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Dietz JBN, Simonsen ABN, Menné T, Ahlstrøm MG, Flyvholm MA, Blomberg MH, Erichsen CY, Meyer HW, Viskum S, Ahrensbøll-Friis U, John SM, Johansen JD. Assessing the efficacy of a German-inspired intervention on occupational contact dermatitis in Denmark: A randomised controlled trial with 3-month follow-up. Contact Dermatitis 2024; 90:280-290. [PMID: 38052587 DOI: 10.1111/cod.14457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Occupational contact dermatitis (OCD) is a prevalent, often chronic disease that poses a risk for job loss and decreased quality of life. In Germany, a multi-step prevention programme emphasising early detection and highly specialised multidisciplinary treatment has been implemented with great success. OBJECTIVES To examine the effectiveness of a Danish-adapted version of the German prevention effort on OCD severity, quality of life and occupational consequences at 3-month follow-up. METHODS Randomised, controlled trial. Participants were recruited after the first referral from General Practitioner to Dermatologist with suspected OCD. The intervention group (IG) received a Danish-adapted, multidisciplinary intervention, while the control group (CG) navigated the Danish healthcare system without interference from the study. OCD severity, occupational consequences and quality of life were assessed at 3-month follow-up using self-reported questionnaires. RESULTS A statistically significant decrease in the severity of eczema was found at 3-month follow-up in the IG compared to the CG. The IG were statistically significantly more likely to have seen a dermatologist at 3-month follow-up. Higher treatment level in the IG was indicated by the results but was not statistically significant. No significant difference was found in quality of life or occupational consequences. CONCLUSIONS These initial findings suggest that early and specialised treatment of OCD improves OCD prognosis.
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Affiliation(s)
- Jojo Biel-Nielsen Dietz
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Anne Birgitte N Simonsen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Torkil Menné
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Malin G Ahlstrøm
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Mari-Ann Flyvholm
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Maria H Blomberg
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Christina Y Erichsen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Harald W Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sven Viskum
- Unit of Social Medicine, Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark
| | - Ulrik Ahrensbøll-Friis
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Swen M John
- Department of Dermatology, Environmental Health and Health Theory, University of Osnabrück and Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Jeanne D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
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Sedeh FB, Michaelsdóttir TE, Jemec GBE, Mortensen OS, Ibler KS. What do professional cleaners know about the skin care? A questionnaire-based study. Contact Dermatitis 2023; 88:286-293. [PMID: 36621909 DOI: 10.1111/cod.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND Correct daily skin care is important regarding hand eczema (HE). However, only a few studies have evaluated the level of knowledge among hospital cleaners. OBJECTIVE To examine the level of knowledge regarding skin protective behaviour and risk factors with respect to HE in hospital cleaners. METHODS All cleaners working in four hospitals in Denmark were invited to participate in the study, which was based on a questionnaire consisting of 22 questions. RESULTS 142 of 236 cleaners (response rate = 60.1%) were included. The mean of total correct answers were approximately five out of nine questions. 85.6% of participants evaluated themselves to have a low degree of knowledge of skin care and protection. Based on the number of correct answers, 90% were defined as having low knowledge. Being born or raised outside of Denmark was statistically significantly associated with lower level of knowledge. Risk factors for HE such as, work with wet hands, and use of household cleaning products were only recognized as risk factors by less than 50%. CONCLUSION Our study indicates that Danish hospital cleaners have a low degree of knowledge regarding skin care and protection. Cleaning workers born or raised outside of Denmark are in need of special attention.
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Affiliation(s)
| | | | | | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbaek University Hospital, Holbaek, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Health Promotion Model-Based Skin Health Program to Improve Skin Health Behaviors, Quality of Life, and Self-Efficacy and Reduce Eczema Symptoms in Hairdresser Apprentices. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Rehabilitation and Prevention of Hand Eczema. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_71] [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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Keefe AR, Demers PA, Neis B, Arrandale VH, Davies HW, Gao Z, Hedges K, Holness DL, Koehoorn M, Stock SR, Bornstein S. A scoping review to identify strategies that work to prevent four important occupational diseases. Am J Ind Med 2020; 63:490-516. [PMID: 32227359 DOI: 10.1002/ajim.23107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite being largely preventable, many occupational diseases continue to be highly prevalent and extremely costly. Effective strategies are required to reduce their human, economic, and social impacts. METHODS To better understand which approaches are most likely to lead to progress in preventing noise-related hearing loss, occupational contact dermatitis, occupational cancers, and occupational asthma, we undertook a scoping review and consulted with a number of key informants. RESULTS We examined a total of 404 articles and found that various types of interventions are reported to contribute to occupational disease prevention but each has its limitations and each is often insufficient on its own. Our principal findings included: legislation and regulations can be an effective means of primary prevention, but their impact depends on both the nature of the regulations and the degree of enforcement; measures across the hierarchy of controls can reduce the risk of some of these diseases and reduce exposures; monitoring, surveillance, and screening are effective prevention tools and for evaluating the impact of legislative/policy change; the effect of education and training is context-dependent and influenced by the manner of delivery; and, multifaceted interventions are often more effective than ones consisting of a single activity. CONCLUSIONS This scoping review identifies occupational disease prevention strategies worthy of further exploration by decisionmakers and stakeholders and of future systematic evaluation by researchers. It also identified important gaps, including a lack of studies of precarious workers and the need for more studies that rigorously evaluate the effectiveness of interventions.
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Affiliation(s)
- Anya R. Keefe
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | - Paul A. Demers
- Occupational Cancer Research Centre, Cancer Care Ontario Toronto Ontario Canada
| | - Barbara Neis
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
| | | | - Hugh W. Davies
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Zhiwei Gao
- Department of Clinical Epidemiology, Faculty of MedicineMemorial University St. John's Newfoundland Canada
| | - Kevin Hedges
- Occupational Health Clinics for Ontario Workers Ottawa Ontario Canada
| | - D. Linn Holness
- Department of Medicine and Public Health SciencesSt. Michael's Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Mieke Koehoorn
- Occupational and Environmental Health, School of Population and Public HealthUniversity of British Columbia Vancouver British Columbia Canada
| | - Susan R. Stock
- Division of Biological Risks and Occupational HealthInstitut national de santé publique du Québec (Quebec Institute of Public Health) Montreal Quebec Canada
- Department of Social and Preventive MedicineSchool of Public Health, Université de Montreal Montreal Quebec Canada
| | - Stephen Bornstein
- SafetyNet Centre for Occupational Health and Safety Research, Memorial University St. John's Newfoundland Canada
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Rehabilitation and Prevention of Hand Eczema. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_71-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Papadatou Z, Williams H, Cooper K. Effectiveness of interventions for preventing occupational irritant hand dermatitis: a quantitative systematic review. ACTA ACUST UNITED AC 2019; 16:1398-1417. [PMID: 29894409 DOI: 10.11124/jbisrir-2017-003405] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this review was to identify, appraise and synthesize the best available evidence on the effectiveness of moisturizers, barrier creams, protective gloves, skin protection education and complex interventions (a combination of two or more of the interventions listed here) in preventing occupational irritant hand dermatitis (OIHD) in wet workers, comparing each intervention to an alternative intervention or to usual care (workers' regular skin care regimen). INTRODUCTION The most significant occupational skin problem potentially encountered in wet work occupations is occupational dermatitis. When the skin comes into contact with hazardous substances at work, this can cause occupational dermatitis. Substances which may cause occupational dermatitis include cleaning products, organic solvents, metalworking fluids, cement, flour, adhesives, other chemicals and even certain plants. Occupational skin disease has adverse effects on quality of life and the long term prognosis for skin health is poor unless workplace exposures are addressed. To date, no systematic review has been undertaken to determine the effectiveness of interventions for the primary prevention of OIHD in wet workers. INCLUSION CRITERIA The review included any workers from healthcare (e.g. nurses, doctors and allied health professionals) and also people in different wet work occupations (e.g. hairdressers, florists, catering workers, metal workers) at similar risk of OIHD. Studies that assessed the following interventions in the primary prevention of OIHD in wet workers at the workplace and at home (before and after work) were included:Types of studies considered were experimental study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, and before and after studies. Primary outcome measures were OIHD incidence, and secondary outcome measures were product evaluation and change of occupation because of OIHD versus staying in the occupation. METHODS Published and unpublished literature in the English language was sought between 2004 and 2017. The databases searched included: COCHRANE CENTRAL, MEDLINE, CINAHL, AMED and Embase. The search for unpublished studies included: Google Scholar, Open DOAR and Robert Gordon University's thesis database, "OPEN AIR". RESULTS There were no studies located that met the inclusion requirements of this review. CONCLUSION There is currently no evidence available to determine the effectiveness of interventions to prevent OIHD amongst wet workers that met this review's inclusion criteria.
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Affiliation(s)
- Zoi Papadatou
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
| | - Hector Williams
- School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
| | - Kay Cooper
- The Scottish Centre for Evidence-based Multi-professional Practice: a Joanna Briggs Institute Centre of Excellence.,School of Health Sciences, Robert Gordon University, Aberdeen, Scotland
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Wilke A, Brans R, Nordheider K, Braumann A, Hübner A, Sonsmann FK, John SM, Wulfhorst B. Skin Protection Seminars to Prevent Occupational Skin Diseases: Results of a Prospective Longitudinal Study in Apprentices of High-risk Professions. Saf Health Work 2018; 9:398-407. [PMID: 30559987 PMCID: PMC6284163 DOI: 10.1016/j.shaw.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/16/2018] [Accepted: 05/12/2018] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Antje Braumann
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Hamburg, Germany
| | - Anja Hübner
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Flora K. Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Swen M. John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Britta Wulfhorst
- Faculty of Human Sciences/Department of Educational Sciences, MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
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Bauer A, Rönsch H, Elsner P, Dittmar D, Bennett C, Schuttelaar MA, Lukács J, John SM, Williams HC. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database Syst Rev 2018; 4:CD004414. [PMID: 29708265 PMCID: PMC6494486 DOI: 10.1002/14651858.cd004414.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Occupational irritant hand dermatitis (OIHD) causes significant functional impairment, disruption of work, and discomfort in the working population. Different preventive measures such as protective gloves, barrier creams and moisturisers can be used, but it is not clear how effective these are. This is an update of a Cochrane review which was previously published in 2010. OBJECTIVES To assess the effects of primary preventive interventions and strategies (physical and behavioural) for preventing OIHD in healthy people (who have no hand dermatitis) who work in occupations where the skin is at risk of damage due to contact with water, detergents, chemicals or other irritants, or from wearing gloves. SEARCH METHODS We updated our searches of the following databases to January 2018: the Cochrane Skin Specialised Register, CENTRAL, MEDLlNE, and Embase. We also searched five trials registers and checked the bibliographies of included studies for further references to relevant trials. We handsearched two sets of conference proceedings. SELECTION CRITERIA We included parallel and cross-over randomised controlled trials (RCTs) which examined the effectiveness of barrier creams, moisturisers, gloves, or educational interventions compared to no intervention for the primary prevention of OIHD under field conditions. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcomes were signs and symptoms of OIHD developed during the trials, and the frequency of treatment discontinuation due to adverse effects. MAIN RESULTS We included nine RCTs involving 2888 participants without occupational irritant hand dermatitis (OIHD) at baseline. Six studies, including 1533 participants, investigated the effects of barrier creams, moisturisers, or both. Three studies, including 1355 participants, assessed the effectiveness of skin protection education on the prevention of OIHD. No studies were eligible that investigated the effects of protective gloves. Among each type of intervention, there was heterogeneity concerning the criteria for assessing signs and symptoms of OIHD, the products, and the occupations. Selection bias, performance bias, and reporting bias were generally unclear across all studies. The risk of detection bias was low in five studies and high in one study. The risk of other biases was low in four studies and high in two studies.The eligible trials involved a variety of participants, including: metal workers exposed to cutting fluids, dye and print factory workers, gut cleaners in swine slaughterhouses, cleaners and kitchen workers, nurse apprentices, hospital employees handling irritants, and hairdressing apprentices. All studies were undertaken at the respective work places. Study duration ranged from four weeks to three years. The participants' ages ranged from 16 to 67 years.Meta-analyses for barrier creams, moisturisers, a combination of both barrier creams and moisturisers, or skin protection education showed imprecise effects favouring the intervention. Twenty-nine per cent of participants who applied barrier creams developed signs of OIHD, compared to 33% of the controls, so the risk may be slightly reduced with this measure (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.72 to 1.06; 999 participants; 4 studies; low-quality evidence). However, this risk reduction may not be clinically important. There may be a clinically important protective effect with the use of moisturisers: in the intervention groups, 13% of participants developed symptoms of OIHD compared to 19% of the controls (RR 0.71, 95% CI 0.46 to 1.09; 507 participants; 3 studies; low-quality evidence). Likewise, there may be a clinically important protective effect from using a combination of barrier creams and moisturisers: 8% of participants in the intervention group developed signs of OIHD, compared to 13% of the controls (RR 0.68, 95% CI 0.33 to 1.42; 474 participants; 2 studies; low-quality evidence). We are uncertain whether skin protection education reduces the risk of developing signs of OIHD (RR 0.76, 95% CI 0.54 to 1.08; 1355 participants; 3 studies; very low-quality evidence). Twenty-one per cent of participants who received skin protection education developed signs of OIHD, compared to 28% of the controls.None of the studies addressed the frequency of treatment discontinuation due to adverse effects of the products directly. However, in three studies of barrier creams, the reasons for withdrawal from the studies were unrelated to adverse effects. Likewise, in one study of moisturisers plus barrier creams, and in one study of skin protection education, reasons for dropout were unrelated to adverse effects. The remaining studies (one to two in each comparison) reported dropouts without stating how many of them may have been due to adverse reactions to the interventions. We judged the quality of this evidence as moderate, due to the indirectness of the results. The investigated interventions to prevent OIHD probably cause few or no serious adverse effects. AUTHORS' CONCLUSIONS Moisturisers used alone or in combination with barrier creams may result in a clinically important protective effect, either in the long- or short-term, for the primary prevention of OIHD. Barrier creams alone may have slight protective effect, but this does not appear to be clinically important. The results for all of these comparisons were imprecise, and the low quality of the evidence means that our confidence in the effect estimates is limited. For skin protection education, the results varied substantially across the trials, the effect was imprecise, and the pooled risk reduction was not large enough to be clinically important. The very low quality of the evidence means that we are unsure as to whether skin protection education reduces the risk of developing OIHD. The interventions probably cause few or no serious adverse effects.We conclude that at present there is insufficient evidence to confidently assess the effectiveness of interventions used in the primary prevention of OIHD. This does not necessarily mean that current measures are ineffective. Even though the update of this review included larger studies of reasonable quality, there is still a need for trials which apply standardised measures for the detection of OIHD in order to determine the effectiveness of the different prevention strategies.
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Affiliation(s)
- Andrea Bauer
- University Hospital Carl Gustav Carus, Technical University DresdenDepartment of DermatologyFetscherstr. 74DresdenGermany01307
| | - Henriette Rönsch
- University Hospital Carl Gustav Carus, Technical University DresdenDepartment of DermatologyFetscherstr. 74DresdenGermany01307
| | - Peter Elsner
- Friedrich Schiller UniversityDepartment of Dermatology and AllergologyErfurter Strasse 35JenaGermanyD 07743
| | - Daan Dittmar
- University Medical Center GroningenDepartment of DermatologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Cathy Bennett
- Coventry UniversityCentre for Innovative Research Across the Life Course (CIRAL)Richard Crossman BuildingGosford StreetCoventryUKCV1 5FB
| | | | - Judit Lukács
- University Hospital JenaDepartment of DermatologyErfurter Str. 35JenaGermany07743
| | - Swen Malte John
- University of OsnabrueckDepartment of Dermatology, Environmental Medicine, Health TheorySedanstr 115OsnabrueckGermanyDE 49069
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Zack B, Arrandale VH, Holness DL. Preventing Occupational Skin Disease: A Review of Training Programs. Dermatitis 2017; 28:169-182. [DOI: 10.1097/der.0000000000000278] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Papadatou Z, Cooper K, Klein S, MacDuff C, Steiner M. Effectiveness of interventions for preventing occupational irritant hand dermatitis. ACTA ACUST UNITED AC 2016; 14:72-81. [DOI: 10.11124/jbisrir-2016-003159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hand Dermatitis: Utilizing Subtype Classification to Direct Intervention. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0090-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lukács J, Schliemann S, Elsner P. Occupational contact urticaria caused by food - a systematic clinical review. Contact Dermatitis 2016; 75:195-204. [DOI: 10.1111/cod.12653] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Judit Lukács
- Department of Dermatology; University Hospital Jena; 07743 Jena Germany
| | | | - Peter Elsner
- Department of Dermatology; University Hospital Jena; 07743 Jena Germany
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Aktas E, Esin MN. Skin disease symptoms and related risk factors among young workers in high-risk jobs. Contact Dermatitis 2016; 75:96-105. [DOI: 10.1111/cod.12606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Emine Aktas
- Istanbul University Florence Nightingale Faculty of Nursing; Public Health Nursing Department; 34381 Şişli/Istanbul Turkey
| | - M. Nihal Esin
- Istanbul University Florence Nightingale Faculty of Nursing; Public Health Nursing Department; 34381 Şişli/Istanbul Turkey
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Mollerup A, Harboe G, Johansen JD. User evaluation of patient counselling, combining nurse consultation and eHealth in hand eczema. Contact Dermatitis 2016; 74:205-16. [PMID: 26822623 DOI: 10.1111/cod.12534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/08/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE This study reports the findings from a user evaluation of a counselling programme for hand eczema patients in which face-to-face encounters were supplemented with user access to a new website. PATIENTS AND METHODS Patients treated for hand eczema in two different settings were included consecutively. Website utilization was examined by use of the transaction log. Comparisons were made between participants who used the website and those who did not. The patients' perspectives were explored by the use of interviews. RESULTS Among potential website users (n = 140), 88 patients (63%) had an average of 5.1 site visits. At follow-up, the website users had improved more in quality of life (p = 0.014), current burden of disease (p = 0.053), and itching (p = 0.042). The website users reported more changes in habits than did the non-website users (p = 0.024). No differences in clinical severity of hand eczema were found. The interviewees were generally satisfied with the counselling and the website. The strict log-on procedures were considered to be an obstacle to using the site. The consecutive inclusion of participants was considered to be a barrier to engagement in the dialogue forum. CONCLUSIONS The website users benefited from the website, although this was not substantiated by clinical measurements. The trial design partly hampered website utilization. An initial feasibility study could have been warranted.
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Affiliation(s)
- Annette Mollerup
- The National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
| | - Gitte Harboe
- Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
| | - Jeanne D Johansen
- The National Allergy Research Centre, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, 2900, Hellerup, Denmark
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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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Antonov D, Schliemann S, Elsner P. Hand dermatitis: a review of clinical features, prevention and treatment. Am J Clin Dermatol 2015; 16:257-270. [PMID: 25920436 DOI: 10.1007/s40257-015-0130-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hand dermatitis is a socially significant health problem. This review provides a discussion on the clinical features and patterns as well as the differential diagnosis of hand dermatitis, because these are essential for proper diagnosis in clinical practice. The morphology, however, is poorly related to the etiology in chronic cases. In all cases of chronic hand dermatitis, a full diagnostic examination should be undertaken and the etiology should be clarified and addressed in the treatment concept, instead of just moving directly from a morphological diagnosis to therapy. Preventive measures should be included in the treatment concept according to etiology. A stepwise approach for escalating therapy is advised, including basic topical therapy, topical corticosteroids, calcineurin inhibitors, as well as phototherapy and systemic therapy with corticosteroids, alitretinoin, cyclosporine, methotrexate, azathioprine, and others.
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Aktas E, Esin MN. A Turkish translation of the Nordic Occupational Skin Questionnaire (NOSQ-2002/LONG) adapted for young workers in high-risk jobs. Int J Dermatol 2015; 55:278-88. [DOI: 10.1111/ijd.12740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 03/18/2014] [Accepted: 04/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Emine Aktas
- Department of Public Health Nursing; Florence Nightingale Faculty of Nursing; Istanbul University; Istanbul Turkey
| | - Melek Nihal Esin
- Department of Public Health Nursing; Florence Nightingale Faculty of Nursing; Istanbul University; Istanbul Turkey
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van der Meer EWC, Boot CRL, van der Gulden JWJ, Knol DL, Jungbauer FHW, Coenraads PJ, Anema JR. Hands4U: the effects of a multifaceted implementation strategy on hand eczema prevalence in a healthcare setting. Results of a randomized controlled trial. Contact Dermatitis 2014; 72:312-24. [DOI: 10.1111/cod.12313] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Esther W. C. van der Meer
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
| | - Cécile R. L. Boot
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
- Body©Work, Research Centre Physical Activity, Work and Health, TNO‐VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
| | - Joost W. J. van der Gulden
- Department of Primary and Community Care Centre for Family Medicine, Geriatric care and Public Health, Radboud University Nijmegen Medical Centre PO Box 9101 6500 HB Nijmegen The Netherlands
| | - Dirk L. Knol
- Department of Epidemiology and Biostatistics EMGO Institute for Health and Care Research, VU University Medical Centre De Boelelaan 1118 1081 HZ Amsterdam The Netherlands
| | - Frank H. W. Jungbauer
- Department of Occupational Health University Medical Centre Groningen, University of Groningen Hanzeplein 1 9713GZ, Groningen The Netherlands
| | - Pieter Jan Coenraads
- Dermatology Department University Medical Centre Groningen, University of Groningen Hanzeplein 1 9713GZ, Groningen The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health EMGO Institute for Health and Care Research, VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
- Body©Work, Research Centre Physical Activity, Work and Health, TNO‐VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
- Research Centre for Insurance Medicine AMC‐UWV‐VU University Medical Centre van der Boechorststraat 7 1081 BT Amsterdam The Netherlands
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Clemmensen KKB, Randbøll I, Ryborg MF, Ebbehøj NE, Agner T. Evidence-based training as primary prevention of hand eczema in a population of hospital cleaning workers. Contact Dermatitis 2014; 72:47-54. [DOI: 10.1111/cod.12304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Kim K. B. Clemmensen
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Ingelise Randbøll
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Malene F. Ryborg
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Niels E. Ebbehøj
- Department of Occupational and Environmental Medicine; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
| | - Tove Agner
- Department of Dermatology; Bispebjerg Hospital; Bispebjerg Bakke 23 2400 Copenhagen NV Denmark
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Girbig M, Seidler L, Hegewald J, Apfelbacher C, Seidler A, Deckert S, Rossa K, Butler J, Flyvholm MA, Schmitt J. Translation and cross-cultural adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) to German. J Occup Med Toxicol 2014. [DOI: 10.1186/s12995-014-0029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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van Holland BJ, Soer R, de Boer MR, Reneman MF, Brouwer S. Preventive occupational health interventions in the meat processing industry in upper-middle and high-income countries: a systematic review on their effectiveness. Int Arch Occup Environ Health 2014; 88:389-402. [PMID: 25099824 DOI: 10.1007/s00420-014-0964-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effectiveness of occupational health interventions in the meat processing industry on work and health-related outcomes. METHODS A systematic literature review was performed. PubMed, Embase, and The Cochrane Library were searched. Studies were included when they reported on an intervention among employees in the meat processing industry and with outcomes related to work or health. Studies were assessed on risk of bias, and data were synthesized by type of intervention. RESULTS A total of 13 articles reporting on two randomized controlled trials and nine non-randomized intervention studies were retrieved. Studies were categorized into three topics: ergonomics programs, skin protection, and Q fever vaccination. All studies had high risk of bias. Based on four studies, there was limited evidence for workplace health and safety programs showing reductions in musculoskeletal injury severity, reduction of lost work days, and reduction of costs and claims for several musculoskeletal disorders. There was limited evidence for added rest breaks resulting in improved productivity at the end of a workday and in reductions of perceived discomfort in various body regions at the end of the workday. One study on skin protection showed reductions of eczema prevalence, although evidence was moderate. Based on four studies, there was high-quality evidence for strong effectiveness of Q fever vaccination. CONCLUSION This review presents evidence for the effectiveness of a variety of workplace interventions. There was limited evidence for effectiveness of ergonomic interventions, moderate evidence of a skin protection intervention, and strong evidence for Q fever vaccination.
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Affiliation(s)
- Berry J van Holland
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Dilgtweg 5, 9751 ND, Haren, Groningen, The Netherlands,
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van der Meer EWC, Boot CRL, Twisk JWR, Coenraads PJ, Jungbauer FHW, van der Gulden JWJ, Anema JR. Hands4U: the effectiveness of a multifaceted implementation strategy on behaviour related to the prevention of hand eczema-a randomised controlled trial among healthcare workers. Occup Environ Med 2014; 71:492-9. [PMID: 24828091 PMCID: PMC4078713 DOI: 10.1136/oemed-2013-102034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives To investigate the effects of a multifaceted implementation strategy on behaviour, behavioural determinants, knowledge and awareness of healthcare workers regarding the use of recommendations to prevent hand eczema. Methods The Hands4U study is a randomised controlled trial. A total of 48 departments (n=1649 workers) were randomly allocated to the multifaceted implementation strategy or the control group (minimal implementation strategy). Within the departments designated to the multifaceted implementation strategy, participatory working groups were set up to enhance the implementation of the recommendations for hand eczema. In addition, working group members were trained to become role models, and an education session was given within the department. Outcome measures were awareness, knowledge, receiving information, behaviour and behavioural determinants. Data were collected at baseline, with a 3- and 6-month follow-up. Results Statistically significant effects were found after 6 months for awareness (OR 6.30; 95% CI 3.41 to 11.63), knowledge (B 0.74; 95% CI 0.54 to 0.95), receiving information (OR 9.81; 95% CI 5.60 to 17.18), washing hands (B −0.40; 95% −0.51 to −0.29), use of moisturiser (B 0.29; 95% CI 0.20 to 0.38), cotton under gloves (OR 3.94; 95% CI 2.04 to 7.60) and the overall compliance measure (B 0.14; 95% CI 0.02 to 0.26), as a result of the multifaceted implementation strategy. No effects were found for behavioural determinants. Conclusions The multifaceted implementation strategy can be used in healthcare settings to enhance the implementation of recommendations for the prevention of hand eczema. Trial registration number NTR2812.
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Affiliation(s)
- Esther W C van der Meer
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Cécile R L Boot
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Health Sciences Section Methodology and Applied Biostatistics, VU University, Amsterdam, The Netherlands
| | - Pieter Jan Coenraads
- Dermatology Department, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank H W Jungbauer
- Department of Occupational Health, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joost W J van der Gulden
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands Research Center for Insurance Medicine AMC-UMCG-UWV-VU University Medical Center, Amsterdam, The Netherlands
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Fisker MH, Ebbehøj NE, Jungersted JM, Agner T. What do patients with occupational hand eczema know about skin care? Contact Dermatitis 2014; 69:93-8. [PMID: 23869728 DOI: 10.1111/cod.12060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study was to examine the knowledge of skin care and treatment of hand eczema (HE) in a sample of patients with newly reported occupational HE. MATERIALS AND METHODS A questionnaire consisting of 13 questions about knowledge of skin care and treatment of HE was sent to all patients with occupational HE reported to the National Board of Industrial Injuries in the period 1 January 2010 to 31 March 2010. RESULTS Three hundred and seventy individuals, 269 females and 101 males, with a mean age of 39.9 years, responded to the questionnaire (response rate of 73%). The overall percentage of correct answers was 73%. Variables significantly influencing the level of knowledge were sex and age, with a need for more information in males and in patients above the age of 50 years. No significant influence of level of education, eczema activity, previous information about HE, previous or current atopic eczema or dermatology life quality index (DLQI) was found. CONCLUSION There is still potential for improvement of the level of knowledge among patients with occupational HE. Special attention should be paid to males and patients above the age of 50 years.
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Affiliation(s)
- Maja H Fisker
- Department of Occupational Medicine, University of Copenhagen, Bispebjerg Hospital, 2400 Copenhagen NV, Denmark.
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Fisker MH, Agner T, Lindschou J, Bonde JP, Ibler KS, Gluud C, Winkel P, Ebbehøj NE. Protocol for a randomised trial on the effect of group education on skin-protective behaviour versus treatment as usual among individuals with newly notified occupational hand eczema - the Prevention of Hand Eczema (PREVEX) Trial. BMC DERMATOLOGY 2013; 13:16. [PMID: 24245553 PMCID: PMC4225615 DOI: 10.1186/1471-5945-13-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
Abstract
Background The incidence of occupational hand eczema is approximately 0.32 per 1,000 person years. The burden of the disease is high, as almost 60% has eczema-related sick leave during the first year after notification, and 15% are excluded from the workforce 12 years after disease onset. New treatments and prevention strategies are needed. Methods/Design Trial design: The PREVEX trial is a randomised, parallel-group, superiority trial. Participants: All individuals from the Capital Region of Denmark and Region Zealand with a suspected occupational skin disorder notified to the National Board of Industrial Injuries between June 2012 and December 2013 are invited to participate in the trial. Inclusion criteria are: self-reported hand eczema and informed consent. Exclusion criteria are: age <18 years or >65 years; permanent exclusion from the workforce; inability to understand the Danish language; any serious medical condition; and lack of written informed consent. We plan to randomise 742 participants. Interventions: The experimental intervention is an educational course in skin-protective behaviour and written information about skin care related to the participants' specific occupation. Also, a telephone hotline is available and a subgroup will be offered a work-place visit. The experimental and the control group have access to usual care and treatment. All participants are contacted every eighth week with questions regarding number of days with sick leave or other absence from work. 12 months after randomisation follow-up is completed. Objective: To assesses the effect of an educational course versus treatment as usual in participants with newly notified occupational hand eczema. Randomisation: Participants are centrally randomised according to a computer-generated allocation sequence with a varying block size concealed to investigators. Blinding: It is not possible to blind the participants and investigators, however, data obtained from registers, data entry, statistical analyses, and drawing of conclusions will be blinded. Outcomes: The three co-primary outcomes, assessed at 12 months, are: total number of self-reported days with sick leave; health-related quality of life; and subjective assessment of hand eczema severity. Explorative outcomes are: self-reported eczema-related sick leave, absence from work registered by the DREAM-register and by self-report, risk behaviour, knowledge of skin protection and performance management (self-efficacy; and self-evaluated ability to self-care). Discussion The PREVEX trial will be the first individually randomised trial to investigate the benefits and harms of group-based education in patients with newly notified occupational hand eczema. Trial registration ClinicalTrials.gov Identifier: NCT01899287
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Affiliation(s)
- Maja Hvid Fisker
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark.
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Adisesh A, Robinson E, Nicholson PJ, Sen D, Wilkinson M. U.K. standards of care for occupational contact dermatitis and occupational contact urticaria. Br J Dermatol 2013; 168:1167-75. [PMID: 23374107 PMCID: PMC3734701 DOI: 10.1111/bjd.12256] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/27/2022]
Abstract
The diagnosis of occupational contact dermatitis (OCD) and occupational contact urticaria (OCU) is a process that involves fastidious clinical and occupational history taking, clinical examination, patch testing and skin-prick testing. A temporal relationship of work and/or the presence of a rash on the hands only raises suspicion of an occupational cause, and does not necessarily confirm an occupational causation. The identification of allergy by patch or prick tests is a major objective, as exclusion of an offending allergen from the environment can contribute to clinical recovery in the individual worker and avoidance of new cases of disease. This can be a complex process where allergens and irritants, and therefore allergic and irritant contact dermatitis, may coexist. This article provides guidance to healthcare professionals dealing with workers exposed to agents that potentially cause OCD and OCU. Specifically it aims to summarize the 2010 British Occupational Health Research Foundation (BOHRF) systematic review, and also to help practitioners translate the BOHRF guideline into clinical practice. As such, it aims to be of value to physicians and nurses based in primary and secondary care, as well as occupational health and public health clinicians. It is hoped that it will also be of value to employers, interested workers and those with responsibility for workplace standards, such as health and safety representatives. Note that it is not intended, nor should it be taken to imply, that these standards of care override existing statutory and legal obligations. Duties under the U.K. Health and Safety at Work Act 1974, the Management of Health and Safety at Work Regulations 1999, the Control of Substances Hazardous to Health Regulations 2002, the Equality Act 2010 and other relevant legislation and guidance must be given due consideration, as should laws relevant to other countries.
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Affiliation(s)
- A Adisesh
- Centre for Workplace Health, Health & Safety Laboratory, Harpur Hill, Buxton, SK17 9JN, UK
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Ibler KS, Jemec GBE, Diepgen TL, Gluud C, Lindschou Hansen J, Winkel P, Thomsen SF, Agner T. Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial. BMJ 2012; 345:e7822. [PMID: 23236031 PMCID: PMC3520547 DOI: 10.1136/bmj.e7822] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Kristina Sophie Ibler
- Department of Dermatology, Roskilde Hospital, Health Science Faculty, Køgevej 7-13, 4000 Roskilde, Denmark.
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Holness DL, Kudla I. Workers with occupational contact dermatitis: workplace characteristics and prevention practices. Occup Med (Lond) 2012; 62:455-7. [PMID: 22837331 DOI: 10.1093/occmed/kqs115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There are many gaps in knowledge related to prevention practices in place for workers who subsequently develop occupational contact dermatitis (OCD). AIMS To describe the workplace characteristics and the prevention practices in workplaces where workers developed hand dermatitis. METHODS Consecutive cases of probable OCD were enrolled from a specialist occupational health clinic. At the time of the initial assessment, questionnaires were administered to collect information about clinical presentation, workplace characteristics and prevention practices at work. RESULTS 100 workers with hand dermatitis were enrolled in the study and 78 were considered to have OCD. Two-thirds of these had had some occupational health and safety or Workplace Hazardous Materials Information System (WHMIS) training in their workplace, however, training related to glove use and skin care was less common. Unionized workers were more likely to have received training. Workers involved in wet work were less likely to report training. CONCLUSIONS These findings suggest that there are gaps in prevention programs for work-related skin disease. Research is needed on effective strategies that are sustainable in the workplace.
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Affiliation(s)
- D L Holness
- Department of Occupational and Environmental Health, St. Michael's Hospital Toronto, Ontario, Canada.
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Wilke A, Gediga G, Schlesinger T, John SM, Wulfhorst B. Sustainability of interdisciplinary secondary prevention in patients with occupational hand eczema: a 5-year follow-up survey. Contact Dermatitis 2012; 67:208-16. [DOI: 10.1111/j.1600-0536.2012.02132.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mollerup A, Veien NK, Johansen JD. Chronic hand eczema--self-management and prognosis: a study protocol for a randomised clinical trial. BMC DERMATOLOGY 2012; 12:6. [PMID: 22691871 PMCID: PMC3492110 DOI: 10.1186/1471-5945-12-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/14/2012] [Indexed: 02/08/2023]
Abstract
Background Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. Discussion The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.
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Affiliation(s)
- Annette Mollerup
- National Allergy Research Centre, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
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Inventory of the chemicals and the exposure of the workers' skin to these at two leather factories in Indonesia. Int Arch Occup Environ Health 2011; 85:517-26. [PMID: 21938525 PMCID: PMC3371324 DOI: 10.1007/s00420-011-0700-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 09/09/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Tannery workers are exposed to hazardous chemicals. Tannery work is outsourced to newly industrialized countries (NICs) where attention into occupational health hazards is limited. In this study, we investigated the skin exposure to hazardous chemicals in tannery workers and determined the prevalence of occupational skin diseases (OSDs) at tanneries in a NIC. METHODS A cross-sectional study on the observation of the working process and an inventory and risk assessment of the chemicals used. Classification of chemicals as potential sensitizers/irritants and a qualitative assessment of exposure to these chemicals. Workers were examined and interviewed using Nordic Occupational Skin Questionnaire-2002/LONG. RESULTS The risk of OSDs at the investigated tanneries was mainly related to the exposure of the workers' skin to chemicals in hot and humid environmental conditions. In 472 workers, 12% reported a current OSD and 9% reported a history of OSD. In 10% of all cases, an OSD was confirmed by a dermatologist and 7.4% had an occupational contact dermatitis (OCD). We observed that personal protective equipment (PPE) used was mainly because of skin problems in the past and not as a primary protection against OSD. CONCLUSION We observed a high frequency and prolonged exposure to many skin hazardous factors in tannery work although PPE was relatively easily available and which was generally used as a secondary preventative measure. The observed point-prevalence in this study was at the same level as that reported for other high-risk OSDs in Western countries and other tanneries in NICs. However, the observed point-prevalence in this study was lower than that reported in India and Korea. The results of our study and those of other studies at tanneries from other NICs were probably influenced by Healthy Worker Survivor Effect (HWSE).
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van der Meer EWC, Boot CRL, Jungbauer FHW, van der Klink JJL, Rustemeyer T, Coenraads PJ, van der Gulden JW, Anema JR. Hands4U: a multifaceted strategy to implement guideline-based recommendations to prevent hand eczema in health care workers: design of a randomised controlled trial and (cost) effectiveness evaluation. BMC Public Health 2011; 11:669. [PMID: 21867490 PMCID: PMC3223855 DOI: 10.1186/1471-2458-11-669] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Workers in wet work occupations have a risk for developing hand eczema. Prevention strategies exist, but compliance to the proposed recommendations is poor. Therefore, a multifaceted implementation strategy (MIS) is developed to implement these recommendations to reduce hand eczema among health care workers performing wet work. METHODS/DESIGN This study is a randomised controlled trial in three university hospitals in the Netherlands. Randomisation to the control or intervention group is performed at department level. The control group receives a leaflet containing the recommendations only. The intervention group receives the MIS which consists of five parts: 1) within a department, a participatory working group is formed to identify problems with the implementation of the recommendations, to find solutions for it and implement these solutions; 2) role models will help their colleagues in performing the desired behaviour; 3) education to all workers will enhance knowledge about (the prevention of) hand eczema; 4) reminders will be placed at the department reminding workers to use the recommendations; 5) workers receive the same leaflet as the control group containing the recommendations. Data are collected by questionnaires at baseline and after 3, 6, 9 and 12 months. The primary outcome measure is self-reported hand eczema. The most important secondary outcome measures are symptoms of hand eczema; actual use of the recommendations; sick leave; work productivity; and health care costs.Analyses will be performed according to the intention to treat principle. Cost-effectiveness of the MIS will be evaluated from both the societal and the employer's perspective. DISCUSSION The prevention of hand eczema is important for the hospital environment. If the MIS has proven to be effective, a major improvement in the health of health care workers can be obtained. Results are expected in 2014. TRIAL REGISTRATION NUMBER NTR2812.
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Affiliation(s)
- Esther W C van der Meer
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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Weistenhöfer W, Baumeister T, Drexler H, Kütting B. How to quantify skin impairment in primary and secondary prevention? HEROS: a proposal of a hand eczema score for occupational screenings. Br J Dermatol 2011; 164:807-13. [DOI: 10.1111/j.1365-2133.2010.10181.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nicholson PJ, Llewellyn D, English JS. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis 2011; 63:177-86. [PMID: 20831687 DOI: 10.1111/j.1600-0536.2010.01763.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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van Gils RF, Boot CR, van Gils PF, Bruynzeel D, Coenraads PJ, van Mechelen W, Riphagen II, Anema JR. Effectiveness of prevention programmes for hand dermatitis: a systematic review of the literature. Contact Dermatitis 2011; 64:63-72. [DOI: 10.1111/j.1600-0536.2010.01825.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
The successful treatment of hand dermatitis (HD) depends less on the selection of the proper topical steroid or a particular systemic agent than on addressing any underlying cause or perpetuating factor. Thus, innovative treatment is based on comprehensively addressing the patient's problem. Aggressive approaches may be required for the most severe forms of HD.
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Affiliation(s)
- William Abramovits
- Department of Medicine, Baylor University Medical Center, Dallas, TX, USA.
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Ibler KS, Agner T, Hansen JL, Gluud C. The Hand Eczema Trial (HET): Design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema. BMC DERMATOLOGY 2010; 10:8. [PMID: 20807407 PMCID: PMC2939593 DOI: 10.1186/1471-5945-10-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 08/31/2010] [Indexed: 11/10/2022]
Abstract
Background Hand eczema is the most frequently recognized occupational disease in Denmark with an incidence of approximately 0.32 per 1000 person-years. Consequences of hand eczema include chronic severe eczema, prolonged sick leave, unemployment, and impaired quality of life. New preventive strategies are needed to reduce occupational hand eczema. Methods/Design We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease severity (Hand Eczema Severity Index); self-evaluated disease severity; number of eruptions; quality of life; skin protective behaviour, and knowledge of skin protection. The patients are centrally randomised to intervention versus no intervention 1:1 stratified for hospital, profession, and severity score. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary outcome is observer-blinded assessment of disease severity and the secondary outcomes are unblinded assessments of disease severity; number of eruptions; knowledge of skin protection; skin-protective behaviour, and quality of life. Trial registration The trial is registered in ClinicalTrials.Gov, NCT01012453.
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Bauer A, Schmitt J, Bennett C, Coenraads PJ, Elsner P, English J, Williams HC. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database Syst Rev 2010:CD004414. [PMID: 20556758 DOI: 10.1002/14651858.cd004414.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Occupational irritant hand dermatitis (OIHD) is an important cause of discomfort in the working population. Different preventive measures are in place but it is not clear how effective these are. OBJECTIVES To assess the effect of interventions for preventing OIHD in healthy people who work in occupations where the skin is at risk of damage. SEARCH STRATEGY In May 2010, we searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLlNE and EMBASE. Conference proceedings, and ongoing trials registers were also searched. SELECTION CRITERIA Randomised controlled trials (RCTs) studying the effectiveness of barrier creams, moisturisers, gloves, complex educational interventions, and other interventions for the prevention of OIHD. DATA COLLECTION AND ANALYSIS Two authors independently assessed the trials and extracted data. MAIN RESULTS Four RCTs involving 894 participants from different occupations were included. The primary outcome was numbers of new cases.One large RCT of 708 print and dye workers compared 2 barrier creams (containing silicone or hydrocarbon) versus no intervention. Fewer workers using barrier creams developed OIHD than those who did not (39.9% versus 45%, (OR 0.75, 95% CI 0.53 to 1.07. P = 0.11) but this was not statistically significant.In 1 RCT of 54 metal workers less developed OIHD when using an after work emollient or a barrier cream compared to no intervention. There was no statistical difference between the groups at different times of follow-up.One RCT of 111 cleaners and kitchen workers compared a moisturiser (Locobase) versus no intervention using a cross-over design. While using the moisturiser no participant developed OIHD. During the control period with no skin treatment, 19 (20.4%) out of 93 participants developed OIHD.One RCT of 21 hairdressers compared a barrier cream containing aluminium chlorohydrate (Excipial protect) versus its vehicle. No participant developed OIHD while the products were used.Only limited side-effects such as transient itching, stinging, and dryness were reported for the interventions. AUTHORS' CONCLUSIONS Although the findings of this review were generally positive, no statistical significance was reached. We conclude that at present there is insufficient evidence for the effectiveness of most of the interventions used in the primary prevention of OIHD. This does not mean that current measures are necessarily ineffective, as the limited studies to date have been rather small and of poor quality. Larger well designed RCTs are now needed in different workplaces to establish the effectiveness of various preventative strategies.
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Affiliation(s)
- Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstr. 74, Dresden, Germany, 01307
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Sala-Sastre N, Herdman M, Navarro L, de la Prada M, Pujol RM, Serra C, Alonso J, Flyvholm MA, Giménez-Arnau AM. Principles and methodology for translation and cross-cultural adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) to Spanish and Catalan. Contact Dermatitis 2009; 61:109-16. [PMID: 19706051 DOI: 10.1111/j.1600-0536.2009.01576.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. The Nordic Occupational Skin Questionnaire (NOSQ-2002), developed in English, is a useful tool for screening of occupational skin diseases. OBJECTIVES To culturally adapt the NOSQ-2002 to Spanish and Catalan and to assess the clarity, comprehension, cultural relevance and appropriateness of the translated versions. METHODS The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) principles of good practice for the translation and cultural adaptation of patient-reported outcomes were followed. RESULTS After translation into the target language, a first consensus version of the questionnaire was evaluated in multiple cognitive debriefing interviews. The expert panel introduced some modifications in 39 (68%) and 27 (47%) items in the Spanish and Catalan version, respectively (e.g. addition of examples and definitions, reformulation of instructions and use of direct question format). This version was back translated and submitted to the original authors, who suggested a further seven and two modifications in the Spanish and Catalan versions, respectively. A second set of cognitive interviews were performed. A consensus version of both questionnaires was obtained after final modifications based on comments by the patients. CONCLUSIONS The final versions of the Spanish and Catalan NOSQ-2002 questionnaires are now available at www.NRCWE.dk/NOSQ.
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Affiliation(s)
- Nohemi Sala-Sastre
- Department of Dermatology, Hospital del Mar, IMAS, Universitat Autònoma, Barcelona, Spain
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Wulfhorst B, Bock M, Gediga G, Skudlik C, Allmers H, John SM. Sustainability of an interdisciplinary secondary prevention program for hairdressers. Int Arch Occup Environ Health 2009; 83:165-71. [DOI: 10.1007/s00420-009-0480-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 10/16/2009] [Indexed: 11/25/2022]
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Sala-Sastre N, Herdman M, Navarro L, de la Prada M, Pujol R, Serra C, Alonso J, Flyvholm M, Giménez-Arnau A. Dermatosis profesionales. Adaptación transcultural del cuestionario Nordic Occupational Skin Questionnaire (NOSQ-2002) del inglés al castellano y al catalán. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)72281-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Occupational Dermatoses: Cross-Cultural Adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) From English to Spanish and Catalan. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Dulon M, Pohrt U, Skudlik C, Nienhaus A. Prevention of occupational skin disease: a workplace intervention study in geriatric nurses. Br J Dermatol 2009; 161:337-44. [DOI: 10.1111/j.1365-2133.2009.09226.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kütting B, Weistenhöfer W, Baumeister T, Uter W, Drexler H. Current acceptance and implementation of preventive strategies for occupational hand eczema in 1355 metalworkers in Germany. Br J Dermatol 2009; 161:390-6. [PMID: 19416271 DOI: 10.1111/j.1365-2133.2009.09085.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effectiveness of a skin care programme is based mainly on the effectiveness of the products used and the frequency and diligence of the application of skin care products. OBJECTIVES The present cross-sectional study was aimed at evaluating the implementation and acceptance of generally recommended skin protective means at the workplace. METHODS We included in our study 1355 metalworkers, employed in 19 factories, mainly of small or medium-size. The majority of participants were male (96.7%, n = 1310). The investigation included a standardized interview and a dermatological examination of the hands. RESULTS More than half of all participants (52.4%) had suffered from skin problems of the hands at some time. Three hundred and ninety-six subjects (29%) indicated they followed the skin protection regimen as it was generally recommended, i.e. the use of barrier creams in combination with moisturizers. A similar number of participants (28%) denied any use of protective creams. In general, compliance in men was significantly poorer than in women. Participants with past or present history of hand eczema used both barrier creams and moisturizers significantly more often. The skin condition of the hands, examined using a quantitative score, did not differ significantly in the four subgroups defined by different skin protection measures. While acceptance of protective measures was limited, these were available in all factories. CONCLUSIONS Although barrier creams and moisturizers are highly recommended as effective means to prevent irritant contact dermatitis in Germany, our data prove that the compliance of application in this group at special risk for hand eczema is extremely low.
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Affiliation(s)
- B Kütting
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.
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Pal TM, de Wilde NS, van Beurden MM, Coenraads PJ, Bruynzeel DP. Notification of occupational skin diseases by dermatologists in The Netherlands. Occup Med (Lond) 2009; 59:38-43. [DOI: 10.1093/occmed/kqn149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schliemann S, Kelterer D, Bauer A, John SM, Skudlik C, Schindera I, Wehrmann W, Elsner P. Tacrolimus ointment in the treatment of occupationally induced chronic hand dermatitis. Contact Dermatitis 2008; 58:299-306. [PMID: 18416762 DOI: 10.1111/j.1600-0536.2007.01314.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occupational hand dermatitis (OHD) is a common and often chronic condition. Usage of topical corticosteroids is limited in long-term therapy because of potential side-effects. New treatment options are highly appreciated. OBJECTIVE To study efficacy and safety of tacrolimus in patients suffering from OHD. PATIENTS AND METHODS In a prospective, open, multicentre study, 29 patients with OHD of predominantly mild-to-moderate severity were treated with tacrolimus ointment (Protopic 0.1%) during a 4-week active treatment period with twice daily application followed by a 2-month optional treatment period. Efficacy was evaluated by the use of a standardized hand eczema score and by clinical severity rating, conducted on all study visits (screening, baseline and weeks 2, 4, 6, and 12). Adverse events were recorded for safety evaluation. RESULTS The hand eczema score declined significantly after 2 weeks of treatment compared with baseline and further declined until the end of the study. Finally, 12 (44%) patients were clear of hand eczema. Worsening of the dermatitis occurred in 2 patients (7%). Clinical grading indicated improvement too. Overall tolerability was good. CONCLUSION Topical tacrolimus might be an efficacious treatment option for chronic OHD. Blinded and randomized controlled studies are necessary to confirm the results of this pilot study.
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Affiliation(s)
- Sibylle Schliemann
- Department of Dermatology, Friedrich-Schiller-University, D-07740 Jena, Germany.
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Tertiary individual prevention of occupational skin diseases: a decade's experience with recalcitrant occupational dermatitis. Int Arch Occup Environ Health 2008; 81:1059-64. [PMID: 18239930 DOI: 10.1007/s00420-008-0300-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE If employees are threatened to loose their job due to a severe occupational skin disease (OSD), intensive interdisciplinary measures of tertiary individual prevention (TIP) are required. TIP comprises 2-3-weeks in-patient treatment plus intensive health-pedagogic counseling, and consecutive 3-weeks out-patient treatment by the local dermatologists. Each patient (pt) will stay off work for a total of usually 6 weeks to allow full barrier-recovery. METHODS All 1,486 TIP-pts from various high-risk-professions, treated in our institution in the period 1994-2003, were followed up 1 year after the TIP by a standardised questionnaire, which was returned by 1,164 (78%) pts. RESULTS Seven hundred and sixty-four (66%) of the responding 1,164 TIP-pts had successfully remained in their (risk-)professions. It could be demonstrated that to remain in the workplace was dependent on the individual motivation to use skin protection (P < 0.001), the provision of skin protection by the employer (P < 0.001), (higher) age of pt (P < 0.001) and the duration of continued out-patient-treatment by the local dermatologist (P < 0.001). However, there were no significant differences concerning the likelihood of successful job-continuation in the various high-risk-professions, e.g. hairdressers, nurses, metal-workers, food handlers, construction-workers. CONCLUSION The obtained data from TIP reveal remarkable pertinent options for interdisciplinary pt-management in severe OSD in all risk-professions.
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Abstract
Occupational skin diseases are frequent in the healthcare sector. The objective of this study was to obtain baseline data on hand eczema and risk factors for hand eczema in an unselected hospital population. A questionnaire study on hand eczema and risk factors for hand eczema was performed among hospital employees at a middle-size Danish hospital. A total of 1909 employees from all job groups and all departments were included. Response rate was 65.3%. The overall frequency of self-reported hand eczema within the past 12 months was 23%. Divided into job groups, the frequencies varied from 8% to 32% and were significantly higher among assistant nurses (32%), nurses (30%), and nursing aids (27%). For the individual departments, the hand eczema frequencies varied from 7% to 50%, with the highest frequencies reported at medical and surgical wards. Occupational risk factors for hand eczema such as use of protective gloves and hand washing were significantly more frequent among respondents with hand eczema within the past year, which suggests a potential for prevention through workplace interventions. In conclusion, high frequencies of hand eczema were observed among assistant nurses, nurses, and nursing aids. Hand eczema was more frequent among women and in the younger age groups.
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Affiliation(s)
- Mari-Ann Flyvholm
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.
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Jepsen KF, Flyvholm MA. Identification of subjects with atopic dermatitis in questionnaire studies. Contact Dermatitis 2007; 56:218-23. [PMID: 17343623 DOI: 10.1111/j.1600-0536.2006.01059.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The performances of 3 different atopic dermatitis questions from the Danish translation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) were compared with respect to their ability to identify subjects with atopic dermatitis in workplace studies. The wording of the questions were: 'Have you ever had an itchy rash that has been coming and going for at least 6 months, and at sometime has affected skin creases?' (UK question), 'Have you ever had eczema on the fronts of the elbows or behind the knees?' (Nordic-S5a) and 'Have you ever had childhood eczema?' (Nordic-S5b). In a group with occupational exposure including the forearms (gut cleaners) twice as many (44%) answered 'Yes' to the UK question compared with 2 other studies on dairy workers and hospital employees. The question Nordic-S5b gave rise to less positive answers than expected. The Nordic-S5a question gave rise to 15%, 10% and 15% positive answers, respectively, and these frequencies seemed to be independent of the workplace exposure. In conclusion, we recommend the Nordic-S5a question as the question to be used for identification of subjects with atopic dermatitis in adult workplace populations. Furthermore, we found that the UK question led to over-reporting in an adult workplace population with occupational exposure including the forearms.
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