The Utility of an Occupational Contact Dermatitis Patch Test Database in the Analysis of Workplace Prevention Activities in Toronto, Canada.

BACKGROUND: Occupational skin diseases are common suggesting that there are still gaps in workplace prevention. Patch test surveillance systems provide an opportunity to collect work related information in addition to clinical information and patch test results. OBJECTIVES: To examine 5 years of data related to workplace prevention by industry sector in a patch test surveillance database for workers with a diagnosis of occupational contact dermatitis. METHODS: The study was approved by the Research Ethics Board of St Michael's Hospital. Information including demographics, clinical history, healthcare utilization, and workplace characteristics and prevention practices in addition to patch test results was collected from consenting patients. RESULTS: Workers in the healthcare and manufacturing sectors were more likely to report workplace training including skin protection training, whereas those in services and construction were less likely to report training. CONCLUSIONS: Collecting basic workplace information with patch test surveillance databases can inform the occupational health and safety system about prevention practices in the workplace and identify areas for focussed intervention.

Skin Surface pH

The role of skin surface pH, also referred to as "acid mantle," was described more than 90 years ago and due to developing insights has now returned into focus.1

Clinical Insights About the Role of pH in Acne

Acne vulgaris is the most common dermatological disorder globally.1,2 Psychological and emotional distress due to acne, including poor self-esteem, social anxiety, depression, and suicidal ideation have been reported in various studies.3,4, Acne is a complex multifactorial disease with its pathophysiology incompletely elucidated.

Pediatric Wells syndrome (eosinophilic cellulitis) after vaccination: A case report and review of the literature.

A 4-year-old boy presented with erythematous vesicular plaques, ulceration, edema, and pruritus on the left foot and ankle 10 days after receiving the tetanus, diphtheria, pertussis, and polio; measles, mumps, rubella, and varicella; and hepatitis A/B vaccines. Biopsy showed eosinophilic infiltrates and flame figures, suggesting Wells syndrome. Patch testing showed a 1+ reaction to neomycin and aluminum hydroxide, with a recall reaction of Wells syndrome of the feet bilaterally. We report a rare case of pediatric Wells syndrome triggered by nonthimerosal vaccine components confirmed by patch testing.

Return to Work for Nurses With Hand Dermatitis.

BACKGROUND: Occupational skin disease is common in healthcare workers. If the healthcare worker develops moderate to severe dermatitis, return to work (RTW) may be challenging. OBJECTIVES: The study objectives were to review the impact of an RTW program on the work status of nurses with occupational hand dermatitis and to identify successful intervention methods and strategies. METHODS: Nurses who received RTW services at a tertiary occupational medicine clinic were identified, and information related to their diagnosis and RTW was abstracted from their charts. RESULTS: Eighteen nurses with irritant hand dermatitis who received RTW services were identified. Twelve nurses (67%) were performing administrative duties because of their skin condition when admitted to the RTW program, and others were performing patient care with modifications. A graduated RTW trial was commonly implemented with optimized skin care management and monitoring by physicians and the RTW coordinator. Upon discharge, 14 nurses (78%) had returned to their nursing roles with direct patient care, 3 (17%) were working as nurses in non-patient care roles, and 1 (6%) was on permanent disability. CONCLUSIONS: A graduated RTW trial to reduce cumulative irritant exposure is a crucial strategy to facilitate nurses' transition back to work and to maintain direct patient care nursing roles.

Moisturizers and Ceramide-containing Moisturizers May Offer Concomitant Therapy with Benefits.

INTRODUCTION: Ceramide-containing moisturizers may offer benefits as an adjunct to acne treatment. METHODS: An expert panel of 11 Canadian dermatologists, including an international clinical scientist, used the following modified Delphi process: 1) A systematic literature review for acne treatment, dry skin, irritation, depletion of ceramides in acne, and benefits of moisturizers and ceramide-containing moisturizers was conducted; 2) panel members gave their opinion on the resulting statements, taking into account their treatment practices; 3) a panel meeting was held during the 2011 Canadian Dermatology Update to determine final statements; 4) the panel reviewed the final document. RESULTS: The panel reached the following consensus (11/11): 1) A very important reason for nonadherence to acne treatment is dry skin and irritation; 2) skin barrier dysfunction may contribute to acne; 3) dry skin and irritation commonly results from topical acne treatment; 4) dry skin and irritation commonly results from systemic retinoid therapy; 5) moisturizers can improve dryness and irritation resulting from acne treatment; 6) ceramide-containing moisturizers may enhance adherence and complement existing acne therapies; 7) adjunctive therapy with moisturizers should be considered in acne-treated patients. CONCLUSION: The panel proposes that adjunctive therapy with moisturizers, particularly ceramide-containing moisturizers, should be considered in acne-treated patients.

Hand and upper extremity function in workers with hand dermatitis.

BACKGROUND: Traditional methods of assessing impairment associated with skin conditions focus on clinical severity, medication usage, activities of daily living, and quality of life. Assessment of function and ability to work may provide important additional information when determining readiness to work. OBJECTIVES: The objective was to gain an understanding of the functional impairment of the hand and upper extremity associated with hand dermatitis and the impact of hand dermatitis on quality of life, work instability, and productivity. METHODS: Sixty-two patients with suspected contact dermatitis of the hands participated in physical and functional assessments of the upper extremity and patient-reported questionnaires including Dermatology Life Quality Index, Short Form 36 Health Survey, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Work Instability Scale, and Work Limitations Questionnaire. RESULTS: Numbness and finger joint restrictions were moderate to severe in 29% and 30% of the workers, respectively. Positive Tinel and/or Phalen signs occurred in 25%. Forty-eight percent reported moderate-to-high work instability, and 31% reported a greater than 10% decrease in work productivity. Thirty-five percent missed work in the past year, 19% were doing a different job, and 9% were not working. CONCLUSIONS: Patients with hand dermatitis demonstrate significant functional compromise of the hand and a decrease in ability to work.

Diagnosis and treatment of hand dermatitis.

PURPOSE: To enhance the learner's competence with knowledge of hand dermatitis. TARGET AUDIENCE: : This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Demonstrate knowledge of the pathophysiology and assessment of, and diagnostic testing for, hand dermatitis. 2. Apply knowledge of hand dermatitis to patient care scenarios for treatment recommendations and patient education. Hand dermatitis is a common disorder with different clinical presentations. Contact (irritant and allergic) dermatitis is the most common subtype with atopic dermatitis and dyshidrotic eczema as common differential diagnoses. The exact diagnosis and differential diagnoses (psoriasis, fungal infections) are important for specific investigations and treatment plans.

Pathway to dry skin prevention and treatment.

BACKGROUND: This article presents an evidence-supported clinical pathway for dry skin prevention and treatment. OBJECTIVE: The development of the pathway involved the following: a literature review was conducted and demonstrated that literature on dry skin is scarce. To compensate for the gap in the available literature, a modified Delphi method was used to collect information on prevention and treatment practice through a panel, which included 10 selected dermatologists who currently provide medical care for dermatology patients in Ontario. An advisor experienced in this therapeutic area guided the process, including a central meeting. Panel members completed a questionnaire regarding their individual practice in caring for these patients and responded to questions on assessment of dry skin etiology, frequency of skin care visits for consultation and follow-up, assessment, and referral to other specialties. The panel members reviewed a summary of all responses and reached a consensus. The result was presented as a clinical pathway. CONCLUSION: The panel concluded that our current awareness of dry skin and therefore prevention and effective treatment is limited; that identifying dry skin and its clinical issues requires tools such as clinical pathways, which may improve patient outcomes; and that additional research on dry skin etiology, prevention, and treatment is necessary.