Frequency of occupational contact dermatitis in an ambulatory of dermatologic allergy

Clinical, Occupational and Allergological Profile of 455 Patients with Occupational Contact Dermatitis: A 5-Year Study from a Tertiary Care Center of North India

Objectives:

To evaluate clinical and occupational profile and common allergens in patients with occupational contact dermatitis (OCD).

Materials and Methods:

The records of 455 (M:F 2:1) patients aged 18-85 years with allergic contact dermatitis were analyzed retrospectively. The diagnosis of OCD and patterns of dermatitis were defined by standard criteria. Indian standard series comprising 20 allergens and when suspected patient's own products were patch tested by Finn chamber method as per European Society of Contact Dermatitis guidelines and relevance of positive results was defined clinically.

Results:

Airborne contact dermatitis (27.7%), acral dermatitis (14.1%), hand dermatitis (12.9%), acrofacial dermatitis (12.7%), and facial dermatitis (10.5%) were the common patterns. Agriculturists (51.2%), homemakers (27.9%), office workers (24.6%), and construction workers (4.6%) comprised the majority. Positive patch test results in 58% cases were from parthenium (31.7%), p-paraphenylenediamine (PPD) (22.9%), nickel (16%), fragrance mix (11%), potassium dichromate (10.7%), cobalt (7.6%), and mercaptobenzothiazole (4.9%). Hair colorants, shoe chips, and shaving cream also produced relevant positive reactions. Parthenium, PPD, fragrance mix, and potassium dichromate in agriculturists; nickel, parthenium, PPD, fragrance mix, and potassium dichromate in women, and potassium dichromate and parthenium in construction workers elicited the most positive reactions. PPD and hair colorants elicited positive reaction mainly in office workers.

Conclusions:

The agriculturists, homemakers, and construction workers have OCD most frequently. Parthenium in farmers, potassium dichromate in construction workers, nickel in women, and PPD in office workers were the major contact allergens. The study is limited by its retrospective design, small number of patients, and limited number of patch test allergens.

Sociodemographic, environmental and labor conditions related to the presence of conjunctivitis and skin irritation in a group of informal street vendors in downtown Medellin, 2015-2019

Introduction

Occupational diseases are those that may have a causal relationship with occupational activity or environment. However, this definition does not specify how this disease would be identified and acknowledged for workers with subsistence jobs.

Objectives

To determine sociodemographic, labor and environmental conditions that collaborate to explain the presence of eye and skin irritation among informal vendors in downtown Medellin.

Methods

Descriptive cross-sectional study with analytical intention, primary sources of information, and administration of assisted survey including self-reported eye and skin irritation in 686 workers.

Results

Predominantly male population with mean age of 50 (±11.8) years. A total of 23.5 % of workers had worked as vendors for their entire life; 37.5% had worked as vendors for 11 to 20 years as vendors; and 81.5%worked for more than 8 hours a day. According to 69.8% of the sample, poor air quality affected their work, and 80.0% believed that pollution was generated by vehicle fleet. The polluted areas generated unpleasant odors (50.2%) and air pollution (89.4%). The prevalence of eye and skin irritation was 65.4%. Not having working license and having fair, poor, or very poor job tenure significantly reduced the prevalence of eye and skin irritation. Conversely, exposure to polluted water, working in the professional for more than 30 years, male sex, and age older than 60 years were associated with increased prevalence of irritation.

Conclusions

Eye and skin irritation was mainly explained by non-modifiable sociodemographic and labor conditions and by consumption of polluted water; however, implementing public health actions could reduce workers' socio-environmental and labor vulnerability.

Patch Testing of Mercaptobenzothiazole and Mercapto Mix: The North American Contact Dermatitis Group Experience, 1994-2016

OBJECTIVES

Mercapto compounds are a category of rubber accelerators that may cause allergic contact dermatitis. This study characterizes patch test reactions to mercaptobenzothiazole (MBT) and mercapto mix (MM) in a large North American population.

METHODS

The 1994-2016 North American Contact Dermatitis Group screening series data were analyzed. Patients with allergic reactions to either MBT or MM (mercapto+) were included. The following characteristics were analyzed: strength of reaction, clinical and occupational relevance, coreactivity with other rubber accelerators, and sources of exposure.

RESULTS

A total of 49,795 patients were tested to mercapto compounds from 1994 to 2016; 633 (1.3%) had positive reactions to MBT and/or MM. The frequency to both MBT and MM significantly decreased over time (P < 0.0001). Mercapto+ patients were significantly more likely to be male, have occupationally related skin disease, and report involvement of the hands and/or feet (P < 0.0001). They were significantly less likely to have face, scalp/ears/neck, or trunk involvement (P ≤ 0.0001). There was significant coreactivity with carba mix (23.4%) and thiuram mix (32.5%). Mercaptobenzothiazole and MM reactions were frequently clinically (81.7% and 83.5%, respectively) and occupationally relevant (29.8% and 33.4%, respectively). Gloves were the most common source (31.3% and 30.9%, respectively).

CONCLUSIONS

Patch test positivity to mercapto compounds significantly decreased from 1994 to 2016 but remains clinically and occupationally relevant.

Occupational dermatoses in the Brazilian South region recorded in a reporting system (2007 to 2016)

Background

Occupational dermatoses must be mandatorily reported in Brazil.

Objective

To characterize the reporting of occupational dermatoses in the Brazilian South region, and describe the profile of the involved workers.

Method

Retrospective and descriptive study of 396 cases of occupational dermatoses reported from 2007 through 2016 via the Information System for Notifiable Diseases.

Results

3.6 and 2.2 cases / 10,000 workers / year were of men and women, respectively. The highest incidence of occupational dermatoses corresponded to age range 50 to 64 years old, 1.8 cases / 10,000 workers / year, and to maintenance and repair workers, 3.6 cases / 10,000 workers / year. Most cases involved whites (77%) and workers not having completed elementary school (37.6%). Patch testing was only performed for 11.4% of cases.

Conclusion

Reinforcing measures to promote the use of personal protective equipment is necessary, as well as to improve reporting and sensitize professionals to perform accurate reports in official systems.

Occupational dermatoses among healthcare workers in a hospital center in Portugal

BACKGROUND

Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually.

OBJECTIVE

To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors.

METHODS

Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year.

RESULTS

About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%).

CONCLUSION

The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.

Sociodemographic and clinical profile of patients with occupational contact dermatitis seen at a work-related dermatology service, 2000 - 2014

BACKGROUND

Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health.

OBJECTIVES

To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service.

METHODS

It is a cross-sectional and retrospective study, based on information obtained from the service's database.

RESULTS

Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde.

STUDY LIMITATIONS

The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series.

CONCLUSIONS

It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.

Assessment of patch test results carried out during ten years in a city in southern Brazil

BACKGROUND

Contact dermatitis affects up to 20% of the population. Patch testing for contact allergy may be needed to confirm the diagnosis.

OBJECTIVES

To describe and discuss the results of patch tests performed in a city in southern Brazil.

METHODS

A cross-sectional analysis was performed on all skin test results over ten years. Variables such as gender, age at the time of testing, and test results were evaluated. Triggering factors, duration of complain, and previous medications used related to the clinical history were retrieved for some patients by reviewing their medical records.

RESULTS

The sample was composed of 539 patch tests, of which 411 (76.2%) were from women. The age of the tested subjects ranged from 5 to 87 years. The prevalence of positive reactions in the patch tests was 391 (72.5%). The most prevalent positive reaction was to nickel sulfate (196; 36.4%), which had statistical significance when associated with female gender (p<0,001).

STUDY LIMITATIONS

Database obtained through secondary sources (the reports of the exams and the medical records), occurring the incomplete registration of some information.

CONCLUSIONS

Data analysis at the local level is important to define preventive policies.

FAKTOR YANG BERHUBUNGAN DENGAN DERMATITIS KONTAK AKIBAT KERJA PADA PEKERJA PROYEK BANDARA

The incidence of contact dermatitis in Indonesia varies greatly and affects most workers. Epidemiological studied showed the incidence of Occupational Contact Dermatitis (OCD) was 0.5–1.9 cases/1000 workers/year. Aircarft Filling Depot Project at Juanda Airport is a construction project that is working on hydrant system and topping up development. This study was aimed at identifying risk factors of OCD among the project workers. A cross sectional design was used on 47 workers whom randomly selected during period May-June 2017. Data was collected using a questionnaire with the researcher’s guide. Occupational Contact Dermatitis is diagnosed by general practitioner that located in Naval Hospital (RUMKITAL) dr. Soekantyo Jahja Surabaya. Occupational contact dermatitis risk factors were analyzed using Chi-square test, followed by multiple logistic regression test. Of 47 workers, 21 (43.8%) experienced OCD. The use of personal protective equipment (PPE), duration of contact, personal hygiene, and history of skin diseases were associated with OCD (p < 0.01), whereas the type of work was not related to OCD (p = 0.491). The most dominant factor causing OCD was personal hygiene (OR = 9.659), followed by duration of contact (OR = 8.576), and history of skin disease (OR = 3.420). In conclusion, factors of use of PPE, length of contact, personal hygiene, and history of skin relationship with DKAK, while the type of work is not related to DKAKKeywords: aircraft filling depots project, occupational contact dermatitis, risk factor

Occupational dermatoses reported in Brazil from 2007 to 2014

BACKGROUND

Occupational diseases are very prevalent in the world, especially in developing countries. Occupational dermatoses are responsible for most of these cases. However, epidemiological studies are rare in Brazil.

OBJECTIVES

To verify the panorama of occupational skin diseases in Brazil describing frequencies of work-related dermatoses and their sociodemographic and occupational patterns.

METHODS

We used retrospective data from the Notifiable Diseases Information System, (from 2007-2014) tabulated with the Tab program for Windows - TabWin12. We used intentional non-probability sampling and sequential selection, considering all notified occupational dermatoses.

RESULTS

All cases of occupational dermatoses referred to in the period were analyzed (n = 4710). Males and the age group of 35-49 years were the most affected. The most affected body area was the upper limb (34.2%) and the hand (25.4%). The "causative agent" field in the forms was not filled in 69.4% of cases, with chrome as the most prevalent cause reported (11.8%). ICD-10 codes more prevalent were L23, L24, and L25, corresponding to 34.2% of the sample. In total, 29% of patients needed to take a sick leave. No cases evolved to death and there were 0.2% of total as permanent disability.

STUDY LIMITATIONS

The amount of missing information for various items in the system draws attention.

CONCLUSIONS

Treatment of patients with occupational dermatitis include the identification and removal of the causative agent and specific treatment of the disease. Diagnosis delay in cases of occupational dermatoses brings social and financial consequences to the work and life of workers.

Nickel, chromium and cobalt: the relevant allergens in allergic contact dermatitis. Comparative study between two periods: 1995-2002 and 2003-2015

BACKGROUND

Metals are common agents of allergic contact dermatitis, occupational or not, with decreasing incidence over the last years in some countries that have regulated the amount of nickel in objects.

OBJECTIVES

To analyze and compare with previous studies the profile of metal sensitization between 2003-2015.

METHODS

Patients who underwent patch testing between 2003-2015 were evaluated retrospectively regarding the sensitization rates to metals, the associations between them, the relationship with profession and epidemiology.

RESULTS

Of the 1,386 patients tested, 438 (32%) had positive test to some metal, similar results to the 404/1,208 (33%) of the previous study (1995-2002) performed at the same service (p=0.32). The frequency of nickel (77%), cobalt (32%) and chromium (29%) changed slightly (p=0.20). Most cases of sensitization to chromium were related to the occupation (64%), in contrast to nickel and cobalt (p<0.0001). There was a predominance of females among those sensitized to metal in both studies (p=0.63) and the age group of 20-49 years old (p=0.11); the number of fair-skinned individuals increased (p<0.001), as well as the lesions in the cephalic segment (50.5%; p<0.0001) and hands (45%; p<0.0001), which are not the most frequent location anymore. The number of cleaners decreased (39% vs. 59%; p<0.0001), which still lead in front of bricklayers/painters, which increased (14% vs. 9%; p=0.013). The frequency of wet work reduced (65% vs. 81%; p<0.0001).

STUDY LIMITATIONS

The study included a single population group; only patients with positive tests to metals were considered - the others were not evaluated for the possibility of false negatives.

CONCLUSION

The sensitization to metals, occupational or not, has been significant over the last 21 years, with few epidemiological changes.

Occupational allergic disease: socio-epidemiological aspects from a specialized outpatient clinic in the city of Sao Paulo, Brazil

Background

Occupational diseases involving the immune system are considered to be occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers.

Objectives

To describe demographic and clinical characteristics of patients with OAD and their social outcomes.

Methods

Descriptive and retrospective study of the medical records of patients diagnosed with OAD cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil.

Results

A total of 72 patients exhibited OAD, with age 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health care (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) workers remained in their jobs, 19 (26%) changed function, 7 (10%) changed occupation, 7 (10%) were fired and 3 (4%) retired.

Conclusions

In the present study, OAD prevailed among males and within the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same job position even after diagnosis.

Health care utilization characteristics in patch test patients

BACKGROUND

The length of time between onset of symptoms and definitive diagnosis is associated with outcomes in contact dermatitis (CD). Understanding the health care experience of patients with CD could identify areas for improvement.

OBJECTIVE

The objective of the study was to describe the health care experience of individuals being patch tested and the barriers and facilitators to their seeking care.

METHODS

One hundred forty-nine patients completed a survey containing information on types of health care providers seen, length of wait times, and barriers and facilitators to seeking care.

RESULTS

Sixty-six percent were first assessed by their family physicians. Forty-five percent waited more than 3 months before seeing a health care provider. Common reasons for delay included thinking their symptoms (1) would get better, (2) were not serious enough, or (3) were not limiting their ability to work or carry out other activities. Most patients waited less than 3 months for dermatological assessment and for patch test consultation after referral.

CONCLUSIONS

Patients with possible CD spend considerable time in the health care system before they undergo definitive assessment. Understanding the reasons for not seeking care may be useful for promoting earlier evaluation and intervention to result in better outcomes.

Clinical profile and quality of life of patients with occupational contact dermatitis from New Delhi, India

BACKGROUND

Data regarding occupational contact dermatitis (OCD) and its effect on quality of life (QOL) in India are limited.

OBJECTIVES/AIMS

To evaluate patients with OCD and record the outcome of treatment.

PATIENTS/MATERIALS/METHODS

All patients with OCD were evaluated for severity of disease (by the use of physician global assessment) and its effect on QOL (by use of the Dermatology Life Quality Index) questionnaire) at the first visit and after 3 months of treatment.

RESULTS

Among 117 patients with OCD, hand eczema was present in 81.2%. Positive patch test reactions were found in 76%. The most common allergens were Parthenium hysterophorus and potassium dichromate. The most frequent diagnosis was occupational allergic contact dermatitis (OACD) (57%), caused by farming and construction work, followed by occupational irritant contact dermatitis (OICD) (24%), caused by wet work. Severe psychosocial distress was recorded in 62.5% of patients. After 3 months of treatment, 83% improved significantly, and 54% had improvement in QOL.

CONCLUSIONS

Farmers were most frequently affected, followed by construction workers and housewives. OACD was found at a higher frequency than OICD. The most frequent allergens were Parthenium hysterophorus in farmers, potassium dichromate in construction workers, and vegetables in housewives. OCD has a significant impact on QOL. Patch testing, in addition to standard treatment, improves the outcome considerably.

Concurrent sensitization to metals and occupation

BACKGROUND

Cosensitization to nickel, cobalt and chromium occurs in the general population and in some occupational groups.

OBJECTIVES

To estimate the isolated and concurrent occurrence of nickel, cobalt and chromium contact sensitization and their association with individual and occupational risk factors.

PATIENTS/METHODS

Twelve thousand four hundred and ninety-two patients were patch tested with the European baseline series between 1997 and 2004 in north-eastern Italy. The associations between patch test results and patient characteristics and occupations were investigated by means of multinomial logistic regression analysis.

RESULTS

Of the patients, 34.7% (4334 patients) had one or more positive patch test reactions to metals. As compared with those with negative reactions to all three metals, nickel sensitization was significantly higher in females than in males, not only as monosensitization, but also as cosensitization with cobalt, with chromium, or with both metals. Building and related trades workers showed positive reactions to chromium + nickel [odds ratio (OR) 1.99; 95% confidence interval (CI) 1.05-3.76) and chromium + cobalt (OR 2.61; 95% CI 1.46-4.67]. Cleaning workers showed a high prevalence of nickel, chromium, nickel + chromium and nickel + cobalt + chromium cosensitization (ORs 1.29, 1.66, 2.11, and 1.79, respectively). An excess risk for cosensitization to all three metals was found in textile and leather workers (OR 2.19; 95% CI 1.10-4.33), and in bartenders (OR 2.10; 95% CI 1.03-4.26).

CONCLUSIONS

Some occupational groups are more likely to develop nickel, cobalt and chromium cosensitization.