM, Kunkeler ACM, Ljubojevic Hadzavdic S, Molin S, Nixon R, Oosterhaven JAF, Rustemeyer T, Serra-Baldrich E, Shah M, Simon D, Skudlik C, Spiewak R, Valiukevičienė S, Voorberg AN, Weisshaar E, Agner T. Guidelines for diagnosis, prevention and treatment of hand eczema. Contact Dermatitis 2021; 86:357-378. [PMID: 34971008 DOI: 10.1111/cod.14035] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Jacob P Thyssen
- Dep. Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marie L A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jose H Alfonso
- Dep. of Dermatology, Oslo University Hospital, Oslo, Norway.,Dep. of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Klaus E Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Irena Angelova-Fischer
- Department of Dermatology, Comprehensive Allergy Center, Kepler University Hospital, Linz, Austria
| | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Alicia Cannavo
- Contact Dermatitis and Occupational Dermatoses, Hospital de Clínicas "José de San Martín", Buenos Aires University, Argentina
| | | | - Marie-Noelle Crépy
- Department of Occupational and Environmental Diseases, University Hospital of Centre of Paris, Hotel-Dieu Hospital, AP-HP, Paris, France.,Department of Dermatology, University Hospital of Centre of Paris, Cochin Hospital, AP-HP, Paris, France
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Manigé Fartasch
- Institute for Prevention and Occupational Medicine (IPA) of the German Social Accident Insurance, Department of Clinical and Experimental Occupational Dermatology, Ruhr University Bochum, Bochum, Germany
| | | | - Ana M Giménez-Arnau
- Department of Dermatology, Hopsital del Mar, IMIM , Universitat Autònoma de Barcelona
| | - Margarida Gonçalo
- Clinic of Dermatology - University Hospital and Faculty of Medicine, University of Coimbra, Portugal
| | | | - Carsten R Hamann
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Wolfram Hoetzenecker
- Department of Dermatology, Kepler University Hospital and Kepler University Linz, Linz, Austria
| | - Jeanne Duus Johansen
- Department of Dermatology and Allergy, National Allergy Research Centre, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Swen M John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Amalia C M Kunkeler
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Sonja Molin
- Division of Dermatology, Queen's University, Kingston, Canada
| | - Rosemary Nixon
- Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, Australia
| | - Jart A F Oosterhaven
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas Rustemeyer
- Department of Dermatology-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Mili Shah
- Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany.,Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Angelique N Voorberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tove Agner
- Dep. Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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9
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Li Y, Li L. Contact Dermatitis: Classifications and Management. Clin Rev Allergy Immunol 2021; 61:245-281. [PMID: 34264448 DOI: 10.1007/s12016-021-08875-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/04/2023]
Abstract
Contact dermatitis (CD) is a common inflammatory skin disease caused by exposure to contact allergens and irritants. It is also the most common reason of occupational dermatitis and contributes greatly to hand dermatitis and facial dermatitis. Besides the two major forms of contact dermatitis: allergic contact dermatitis and irritant contact dermatitis, other subtypes of CD have been recognized including immediate skin reactions, photoinduced contact dermatitis, systemic contact dermatitis, and non-eczematous contact dermatitis. CD is a great imitator which can mimic many kinds of skin diseases, such as atopic dermatitis, lichen planus, and angioedema. For the diagnosis of CD, a complete medical history, including occupational history, is very important. It can give a clue of CD and provide a list of suspected substances. Besides the well-known diagnostic test, patch testing, there are many other diagnostic tests can be used to help diagnosis of CD and identify the causative allergens, including photopatch test, skin tests for detecting of immediate contact reactions, serum allergen-specific IgE test, and qualitative and quantitative testing of allergen in the suspected materials patients exposed to and challenge test. Before the treatment, the suspected irritants or allergens should be avoided completely. This includes both the removal of the patient from the environment that contains those substances and the promotion of the metabolism and expulsion of the allergens that have been absorbed by the body. In addition, it is also important to restore the skin barrier and reduce skin inflammation through multiple treatments, such as emollients, topical corticosteroids, and antihistamines, as well as systemic corticosteroids and immunosuppressants. Early and appropriate treatments are important to prevent further deterioration and persistence of the skin condition.
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Affiliation(s)
- Yan Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Linfeng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Kim HJ, Bang CH, Kim HO, Lee DH, Ko JY, Park EJ, Son SW, Ro YS. 2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema. Ann Dermatol 2021; 33:351-360. [PMID: 34341637 PMCID: PMC8273322 DOI: 10.5021/ad.2021.33.4.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients' quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. Objective These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. Methods A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. Results Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. Conclusion These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Suk Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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Ashbaugh AG, Abel MK, Murase JE. Protein Causes of Urticaria and Dermatitis. Immunol Allergy Clin North Am 2021; 41:481-491. [PMID: 34225902 DOI: 10.1016/j.iac.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Protein contact dermatitis is a cutaneous hypersensitivity reaction after chronic, recurrent exposure or chronic irritation to animal or plant protein. Although the pathophysiological mechanisms underlying protein contact dermatitis are not well characterized, protein contact dermatitis is thought to be caused by combined type I/IV-mediated, type-1 mediated, or a Langerhans cell immunoglobulin E-mediated delayed hypersensitivity reaction. This chapter reviews the epidemiology, pathogenesis, clinical features, common protein allergens, diagnostic process, treatment options, and prognosis of protein contact dermatitis.
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Affiliation(s)
- Alyssa Gwen Ashbaugh
- Department of Dermatology, University of California, San Francisco, Third and Fourth Floors, 1701 Divisadero St, San Francisco, CA 94115, USA; School of Medicine, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA 92617, USA
| | - Mary Kathryn Abel
- Department of Dermatology, University of California, San Francisco, Third and Fourth Floors, 1701 Divisadero St, San Francisco, CA 94115, USA; School of Medicine, University of California, San Francisco, 533 Parnassus Ave, San Francisco, CA 94143, USA
| | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, Third and Fourth Floors, 1701 Divisadero St, San Francisco, CA 94115, USA; Department of Dermatology, Palo Alto Foundation Medical Group, 701 East El Camino Real (31-104), Mountain View, CA 94040, USA.
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Brans R, John SM, Frosch PJ. Clinical Aspects of Irritant Contact Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brans R, John SM, Frosch PJ. Clinical Aspects of Irritant Contact Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_16-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Hand dermatitis is a common condition with a lifetime prevalence of 20%. Glove allergic contact dermatitis (ACD) is a very important dermatitis affecting health care workers, hairdressers, cleaning personnel, kitchen workers, craftsmen, construction workers, laboratory workers, and homemakers. Occupationally related cases may be severe and can result in significant disability. Glove ACD is most commonly due to exposure to rubber accelerators, which are compounds that are added to rubber during production to increase strength and durability. Given the known allergic potential of these compounds, glove manufacturing companies have reformulated gloves leading to the introduction of new rubber allergens. In this review, we will discuss risk factors for glove ACD, both common and uncommon allergens in gloves, common contact allergens that permeate gloves, and patch testing to help uncover the inciting allergen(s).
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Bartsch N, Girard M, Schneider L, Weijgert VVD, Wilde A, Kappenstein O, Vieth B, Hutzler C, Luch A. Chemical stabilization of polymers: Implications for dermal exposure to additives. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2018; 53:405-420. [PMID: 29334019 DOI: 10.1080/10934529.2017.1412192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Technical benefits of additives in polymers stand in marked contrast to their associated health risks. Here, a multi-analyte method based on gas chromatography coupled to tandem mass spectrometry (GC-MS/MS) was developed to quantify polymer additives in complex matrices such as low-density polyethylene (LDPE) and isolated human skin layers after dermal exposure ex vivo. That way both technical aspects and dermal exposure were investigated. The effects of polymer additivation on the material were studied using the example of LDPE. To this end, a tailor-made polymer was applied in aging studies that had been furnished with two different mixtures of phenol- and diarylamine-based antioxidants, plasticizers and processing aids. Upon accelerated thermo-oxidative aging of the material, the formation of LDPE degradation products was monitored with attenuated total reflectance-Fourier transformed infrared (ATR-FTIR) spectroscopy. Compared to pure LDPE, a protective effect of added antioxidants could be observed on the integrity of the polymer. Further, thermo-oxidative degradation of the additives and its kinetics were investigated using LDPE or squalane as matrix. The half-lives of additives in both matrices revealed significant differences between the tested additives as well as between LDPE and squalane. For instance, 2-tert-butyl-6-[(3-tert-butyl-2-hydroxy-5-methylphenyl)methyl]-4-methylphenol (Antioxidant 2246) showed a half-life 12 times lower when incorporated in LDPE as compared to squalane. As a model for dermal exposure of consumers, human skin was brought into contact with the tailor-made LDPE containing additives ex vivo in static Franz diffusion cells. The skin was then analyzed for additives and decomposition products. This study proved 10 polymer additives of diverse pysicochemical properties and functionalities to migrate out of the polymer and eventually overcome the intact human skin barrier during contact. Moreover, their individual distribution within distinct skin layers was demonstrated. This is exemplified by the penetration of the procarcinogenic antioxidant N-phenylnaphthalen-2-amine (Neozon D) into the viable epidermis and the permeation through the skin of the neurotoxic plasticizer N-butylbenzenesulfonamide (NBBS). In addition, the analyses of additive degradation products in the isolated skin layers revealed the presence of 2-tert-butyl-4-methylphenol in all layers after contact to a polymer with substances of origin like Antioxidant 2246. Thus, attention needs to be paid to absorption of polymer additives together with their degradation products when it comes to dermal exposure assessment.
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Affiliation(s)
- N Bartsch
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - M Girard
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - L Schneider
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - V Van De Weijgert
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - A Wilde
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - O Kappenstein
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - B Vieth
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - C Hutzler
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
| | - A Luch
- a Department of Chemical and Product Safety , German Federal Institute for Risk Assessment (BfR) , Berlin , Germany
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Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, Fartasch M, Gimenez-Arnau A, Nixon R, Sasseville D, Agner T. Guidelines for diagnosis, prevention and treatment of hand eczema. J Dtsch Dermatol Ges 2015; 13:e1-22. [PMID: 25763418 DOI: 10.1111/ddg.12510_1] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful me-dical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in “head-to-head” RCTs are needed.The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wis-senschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medi-cal Societies in Germany).No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest.
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Tiedemann D, Clausen ML, John SM, Angelova-Fischer I, Kezic S, Agner T. Effect of glove occlusion on the skin barrier. Contact Dermatitis 2015; 74:2-10. [DOI: 10.1111/cod.12470] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel Tiedemann
- Department of Dermatology; Bispebjerg Hospital, University of Copenhagen; 2400 Copenhagen Denmark
| | - Maja Lisa Clausen
- Department of Dermatology; Bispebjerg Hospital, University of Copenhagen; 2400 Copenhagen Denmark
| | - Swen Malthe John
- Department of Dermatology, Environmental Medicine, Health Theory; Lower Saxoninan Institute of Occupational Dermatology, University of Osnabrueck; D-49069 Osnabrueck Germany
| | - Irena Angelova-Fischer
- Department of Dermatology; University of Lübeck; 23538 Lübeck Germany
- Centre for Comprehensive Inflammation Medicine, University Hospital Schleswig-Holstein Campus Lübeck; 23538 Lübeck Germany
| | - Sanja Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre; 1105 AZ Amsterdam The Netherlands
| | - Tove Agner
- Department of Dermatology; Bispebjerg Hospital, University of Copenhagen; 2400 Copenhagen Denmark
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Weistenhöfer W, Wacker M, Bernet F, Uter W, Drexler H. Occlusive gloves and skin conditions: is there a problem? Results of a cross-sectional study in a semiconductor company. Br J Dermatol 2015; 172:1058-65. [PMID: 25319754 DOI: 10.1111/bjd.13481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although there is poor scientific evidence that working with occlusive gloves is as damaging as wet work, prolonged glove occlusion is considered to be a risk factor for developing hand eczema similar to wet work. OBJECTIVES To assess the effects of wearing occlusive gloves during the whole working day, without exposure to any additional hazardous substances, on skin condition and skin barrier function. METHODS We investigated 323 employees of a semiconductor production company in Germany: 177 clean-room workers wearing occlusive gloves during the whole shift (exposed group) and 146 employees working in administration (control group). A standardized interview was performed, the skin condition of both hands was studied using the quantitative skin score HEROS, and transepidermal water loss (TEWL) and stratum corneum hydration were measured. RESULTS There was no significant difference in skin condition between the two subgroups. Values for TEWL and corneometry were significantly higher in exposed participants (P < 0·05). However, the TEWL values were similar to control values if participants took off the occlusive gloves at least 30 min before the measurement. Hence, the effect of occlusion on skin barrier function seems to be transient. CONCLUSIONS Prolonged wearing of occlusive gloves with clean hands and without exposure to additional hazardous substances does not seem to affect the skin negatively.
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Affiliation(s)
- W Weistenhöfer
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, D-91054, Erlangen, Germany
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Chang CJ, Yu DY, Chang SY, Hsiao YC, Ting K, Chen KT, Hou KH. Real-time photothermal imaging and response in pulsed dye laser treatment for port wine stain patients. Biomed J 2015; 38:342-9. [PMID: 25566801 DOI: 10.4103/2319-4170.148903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This study was performed to assess the photothermal response of highly focused laser energy using infrared thermal imaging instrument to detect and assess the actual temperature distribution during flash lamp pumped pulsed dye laser (FLPPDL) treatment for port wine stain (PWS) patients and avoiding its complications. METHODS A retrospective review of 40 patients with PWS birthmark treated with FLPPDL (l = 585 nm, tp = 1500 ms, 7 mm spot) was conducted over a 2-year period. Subjects' ages ranged between 28 and 46 years (mean 29 years); there were 24 females and 16 males. Twenty patients received non-cooling laser treatment (NC-LT) using light dosages of 5-12 J/cm 2 . Another 20 patients received cryogen spray cooling laser treatment (CSC-LT) using light dosages of 5-12 J/cm 2 . A real-time infrared thermal imaging and the thermal wave equation were used for assessment. The results of temperature distributions related to the energy change were analyzed. RESULTS Proper temperature measurement using infrared thermal imaging instrument and thermal wave equation in non-cooled PWS patients showed that the energy density of pulsed dye laser (PDL) higher than 7 J/cm 2 can reach >44°C and result in burn injury. However, when energy densities beyond 10 J/cm 2 were administered, along with using CSC, thermal damage was could still be minimized without the risk of damage to the treated area. CONCLUSION Using infrared thermal imaging instrument and thermal wave equation, we can predict the skin temperature distribution in FLPPDL for PWS patients during the treatment. In conjunction with CSC, the complications can be minimized.
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Affiliation(s)
- Cheng-Jen Chang
- Department of Plastic Surgery, Chang Gung Memorial Hospital at Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Validation of a Questionnaire on Hand Hygiene in the Construction Industry. ACTA ACUST UNITED AC 2014; 58:1046-56. [DOI: 10.1093/annhyg/meu053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jungersted JM, Agner T. Eczema and ceramides: an update. Contact Dermatitis 2013; 69:65-71. [DOI: 10.1111/cod.12073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/21/2013] [Accepted: 02/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tove Agner
- Department of Dermatology; Bispebjerg Hospital; Copenhagen; 2400; Denmark
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Antonov D, Kleesz P, Elsner P, Schliemann S. Impact of glove occlusion on cumulative skin irritation with or without hand cleanser-comparison in an experimental repeated irritation model. Contact Dermatitis 2013; 68:293-9. [DOI: 10.1111/cod.12028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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Fartasch M, Taeger D, Broding HC, Schöneweis S, Gellert B, Pohrt U, Brüning T. Evidence of increased skin irritation after wet work: impact of water exposure and occlusion. Contact Dermatitis 2012; 67:217-28. [DOI: 10.1111/j.1600-0536.2012.02063.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Todd ECD, Michaels BS, Greig JD, Smith D, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 8. Gloves as barriers to prevent contamination of food by workers. J Food Prot 2010; 73:1762-73. [PMID: 20828485 DOI: 10.4315/0362-028x-73.9.1762] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The role played by food workers and other individuals in the contamination of food has been identified as an important contributing factor leading to foodborne outbreaks. To prevent direct bare hand contact with food and food surfaces, many jurisdictions have made glove use compulsory for food production and preparation. When properly used, gloves can substantially reduce opportunities for food contamination. However, gloves have limitations and may become a source of contamination if they are punctured or improperly used. Experiments conducted in clinical and dental settings have revealed pinhole leaks in gloves. Although such loss of glove integrity can lead to contamination of foods and surfaces, in the food industry improper use of gloves is more likely than leakage to lead to food contamination and outbreaks. Wearing jewelry (e.g., rings) and artificial nails is discouraged because these items can puncture gloves and allow accumulation of microbial populations under them. Occlusion of the skin during long-term glove use in food operations creates the warm, moist conditions necessary for microbial proliferation and can increase pathogen transfer onto foods through leaks or exposed skin or during glove removal. The most important issue is that glove use can create a false sense of security, resulting in more high-risk behaviors that can lead to cross-contamination when employees are not adequately trained.
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Affiliation(s)
- Ewen C D Todd
- Department of Advertising Public Relations and Retailing, Michigan State University, East Lansing, Michigan 48824, USA.
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Jungersted JM, Høgh JK, Hellgren LI, Jemec GBE, Agner T. Skin barrier response to occlusion of healthy and irritated skin: Differences in trans-epidermal water loss, erythema and stratum corneum lipids. Contact Dermatitis 2010; 63:313-9. [DOI: 10.1111/j.1600-0536.2010.01773.x] [Citation(s) in RCA: 38] [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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Bock M, Damer K, Wulfhorst B, John SM. Semipermeable glove membranes-effects on skin barrier repair following SLS irritation. Contact Dermatitis 2009; 61:276-80. [DOI: 10.1111/j.1600-0536.2009.01622.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Wetzky U, Bock M, Wulfhorst B, John SM. Short- and long-term effects of single and repetitive glove occlusion on the epidermal barrier. Arch Dermatol Res 2009; 301:595-602. [PMID: 19582471 DOI: 10.1007/s00403-009-0980-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 05/26/2009] [Accepted: 06/24/2009] [Indexed: 11/30/2022]
Abstract
The aim of this study was to analyse the occlusive effects of glove materials (polyvinyl chloride, natural rubber latex) on epidermal barrier function and to relate the findings to the definitions of wet work in the current German ordinance on hazardous substances (2007) and in the German technical regulations on hazardous substances (TRGS 401; 2008). Short-term effects of wearing gloves once for 4 h, as well as the long-term effects of wearing gloves for 4 h daily for 7 days were assessed in a group of 20 healthy volunteers using non-invasive methods (transepidermal water loss (TEWL), capacitance, skin colour, skin surface pH). Data were collected 30 min and 3 h after single use, as well as 1 day after a 1-week application. TEWL and capacitance data showed hyperhydration of the horny layer 30 min after a 4-h occlusion as compared to baseline (p < 0.05). Three hours later, full recovery to basal values was observed. Additionally, a significant long-term effect after daily occlusion for 4 h for 7 days could not be demonstrated. In current literature, there is controversial evidence concerning the effects of glove occlusion. This study could not verify significant damage to skin barrier after 7 days of repeated occlusion 4 h daily in healthy volunteers. These findings require further discussion regarding the definitions in the current German ordinance on hazardous substances and in the TRGS 401.
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Affiliation(s)
- Ulrike Wetzky
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrueck, 49090 Osnabrueck, Germany.
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Chang CJ, Hsiao YC, Mihm MC, Nelson JS. Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone for treatment of port wine stain birthmarks. Lasers Surg Med 2009; 40:605-10. [PMID: 18951427 DOI: 10.1002/lsm.20716] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to improve port wine stain (PWS) therapeutic outcome in response to laser therapy. Our specific aim was to determine whether the combined use of pulsed dye laser (PDL) therapy and topical Imiquimod versus PDL alone can improve PWS therapeutic outcome. STUDY DESIGN/MATERIALS AND METHODS This pilot study involved a retrospective review of 20 subjects, all Asian, with PWS. Subject ages ranged between 3 and 56 years. Upon enrollment, three test sites were prospectively identified on each subject for treatment assignments to the following regimens: (A) PDL+Imiquimod; (B) PDL alone; and (C) Imiquimod alone. PDL test sites received a single treatment with a 585 nm wavelength; 1.5 milliseconds pulse duration; spot size 7 mm using a light dosage of 10 J/cm2 with cryogen spray cooling. For the PDL+Imiquimod and Imiquimod alone test sites, subjects were instructed to apply Imiquimod topically to the sites once daily for 1 month after PDL exposure. Subjects were followed-up at 1, 3, 6, and 12 months after PDL exposure to evaluate each of the three test sites. The primary efficacy measurement was the quantitative assessment of blanching responses as measured by a DermoSpectrometer to calculate the hemoglobin-index of each site at 1, 3, 6, and 12 months after PDL exposure. Subjects were also closely monitored for any adverse effects. RESULTS Based on paired sample test analysis, there were clinically, and statistically significant, differences in blanching responses over time favoring PWS receiving PDL+Imiquimod as compared to either PDL or Imiquimod alone (P<0.05). At 12 months, it should be noted that there was some evidence of redarkening of PWS test sites treated by PDL+Imiquimod and PDL alone, presumably due to revascularization of blood vessels. However, based on comparison of the hemoglobin-indices determined at 1 and 12 months after PDL exposure, there was less revascularization of PWS test sites treated with PDL+Imiquimod as compared to PDL alone (P<0.05). Transient hyperpigmentation was noted in 10% (n = 2) and 40% (n = 8) of subjects on the PDL+Imiquimod and PDL alone test sites, respectively. On all sites, hyperpigmentation resolved spontaneously without medical intervention within 6 months. Permanent hypopigmentation or scarring was not observed on any test site. CONCLUSION Based on the results of this pilot study, PDL+Imiquimod resulted in superior blanching responses over time as compared to PDL alone for treatment of test sites on PWS lesions. Although the PDL+Imiquimod approach is intriguing, clinical validation in large PWS patient samples is required.
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Affiliation(s)
- Cheng-Jen Chang
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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Todd ECD, Greig JD, Bartleson CA, Michaels BS. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 5. Sources of contamination and pathogen excretion from infected persons. J Food Prot 2008; 71:2582-95. [PMID: 19244919 DOI: 10.4315/0362-028x-71.12.2582] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this article, the fifth in a series reviewing the role of food workers in foodborne outbreaks, background information on the routes of infection for food workers is considered. Contamination most frequently occurs via the fecal-oral route, when pathogens are present in the feces of ill, convalescent, or otherwise colonized persons. It is difficult for managers of food operations to identify food workers who may be excreting pathogens, even when these workers report their illnesses, because workers can shed pathogens during the prodrome phase of illness or can be long-term excretors or asymptomatic carriers. Some convalescing individuals excreted Salmonella for 102 days. Exclusion policies based on stool testing have been evaluated but currently are not considered effective for reducing the risk of enteric disease. A worker may exhibit obvious signs of illness, such as vomiting, but even if the ill worker immediately leaves the work environment, residual vomitus can contaminate food, contact surfaces, and fellow workers unless the clean-up process is meticulous. Skin infections and nasopharyngeal or oropharyngeal staphylococcal or streptococcal secretions also have been linked frequently to worker-associated outbreaks. Dermatitis, rashes, and painful hand lesions may cause workers to reduce or avoid hand washing. Regardless of the origin of the contamination, pathogens are most likely to be transmitted through the hands touching a variety of surfaces, highlighting the need for effective hand hygiene and the use of barriers throughout the work shift.
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Affiliation(s)
- Ewen C D Todd
- Department of Advertising Public Relations and Retailing, Michigan State University, East Lansing, Michigan 48824, USA.
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Anveden I, Meding B. Skin exposure in geriatric care ? a comparison between observation and self-assessment of exposure. Contact Dermatitis 2007; 57:253-8. [PMID: 17868219 DOI: 10.1111/j.1600-0536.2007.01211.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to compare observation and self-assessment of skin exposure to irritants during a working day in nursing in geriatric care. The study group consisted of 40 volunteers, 13 nurses, and 27 assistant nurses. Before the start of a working day, the participants completed a questionnaire regarding skin exposure to water, gloves, hand disinfection, and moisturizers. Observers subsequently used a hand-held computer to register the time and frequency of each exposure. The total mean skin exposure time was 96 min per working day, including glove use. The mean exposure time to water was 9 min per working day. A tendency to overestimate was found for all exposures. A strong correlation between self-reports and observations was found for hand disinfection and moisturizers, while a moderate correlation was found for gloves and number of water exposures and a weak correlation for total time of water exposure. Despite the differences between self-assessment and observation of the exposure, we consider the questionnaire to be useful for surveying skin exposure in nursing. Furthermore, the observations in this study suggest that nursing work in geriatric care may comprise limited exposure to water.
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Affiliation(s)
- Ingegärd Anveden
- Occupational and Environmental Health, Centre for Public Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Buraczewska I, Broström U, Lodén M. Artificial reduction in transepidermal water loss improves skin barrier function. Br J Dermatol 2007; 157:82-6. [PMID: 17553058 DOI: 10.1111/j.1365-2133.2007.07965.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Artificial reduction of abnormal transepidermal water loss (TEWL) is considered to improve skin diseases associated with a defective barrier function. Treatment of the skin with moisturizers is also known to influence skin barrier function. Whether or not differences in occlusion between creams contribute to their effects on the skin barrier function is unknown. OBJECTIVES To investigate the long-term effects of a semipermeable membrane on the skin barrier function in normal skin. In addition, the occlusive properties of two creams were studied. METHODS The study was randomized, controlled and evaluator-blind using measurement of TEWL and skin susceptibility to sodium lauryl sulphate as indicators of skin barrier function. RESULTS Coating of the skin with a silicone membrane for 23 h per day for 3 weeks improved skin barrier function, whereas no significant changes were found after using the membrane for 8 h per day. CONCLUSIONS Differences between creams in terms of their effect on skin barrier function cannot be solely explained by their occlusive properties.
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Affiliation(s)
- I Buraczewska
- ACO HUD NORDIC AB, Research and Development, Box 622, SE-194 26 Upplands Väsby, Sweden
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Marques JPP, Basso DSB, Nunes AS. A new technique associated with the evaporimetry method for evaluating occlusion. Int J Cosmet Sci 2007; 29:97-102. [DOI: 10.1111/j.1467-2494.2007.00357.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Anveden I, Lidén C, Alderling M, Meding B. Self-reported skin exposure--validation of questions by observation. Contact Dermatitis 2006; 55:186-91. [PMID: 16918619 DOI: 10.1111/j.1600-0536.2006.00907.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to validate questions regarding skin exposure using observation. The study group consisted of 40 individuals in 5 different occupations: nurse in an intensive care unit, car mechanic, hairdresser, kitchen worker, and office worker. The participants completed a questionnaire before the start of a working day. The questionnaire covered total skin exposure times to water, foodstuffs, chemicals, and occlusive gloves and also covered the frequency of hand-washing during a working day. Observers subsequently used a hand-held computer to register the time and the frequency of each exposure. A strong correlation between self-reports and observations was found for questions regarding exposure times to water, foodstuffs, and occlusive gloves and also a moderate correlation for questions regarding frequency of hand-washing. The present observation method was insufficient for estimating total exposure times to chemicals as the true exposure time is influenced by, e.g. the use of contaminated protective gloves and the efficacy with which the chemicals were removed. The inter-observer reliability showed a very strong correlation. We consider the questions regarding skin exposure to water, foodstuffs, protective gloves, and hand-washing to be useful for future studies. The observation method seems to be reliable, useful, and easy to apply.
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Affiliation(s)
- Ingegärd Anveden
- Occupational and Environmental Health, Centre for Public Health, SE-17176, Stockholm, Sweden.
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Mirza R, Maani N, Liu C, Kim J, Rehmus W. 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. Contact Dermatitis 2006; 55:20-5. [PMID: 16842549 DOI: 10.1111/j.0105-1873.2006.00833.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: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Raeesa Mirza
- Department of Dermatology, Clinical Trials, Stanford University, Stanford, CA 94305-5334, USA
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Abstract
Due to the clinical findings in a single patient's case, formaldehyde was suspected to be present in clinically relevant levels in reusable protective gloves. Therefore, 9 types of gloves were investigated with the semi-quantitative chromotropic acid method. It was found that 6/9 gloves emitted some formaldehyde and that 4/9 gloves emitted > or =40 microg of formaldehyde. Most of the formaldehyde was found on the inside of the gloves. To get an indication of the clinical relevance, a comparison with a protective cream declared to contain the formaldehyde-releasing agent diazolidinyl urea was performed by comparing areas of gloves with areas of cream layers with thickness 1-2 mg/cm(2). It was found that the amounts of formaldehyde emitted from the gloves might be in the same range as emitted from a layer of cream.
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Affiliation(s)
- Ann Pontén
- Department of Occupational and Environmental Dermatology, Lund University, Malmö University Hospital, Malmö, Sweden.
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Fluhr JW, Akengin A, Bornkessel A, Fuchs S, Praessler J, Norgauer J, Grieshaber R, Kleesz P, Elsner P. Additive impairment of the barrier function by mechanical irritation, occlusion and sodium lauryl sulphate in vivo. Br J Dermatol 2005; 153:125-31. [PMID: 16029337 DOI: 10.1111/j.1365-2133.2005.06430.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The interaction between potential irritants in the workplace might be important because workers are not usually exposed to a single irritant, but to multiple potentially harmful substances. Physical irritant contact dermatitis caused by friction or mechanical abrasion is a common occupational dermatosis. Prolonged water exposure by occlusion is also common in the workplace. Several studies have revealed the negative effect of the common anionic detergent sodium lauryl sulphate (SLS) on permeability barrier function. OBJECTIVES To study the additive impairment of permeability barrier function by mechanical irritation combined with 0.5% SLS or prolonged water exposure by occlusion, as models of mild irritation. METHODS The volar forearms of 20 healthy volunteers were exposed to mechanical irritation and occlusion with water or 0.5% SLS for four consecutive days in a combined tandem repeated irritation test (TRIT). Permeability barrier function was measured with a Tewameter TM 210. Irritation was assessed with a Chromameter CR 300 and a visual score. RESULTS Barrier disruption in our model was rated as follows: occlusion with SLS and mechanical irritation > occlusion with SLS > occlusion with water and mechanical irritation > mechanical irritation and occlusion with water > occlusion with a glove and mechanical irritation > mechanical irritation > occlusion with water. Barrier disruption caused by occlusion or mechanical irritation was enhanced by the tandem application. The choice of irritant under occlusion, time of occlusion and order of tandem application all affected the degree of barrier disruption. Evaporimetry was able to detect early stages in the development of an irritant reaction before it became visible. Chromametry was not able to detect this early response. CONCLUSIONS Physical irritants (friction, abrasive grains, occlusion) and detergents such as SLS represent a significant irritation risk and should be minimized, especially when acting together, as shown in our TRIT model.
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Affiliation(s)
- J W Fluhr
- Skin Physiology Laboratory, Department of Dermatology and Allergology, Friedrich-Schiller-University, Erfurter Str. 35, 07740 Jena, Germany.
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Aasmoe L, Bang B, Andorsen GS, Evans R, Gram IT, Løchen ML. Skin symptoms in the seafood-processing industry in north Norway. Contact Dermatitis 2005; 52:102-7. [PMID: 15725289 DOI: 10.1111/j.0105-1873.2005.00515.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A survey of occupational skin problems, based on a questionnaire, was carried out among 883 workers in different types of seafood-processing industries in northern Norway. The prevalence of dry skin, itching, rash/eczema, chapped skin and chronic sores was significantly higher among production workers (55.6%) in the white fish-, shrimp- and salmon-processing industries, compared to administrative workers in the same industries (27.5%). Among production workers, there was a significantly higher prevalence of skin symptoms among females (60.2%) compared to males (50.1%). A strong sex division of work tasks rather than sex itself may explain this. There was no sex difference among administrative workers. Several risk factors for skin symptoms to occur are indicated. The workers are exposed to raw materials and a mixture of water and juice from the fish or shrimp, salt, detergents and disinfectants. Gloves may also cause skin problems. Major risk factors believed to cause skin symptoms were contact with raw materials, fish juice, water and gloves. The results also indicate that skin symptoms are of moderate severity and seldom interfere with working capacity.
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Affiliation(s)
- L Aasmoe
- Department of Occupational and Environmental Medicine, University Hospital North Norway, Tromsø.
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Jungbauer FHW, Steenstra FB, Groothoff JW, Coenraads PJ. Characteristics of wet work in nurses. Int Arch Occup Environ Health 2005; 78:248-51. [PMID: 15785948 DOI: 10.1007/s00420-004-0561-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 07/23/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND OBJECTIVES Nursing is known for its high prevalence of hand dermatitis, mainly caused by the intense exposure to wet work in nursing activities. We aimed to study the characteristics of wet work exposure in nursing. METHOD Trained observers monitored the duration and frequency of different wet work activities in 45 randomly chosen nurses from different wards during a morning shift, using a method of continuous observation based on labour-observation techniques. RESULTS Wet work in intensive care units accounted for 24% of the overall morning shift duration, with a frequency of 49 incidents. This was 16% in dialysis wards, with a frequency of 30 incidents, and 9% on regular wards, with a frequency of 39 incidents. The wet work activities had short mean duration cycles. The mean duration of occlusion by gloves was 3.1 min on regular wards and 6.7 min in intensive care units. DISCUSSION The characteristics of wet work in nurses differed substantially, depending on the ward. According to the German regulation TRGS 531, our observations classify nursing as a wet work occupation, due to the frequency of wet work rather than its duration. The mean duration of occlusion in our observations was short, which makes an occlusion-induced irritating effect doubtful. Reduction in wet work exposure in nursing on regular wards could focus on the reduction of the frequency of hand-washing and patient-washing. We suggest increasing the use of gloves for patient washing. Although this will increase exposure to occlusion from gloves, it may reduce the frequency of exposure to water and soap by about a quarter.
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Affiliation(s)
- F H W Jungbauer
- Department of Dermatology, Groningen University Hospital, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Jungbauer FHW, Van Der Harst JJ, Schuttelaar ML, Groothoff JW, Coenraads PJ. Characteristics of wet work in the cleaning industry. Contact Dermatitis 2005; 51:131-4. [PMID: 15479201 DOI: 10.1111/j.0105-1873.2004.00421.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Wet work is the main cause of occupational contact dermatitis in the cleaning industry. Dermatologists and occupational physicians need to base their primary and secondary prevention for workers in the cleaning industry on the characteristics of wet work exposures. We quantified the burden of wet work in professional office cleaning activities with a continuous standardized observation by trained observers of 41 office cleaners. Duration and frequency of wet work exposure and of different cleaning activities were assessed. Wet work made up 50% of such cleaning work. Within a typical 3-hr shift, a mean frequency of 68 episodes of wet work was observed, which classifies office cleaning as wet work. Skin exposure to irritants was markedly different among cleaners who did the same cleaning activities. Reduction in skin irritation can be achieved by training the workers. Because this group of workers, who have a low level of education, has a high risk of developing irritant hand dermatitis, a special effort on training and instruction should be made. A reduction of exposure can be achieved by: using gloves more often; using gloves for a shorter period of time; using gloves while doing activities that otherwise cause the skin to be in contact with water and cleaning substances and washing hands with water only, reserving soap for when the hands are visibly dirty.
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Affiliation(s)
- F H W Jungbauer
- Department of Dermatology, Groningen University Hospital, Groningen, the Netherlands.
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Abstract
Prevention of hand dermatitis among nurses can be achieved by reduction of wet-work exposure. A preventive programme should be based on knowledge of exposure levels. An accurate method to assess such exposure levels is needed. Duration and frequency of wet-work activities were assessed by a questionnaire, in various parts of the health care sector. In addition, a randomly chosen sample from this population was observed for the duration and frequency of wet work. In contrast to the questionnaire, the observation method showed less than half the duration of wet work. Observation detected almost double the frequency that was reported with the questionnaire. Gloves were observed to be used daily in special care units for short time periods. A questionnaire does not accurately assess the quantity of wet-work activities. On regular wards, the exposure to irritants is mainly associated with the frequency of wet hands, rather than the duration of wet hands. We assume that the short-term use of gloves on special care units does not cause an increased risk of hand dermatitis. Preventive programmes can focus on decreasing the frequency of wet hands by encouraging the use of gloves; the use of gloves should not only be advised to prevent infections but also to protect against hand dermatitis.
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Affiliation(s)
- F H W Jungbauer
- Department of Dermatology, Groningen University Hospital, Post Box 30.001, 9700 RB Groningen, The Netherlands.
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Michaels B, Gangar V, Lin CM, Doyle M. Use limitations of alcoholic instant hand sanitizer as part of a food service hand hygiene program. ACTA ACUST UNITED AC 2003. [DOI: 10.1046/j.1471-5740.2003.00067.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND When evaluating transepidermal water loss (TEWL) in patch testing, the occlusive effect of the patch must be considered as an important artificial impairment of the measurement. OBJECTIVES To investigate the time course of effects of occlusion. METHODS Epicutaneous patches with sodium lauryl sulphate (SLS) 0.25%, SLS 0.5%, water and an empty test chamber (control) were applied on the volar forearm for different time intervals (12, 24, 48 h). Test reactions were evaluated by measurement of TEWL immediately, every 15 min during the first hour, every 30 min during the following 3 h and 24 h after patch removal. RESULTS After patch removal, TEWL values showed a steep increase. When compared with basal values, TEWL values after SLS patch testing remained increased for 24 h, whereas TEWL values on water patch sites were only significantly increased for up to 180 min, and on empty patch sites for only up to 120 min after patch removal. The prolonged increase in TEWL values in SLS patch testing seemed to be induced by barrier function damage caused by SLS itself, as shown in various earlier studies. After the initial increase, TEWL values showed a significant decrease for all patches from 0 to 120 min after patch removal. Patch testing with water gave a significant decrease in TEWL values up to 180 min, and for empty chambers (control) up to 150 min after removal of patches. These data suggest that the occlusive effect on TEWL in patch testing ends 3 h after the removal of test chambers. CONCLUSIONS We recommend TEWL measurement in SLS patch testing after a period of at least 3 h after patch removal. For practical purposes a 24-h period after patch removal may be useful.
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Affiliation(s)
- K Friebe
- Department of Dermatology, Philipp University of Marburg, Deutschhausstr. 9, Germany
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Abstract
Educational programmes, including evidence-based recommendations on skin protection (skin protection programmes), have been proposed for the prevention of irritant contact dermatitis in occupations with a high frequency of this disease. Recent intervention studies directed at wet-work employees showed a positive influence on wet-work behaviour and on clinical skin symptoms. The structure and implementation of skin protection programmes are discussed.
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Affiliation(s)
- Tove Agner
- Department of Dermatology, Gentofte University Hospital, Hellerup, Denmark.
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Gill CO, Jones T. Effects of wearing knitted or rubber gloves on the transfer of Escherichia cohi between hands and meat. J Food Prot 2002; 65:1045-8. [PMID: 12092720 DOI: 10.4315/0362-028x-65.6.1045] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
On eight occasions, five volunteers each handled five pieces of meat with bare hands or while wearing dry or wet knitted gloves or rubber gloves after hands had been inoculated with Escherichia coli or after handling a piece of meat inoculated with E. coli. On each occasion, after all meat was handled, each piece of meat, glove, and hand were sampled to recover E. coli. When hands were inoculated, E. coli was recovered from all meat handled with bare hands, in lesser numbers from some pieces handled with knitted gloves, and from only one piece handled with rubber gloves. When pieces of inoculated meat were handled, the numbers of E. coli transferred to uninoculated meat from bare hands or rubber gloves decreased substantially with each successive piece of uninoculated meat, but decreases were small with knitted gloves. The findings indicate that, compared with bare hands, the use of knitted gloves could reduce the transfer of bacteria from hands to meat but could increase the transfer of bacteria between meat pieces, whereas the use of rubber gloves could largely prevent the first and greatly reduce the second type of bacteria transfer.
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Affiliation(s)
- C O Gill
- Agriculture and Agri-Food Canada, Lacombe Research Centre, Alberta.
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