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Bauer A, Haufe E, Heinrich L, Seidler A, Schulze HJ, Elsner P, Drexler H, Letzel S, John SM, Fartasch M, Brüning T, Dugas-Breit S, Gina M, Weistenhöfer W, Bachmann K, Bruhn I, Lang BM, Brans R, Allam JP, Grobe W, Westerhausen S, Knuschke P, Wittlich M, Diepgen TL, Schmitt J. Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study. J Occup Med Toxicol 2020; 15:28. [PMID: 32944060 PMCID: PMC7488106 DOI: 10.1186/s12995-020-00279-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 08/12/2020] [Indexed: 01/13/2023] Open
Abstract
Background A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates. Objectives To evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure. Methods Six hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age2, sex, phototype and non-occupational UV exposure were calculated. Results Participants with high versus no (OR 2.08; 95% CI 1.24–3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15–3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses. Conclusion The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.
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Affiliation(s)
- A Bauer
- Department of Dermatology, University AllergyCentre, Medical Faculty Carl Gustav Carus, Technical University Dresden, Fetscherstr 74, D-01307 Dresden, Germany
| | - E Haufe
- Centre of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - L Heinrich
- Centre of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - A Seidler
- Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany.,Institute and Outpatient Clinics of Occupational and Social Medicine, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - H J Schulze
- Department of Dermatology, Dermatological Radiotherapy and Dermatohistopathology, Special Clinics Hornheide, Münster, Germany
| | - P Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - H Drexler
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - S Letzel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre, Johannes-Gutenberg University Mainz, Mainz, Germany
| | - S M John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück and Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - M Fartasch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (DGUV), Institute of Ruhr University Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (DGUV), Institute of Ruhr University Bochum (IPA), Bochum, Germany
| | - S Dugas-Breit
- Department of Dermatology, Dermatological Radiotherapy and Dermatohistopathology, Special Clinics Hornheide, Münster, Germany
| | - M Gina
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - W Weistenhöfer
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - K Bachmann
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - I Bruhn
- Department of Dermatology, University AllergyCentre, Medical Faculty Carl Gustav Carus, Technical University Dresden, Fetscherstr 74, D-01307 Dresden, Germany
| | - B M Lang
- Department of Dermatology, University Medical Centre, Johannes-Gutenberg University Mainz, Mainz, Germany
| | - R Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück and Institute of Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - J P Allam
- Department of Dermatology and Allergology, Christine Kühne Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - W Grobe
- Department of Dermatology and Allergology, Christine Kühne Center for Allergy Research and Education, University of Bonn, Bonn, Germany
| | - S Westerhausen
- Department of Radiation, Institute of Occupational Health and Safety of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany
| | - P Knuschke
- Department of Dermatology, Experimental Photobiology, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - M Wittlich
- Department of Radiation, Institute of Occupational Health and Safety of the German Social Accident Insurance (DGUV), Sankt Augustin, Germany
| | - T L Diepgen
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J Schmitt
- Centre of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Uter W, Aalto-Korte K, Agner T, Andersen KE, Bircher AJ, Brans R, Bruze M, Diepgen TL, Foti C, Giménez Arnau A, Gonçalo M, Goossens A, McFadden J, Paulsen E, Svedman C, Rustemeyer T, White IR, Wilkinson M, Johansen JD. The epidemic of methylisothiazolinone contact allergy in Europe: follow-up on changing exposures. J Eur Acad Dermatol Venereol 2019; 34:333-339. [PMID: 31419348 DOI: 10.1111/jdv.15875] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Methylisothiazolinone (MI) has caused an unprecedented epidemic of contact allergy in Europe and elsewhere. Subsequently, regulatory action has been taken, at least in Europe, aiming at reducing risk of MI sensitization. OBJECTIVE To follow-up on the prevalence of contact allergy to MI in consecutively patch tested patients and assess the spectrum of products containing MI or methylchloroisothiazolinone (MCI)/MI in patients positive to MI which elicited current allergic contact dermatitis. METHODS A cross-sectional survey was performed in 2016 and 2017, including all adult patients patch tested with the baseline series (including MI 0.2% aq.) between 1 May and 31 October at 14 centres in 11 European countries. Patients with positive reactions (+ to +++) to MI were further examined regarding history, clinical characteristics and eliciting products, which were categorized into 34 types and 4 classes (leave-on, rinse-off, household, occupational). The results were compared with the reference year 2015. RESULTS A total of 317 patients, n = 202 of 4278 tested in 2016 (4.72%) and n = 115 of 3879 tested in 2017 (2.96%), had positive reactions to MI; the previous result from 2015 was 5.97% (P < 0.0001). The share of currently relevant contact allergy among all positive reactions declined significantly as well (P = 0.0032). Concerning product classes, a relative decline of leave-on and a relative increase of rinse-off and household products was noted. CONCLUSION The prevalence of MI contact allergy decreased by 50% from 2015 to 2017. As a consequence of regulation, the share of cosmetics products (leave-on in particular) eliciting allergic contact dermatitis is decreasing. The chosen method of analysing causative products in sensitized patients has proven useful to monitor effects of intervention.
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Affiliation(s)
- W Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - K Aalto-Korte
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - T Agner
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - K E Andersen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - A J Bircher
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - R Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - M Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - C Foti
- Unit of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - A Giménez Arnau
- Department of Dermatology, Hospital del Mar, IMIM, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Goossens
- Contact Allergy Unit, Department of Dermatology, University Hospital KU Leuven, Leuven, Belgium
| | - J McFadden
- Guy's Hospital, St John's Institute of Dermatology, London, UK
| | - E Paulsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - C Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - T Rustemeyer
- Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - I R White
- Guy's Hospital, St John's Institute of Dermatology, London, UK
| | - M Wilkinson
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J D Johansen
- Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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3
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Passeron T, Bouillon R, Callender V, Cestari T, Diepgen TL, Green AC, van der Pols JC, Bernard BA, Ly F, Bernerd F, Marrot L, Nielsen M, Verschoore M, Jablonski NG, Young AR. Sunscreen photoprotection and vitamin D status. Br J Dermatol 2019; 181:916-931. [PMID: 31069788 PMCID: PMC6899926 DOI: 10.1111/bjd.17992] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 12/16/2022]
Abstract
Background Global concern about vitamin D deficiency has fuelled debates on photoprotection and the importance of solar exposure to meet vitamin D requirements. Objectives To review the published evidence to reach a consensus on the influence of photoprotection by sunscreens on vitamin D status, considering other relevant factors. Methods An international panel of 13 experts in endocrinology, dermatology, photobiology, epidemiology and biological anthropology reviewed the literature prior to a 1‐day meeting in June 2017, during which the evidence was discussed. Methods of assessment and determining factors of vitamin D status, and public health perspectives were examined and consequences of sun exposure and the effects of photoprotection were assessed. Results A serum level of ≥ 50 nmol L−1 25(OH)D is a target for all individuals. Broad‐spectrum sunscreens that prevent erythema are unlikely to compromise vitamin D status in healthy populations. Vitamin D screening should be restricted to those at risk of hypovitaminosis, such as patients with photosensitivity disorders, who require rigorous photoprotection. Screening and supplementation are advised for this group. Conclusions Sunscreen use for daily and recreational photoprotection does not compromise vitamin D synthesis, even when applied under optimal conditions. What's already known about this topic? Knowledge of the relationship between solar exposure behaviour, sunscreen use and vitamin D is important for public health but there is confusion about optimal vitamin D status and the safest way to achieve this. Practical recommendations on the potential impact of daily and/or recreational sunscreens on vitamin D status are lacking for healthy people.
What does this study add? Judicious use of daily broad‐spectrum sunscreens with high ultraviolet (UV) A protection will not compromise vitamin D status in healthy people. However, photoprotection strategies for patients with photosensitivity disorders that include high sun‐protection factor sunscreens with high UVA protection, along with protective clothing and shade‐seeking behaviour are likely to compromise vitamin D status. Screening for vitamin D status and supplementation are recommended in patients with photosensitivity disorders.
Linked Comment: https://doi.org/10.1111/bjd.18126. https://doi.org/10.1111/bjd.18494 available online
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Affiliation(s)
- T Passeron
- Department of Dermatology, CHU Nice, Université Côte d'Azur, CHU Nice, 151, route de Ginestière, 06200, Nice, France.,C3M, INSERM U1065 Université Côte d'Azur, 151, route de Ginestière, 06200, Nice, France
| | - R Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Gasthuisberg, 3000, Leuven, Belgium
| | - V Callender
- Callender Dermatology & Cosmetic Center, 12200 Annapolis Road, Suite 315, Glenn Dale, MD, 20769, U.S.A
| | - T Cestari
- Federal University of Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Ramiro Barcellos 2350 zone 13, Porto Alegre, RS, 90035-903, Brazil
| | - T L Diepgen
- Department of Clinical Social Medicine, University of Heidelberg, Voßstr. 2, 69115, Heidelberg, Germany
| | - A C Green
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia.,CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, M13 9NQ, U.K
| | - J C van der Pols
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, QLD, 4059, Australia
| | - B A Bernard
- L'Oréal R&I, Scientific Directorate, 9 rue Pierre Dreyfus, 92110, Clichy, France
| | - F Ly
- Faculty of Medicine, Pharmacy and Odontology, University Cheikh Anta Diop of Dakar, BP 5825, Dakar, Senegal
| | - F Bernerd
- L'Oréal R&I, 1 Avenue Eugène Schueller, 93600, Aulnay-sous-bois, France
| | - L Marrot
- L'Oréal R&I, 1 Avenue Eugène Schueller, 93600, Aulnay-sous-bois, France
| | - M Nielsen
- L'Oréal R&I, Scientific Directorate, 9 rue Pierre Dreyfus, 92110, Clichy, France
| | - M Verschoore
- L'Oréal R&I, Scientific Directorate, 9 rue Pierre Dreyfus, 92110, Clichy, France
| | - N G Jablonski
- Department of Anthropology, The Pennsylvania State University, 409 Carpenter Building, University Park, PA, 16802, U.S.A
| | - A R Young
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
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4
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Haufe E, Heinrich L, Diepgen TL, Schmitt J. Natürliche UV-Exposition an beruflich exponierten Körperstellen: Zusammenhang von UV-Dosis und Plattenepithelkarzinom-Risiko. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E Haufe
- Medizinische Fakultät und Universitätsklinikum der TU Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
| | - L Heinrich
- Medizinische Fakultät und Universitätsklinikum der TU Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
| | - TL Diepgen
- Universität Heidelberg, Abteilung Klinische Sozialmedizin, Heidelberg, Deutschland
| | - J Schmitt
- Medizinische Fakultät und Universitätsklinikum der TU Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
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Abstract
AbstractInternet information undergoes no quality controls and virtually anybody can publish anything. Because of this, it is difficult for searchers to take information retrieved from the Internet at face value. A related problem is the uncontrolled promotion of medical products on the Internet. A further problem of today’s Internet is that authors use no uniform keywords and other descriptive labels, which deteriorates the quality of search results. A solution for all these problems could be widespread use of descriptive and evaluative metainformation associated with medical Internet information. Our concept is based on a recently established infrastructure for assigning metadata to Internet information, the so-called PICS Standard (Platform for Internet Content Selection). We prototyped a PICS-based rating vocabulary for medical information (med-PICS), containing descriptive and evaluative categories, to be used by the webauthor and third-party label services (such as medical associations), respectively. We propose an international effort to assign metadata to medical Internet information.
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. Response to letter to the editor re. Hines J, Wilkinson SM, John SM, et al. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:e308. [PMID: 27878862 DOI: 10.1111/jdv.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, DE5 8JZ, UK
| | - S M Wilkinson
- Leeds Teaching Hospitals NHS Trust, Leeds, LS7 4SA, UK
| | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Am Finkenhügel 7a, 49076, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Grabengasse 1, 69117, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, NG7 2FT, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Moerser Landstraβe 352, 47802, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - H I Maibach
- Dermatology Department, University of California San Francisco, 94115, San Francisco, CA, USA
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7
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Agner T, Aalto-Korte K, Andersen KE, Foti C, Gimenéz-Arnau A, Goncalo M, Goossens A, Le Coz C, Diepgen TL. Factors associated with combined hand and foot eczema. J Eur Acad Dermatol Venereol 2016; 31:828-832. [PMID: 27768241 DOI: 10.1111/jdv.14016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND As for hand eczema, the aetiology of foot eczema is multifactorial and not very well understood. The aim of the present study was to identify factors associated with foot eczema in a cohort of hand eczema patients being classified into different subgroups. METHODS Associations between foot and hand eczema were studied in a cross-sectional design in a cohort of hand eczema patients. Consecutive patients were recruited from nine different European Centres during the period October 2011-September 2012. Data on demographic factors, presence of foot eczema, hand eczema duration and severity, and whether the hand eczema was work-related or not were available, as well as patch-test results. RESULTS Of a total of 427 hand eczema patients identified, information on foot eczema was available in 419 patients who were included in the present study. A total of 125 patients (29.8%) had concomitant foot and hand eczema. It was found more often in association with hyperkeratotic hand eczema (P = 0.007) and was less often associated with irritant hand eczema (P < 0.001). However, foot eczema was nevertheless found in 18% of patient with irritant hand eczema and in 25% of patients with occupational hand eczema. Combined foot and hand eczema was associated with more severe and long-standing hand eczema (P < 0.001 and P = 0.004, respectively). Contact allergy was found in 51.8% with no difference between patients with combined foot and hand eczema and patients with hand eczema only. CONCLUSION Occurrence of combined foot and hand eczema is a common finding and not restricted to endogenous hand eczema.
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Affiliation(s)
- T Agner
- Department of Dermatology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - K Aalto-Korte
- Occupational Medicine, Finnish Institute of Occupational Health, Helsinki, Finland
| | - K E Andersen
- Department of Dermatology and Allergy Centre, Centre for Innovative Medical Technology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy
| | - A Gimenéz-Arnau
- Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mediques, Universitat Autònoma, Barcelona, Spain
| | - M Goncalo
- Clinic of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Goossens
- Department of Dermatology, University Hospital KU Leuven, Leuven, Belgium
| | - C Le Coz
- Cabinet de Dermatologie, Strasbourg, France
| | - T L Diepgen
- Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:53-64. [PMID: 27545662 PMCID: PMC5434821 DOI: 10.1111/jdv.13851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
Contact dermatitis is one of the most common occupational diseases, with serious impact on quality of life, lost days at work and a condition that may be chronically relapsing. Regular prophylactic skin cream application is widely acknowledged to be an effective prevention strategy against occupational contact dermatitis; however, compliance rates remain low. To present a simple programme for skin cream application in the workplace with focus on implementation to drive down the rate of occupational irritant contact dermatitis, an expert panel of eight international dermatologists combined personal experience with extensive literature review. The recommendations are based on clinical experience as supported by evidence-based data from interventional studies. The authors identified three moments for skin cream application in the work place: (i) before starting a work period; (ii) after washing hands; and (iii) after work. Affecting behaviour change requires systematic communications, monitoring and reporting, which is proposed through Kotter's principles of organizational change management. Measurement tools are provided in the appendix. Interventional data based on application of this proposal is required to demonstrate its effectiveness.
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Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, UK
| | | | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Schnuch A, Lessmann H, Becker D, Diepgen TL, Drexler H, Erdmann S, Fartasch M, Greim H, Kricke-Helling P, Merget R, Merk H, Nowak D, Rothe A, Stropp G, Wallenstein G, Uter W. Designation of substances as skin sensitizing chemicals: a reply. Hum Exp Toxicol 2016; 24:157-9. [PMID: 15901055 DOI: 10.1191/0960327105ht512xx] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Diepgen TL, Ofenloch R, Bruze M, Cazzaniga S, Coenraads PJ, Elsner P, Goncalo M, Svensson Å, Naldi L. Prevalence of fragrance contact allergy in the general population of five European countries: a cross-sectional study. Br J Dermatol 2015; 173:1411-9. [PMID: 26332456 DOI: 10.1111/bjd.14151] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Contact allergy to fragrances is assessed mostly in clinical populations of patients. Studies in the general population are scarce and vary in their methodology across countries. OBJECTIVES To determine the prevalence of fragrance contact allergy in the European general population and to assess the clinical relevance of positive patch test reactions to different fragrances. METHODS In five European countries (Germany, Italy, the Netherlands, Portugal and Sweden) a random sample from the general population aged 18-74 years was drawn. In total, 12 377 subjects were interviewed in this cross-sectional study and a random sample (n = 3119) was patch tested using the TRUE Test and Finn Chamber techniques. Patch test procedures were harmonized by mandatory training before the study and monitoring during the study. RESULTS The highest prevalence for contact allergy of 2·6% [95% confidence interval (CI) 2·1-3·2] was found for fragrance mix (FM) I in petrolatum, with a high content of atranol and chloratranol, followed by 1·9% (95% CI 1·5-2·4) for FM II in petrolatum. The conservatively estimated prevalence of fragrance contact allergy was 1·9% (95% CI 1·5-2·5). This is defined as the existence of a positive patch test to FM I or FM II; any of their individual materials; Myroxylon pereirae; sesquiterpene lactones or 3- and 4-hydroxyisohexyl 3-cyclohexene carboxaldehyde that show clinical relevance, defined conservatively as lifetime avoidance of scented products and an itchy skin rash lasting > 3 days in a lifetime. Using the reported lifetime prevalence of any contact dermatitis instead of the lifetime prevalence of any itchy skin rash, the prevalence is 0·8% (95% CI 0·5-1·2). The prevalence rates of contact allergy to fragrances in women are about twice those in men. CONCLUSIONS This study helps to identify targets for prevention of fragrance allergy.
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Affiliation(s)
- T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Thibautstraße 3, 69115, Heidelberg, Germany
| | - R Ofenloch
- Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Thibautstraße 3, 69115, Heidelberg, Germany
| | - M Bruze
- Department of Occupational and Environmental Dermatology, University Hospital Malmö, S-20502, Malmö, Sweden
| | - S Cazzaniga
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Centro Studi GISED - FROM Presidio Ospedaliero Matteo Rota, Via Garibaldi 13/15, 24122, Bergamo, Italy
| | - P J Coenraads
- Occupational and Environmental, Dermatology Unit, State University Hospital, P.O. Box 30.001, NL-9700 RB, Groningen, the Netherlands
| | - P Elsner
- Klinik für Dermatologie und dermatologische Allergologie, Klinikum der FSU Jena, Erfurter Str. 35, D-07740, Jena, Germany
| | - M Goncalo
- Clinica de Dermatologia, Hospital da Universidade Praceta Motal Pinto, Rua Infanta D.Maria, n 30-A-3D, P-3000-075, Coimbra, Portugal
| | - Å Svensson
- Department of Dermatology, University Hospital Malmö, S-20502, Malmö, Sweden
| | - L Naldi
- Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Centro Studi GISED - FROM Presidio Ospedaliero Matteo Rota, Via Garibaldi 13/15, 24122, Bergamo, Italy
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Affiliation(s)
- T L Diepgen
- Department of Dermatology, Friedrich-Alexander University Erlangen-Nuremberg, Germany
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Affiliation(s)
- U Funke
- Gesundheitswesen AUDI AG, Ingolstadt, Germany
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Apfelbacher C, Popielnicki A, Bauer A, Diepgen TL, Elsner P, Dawsey R, Mahler V, Molin S, Schmitt J, Weisshaar E, Ofenloch RF. Severity And Functional Disability Of Patients With Occupational Contact Dermatitis: Validation Of The German Version Of The Occupational Contact Dermatitis Disease Severity Index (ODDI). Value Health 2014; 17:A567. [PMID: 27201885 DOI: 10.1016/j.jval.2014.08.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - A Bauer
- University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | | | - P Elsner
- University Hospital Jena, Jena, Germany
| | | | - V Mahler
- University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - S Molin
- Ludwig-Maximilians-University Munich, München, Germany
| | - J Schmitt
- Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - E Weisshaar
- University Hospital Heidelberg, Heidelberg, Germany
| | - R F Ofenloch
- University Hospital Heidelberg, Heidelberg, Germany
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Ofenloch RF, Weisshaar E, Dumke AK, Molin S, Diepgen TL, Apfelbacher C. How Can the Quality of Life in Hand Eczema Questionnaire (qolheq) be Interpreted? A Banding Study. Value Health 2014; 17:A612. [PMID: 27202137 DOI: 10.1016/j.jval.2014.08.2148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- R F Ofenloch
- University Hospital Heidelberg, Heidelberg, Germany
| | - E Weisshaar
- University Hospital Heidelberg, Heidelberg, Germany
| | - A-K Dumke
- University Hospital Jena, Jena, Germany
| | - S Molin
- University Hospital Munich, Munich, Germany
| | - T L Diepgen
- University Hospital Heidelberg, Heidelberg, Germany
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Böhm D, Stock Gissendanner S, Finkeldey F, John SM, Werfel T, Diepgen TL, Breuer K. Severe occupational hand eczema, job stress and cumulative sickness absence. Occup Med (Lond) 2014; 64:509-15. [DOI: 10.1093/occmed/kqu076] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ofenloch RF, Weisshaar E, Dumke AK, Molin S, Diepgen TL, Apfelbacher C. The Quality of Life in Hand Eczema Questionnaire (QOLHEQ): validation of the German version of a new disease-specific measure of quality of life for patients with hand eczema. Br J Dermatol 2014; 171:304-12. [PMID: 24397866 DOI: 10.1111/bjd.12819] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is widely used as a patient-reported outcome to evaluate clinical trials. In routine care it can also be used to improve treatment strategies or to enhance patients' self-awareness and empowerment. Therefore a disease-specific instrument is needed that assesses in detail all the impairments caused by the disease of interest. For patients with hand eczema (HE) such an instrument was developed by an international expert group, but its measurement properties are unknown. OBJECTIVES To validate the German version of the Quality of Life in Hand Eczema Questionnaire (QOLHEQ), which covers the domains of (i) symptoms, (ii) emotions, (iii) functioning and (iv) treatment and prevention. METHODS The QOLHEQ was assessed up to three times in 316 patients with HE to test reliability and sensitivity to change. To test construct validity we also assessed several reference measures. The scale structure was analysed using the Rasch model for each subscale and a structural equation model was used to test the multi domain structure of the QOLHEQ. RESULTS After minor adaptions of the scoring structure, all four subscales of the QOLHEQ did not significantly misfit the Rasch model (α > 0·05). The fit indices of the structural equation model showed a good fit of the multi domain construct with four subscales assessing HRQOL. Nearly all a priori-defined hypotheses relating to construct validity could be confirmed. The QOLHEQ showed a sensitivity to change that was superior compared with all reference measures. CONCLUSIONS The QOLHEQ is ready to be used in its German version as a sensitive outcome measure in clinical trials and for routine monitoring. The treatment-relevant subscales enable its use to enhance patients' self-awareness and to monitor treatment decisions.
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Affiliation(s)
- R F Ofenloch
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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Ellsäßer G, Diepgen TL. Atopische Erkrankungen und soziale Lage bei Einschulungskindern im Land Brandenburg Trendanalyse 1994–2000. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-001-0344-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ellsäßer G, Diepgen TL. Epidemiologische Analyse von Sturzunfällen im Kindesalter (<15 Jahre) Konsequenzen für die Prävention. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 45:267-76. [DOI: 10.1007/s00103-001-0371-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sonsmann FK, Strunk M, Gediga K, John C, Schliemann S, Seyfarth F, Elsner P, Diepgen TL, Kutz G, John SM. Standardization of skin cleansingin vivo: part I. Development of an Automated Cleansing Device (ACiD). Skin Res Technol 2013; 20:228-38. [DOI: 10.1111/srt.12112] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- F. K. Sonsmann
- Department of Occupational Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- iDerm - Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück; Osnabrück Germany
| | - M. Strunk
- Department of Occupational Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
| | - K. Gediga
- iDerm - Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück; Osnabrück Germany
| | - C. John
- Department of Occupational Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
| | - S. Schliemann
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - F. Seyfarth
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - P. Elsner
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - T. L. Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology; University Heidelberg; Heidelberg Germany
| | - G. Kutz
- Department of Pharmaceutical Technology; Hochschule Ostwestfalen-Lippe - University of Applied Sciences; Lemgo Germany
| | - S. M. John
- Department of Occupational Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- iDerm - Institute for Interdisciplinary Dermatological Prevention and Rehabilitation at the University of Osnabrück; Osnabrück Germany
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Sonsmann FK, Strunk M, Gediga K, Schliemann S, Seyfarth F, Elsner P, Diepgen TL, Kutz G, John SM. Standardization of skin cleansingin vivo: part II. Validation of a newly developed Automated Cleansing Device (ACiD). Skin Res Technol 2013; 20:239-45. [DOI: 10.1111/srt.12113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- F. K. Sonsmann
- Department of Occupational Dermatology; Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- iDerm - Institute for Interdisciplinary Dermatological Prevention and Rehabilitation; University of Osnabrück; Osnabrück Germany
| | - M. Strunk
- Department of Occupational Dermatology; Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
| | - K. Gediga
- iDerm - Institute for Interdisciplinary Dermatological Prevention and Rehabilitation; University of Osnabrück; Osnabrück Germany
| | - S. Schliemann
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - F. Seyfarth
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - P. Elsner
- Department of Dermatology; University Hospital Jena; Jena Germany
| | - T. L. Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology; University of Heidelberg; Heidelberg Germany
| | - G. Kutz
- Department of Pharmaceutical Technology; Hochschule Ostwestfalen-Lippe - University of Applied Sciences; Lemgo Germany
| | - S. M. John
- Department of Occupational Dermatology; Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- iDerm - Institute for Interdisciplinary Dermatological Prevention and Rehabilitation; University of Osnabrück; Osnabrück Germany
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21
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Diepgen TL, Merk HF. [UV-induced occupational skin diseases]. Hautarzt 2012; 63:768. [PMID: 23052101 DOI: 10.1007/s00105-012-2400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T L Diepgen
- Abt. Klinische Sozialmedizin, Berufs- und Umweltdermatologie, Universitätsklinikum Heidelberg, Thibautstr. 3, 69115, Heidelberg, Deutschland.
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Abstract
BACKGROUND Diagnostic classification of chronic hand eczema (CHE) represents a major clinical and taxonomic challenge because of its wide aetiological and clinical heterogeneity. AIM To develop an algorithm for the diagnosis and classification of CHE. METHODS Well-defined aetiological, clinical and morphological criteria of CHE were arranged graphically in a diagnostic hierarchy, and validated in 137 German patients with hand eczema. RESULTS The algorithm distinguished chronic hand eczema due to contact allergy, irritant damage or a combination of the two, each either with or without atopy, and also atopic hand eczema and idiopathic hand eczema lacking obvious causative factors. Foot involvement helped to distinguish idiopathic from irritant hand eczema. Each subtype could occur either with a hyperkeratotic-rhagadiform, dyshidrotic or mixed morphology, but certain hand eczema subtypes had clear morphological preferences. CONCLUSIONS By providing a more precise clinical definition this diagnostic algorithm could improve the classification and taxonomy of hand eczema subtypes, facilitating more rational treatment decisions and allowing better treatment outcome analysis.
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Affiliation(s)
- S Molin
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.
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Peiser M, Tralau T, Heidler J, Api AM, Arts JHE, Basketter DA, English J, Diepgen TL, Fuhlbrigge RC, Gaspari AA, Johansen JD, Karlberg AT, Kimber I, Lepoittevin JP, Liebsch M, Maibach HI, Martin SF, Merk HF, Platzek T, Rustemeyer T, Schnuch A, Vandebriel RJ, White IR, Luch A. Allergic contact dermatitis: epidemiology, molecular mechanisms, in vitro methods and regulatory aspects. Current knowledge assembled at an international workshop at BfR, Germany. Cell Mol Life Sci 2011; 69:763-81. [PMID: 21997384 PMCID: PMC3276771 DOI: 10.1007/s00018-011-0846-8] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/29/2011] [Accepted: 09/20/2011] [Indexed: 12/13/2022]
Abstract
Contact allergies are complex diseases, and one of the important challenges for public health and immunology. The German ‘Federal Institute for Risk Assessment’ hosted an ‘International Workshop on Contact Dermatitis’. The scope of the workshop was to discuss new discoveries and developments in the field of contact dermatitis. This included the epidemiology and molecular biology of contact allergy, as well as the development of new in vitro methods. Furthermore, it considered regulatory aspects aiming to reduce exposure to contact sensitisers. An estimated 15–20% of the general population suffers from contact allergy. Workplace exposure, age, sex, use of consumer products and genetic predispositions were identified as the most important risk factors. Research highlights included: advances in understanding of immune responses to contact sensitisers, the importance of autoxidation or enzyme-mediated oxidation for the activation of chemicals, the mechanisms through which hapten-protein conjugates are formed and the development of novel in vitro strategies for the identification of skin-sensitising chemicals. Dendritic cell cultures and structure-activity relationships are being developed to identify potential contact allergens. However, the local lymph node assay (LLNA) presently remains the validated method of choice for hazard identification and characterisation. At the workshop the use of the LLNA for regulatory purposes and for quantitative risk assessment was also discussed.
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Affiliation(s)
- M. Peiser
- Department of Product Safety, German Federal Institute for Risk Assessment (BfR), Thielallee 88-92, 14195 Berlin, Germany
| | - T. Tralau
- Department of Product Safety, German Federal Institute for Risk Assessment (BfR), Thielallee 88-92, 14195 Berlin, Germany
| | - J. Heidler
- Department of Product Safety, German Federal Institute for Risk Assessment (BfR), Thielallee 88-92, 14195 Berlin, Germany
| | - A. M. Api
- Research Institute for Fragrance Materials, Hackensack, NJ USA
| | | | | | - J. English
- Nottingham University Hospitals, Nottingham, UK
| | - T. L. Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | | | - A. A. Gaspari
- School of Medicine, University of Maryland, Baltimore, MD USA
| | - J. D. Johansen
- Department of Derma-allergology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A. T. Karlberg
- Department of Chemistry, Dermatochemistry and Skin Allergy, University of Gothenburg, Gothenburg, Sweden
| | - I. Kimber
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | | | - M. Liebsch
- Department of Experimental Toxicology and ZEBET, Center for Alternatives to Animal Testing, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - H. I. Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA USA
| | - S. F. Martin
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - H. F. Merk
- Department of Dermatology and Allergology, University Hospitals Aachen, Aachen, Germany
| | - T. Platzek
- Department of Product Safety, German Federal Institute for Risk Assessment (BfR), Thielallee 88-92, 14195 Berlin, Germany
| | - T. Rustemeyer
- VU University Medical Center, Amsterdam, The Netherlands
| | - A. Schnuch
- Department of Dermatology, University of Göttingen, Göttingen, Germany
| | - R. J. Vandebriel
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - I. R. White
- St. John’s Institute of Dermatology, St. Thomas’ Hospital, London, UK
| | - A. Luch
- Department of Product Safety, German Federal Institute for Risk Assessment (BfR), Thielallee 88-92, 14195 Berlin, Germany
- Department of Experimental Toxicology and ZEBET, Center for Alternatives to Animal Testing, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
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Abstract
BACKGROUND Eczema is a chronic inflammatory skin disease and is among the most frequent chronic conditions in childhood and adolescence. It is the aim of this study to investigate determinants of eczema in German children and adolescents. METHODS Data were drawn from the public use files of the German Interview and Examination Survey for Children and Adolescents (KIGGS), a nationwide cross-sectional representative survey conducted between 2003 and 2006, including 17,641 children aged 0-17 (response rate: 66.6%). We investigated the association of a broad set of environmental and lifestyle exposures with ever physician-diagnosed eczema by means of univariable analyses and multivariable logistic regression modelling. RESULTS The weighted prevalence of ever physician-diagnosed eczema was 13.2% [95% confidence interval (CI) 12.5-13.9%]. In multivariable analysis, significant positive associations of parental allergies (OR 1.94, 95% CI 1.72-2.19), parent-reported infection after birth (OR 1.45, 95% CI 1.05-2.00) and parent-reported jaundice after birth (OR 1.27, 95% CI 1.04-1.54) were revealed. Being a migrant (OR 0.63, 95% CI 0.49-0.80) and keeping a dog (OR 0.78, 95% CI 0.64-0.96) showed significant inverse associations with eczema. Other lifestyle (alcohol consumption during pregnancy) and environmental factors (mould on the walls, pets, origin from East/West Germany) were not significantly related to eczema. CONCLUSIONS This study suggests that a family history of allergies is the strongest determinant of eczema. Perinatal health problems were associated with eczema, pointing to the importance of early life factors in the manifestation of eczema.
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Affiliation(s)
- C J Apfelbacher
- Department of Clinical Social Medicine, University Hospital Heidelberg, Thibautstrasse 3, Heidelberg, Germany.
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Dirschka T, Reich K, Bissonnette R, Maares J, Brown T, Diepgen TL. An open-label study assessing the safety and efficacy of alitretinoin in patients with severe chronic hand eczema unresponsive to topical corticosteroids. Clin Exp Dermatol 2010; 36:149-54. [DOI: 10.1111/j.1365-2230.2010.03955.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Matterne U, Diepgen TL, Weisshaar E. Differential effects of a tertiary individual prevention programme for patients with occupational skin disease depending on diagnosis. J Eur Acad Dermatol Venereol 2010; 24:1089-93. [DOI: 10.1111/j.1468-3083.2010.03604.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diepgen TL, Andersen KE, Brandao FM, Bruze M, Bruynzeel DP, Frosch P, Gonçalo M, Goossens A, Le Coz CJ, Rustemeyer T, White IR, Agner T. Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema. Br J Dermatol 2008; 160:353-8. [PMID: 19016702 DOI: 10.1111/j.1365-2133.2008.08907.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand eczema is a long-lasting disease with a high prevalence in the background population. The disease has severe, negative effects on quality of life and sometimes on social status. Epidemiological studies have identified risk factors for onset and prognosis, but treatment of the disease is rarely evidence based, and a classification system for different subdiagnoses of hand eczema is not agreed upon. Randomized controlled trials investigating the treatment of hand eczema are called for. For this, as well as for clinical purposes, a generally accepted classification system for hand eczema is needed. OBJECTIVES The present study attempts to characterize subdiagnoses of hand eczema with respect to basic demographics, medical history and morphology. METHODS Clinical data from 416 patients with hand eczema from 10 European patch test clinics were assessed. RESULTS A classification system for hand eczema is proposed. CONCLUSIONS It is suggested that this classification be used in clinical work and in clinical trials.
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Affiliation(s)
- T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Thibautstr. 3, 69115 Heidelberg, Germany.
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Wahn U, Warner J, Simons FER, de Benedictis FM, Diepgen TL, Naspitz CK, de Longueville M, Bauchau V. IgE antibody responses in young children with atopic dermatitis. Pediatr Allergy Immunol 2008; 19:332-6. [PMID: 18422892 DOI: 10.1111/j.1399-3038.2007.00643.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 2184 young children aged 13-24 months with atopic dermatitis (SCORAD 5-59) serum IgE antibodies to a standard panel of food and inhalant allergens were assayed. The frequency of positive IgE responses (>0.35 kU/l) increased with greater severity of skin disease. A significant minority of infants had levels of IgE antibody to foods to suggest they were at risk of acute reaction to those foods (7% to hen's egg, 3% to cow's milk, 4% to peanut). Our findings indicate that the frequency of positive IgE responses is related to disease severity and suggest that differences in the time course of the development of IgE responses to food, which are at maximum prevalence within the first year of life, while inhalant allergies, are still developing between 1 and 2 yr and beyond.
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Affiliation(s)
- U Wahn
- Pneumologie und Immunologie, University Kinder & Poliklinik Klinik für Pädiatrie mit Schwerpunkt, Berlin, Germany.
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Diepgen TL. Chapter 5. Treatment success factors: diagnostic and treatment choices, and patient education. Acta Derm Venereol 2008. [DOI: 10.2340/00015555-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hill DJ, Hosking CS, de Benedictis FM, Oranje AP, Diepgen TL, Bauchau V. Confirmation of the association between high levels of immunoglobulin E food sensitization and eczema in infancy: an international study. Clin Exp Allergy 2007; 38:161-8. [PMID: 18028467 DOI: 10.1111/j.1365-2222.2007.02861.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies of Australian infants have reported that more than 80% of those with moderate atopic eczema (AE) have high levels of IgE food sensitization (IgE-FS) that are commonly associated with IgE food allergy. OBJECTIVES To explore the relationship between high levels of IgE-FS and AE in a large cohort of young children with eczema participating in a multi-centre, international study. METHODS Two thousand one hundred and eighty-four subjects (mean age 17.6 months, range 11.8-25.4; 1246 males) with active eczema from atopic families from 94 centres in 12 countries were studied. Clinical history, Scoring Atopic Dermatitis index as a measure of eczema severity and CAP-FEIA measurements for total IgE and IgE antibody levels to cow milk, egg and peanut were entered into a database. If CAP-FEIA levels exceeded previously reported age-specific cut-off levels for 95% positive predictive values (PPVs) for food allergy, subjects were defined as having high-risk IgE-FS (HR-IgE-FS). RESULTS Serum was available from 2048 patients; 55.5% were atopic. The frequency of HR-IgE-FS to milk, egg and/or peanut was the greatest in patients whose eczema developed in the first 3 months of life and the least in those whose eczema developed after 12 months (P<0.0001). In a regression analysis to allow for potential confounding factors, children with HR-IgE-FS had the most severe eczema and the youngest age of onset (P<0.001); 64% of infants with severe eczema of onset-age <3 months had HR-IgE-FS. CONCLUSION Early-onset severe eczema in infancy was associated with HR-IgE-FS. Clinical implications Food allergies should be routinely assessed in infants with moderate or severe eczema. Capsule summary In eczematous infants, the earlier the age of onset, and the greater the severity of eczema, the greater the frequency of associated high levels of IgE-FS.
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Affiliation(s)
- D J Hill
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic., Australia.
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Shab A, Scheidt R, Weisshaar E, Diepgen TL. Erste deskriptive Ergebnisse einer europäisch-multizentrischen Studie: Duftstoffsensibilisierungen in der Heidelberger Allgemeinbevölkerung. Akt Dermatol 2007. [DOI: 10.1055/s-2007-1003072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fröhlich MM, Soder S, Apfelbacher CJ, Diepgen TL, Weisshaar E. Sekundäre Individualprävention bei Beschäftigten in Gesundheitsberufen, Küchen- und Reinigungsberufen. Akt Dermatol 2007. [DOI: 10.1055/s-2007-1003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tanko Z, Weisshaar E, Diepgen TL. Berufliche Relevanz der Nickelsensibilisierung anhand von Fallbeispielen. Akt Dermatol 2007. [DOI: 10.1055/s-2007-1003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Contact dermatitis is defined as a pattern of inflammatory response that may occur as a result of contact with external factors. The two most common causes are irritants and allergens. Very few reliable data on prevalence and incidence of contact dermatitis exist, and data from the few studies that have been carried out cannot be compared because of differences in methodology. Occupational contact dermatitis constitutes up to 30% of all occupational diseases for which compensation is payable and affects sufferers' home and social lives as well as their working lives. Patients can be advised about the use of personal protective equipment and creams and emollients to avoid or ameliorate their condition, but there is little epidemiological evidence for their efficacy. Patch testing, using the European Standard Series of Allergens, is necessary to determine which agent is responsible for the condition. Fragrances and preservatives used in cosmetics are among the most common allergens in contact allergic dermatitis, although the frequency of contact allergy in the general population is small. It is to be hoped that the European Dermato-Epidemiology Network Fragrance Study will go some way to addressing the need for a large population-based epidemiological study in order that public health organizations can give reliable advice about avoiding and treating contact dermatitis.
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Affiliation(s)
- T L Diepgen
- Department of Social Medicine, Center of Occupational and Environmental Dermatology, University Hospital Heidelberg, Heidelberg, Germany.
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Wolkewitz M, Rothenbacher D, Löw M, Stegmaier C, Ziegler H, Radulescu M, Brenner H, Diepgen TL. Lifetime prevalence of self-reported atopic diseases in a population-based sample of elderly subjects: results of the ESTHER study. Br J Dermatol 2007; 156:693-7. [PMID: 17493067 DOI: 10.1111/j.1365-2133.2006.07659.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prevalence studies of atopic diseases such as atopic dermatitis (AD), hay fever and allergic asthma have mostly been performed in children. Studies in the adult population are still rare. OBJECTIVES We estimated the lifetime prevalence of different atopic diseases in an elderly population in Saarland, Germany. Additionally we investigated the association between atopic diseases and sociodemographic factors including age, gender, duration of school education (as a proxy measure of socioeconomic status), family history, and size of place of residence. METHODS This study was conducted between June 2000 and December 2002 in the State of Saarland, Germany. Participants aged 50-75 years (n=9961) were recruited by their general practitioner in the context of a general health screening examination. All filled out a standardized questionnaire and reported whether a physician had ever diagnosed an atopic disease (hay fever, AD or asthma). RESULTS Overall, 9949 subjects (mean age 62 years, 45% men) were included in this analysis. The lifetime prevalence of reported AD, hay fever and asthma was 4.3%, 8.3% and 5.5%, respectively. Lifetime prevalence of AD and asthma among women, and lifetime prevalence of hay fever among both genders, strongly decreased with age. Duration of school education (<or= 9 years, 10-11 years, > 11 years) was strongly associated with AD (3.7%, 5.7%, 6.8%; P trend < 0.0001) and hay fever (7.2%, 11.2%, 12.8%; P trend < 0.0001), but only tentatively with asthma. CONCLUSIONS The lifetime prevalence of AD is considerably lower in the elderly compared with the prevalence reported among younger adults in recent studies. Adults with a longer duration of school education appeared to have a higher risk for atopic diseases.
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Affiliation(s)
- M Wolkewitz
- Department of Clinical Social Medicine, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Weisshaar E, Apfelbacher CJ, Schaefer A, Bruckner T, Scheidt R, Diepgen TL. [Tick bites and borreliosis in children attending forest kindergarten: a challenge for prevention]. Gesundheitswesen 2007; 68:775-9. [PMID: 17203452 DOI: 10.1055/s-2006-927207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The aim of this study was to analyse the influence of preventive measures on the risk of being bitten by a tick and of suffering from borreliosis in children attending so-called 'forest kindergartens' (nurseries located in forested areas where children spend all-season full-time outdoors), compared to children attending regular kindergartens. In addition, we aimed to analyse sources of information and the risk of being bitten more than once. METHODS 53 kindergartens (25 forest kindergartens, 28 regular kindergartens) in the state of Baden-Württemberg, Germany participated in this study and protective parental behaviour was recorded. In a prospective cohort study, the numbers of tick bites and cases of borreliosis were recorded monthly (March to October 2004) using a questionnaire. The influence of preventive measures was estimated using multivariate log-binomial regression. RESULTS Altogether, 1707 children of 'forest kindergartens' (506 children) and regular kindergartens (1201 children) were included. Parental protective behaviour was significantly better in forest kindergartens compared to regular kindergartens. There were no substantial differences between effect estimates after stratification for parental protective behaviour. For children attending a 'forest kindergarten, the adjusted risk ratio of being tick bitten was 2.6 (3.3-3.0) which was only slightly different from the unadjusted risk, ratio. CONCLUSION Although protective parental behaviour in 'forest kindergarten' children was significantly better compared to regular kindergarten, children in forest kindergartens are at a considerable risk of tick bites and borreliosis. Implementing effective preventive measures against borreliosis represents a public health challenge.
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Affiliation(s)
- E Weisshaar
- Abteilung Klinische Sozialmedizin, Universitätsklinikum Heidelberg.
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Diepgen TL, Bruynzeel D, Bruze M, White IR. Reply. Contact Dermatitis 2006. [DOI: 10.1111/j.1600-0536.2006.00964_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weisshaar E, Apfelbacher C, Jäger G, Zimmermann E, Bruckner T, Diepgen TL, Gollnick H. Pruritus as a leading symptom: clinical characteristics and quality of life in German and Ugandan patients. Br J Dermatol 2006; 155:957-64. [PMID: 17034525 DOI: 10.1111/j.1365-2133.2006.07430.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pruritus is the most frequent and distressing symptom associated with dermatoses and various internal and neurological diseases. OBJECTIVES To investigate two different populations of patients with pruritus, one in Germany and one in Uganda, with a particular focus on clinical characteristics, aetiology and quality of life. METHODS We investigated by questionnaire 132 patients (59 men, 73 women, mean age 54.5 years) who were referred to the Department of Dermatology at the University Hospital of Magdeburg, Germany, with the diagnosis of pruritus as a leading symptom. The questionnaire was also applied in 84 patients who consulted the Dermatology Clinic at Mbarara, Uganda for pruritus. The questions referred to personal data and disease history of the individual, history and present occurrence of concomitant diseases, present and past therapy, quality, frequency and triggers of itching and scratching, other disorders and complaints, quality of life and impact on work and disability. RESULTS Seventy-five (57%) of the German patients had pruritus due to dermatoses, 47 patients (36%) had pruritus due to a systemic disease and in 10 patients (8%) pruritus was of unknown origin. Most had a history of pruritus of several months up to years. Pruritus associated with dermatoses mostly affected the whole body and was permanent with an undulatory character. Affective reactions such as aggression and depression occurred more frequently in dermatological patients compared with those with systemic pruritus. The former group felt that pruritus had a greater impact on their lives. Almost all Ugandan patients had pruritus due to dermatoses except for three patients with pruritus of unknown origin. Eczema and prurigo were the most frequently observed dermatoses in both German and Ugandan patients. Patients with pruritus in both populations showed an impaired quality of life. There was no pronounced difference between the populations with regard to feelings of depression and suicidal thoughts. CONCLUSIONS A great deal of helpful information in this complex group of patients can be obtained using this questionnaire. Pruritus has a major impact on quality of life and especially impairs those patients with pruritus associated with dermatoses and pruritus of unknown origin.
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Affiliation(s)
- E Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital of Heidelberg, Thibautstrasse 3, 69115 Heidelberg, Germany.
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Diepgen TL. The costs of skin disease. Eur J Dermatol 2006; 16:456-60. [PMID: 16935820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Wang H, Rothenbacher D, Low M, Stegmaier C, Brenner H, Diepgen TL. Atopic Diseases, Immunoglobulin E and Risk of Cancer. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s132-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Diepgen TL, Kanerva L. Occupational skin diseases. Eur J Dermatol 2006; 16:324-30. [PMID: 16709514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
BACKGROUND Epidemiological studies have provided growing evidence of a link between atopy and cancer risk. OBJECTIVES To review the evidence from case-control studies and cohort studies on a possible association between atopic dermatitis (AD) and cancer risk, with particular attention to the case definition of AD. METHODS Studies with quantitative data on the association between AD (eczematous disease) and cancer risk were obtained from MEDLINE in combination with a review of cited references. RESULTS In 23 publications, AD was implicated in the risk of haematological [childhood leukaemia (n = 3), adult leukaemia (n = 3), non-Hodgkin lymphoma (NHL; n = 4) and different haematological cancers (n = 1)], pancreatic (n = 5), skin (n = 2) and brain malignancies (n = 5). The overall picture of the results of these studies shows that a history of AD may be associated with a decreased risk of pancreatic cancer, brain tumour and childhood leukaemia, although in most instances the findings were not statistically significant. No consistent associations were observed for skin cancer or NHL. The definition of AD had varying quality, and was imprecise in the majority of publications. CONCLUSIONS The findings of the epidemiological studies tend to support a lower risk of cancer among persons with a history of AD. Although a more careful definition of AD is needed, these epidemiological studies could provide an estimate of the background cancer risk in patients with AD when the long-term effects of treatments for AD are assessed.
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Affiliation(s)
- H Wang
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Thibaut Str. 3, 69115 Heidelberg, Germany
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Schäfer T, Borowski C, Diepgen TL, Hellermann M, Piechotowski I, Reese I, Roos T, Schmidt S, Sitter H, Werfel T, Gieler U. [Evidence-based and consented guideline on allergy prevention]. J Dtsch Dermatol Ges 2005; 2:1030-6, 1038. [PMID: 16285318 DOI: 10.1046/j.1439-0353.2004.04533.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- T Schäfer
- Institut für Sozialmedizin, Universität Lübeck, DGAI.
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Wolkewitz M, Rothenbacher D, Low M, Stegmaier C, Ziegler H, Radulescu1 M, Brenner H, Diepgen TL. LIFETIME PREVALENCE OF ATOPIC DISEASES IN A POPULATION-BASED SAMPLE OF AN ELDERLY POPULATION: RESULTS OF THE ESTHER-STUDY. J Invest Dermatol 2005. [DOI: 10.1111/j.0022-202x.2005.23877_7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE There is an ongoing debate whether there is a link between a history of atopy and cancer risk. The purpose of this paper is to review the published epidemiological studies on the association between atopy and the risk of cancers. METHODS Through an electronic search (January 1986-April 2004) with an additional review of cited references, we identified studies with quantitative data on the relation of atopy (irrespective of its definition or subtype) to cancer (different cancer sites). RESULTS The protective effect of atopy in colorectal cancer has been observed consistently in the case-control studies, but not in cohort studies. A consistent inverse association between self-reported atopy and glioma risk has been shown, but there is absence of such an association for meningioma. In most studies, the risk of leukaemia, in particular childhood leukaemia, tends to be lower among people with a history of atopy. Studies, which looked at, the association between atopic diseases and risk of cancers of pancreatic, breast, lymphoma showed varying outcomes. Most studies on the atopy-pancreatic cancer relation suggested an inverse association. For lymphoma, most studies have shown no substantial association. Overall evidence indicates an increased risk of lung cancer among persons with a history of asthma. CONCLUSION Despite the mixed results, the emerging picture from most of the currently available epidemiological data indicate that atopic disease is associated with a reduced risk for cancer. Further research should focus on a more carefully defined 'atopy' status and manifestation of different atopic diseases, to advance our understanding of the role that allergies might play in the risk of developing cancer.
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Affiliation(s)
- H Wang
- Department of Clinical Social Medicine, Centre of Occupational and Environmental Dermatology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Bruynzeel DP, Diepgen TL, Andersen KE, Brandão FM, Bruze M, Frosch PJ, Goossens A, Lahti A, Mahler V, Maibach HI, Menné T, Wilkinson JD. Monitoring the European standard series in 10 centres 1996-2000. Contact Dermatitis 2005; 53:146-9. [PMID: 16128753 DOI: 10.1111/j.0105-1873.2005.00541.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 5-year retrospective study of the frequency of sensitization to the 25 allergens of the European standard series (ESS) was conducted in 10 centres in 8 European countries. Included were the results of 26 210 patients. The range in sensitivities differed moderately between the centres. Combining results of different centres and drawing conclusions on incidences can be done only with great care. The information on the ranking of the allergens and their sensitization incidence in the clinics are useful for decisions on the future composition of the standard series. The ESS is still a valid screening tool, and no substances should be deleted.
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Affiliation(s)
- D P Bruynzeel
- Department of Occupational Dermatology, VU University Medical Centre, Amsterdam, the Netherlands.
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Diepgen TL, Coenraads PJ, Wilkinson M, Basketter DA, Lepoittevin JP. Para-phenylendiamine (PPD) 1% pet. is an important allergen in the standard series. Contact Dermatitis 2005; 53:185. [PMID: 16128773 DOI: 10.1111/j.0105-1873.2005.00706.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The high incidence rates of occupational contact dermatitis, its poor prognosis, and the high social and economic impact of the disease for the affected individuals as well as for the medical insurance companies indicates a need to strive for the target of "rehabilitation instead of retirement". Here, we highlight the need and effectiveness of rehabilitation measures in individuals with work related skin diseases (mainly contact dermatitis and hand eczema). We discuss the measures for secondary individual prevention as well as tertiary prevention, which have been established in our department together with the state medical insurance companies, mainly the Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BWG: Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Service). The results of the multicentre study "Optimisation and Quality Assessment of Tertiary Prevention of Occupational Dermatoses" are presented and discussed. Both, the secondary as well as tertiary prevention measures have been successful, which has resulted in a decrease in the total annual rehabilitation costs to the BGW. A reason for this success story is the fact that in Germany these organisations are, in contrast to the health insurance companies, responsible for both acute treatment and the rehabilitation.
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Affiliation(s)
- T L Diepgen
- Abteilung Klinische Sozialmedizin, Berufs- und Umweltdermatologie, Universitätsklinikum Heidelberg.
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Abstract
Hand eczema is a very common skin disease, which can be induced by different causes. Although many interventions ranging from topical corticosteroids and UV therapy to oral cyclosporine and retinoids are available, the treatment of hand eczema can be very difficult and frustrating. The objective of our study was to assess the external evidence of different treatment modalities for hand eczema. Electronic databases (Cochrane, MEDLINE, Embase, Pascal, Jicst-Eplus, Amed) were systematically searched for clinical trials on therapy for hand eczema. Additionally, four general medical journals (BMJ, JAMA, Lancet, NEJM) and 17 specialists dermatological journals were hand searched from 1977 to August 2004. A total of 100 studies were found and 31 identified as randomised clinical trials (RCTs) dealing with different interventions. Due to the poor quality of most of these RCTs, they are inadequate as a guide to clinical practice. There is a need for high-quality RCTs on therapy for hand eczema regarding established as well as new treatment options taking different subgroups of hand eczema into consideration.
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Affiliation(s)
- T L Diepgen
- Abteilung Klinische Sozialmedizin mit Schwerpunkt Berufs- und Umweltdermatologie, Universitätsklinikum, Heidelberg.
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