Occupational contact dermatitis. Recognition and management

Occupational Contact Dermatitis in Construction Workers: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001-2020

Background: Construction workers (CWs) are at risk for occupational contact dermatitis (CD) owing to workplace exposures. Objective: Determine the prevalence of occupational allergic CD and characterize common occupational allergens in CWs referred for patch testing in the United States and Canada. Methods: Retrospective cross-sectional analysis of patients patch tested by the North American Contact Dermatitis Group from 2001 to 2020. Results: Of 47,843 patch-tested patients, 681 (1.4%) were CWs. Compared with non-CWs, CWs were more likely to be male (91.0% vs 30.9%) have occupational skin disease (36.9% vs 11.4%) and have hand involvement (37.2% vs 22.5%) (all P < 0.0001). Of 681 CWs, 60.1% (411) had clinically relevant positive patch test reactions, and nearly 1/3 of CWs (128) had occupationally relevant reactions. Most common occupationally relevant allergens were potassium dichromate 0.25% pet. (30.5%, 39/128), bisphenol A epoxy resin 1% pet. (28.1%, 36/128), carba mix 3% pet. (14.8%, 19/128), cobalt (ii) chloride hexahydrate 1% pet. (14.1%, 18/128), and thiuram mix 1% pet. (14.1%, 18/128). Top sources of occupationally relevant allergens were cement/concrete/mortar (20.4%, 46/225), gloves (15.1%, 34/225), and coatings (paint/lacquer/shellac/varnish/stains) (9.8%, 22/225). Conclusions: Occupational CD in North American CWs is common. In this group, frequently identified etiological sources of occupational allergic CD included metals, epoxy resin, and rubber.

The Use of Acrylate Polymers in Dentistry

The manuscript aimed to review the types of acrylate polymers used in dentistry, as well as their chemical, physical, mechanical, and biological properties. Regarding their consistency and purpose, dental acrylate polymers are divided into hard (brittle), which includes acrylates for the production of plate denture bases, obturator prostheses, epitheses and maxillofacial prostheses, their repairs and lining, and soft (flexible), which are used for lining denture bases in special indications. Concerning the composition and method of polymerization initiation, polymers for the production of denture bases are divided into four types: heat-, cold-, light-, and microwave-polymerized. CAD/CAM acrylate dentures are made from factory blocks of dental acrylates and show optimal mechanical and physical properties, undoubtedly better monomer polymerization and thus biocompatibility, and stability of the shape and colour of the base and dentures. Regardless of the number of advantages that these polymers have to offer, they also exhibit certain disadvantages. Technological development enables the enhancement of all acrylate properties to respond better to the demands of the profession. Special attention should be paid to improving the biological characteristics of acrylate polymers, due to reported adverse reactions of patients and dental staff to potentially toxic substances released during their preparation and use.

Occupational Contact Dermatitis in Hospital Cleaning Workers

BACKGROUND

Health care workers and hospital cleaning workers are at high risk regarding the development of occupational contact dermatitis (OCD).

OBJECTIVES

To determine the prevalence and risk factors of OCD in hospital cleaning workers.

METHODS

A questionnaire was conducted in 245 cleaning workers in our cross-sectional study. The 236 cleaning workers formed the study group. In workers who were prediagnosed with dermatitis, physical examination was performed in the Dermatology Outpatient Clinic, and when necessary, patch test, skin biopsy, and investigation for total immunoglobulin E were conducted. Patients with definite contact dermatitis were diagnosed as having OCD by using the Mathias criteria.

RESULTS

The prevalence rate of OCD was 21.6% and was significantly higher in female workers (26.4%) when compared with male workers (11.0%). Female sex; low educational level; cleaning the external surfaces of the medical equipment, monitors, and accessories; and mixing the cleaning products and use them while performing cleaning activities were determined as the independent risk factors for OCD.

CONCLUSIONS

Occupational contact dermatitis was present at a high rate in hospital cleaning workers. The risk factors should be taken into consideration for prevention of OCD and improvement of the health status of hospital cleaning workers.

The tissue viability imaging system-Suitable method for discovering minimal skin changes in occupational screenings? Results of a cross-sectional field study

BACKGROUND

For early detection of initial skin changes in occupational screenings, only few objective assessment systems are available.

OBJECTIVES

With the aim of assessing an objective measurement method for hand eczema, we trialed the application of the tissue viability imaging (TiVi) system, quantifying erythema non-invasively by polarized light spectroscopy.

MATERIALS AND METHODS

In a field study with 625 employees of a semiconductor production company, 411 were exposed to prolonged wearing of occlusive gloves in the clean room. TiVi system and Hand Eczema Score for Occupational Screenings (HEROS), a quantitative skin score for the hands, were used, supplemented by a standardized personal interview.

RESULTS

TiVi values of 65 up to 246 for each hand (palm or back), for each participant summed to overall 289 up to 848 (median 389), were measured. Higher TiVi values were noted for men, smokers, and with increasing age. Correlation between TiVi and HEROS was only weak. Several factors like skin pigmentation, thickness of the skin, or tattoos seem to influence TiVi results.

CONCLUSIONS

The practical relevance of one-time measurements with the TiVi system in occupational screenings seems to be limited. Specifically, the TiVi system cannot replace dermatological examinations at the workplace. Notwithstanding, the application for other scientific purposes might be useful.

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

Skin symptoms in the construction industry: occurrence and determinants

BACKGROUND

In the construction industry, a relatively high hand eczema prevalence can be expected due to exposure to irritating and allergenic agents.

METHODS

As part of a regular program of voluntary medical examinations, a questionnaire including items on health symptoms and working circumstances is administered to construction industry personnel. We studied 152,200 male workers (response rate 52%). Associations between possible risk factors and self-reported skin symptoms and skin hypersensitivity were assessed using log-binomial regression analysis.

RESULTS

Prevalence of skin symptoms on the hands was 25.4% among construction workers, 14.6% among office personnel. Nuisance due to dust exposure was the most important work-related determinant for skin symptoms [Prevalence Ratio (PR) 1.59, 95% confidence interval (CI): 1.55-1.63]. Cross-sectional findings were supported by longitudinal analyses in a study population subset.

CONCLUSIONS

Skin symptoms are common among construction workers. Nuisance due to dust exposure was associated with higher prevalences of skin symptoms.

[Occupational dermatitis in cleaning and maintenance workers. Analysis of 769 cases declared to the Caisse Nationale d'Assurance Maladie des Travailleurs Salariés between 2004 and 2007]

BACKGROUND

Employees active in the cleaning and maintenance industry (CMI) are particularly exposed to occupational eczema (OE), which affects the hands in 80 to 90% of cases. This risk of OCE in France was evaluated using data collected by the Occupational Risks Division of the French National Health Insurance Fund for Salaried Workers (CNAMTS).

PATIENTS AND METHODS

All cases of OE among CMI employees declared to and recognized by the CNAMTS between 1st January 2004 and 31st December 2007 were selected. The following parameters were noted in each case: age, gender, trade in question, National Health Insurance Office of residence, causal agent and number of days of sick leave. The incidence per 100,000 employees could be determined from the total number of employees followed up by occupational medicine and the numbers working in the CMI.

RESULTS

For the 4 years studied, 769 cases of OE were reported in CMI workers representing 2.6% of the salaried employee population. The annual incidence of OE was 43.5 per 100,000 employees. There was a marked female predominance (75.7%). OE led to loss of 32,714 workdays.

CONCLUSION

This is the first study conducted in France about OE among NIS employees. It highlights the socioeconomic impact of OE. The difficulties of interpretation show the limits of recognition of occupational disease. Analysis of cases of OE in France and monitoring require the development of a specific database to clarify risk situations and identify priority regional and national preventive actions.

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

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.

Integrated, multidisciplinary care for hand eczema: design of a randomized controlled trial and cost-effectiveness study

Background

The individual and societal burden of hand eczema is high. Literature indicates that moderate to severe hand eczema is a disease with a poor prognosis. Many patients are hampered in their daily activities, including work. High costs are related to high medical consumption, productivity loss and sick leave. Usual care is suboptimal, due to a lack of optimal instruction and coordination of care, and communication with the general practitioner/occupational physician and people involved at the workplace. Therefore, an integrated, multidisciplinary intervention involving a dermatologist, a care manager, a specialized nurse and a clinical occupational physician was developed. This paper describes the design of a study to investigate the effectiveness and cost-effectiveness of integrated care for hand eczema by a multidisciplinary team, coordinated by a care manager, consisting of instruction on avoiding relevant contact factors, both in the occupational and in the private environment, optimal skin care and treatment, compared to usual, dermatologist-led care.

Methods

The study is a multicentre, randomized, controlled trial with an economic evaluation alongside. The study population consists of patients with chronic, moderate to severe hand eczema, who visit an outpatient clinic of one of the participating 5 (three university and two general) hospitals. Integrated, multidisciplinary care, coordinated by a care manager, including allergo-dermatological evaluation by a dermatologist, occupational intervention by a clinical occupational physician, and counselling by a specialized nurse on optimizing topical treatment and skin care will be compared with usual care by a dermatologist. The primary outcome measure is the cumulative difference in reduction of the clinical severity score HECSI between the groups. Secondary outcome measures are the patient's global assessment, specific quality of life with regard to the hands, generic quality of life, sick leave and patient satisfaction. An economic evaluation will be conducted alongside the RCT. Direct and indirect costs will be measured. Outcome measures will be assessed at baseline and after 4, 12, 26 and 52 weeks. All statistical analyses will be performed on the intention-to-treat principle. In addition, per protocol analyses will be carried out.

Discussion

To improve societal participation of patients with moderate to severe hand eczema, an integrated care intervention was developed involving both person-related and environmental factors. Such integrated care is expected to improve the patients' clinical signs, quality of life and to reduce sick leave and medical costs. Results will become available in 2011.

Hand dermatitis in primary care: A nurse practitioner's role in management

PURPOSE

Discuss chronic hand contact dermatitis (CD) and its management by nurse practitioners (NPs) in primary care.

DATA SOURCES

Clinical studies, practice guideline, and clinic case.

CONCLUSION

Hand CD is a common form of dermatitis in primary care. Recognition and avoidance of irritants and allergens, proper hand protection, and topical treatments can alleviate this chronic problem, significantly relieve symptoms, and promote skin health.

IMPLICATIONS FOR PRACTICE

A national shortage of dermatologists has caused more patients to seek treatment for skin disorders in primary care. NPs need to be prepared to diagnose and manage common skin problems in primary care.

Contact dermatitis in car repair workers

BACKGROUND

Occupational contact dermatitis (OCD) is a common skin disorder with a poor prognosis.

OBJECTIVES

The objectives of this study were to (1) estimate the prevalence of CD among car repair workers, (2) study some risk factors associated with CD, and (3) conduct an intervention skin care education program.

SUBJECTS AND METHODS

A cross-sectional study was conducted in 87 car repair workers with regular and direct exposure to chemicals at the industrial zone in Zagazig City, Egypt and 76 unexposed assembly booksellers. All workers were subjected to a questionnaire and clinical examination, and those who were diagnosed clinically as CD were patch tested. Intervention study with a skin care education program was carried out on 47 car repair workers. Re-evaluation of the intervention group after 5 months was done.

RESULTS

The total prevalence of CD among car repair workers (18.4%) was significantly higher compared with their controls (3.9%), with the highest prevalence among car mechanics (24.1%) and painters (20.7%); 16.1% of them reported recurrent dermatitis in the last 12 months. Nickel accounted for most positive patch test reactions (33.3%). A significant association was noticed between the prevalence of CD and age, smoking, atopic background and duration of work. After the intervention study, a significantly higher knowledge level about CD was reported.

CONCLUSION

The most important risk factors for OCD among the car repair workers are atopic background and long duration of work. Skin care education program is an important tool for prevention of CD and control of exposure to substances hazardous to the skin.

Occupational Asthma and Occupational Rhinitis in Hairdressers

BACKGROUND

Hairdressers are at risk for occupational respiratory diseases, but the risk factors, causal agents, and underlying mechanisms are not completely defined.

AIM

To describe the features of a large group of hairdressers consecutively referred to our center for suspected occupational asthma (OA) over an 8-year period, the type of occupational respiratory diseases, the etiologic agents, and the diagnostic tests.

RESULTS

Forty-seven hairdressers (mean age, 25 years; range, 17 to 52 years) were studied. On the basis of the response to the specific inhalation challenge (SIC), 24 patients received a diagnosis of OA (51.1%), which was due to persulfate salts in 21 patients (87.5%), permanent hair dyes in 2 patients (8.3%), and latex in 1 patient (4.2%). Thirteen of these 24 patients (54.2%) also received a diagnosis of occupational rhinitis, which was due to persulfate salts in 11 patients (84.6%) and to paraphenylenediamine in two patients (15.4%). Patients with persulfate asthma had a long period of exposure to bleaching agents, a long latent period between the start of exposure and the onset of symptoms, and a prevalent eosinophilic airway inflammation in induced sputum. The skin-prick test with ammonium persulfate performed in a subset of patients gave negative results

CONCLUSIONS

In the present study, we confirmed that persulfate salts are the major agents involved in OA and occupational rhinitis in hairdressers. The positive response to the SIC in only a part of the population of symptomatic exposed workers, the period between the starting of exposure and the onset of symptoms, the type of response to the SIC, and the high frequency of association of asthma with other diseases such as dermatitis and rhinitis suggest an immunologic mechanism that remains to be elucidated.

Sequential application of cold and sodium lauryl sulphate decreases irritation and barrier disruption in vivo in humans

BACKGROUND

Irritant contact dermatitis (ICD) is one of the most frequent types of occupational dermatitis. Different factors are involved in the development of contact dermatitis. In the food-processing industry, the combined exposure to different irritants may be involved in the development of ICD. Few data have been published regarding the irritant potential of sodium lauryl sulphate (SLS) in combination with cold.

OBJECTIVES

The present study was intended to analyse whether cold exposure and low skin temperature influence the development of ICD.

METHODS

Twenty (part I) and 12 (part II) healthy volunteers were exposed twice daily for 4 days to SLS alone, different low temperatures alone (4 degrees C six times for 90 s with an interval of 20 s or 15 degrees C for 10 min) or a combination of cold and SLS (19.6 microL SLS 1% cm(-2), part I; or 52.6 microL SLS 0.5% cm(-2), part II) using the tandem repetitive irritation test. Irritant cutaneous reactions were measured by noninvasive biophysical methods with transepidermal water loss as a parameter for permeability barrier function and skin colour reflectance together with visual scoring as parameters for inflammatory reactions.

RESULTS

Cold alone caused no significant skin reaction compared with untreated control. Exposure to SLS alone and SLS together with cold (independent of the applied temperature of 4 or 15 degrees C) twice daily induced a clear irritant reaction and barrier disturbance. Reactions did not differ whether SLS was applied before or after cold. Furthermore, 'tandem application' of cold and SLS diminished the barrier disruption and irritant reaction compared with SLS alone.

CONCLUSIONS

We conclude that the application of cold may have a protective effect on the development of ICD, at least in our short-term model.

Irritant hand dermatitis: severity of disease, occupational exposure to skin irritants and preventive measures 5 years after initial diagnosis

Irritant contact dermatitis (ICD) is often chronic; its aetiology frequently being related to occupational exposure. Management of ICD involves persistent reduction in exposure to skin irritants such as water, detergents and prolonged occlusion by gloves. The aim of this study was to determine the severity of hand dermatitis 5 years after initial diagnosis and to find out what factors were related to this outcome. A questionnaire survey was carried out on severity of hand dermatitis, exposure to skin irritants and preventive measures, 5 years after initial ICD diagnosis. Of a cohort of 201 patients with ICD, 172 received the questionnaire and 124 (72%) responded. 5 years after initial diagnosis, 50% still had medium and 32% severe hand dermatitis. Patients with severe ICD and high exposure showed low levels of prevention and difficulty in changing their occupational exposure. Use of emollients was predominantly therapeutic rather than preventive. Occupation was changed in 57% of cases, of which 46% was permanent. In this population, ICD is a chronic disease; implementation of secondary preventive measures appears to fail. In occupations with high exposure to skin irritants, implementation of permanent exposure reduction is more difficult, compared to occupations with a medium level of exposure. High exposures might have led to change of occupation; medium exposures could have been reduced to low levels. In occupations with high exposure, women were overrepresented.

Patch testing for allergic contact dermatitis in the allergist office

The identification of allergens responsible for allergic contact dermatitis (ACD) is key to the management of this disease. The patch test (PT) is the only safe, objective, scientific, and practical method for the diagnosis of ACD. There is no single PT panel that will screen all the relevant allergens in a patient's environment. It is generally thought that 20 to 30 allergens in routine screening tests can identify 50% to 70% of clinically relevant ACD. However, the usefulness of patch testing is enhanced with the number of allergens tested. Although the PT might be simple to apply, it might be difficult to read, interpret, and correlate to the patient's symptoms. A familiarity with the patient's environment, the process of the industry in that environment, and the uses of various chemicals in the industry is needed in most cases.