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

The prevalence of hand dermatitis among intensive care unit nurses

BACKGROUND

Healthcare workers are at high risk of developing occupational hand dermatitis (HD) due to their frequent exposure to wet-work and use of gloves. Complaints of HD may interfere with work and cause loss of work productivity, or sick leave, and may have impact on job pleasure and performing daily activities. The prevalence of HD among intensive care unit (ICU) nurses is unknown.

OBJECTIVES

To investigate the point prevalence and the 1-year prevalence of HD among ICU nurses, and to determine the impact of HD on work and daily activities.

METHOD

A questionnaire-based cross-sectional study was performed among ICU nurses. Participants were recruited in the Amsterdam University Medical Centre. A symptom-based questionnaire was used to determine HD and atopic predisposition, and an additional questionnaire was used concerning the influence of HD. ICU nurses with an atopic predisposition or symptoms suiting HD were invited for the hand dermatitis consultation hour (HDCH). Data were analysed with logistic regression.

RESULTS

A total of 184 ICU nurses were included. The point prevalence of HD was 9.8% (95% CI: 5.9-15.0) and the 1-year prevalence was 26.6% (95% CI: 20.4-33.6). Sick leave was reported by 0.5%. HD seemed to have more impact on job pleasure than on work productivity.

CONCLUSION

The high prevalence rate of HD resulting from our study highlights the need for the prevention of occupational HD among healthcare workers.

Occupational Hand Dermatitis in Health Care: Development and Evaluation of an Online Training E-Module

Background: Occupational hand dermatitis (OHD) is an important health concern for health care workers (HCWs), yet there is a lack of accessible training materials on this topic. Objectives: The objective of this study was to develop and evaluate an OHD training e-module for HCWs. Methods: The e-module was created in collaboration with an expert advisory committee and tested by Ontario HCWs through pre- and post-training OHD knowledge tests, a usability survey, and a survey about intent to change work skin care practices. Analyses of survey results included means and paired t-tests. Results: The 10-minute OHD training e-module for HCWs was tested by 254 HCWs and found to be highly usable, to increase OHD knowledge immediately and sustainably, and to change workplace skin care practices. Average OHD knowledge test scores significantly improved by 19% between the pretest (64.50%) and post-test (83.50%). Most 6-month follow-up survey respondents reported changing their skin care work practices (76.69%). Conclusions: This research addresses the previous lack of accessible OHD training for workers in health care settings. The creation and evaluation of a no-cost accessible OHD training e-module for workers in health care settings showed promising results across knowledge increase, knowledge retention, skin care behavior changes, and usability.

Prevalence and risk factors of work-related contact dermatitis symptoms among healthcare cleaners during the COVID-19 pandemic in Northwest Ethiopia: a multicentre cross-sectional survey

OBJECTIVE

This study was aimed to explore the prevalence and risk factors of work-related contact dermatitis (WRCD) symptoms among cleaners working in healthcare institutions in Gondar city, Northwest Ethiopia, during the COVID-19 pandemic.

DESIGN

A multicentre cross-sectional study was conducted from September to October 2021. An interviewer-administered standardised Nordic Occupational Skin Questionnaire, V.2002 (NOSQ-2002) was used to assess WRCD. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14 software. The association between dependent and independent variables was computed with a binary logistic regression. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05.

SETTING

The study was conducted in Gondar city healthcare institutions, Northwestern Ethiopia.

PARTICIPANTS

A total of 409 cleaners participated in this study.

OUTCOME MEASURES

The primary outcome is the prevalence of WRCD symptoms, which was measured using the NOSQ-2002.

RESULTS

The response rate was 95.6%. The majority, 302 (73.8%), of the study participants were female. The mean age (±SD) was 31 (±7.87) years old. The overall prevalence of self-reported WRCD during the last 12 months was 213 (52.1%) (95% CI (47.1% to 57.0%)). The highest symptoms reported were skin redness, 51.6% (n=110), and the most affected skin body sites were hands (hand dermatitis), 74.2% (n=158). Hand washing frequency more than 20 times per day (AOR=1.73, 95% CI (1.03 to 2.92)), personal history of eczema (AOR=1.46, 95% CI (1.01 to 2.42)) and lack of training on skin hazards (AOR=2.06, 95% CI (1.16 to 3.63)) were factors influencing the occurrence of WRCD.

CONCLUSIONS

This study revealed the prevalence of WRCD is common during the COVID-19 pandemic. Adjusting hand washing frequency per day, educating people with atopy about the avoidance of exposure to skin irritants and providing training on skin hazards were recommended to minimise the condition.

Quality of life in patients with allergic and immunologic skin diseases: in the eye of the beholder

Allergic and immunologic skin diseases negatively impact the quality of life (QoL) of affected patients with detrimental consequences. Nonetheless, in everyday clinical practice the evaluation of QoL is often overlooked. Considering the increasing prevalence of atopic dermatitis, allergic contact dermatitis, hereditary angioedema, cutaneous mastocytosis, and urticaria, it is essential to determine the effects of allergic and immunologic skin diseases on QoL. A joint meeting (GET TOGETHER 2021) of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to summarize the features of the main QoL tools used in these diseases and to describe the extent of QoL impairment as well as the impact of treatments on QoL, particularly biologic therapies. The assessment of QoL in patients with allergic and immunologic skin diseases relies on generic, organ-specific and disease-specific questionnaires. While generic and organ-specific questionnaires allow comparison between different diseases, disease-specific questionnaires are designed and validated for specific cohorts: the QoL Index for Atopic Dermatitis (QoLIAD) and the Childhood Atopic Dermatitis Impact Scale (CADIS) in atopic dermatitis, the ACD-11 in allergic contact dermatitis, the Angioedema QoL Questionnaire (AE-QoL) and the Hereditary Angioedema QoL questionnaire (HAE-QoL) in hereditary angioedema, the Mastocytosis QoL Questionnaires (MCQoL e MQLQ) in cutaneous mastocytosis, and the Chronic Urticaria QoL questionnaire (CU-Q2oL) in urticaria. Among the many factors that variably contribute to QoL impairment, pruritus can represent the leading cause of patient discomfort. Biologic therapies significantly ameliorate QoL in atopic dermatitis, hereditary angioedema, mastocytosis and chronic urticaria. In general, adequate management strategies are essential for improving QoL in patients with allergic and immunologic skin diseases.

The Contact Dermatitis Quality of Life Index (CDQL): Survey Development and Content Validity Assessment

BACKGROUND

There is limited measurement and reporting of quality of life (QoL) outcomes for patients with contact dermatitis (CD).

OBJECTIVE

The purpose of this study is to develop a standardized Contact Dermatitis Quality of Life index (CDQL) for adult patients.

METHODS

A list of 81 topics was compiled from a review of QoL measures used previously in CD research. A total of 2 rounds of web-based Delphi surveys were sent to physicians who registered to attend the 2018 American Contact Dermatitis Society meeting, asking that they rank the relevance of topics for measuring QoL in CD using a 4-point scale. Items met consensus for inclusion if at least 78% of respondents ranked them as relevant or very relevant, and their median score was ≥3.25.

RESULTS

Of the 210 physicians contacted, 34 physicians completed the initial survey and 17 completed the follow-up survey. A total of 22 topics met consensus for inclusion in the CDQL, addressing symptoms, emotions, functions of daily living, social and physical functions, work/school functions, and treatment.

CONCLUSIONS

This study was limited by the following factors: few open-ended questions in the initial survey, a lack of direct patient feedback, and long survey length, which likely contributed to lower survey participation. The CDQL is a comprehensive, CD-specific QoL measure developed on the basis of expert consensus via a modified Delphi process to be used by physicians and other health care professionals who care for adult patients with contact dermatitis.

Contact dermatitis

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.

Efficacy of Pumpkin Ointment in Treatment of Chronic Hand Eczema: A Randomized, Active-Controlled, Double Blind Clinical Trial

Background

Hand Eczema (HE) is chronic skin disease with a high prevalence in population. It has negative impact on the quality of life. Due to the public interest in herbal remedies, we attempt to assess the efficacy of pumpkin ointment in treatment of chronic HE in this research.

Methods

This study was conducted in an outpatient clinic at Imam-Khomeini Hospital in Tehran (Iran) from May 2015 to Nov 2016. We performed a double-blind trial on 60 patients with chronic HE randomized to four groups included pumpkin, betamethasone, eucerin and almond ointment (n=15 for each group) for 28 days. Patients were ordered to apply ointments twice a day. Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI) of the patients were evaluated by a dermatologist on the 1st, 14th and 28th d after the start of treatment.

Results

Patients' DLQI scores in pumpkin and betamethasone group was significant and pumpkin group showed a better response in quality of life (P=0.001). Betamethasone and pumpkin ointment were effective and showed significant improvement compared with almond and eucerin and reduce HECSI scores (P=0.002 and P=0.012 respectively). Betamethasone ointment outcome on HECSI scores in comparison with topical pumpkin was significant (P<0.001). No clinically adverse effects were observed.

Conclusion

Although pumpkin ointment showed a better response in patients' DLQI in HE but it was less effective than betamethasone in decreasing HECSI.

Metabolic syndrome and psoriatic arthritis among patients with psoriasis vulgaris: Quality of life and prevalence

Interest has increased in comorbidities associated with psoriasis and their effects on health-related quality of life (HRQoL). This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and psoriatic arthritis (PsA) and to investigate HRQoL and the prevalence of hypertension, type 2 diabetes mellitus (T2DM), obesity and dyslipidemia. In a cross-sectional design, patients diagnosed with plaque psoriasis answered an interview and standardized questionnaires (Dermatology Life Quality Index questionnaire [DLQI], 36-Item Short Form Health Survey [SF-36] and EuroQol Five-Dimension Questionnaire Three-Level version [EQ-5D-3L]). Physical examination and several tests to assess desired outcomes were performed by a dermatologist and a rheumatologist during three visits. The prevalence of MetS and PsA was 50.0% and 41.8%, respectively. Dyslipidemia was the most prevalent (74.5%) secondary comorbidity, followed by hypertension (61.8%), obesity (52.5%) and T2DM (30.9%). The mean (standard deviation) DLQI score was 6.5 (6.9), and mean physical and mental SF-36 measures were 45.2 (10.4) and 45.5 (12.3), respectively, and for EQ-5D-3L, mean utility index and EQ-VAS scores were 0.68 (0.27) and 72.7 (19.7), respectively. PsA and MetS are important comorbidities; a reduced HRQoL is noted among plaque psoriasis patients with these comorbidities, emphasizing the relevance of diagnosis and treatment beyond the care of skin lesions.

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

Background

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

Methods

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

Results

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

Conclusions

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

Electronic supplementary material

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

Presenteeism in a Dutch hand eczema population-a cross-sectional survey

BACKGROUND

Presenteeism (attending work despite complaints and ill health, which should prompt rest and absence) has been overlooked in the field of hand eczema.

OBJECTIVES

To examine the 1-year prevalence of presenteeism related to hand eczema in a population of hand eczema patients who visited a tertiary referral centre. Secondary objectives: to identify intrinsic/extrinsic reasons for presenteeism and to evaluate associated factors.

METHODS

This was a cross-sectional questionnaire study. Presenteeism was defined as "going to work despite feeling you should have taken sick leave because of hand eczema". Respondents answered questions about socio-demographic factors, clinical features, occupational characteristics, and hand eczema related to occupational exposure.

RESULTS

Forty-one per cent (141/346) of patients who had both worked and had hand eczema during the past 12 months reported presenteeism. The most often reported reasons were: "Because I do not want to give in to my impairment/weakness" (46%) and "Because I enjoy my work" (40%). Presenteeism was associated with: mean hand eczema severity; absenteeism because of hand eczema; improvement of hand eczema when away from work; and high-risk occupations.

CONCLUSIONS

In this study, presenteeism was common and predominantly observed in patients with more severe hand eczema and occupational exposure. The most frequently reported reasons for presenteeism were of an intrinsic nature.

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

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

Quality of life in patients with leg ulcers or skin lesions - a pilot study

Introduction

Attempts to determine the quality of life are advisable in patients with ulcers as the group affected with this problem is relatively large. According to one Polish randomized trial, approximately 0.3–2% of the adult population suffers from active or healed venous ulcers.

Aim

To compare the quality of life of patients with leg ulcers of venous and arterial etiology and those with lower limb skin lesions due to chronic venous insufficiency.

Material and methods

This study included 90 consecutive patients with ulcers of venous (n = 30) or arterial etiology (n = 30), or patients with trophic disorders of the skin associated with chronic venous insufficiency (n = 30) treated at the Venous Ulceration Outpatient Clinic and at the Department and Clinic of General Surgery, Dr. J. Biziel Memorial University Hospital No. 2, in Bydgoszcz. This study was designed as a questionnaire survey and included the Skindex-29 instrument for the assessment of quality of life in patients with dermatological conditions.

Results

Overall, the global Skinndex-29 scores of all studied participants ranged between 37 and 136 points, 23.93 points on average. The analyzed groups of patients differed significantly with respect to the average level of the global quality of life determined using the Skindex-29 questionnaire.

Conclusions

Significant differences were observed in the global quality of life of patients who suffered from venous or arterial leg ulcers or skin lesions resulting from chronic venous insufficiency.

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

BACKGROUND

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

OBJECTIVES

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

PATIENTS/MATERIALS/METHODS

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

RESULTS

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

CONCLUSIONS

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

Occupational skin allergies: testing and treatment (the case of occupational allergic contact dermatitis)

Occupational contact dermatitis, including occupational allergic contact dermatitis, is one of the most common occupational diseases. Making a timely and accurate diagnosis is important to improving the outcome. Taking a work history and patch testing are essential elements in the diagnostic process. Management, based on an accurate diagnosis, must include both medical treatment to address the disease and workplace modifications as appropriate to reduce exposure the causative agents.

New optical methods for liveness detection on fingers

This paper is devoted to new optical methods, which are supposed to be used for liveness detection on fingers. First we describe the basics about fake finger use in fingerprint recognition process and the possibilities of liveness detection. Then we continue with introducing three new liveness detection methods, which we developed and tested in the scope of our research activities--the first one is based on measurement of the pulse, the second one on variations of optical characteristics caused by pressure change, and the last one is based on reaction of skin to illumination with different wavelengths. The last part deals with the influence of skin diseases on fingerprint recognition, especially on liveness detection.