Occupational skin diseases in cleaning and kitchen employees: Course and quality of life after measures of secondary individual prevention

Prevalence, risk factors, and prevention of occupational contact dermatitis among professional cleaners: a systematic review

OBJECTIVE

The aim of this study was to investigate the prevalence, risk factors, and prevention of occupational contact dermatitis (OCD), as well as risk factors and consequences of OCD among professional cleaners.

METHODS

A systematic review following PRISMA guidelines was performed using Medline, EMBASE, and Cochrane Library.

RESULTS

Thirty-nine studies containing over 109.000 participants were included in the review. The prevalence of OCD varied between 2.2% and 30.1%. Main occupational risk factors for developing OCD among cleaners included wet work and irritants in cleaning products (bleach, chlorine, ammonia, multi-use-cleaning) and skin contact to metal. The most common contact allergies included rubber, biocides, nickel/cobalt, and perfumes. Other risk factors were inconsistent use of protective gloves and low educational level. Consequences associated with OCD included significant impairment in quality of life, tendency to have unscheduled absence from work, sick leave, increased rate of disability, and recognized degree of injury. Only one prevention study has been published investigating the effect of an educative course in skin-protective behavior in cleaners. The study reported a higher degree of knowledge of skin protection, a decrease in the severity of hand eczema, and a shift toward fewer daily hand washings at follow-up after 3 months.

CONCLUSION

Our study proves that OCD is common in cleaners, and the main risk factors included wet work, irritants, and contact allergies, as well as inconsistent use of protective gloves and low educational level. More focus and a greater number of studies are needed on skin protection in this population.

Effectiveness of secondary prevention in metalworkers with work-related skin diseases and comparison with participants of a tertiary prevention program: A prospective cohort study

BACKGROUND

In Germany, a multistep approach has been established to prevent work-related skin diseases (WRSDs).

OBJECTIVES

To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP).

PATIENTS AND METHODS

In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow-up 8-12 weeks after the SIP or at dismissal from the TIP (3-4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome-wide association study (GWAS).

RESULTS

Ninety-three SIP patients (81.6%) attended the follow-up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS.

CONCLUSIONS

The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP.

Quality of life measurement in occupational skin diseases. Position paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Occupational Skin Disease

The European Academy of Dermatology and Venereology (EADV) has started the 'Healthy Skin @ Work' campaign aimed to raise awareness among the public and EU authorities on the frequency and impact of occupational skin diseases (OSDs). The EADV Task Forces (TFs) on Quality of Life and Patient Oriented Outcomes (QoL/PO) and on OSD present their mutual position statement on QoL assessment in OSDs. The EADV TFs recommend the use of the DLQI as a dermatology-specific instrument and SF-36 as a generic instrument in health-related (HR) QoL studies on OSDs. The OSD-specific questionnaire, LIOD, is not recommended for general use in its present form because of its three months recall period. The EADV TFs discourage the use of non-validated and of non-validated modifications of previously validated HRQoL instruments. The EADV TFs wish to encourage research into: the HRQoL impact of OSDs other than occupational contact dermatitis and hand eczema; comparisons between the effects of different treatments and other interventions on HRQoL in OSDs; and into the HRQoL impairment of patients with OSDs from different countries, and with different provoking factors, to predict if the results of successful therapeutic and educational interventions may be generalized across countries and between occupations.

Impact of Allergic Contact Dermatitis on the Quality of Life and Work Productivity

BACKGROUND

Allergic contact dermatitis (ACD) is a common chronic skin disease that generates considerable public-health and socioeconomic costs. This disease affects the quality of life and the occupational activity of patients.

AIMS

To assess the quality of life (QOL) of patients with ACD and study the impact of this disease on their work productivity.

METHODS

This is a cross-sectional study carried out from January 2012 to December 2014. All patients diagnosed with ACD in the Dermato-Allergology Unit of the Occupational Medicine Department at Farhat Hached University Hospital, in Sousse, were included. The impact of skin disease on the QOL of affected persons was assessed using the Dermatology Life Quality Index (DLQI). The work productivity was measured using the Work Productivity and Activity Impairment Allergic Specific questionnaire (WPAI: AS).

RESULTS

The study population consisted of 150 patients. The average score of DLQI was 6.5. Over the previous 7 days, absenteeism rate was 25.9 ± 15.3%, presenteeism rate was 50.2 ± 32%, overall work productivity loss was 29.6 ± 19.4%, and daily activity impairment was 50.4 ± 32.3%. The DLQI score was significantly associated with atopy (p = 0.03), relapses strictly greater than 10 (p = 0.02), presenteeism (p <10-3), overall work productivity loss (p = 0.01), and daily activity impairment (p = 0.03).

CONCLUSION

The impact of ACD on QOL and occupational activity seems important and requires specific attention from the occupational physician.

Interdisciplinary and multiprofessional outpatient secondary individual prevention of work-related skin diseases in the metalworking industry: 1-year follow-up of a patient cohort

Background

In Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance.

Methods

The multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity.

Results

Data from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program.

Conclusions

The results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a “high-risk” profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining.

Electronic supplementary material

The online version of this article (10.1186/s12895-018-0080-2) contains supplementary material, which is available to authorized users.

Skin Protection Seminars to Prevent Occupational Skin Diseases: Results of a Prospective Longitudinal Study in Apprentices of High-risk Professions

BACKGROUND

Occupational skin diseases (OSDs) are frequent in professions with exposure to skin hazards. Thus, a health educational intervention for apprentices of high-risk professions was conducted. It was the aim of this study to gain insight into possible effects of this intervention.

METHODS

A one-time skin protection seminar was conducted in 140 apprentices of health-related and non-health-related professions [trained cohort (TC)]. In addition, 134 apprentices of the same occupations were monitored [untrained cohort (UTC)]. The OSD-specific knowledge and the skin condition of the hands were assessed at baseline (T0), after the seminar (T1), and after 6 (T2) and 12 months (T3).

RESULTS

The OSD-specific knowledge increased in all cohorts from T0 to T3, but we found a significantly higher knowledge in the TC at T2 (p < 0.001, t = 3.6, df = 196, 95% confidence interval = 0.9, 3.3) and T3 (p < 0.001, t = 3.8, df = 196, 95% confidence interval = 1.0, 3.2) compared to the UTC. Our results indicated a better skin condition of the hands in the TC of the health-related professions but not in the non-health-related professions.

CONCLUSION

The study indicates that an educational intervention may positively influence the disease-specific knowledge and the prevalence of OSD in apprentices. However, definite conclusions cannot be drawn because of the heterogeneous study cohorts and the study design. Future research should aim at tailoring primary prevention to specific target groups, e.g., in view of the duration and frequency of skin protection education, different professions, and gender-specific prevention approaches.

Testing the Hand Dermatitis Screening Tool in the Home Health Care Sector

Workers exposed to wet work are at an increased risk for occupational contact dermatitis and may benefit from screening to detect early disease. The objective of this study was to assess the prevalence of hand dermatitis in home care workers, identify factors that influence presence of disease, and explore feasibility and importance of workplace screening in the home care sector. Following institutional ethics approval, nurses, personal support workers, and rehab therapists at one large home care provider in Ontario, Canada, self-screened for hand dermatitis using the Hand Dermatitis Screening Tool and accompanying photo guide and completed a short feasibility evaluation. Of the 220 participants, 18% had a positive screen for hand dermatitis and 77% reported exposure to wet work. In all, 93% of participants reported using the tool took less than 2 minutes and 84% reported screening for hand dermatitis is important. In conclusion, prevalence of hand dermatitis in home care workers is higher than reported in the general population. Workplace screening for hand dermatitis was deemed important, and the tool was feasible to use in the home care sector.

Individual prevention courses for occupational skin diseases: changes in and relationships between proximal and distal outcomes

BACKGROUND

To treat people with occupational contact dermatitis, the German Accident Prevention and Insurance Association in the Health and Welfare Services offers 2-day individual prevention (IP) seminars.

OBJECTIVES

We investigated whether there are short-term and medium-term changes in proximal (e.g. behaviour) and distal (e.g. symptoms) outcomes after an IP seminar, whether changes in proximal outcomes are associated with changes in distal outcomes, and whether subgroups can be identified that benefit in particular.

PATIENTS/MATERIALS/METHODS

In a prospective study, 502 participants of 85 IP courses completed the health education impact questionnaire (heiQ™) and skin symptom questionnaire (Skindex-29) at the start of the course, immediately thereafter, and after 6 months. Change was assessed according to standardized effect size. Regression techniques were used to analyse associations between proximal and distal outcomes.

RESULTS

After 6 months, participants showed improved self-management skills and preventive behaviour, and less fear of job loss, disease-related symptoms, and emotional distress. Significant associations between proximal and distal outcomes were found. Participants who felt more limited by their skin disease showed greater effects.

CONCLUSIONS

The results are consistent with the assumption that IP courses provide a range of benefits for people with occupational contact dermatitis. Changes in distal outcomes may be influenced by changes in proximal outcomes.

Occupationally related contact dermatitis in North American food service workers referred for patch testing, 1994 to 2010

BACKGROUND

Contact dermatoses are common in food service workers (FSWs).

OBJECTIVES

This study aims to (1) determine the prevalence of occupationally related contact dermatitis among FSWs patch tested by the North American Contact Dermatitis Group (NACDG) and (2) characterize responsible allergens and irritants as well as sources.

METHODS

Cross-sectional analysis of patients patch tested by the NACDG, 1994 to 2010, was conducted.

RESULTS

Of 35,872 patients patch tested, 1237 (3.4%) were FSWs. Occupationally related skin disease was significantly more common in FSWs when compared with employed non-FSWs. Food service workers were significantly more likely to have hand (P < 0.0001) and arm (P < 0.0006) involvement. The rates for irritant and allergic contact dermatitis in FSWs were 30.6% and 54.7%, respectively. Although the final diagnosis of irritant contact dermatitis was statistically higher in FSWs as compared with non-FSWs, allergic contact dermatitis was lower in FSWs as compared with non-FSWs. The most frequent currently relevant and occupationally related allergens were thiuram mix (32.5%) and carba mix (28.9%). Gloves were the most common source of responsible allergens. The NACDG standard tray missed at least 1 occupationally related allergen in 38 patients (4.3%).

CONCLUSIONS

Among FSWs patch tested by the NACDG between 1994 and 2010, the most common allergens were thiuram mix and carba mix. Gloves were the most common source of responsible allergens.

Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial

OBJECTIVE

To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema.

DESIGN

Randomised, observer blinded parallel group superiority clinical trial.

SETTING

Three hospitals in Denmark.

PARTICIPANTS

255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group.

INTERVENTIONS

Education in skin care and individual counselling based on patch and prick testing and assessment of work and domestic related exposures. The control was treatment as usual.

MAIN OUTCOME MEASURES

The primary outcome was clinical severity of disease at five month follow-up measured by scores on the hand eczema severity index. The secondary outcomes were scores on the dermatology life quality index, self evaluated severity of hand eczema, skin protective behaviours, and knowledge of hand eczema from onset to follow-up.

RESULTS

Follow-up data were available for 247 of 255 participants (97%). At follow-up, the mean score on the hand eczema severity index was significantly lower (improved) in the intervention group than control group: difference of means, unadjusted -3.56 (95% confidence interval -4.92 to -2.14); adjusted -3.47 (-4.80 to -2.14), both P<0.001 for difference. The mean score on the dermatology life quality index was also significantly lower (improved) in the intervention group at follow-up: difference of means: unadjusted -0.78, non-parametric test P=0.003; adjusted -0.92, -1.48 to -0.37). Self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves were also statistically significantly better in the intervention group, whereas this was not the case for knowledge of hand eczema.

CONCLUSION

A secondary prevention programme for hand eczema improved severity and quality of life and had a positive effect on self evaluated severity and skin protective behaviour by hand washings and wearing of protective gloves.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01012453.

"The itching hand"- important differential diagnoses and treatment

Skin diseases affecting the hands receive particular individual attention and constitute a considerable emotional burden. Many dermatoses also present with itching of the hands. Itch is often underestimated when it occurs in a comparably limited body area such as the hands. The high occupational significance of the hands in many professions must, nevertheless, be stressed. One of the most frequent diagnoses in itching of the hands is eczema. In the differential diagnosis, less common diseases such as neurological and systemic diseases and adverse drug reactions must also be taken into consideration. Itching of the hands can also be accompanied by other sensations, such as burning, stinging and pain. A thorough history regarding sensations and dysesthesias already allows for a diagnostic classification of the disease in some cases. Itching of the hands requires a careful and thorough diagnostic approach. This forms the basis of a specific and successful therapy which may be adapted stepwise, depending on the underlying cause, and also may require, in addition to causal therapy, symptomatic antipruritic therapy. Therapy should follow the current guidelines for chronic pruritus and hand eczema. This article reviews over the differential diagnosis and therapy of "itching hands".

Cumulative life damage in dermatology

Cumulative life damage is an old concept of considerable face validity, which has attracted more scientific interest in the fields of sociology and psychology than in medicine over the years. The research examines the interconnectivity of the many factors which shape the development of individuals or institutions over time. By focussing on time, context and process, life course research highlights the different effects seemingly similar events may have at different points in time and in different contexts.

A review of the impact of occupational contact dermatitis on quality of life

Occupational contact dermatitis (OCD) is the most common occupational skin disease in many countries. We reviewed the current evidence on how OCD impacts on quality of life (QoL). The three commonly used QoL questionnaires in OCD were the Short-Form Health Survey (SF-36), the Dermatology Life Quality Index (DLQI), and the Skindex. Despite the availability of a variety of validated QoL instruments, none of them is specific to OCD or entirely adequate in capturing the impact of OCD on QoL. Nonetheless, the results of this paper do suggest a significant impact. Use of QoL measures in clinical settings will provide patients with an opportunity to express their concerns and assist clinicians to evaluate the effectiveness of management beyond the clinical outcomes. This paper also highlights the lack of a disease-specific QOL instrument and the importance of developing a validated measure to assess QOL in OCD, enabling comparison across countries and occupational groups.

Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria

BACKGROUND

Occupational contact dermatitis is the most frequently reported work-related skin disease in many countries. A systematic review was commissioned by the British Occupational Health Research Foundation in response to a House of Lords Science and Technology Committee recommendation.

OBJECTIVES

The systematic review aims to improve the prevention, identification and management of occupational contact dermatitis and urticaria by providing evidence-based recommendations.

METHODS

The literature was searched systematically using Medline and Embase for English-language articles published up to the end of September 2009. Evidence-based statements and recommendations were graded using the Royal College of General Practitioner's three-star system and the revised Scottish Intercollegiate Guidelines Network grading system.

RESULTS

Three thousand one hundred and fifty-five abstracts were identified and screened. From these, 786 full papers were obtained and appraised. One hundred and nineteen of these studies were used to produce 36 graded evidence statements and 10 key recommendations.

CONCLUSIONS

This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification and occupational management of occupational contact dermatitis and urticaria, based on and using the best available medical evidence.

Contact allergens and irritants in household washing and cleaning products

BACKGROUND

Household cleaning products often contain potential allergens and irritants but allergic contact dermatitis from these products in general consumers is rarely reported in the literature.

OBJECTIVES

The purpose of this study was to evaluate the presence of irritants and allergens as indicated on the labels or on the product information found on the website of household cleaning products marketed in Italy.

MATERIAL/METHODS

We examined the labels and the product information of 291 liquid household washing and cleaning products, including 43 washing-up liquids, 63 laundry detergents, 61 fabric conditioners, 47 spray detergents, and 77 hard surface cleaning products. We obtained the data from the product information found on the websites for 263 products and directly on the product packages for 28 products. For each product we specifically recorded the presence of surfactants, preservatives, and fragrances listed in Annex III of Directive 76/768/EEC.

RESULTS

The websites of two Italian brands do not respect EU regulations as they provide product information only with bar codes of the products. Preservatives and fragrances are the main allergens declared in the label of household cleaning products with methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) listed in 35.7% and limonene in 43.6% of the products. Surfactants were listed in 16.5% of the studied products.

CONCLUSIONS

Our study shows that household cleaning products in Italian market contain several allergens, particularly preservatives and fragrances. For consumers, at least in Italy, it may not be easy to retrieve product information from the website for two widely sold brands. The information had to be taken from the actual package.