Occupational Chronic Contact Dermatitis Successfully Treated with Dupilumab: A Case Series.

BACKGROUND: Occupational contact dermatitis may progress to a chronic course with an unfavorable prognosis. Dupilumab has been shown to be effective as a treatment for moderate-to-severe atopic dermatitis as well as other types of dermatitis. OBJECTIVES: The aim of the study was to describe cases of chronic recalcitrant occupational contact dermatitis treated with dupilumab and with long-term follow-up. METHODS: A retrospective review of 6 patients treated with dupilumab for chronic occupational contact dermatitis for periods of up to 30 months was performed. RESULTS: All 6 patients had a positive and sustainable response, with dermatitis clearance and the ability to sustain work tasks. CONCLUSIONS: We report a case series of atopic and nonatopic workers with occupational chronic contact dermatitis who failed to achieve remission under various systemic modalities but did so using dupilumab. We suggest considering dupilumab treatment for recalcitrant occupational contact dermatitis.

Expression of retinoid receptors in hand eczema.

BACKGROUND: Hand eczema is the most common occupational skin disease. The etiology is multifactorial. Systemic alitretinoin, a pan-retinoic receptor agonist, has proven efficacy in the treatment of recalcitrant chronic hand eczema; however, its precise mechanism of action in hand eczema is not fully understood. AIMS: Assessment of the level of expression of retinoid receptors (RAR and RXR) in the skin of patients with hand eczema in an attempt to explain their possible role in the pathogenesis of the disease. METHODS: Thirty patients with hand eczema and 30 age- and sex-matched healthy controls were included. Full clinical examination was done, and tissue levels of retinoic acid receptor (RAR) and retinoid x receptor (RXR) were measured by quantitative real-time PCR (qRT-PCR). RESULTS: The levels of RAR and RXR expression were significantly downregulated in the patient group compared to the control group; (P < 0.001) for both. In addition, there was a statistically significant negative correlation between Osnabrück Hand Eczema Severity Index (OHSI) and the levels of RAR and RXR expression (P < 0.001). CONCLUSION: Deficient retinoid receptor expression has a primary role in the pathogenesis, clinical phenotype, and severity of hand eczema and sheds light on the mechanism of action of retinoids in the treatment of chronic hand eczema.

Fiberglass dermatitis: clinical presentations, prevention, and treatment - a review of literatures.

Fiberglass dermatitis is a common form of occupational irritant contact dermatitis. Individuals experience a negative reaction to fiberglass fragments because of mechanical irritation. This review comprehensively analyzes the information in the existing literature on fiberglass dermatitis. Recognizing the different environmental risks factors for acquiring fiberglass dermatitis is necessary for better diagnosis and prevention. In addition to the identification of high-risk populations exposed to fiberglass particles, the common clinical presentation and preventive measures that can reduce the risk of acquiring fiberglass dermatitis are thoroughly discussed.

The Use of an Over-the-Counter Hand Cream With Sweet Almond Oil for the Treatment of Hand Dermatitis.

Hand dermatitis is estimated to affect greater than 15% of the general population. Childhood eczema, frequent hand washing, and occupational exposure to chemicals are predisposing factors. Hand dermatitis treatment involves both prevention of outbreaks and treatment of active disease. Moisturizers are essential to protect the skin from the environment, enhance hydration, and repair the skin barrier. They have been shown in large studies to prevent occupational related breakouts. Natural oils are commonly used in moisturizers for their moisturizing and emollient properties. Sweet almond oil is an oil that contains high levels of fatty acids and has been used for centuries to treat skin diseases such as eczema and psoriasis. In this study, a moisturizer with 7% sweet almond oil and 2% colloidal oatmeal was found to be both safe and effective in treating patients with moderate to severe hand dermatitis.

J Drugs Dermatol. 2018;17(1):78-82.

Patterns of chronic hand eczema: a semantic map analysis of the CARPE registry data.

BACKGROUND: Hand eczema has a high incidence and prevalence and has a negative impact on both physical and psychological well-being, with the risk of persistence as a chronic condition. Epidemiological studies on hand eczema provided mainly descriptive and risk analyses, but pattern analyses of variables associated with hand eczema, in particular chronic hand eczema, have not been explored to date. OBJECTIVES: To investigate and display the semantics of associations between variables of hand eczema obtained from the Swiss and German registries of chronic hand eczema (CARPE) to dissect patterns and novel links. METHODS: This was a cross-sectional study on selected variables from the CARPE registries. Associations between variables were analysed by means of an autoassociative system. A semantic connectivity map was generated by using a maximum spanning tree algorithm. RESULTS: Baseline datasets of 1466 patients with chronic hand eczema (Switzerland: 199; Germany: 1267) were analysed. Occupational exposure had the highest impact in the total and country cohorts. We identified two areas of exposure linked to corresponding occupations that clearly demarcated the sexes. CONCLUSIONS: This study, using semantic connectivity as a novel method of data analysis, reveals the complexity of features characterizing chronic hand eczema as well as novel association patterns that deserve further investigation.

Methotrexate use in allergic contact dermatitis: a retrospective study.

BACKGROUND: Methotrexate, a folate antimetabolite, is used to treat atopic dermatitis and psoriasis. Although methotrexate's therapeutic efficacy has been noted in the literature, there are few data on the efficacy of methotrexate treatment for allergic contact dermatitis. OBJECTIVE: To evaluate the efficacy and tolerability of methotrexate in treating allergic contact dermatitis at a single institution, and also to assess methotrexate efficacy in patients with chronic, unavoidable allergen exposure. METHODS: We performed a retrospective chart review of 32 patients diagnosed with allergic contact dermatitis by positive patch test reactions, and who received treatment with methotrexate from November 2010 to November 2014. Demographic and treatment-associated data were collected from electronic medical records. Ten patients were identified as allergen non-avoiders secondary to their occupation, and were subgrouped as such. RESULTS: Seventy-eight per cent (25/32) of patients showed either a partial or a complete response. Methotrexate had a comparable efficacy rate in the allergen non-avoiders subset, at 10 of 10. Of the 32 patients, 23% (5/22) had complete clearance of their dermatitis, and 1/10 of allergen non-avoiders had complete clearance of their dermatitis. CONCLUSION: Methotrexate is a well-tolerated and effective treatment for allergic contact dermatitis, and shows comparable efficacy to immunomodulatory agents such as cyclosporine and azathioprine, with robust efficacy despite persistent allergen exposure in patients with allergic contact dermatitis.

Multicentre cohort study 'Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assurance of Inpatient Management (ROQ)': results from a 3-year follow-up.

BACKGROUND: A tertiary individual prevention programme (TIP) is offered to patients with severe occupational skin disease (OSD) in Germany. Previously, it was shown that the burden of OSDs is considerably reduced in patients up to 1 year after the TIP. OBJECTIVES: To evaluate the long-term effects of the TIP. PATIENTS AND METHODS: In a prospective multicentre cohort study, the clinical and patient-reported outcome data 3 years after the TIP were evaluated. RESULTS: Of the 1788 patients initially included in the study, 1410 were available for the 3-year follow-up analysis. The severity of OSD, the use of topical corticosteroids and days of absence from work were significantly reduced 3 years after the TIP, and the quality of life and skin protective behaviour were significantly improved. Of the patients, 96.9% were able to resume work. One thousand one hundred and sixty-six patients (82.7%) were still working 3 years after the TIP, 874 of them (75.0%) in the same occupational field. Hairdressers had the lowest rate of remaining in their original profession (41.3%). CONCLUSIONS: The follow-up during 3 years of this unique cohort of patients with OSDs shows that the TIP is associated with sustained improvements in terms of disease severity, ability to work, quality of life, and prognosis.

Effectiveness of Barrier Creams against Irritant Contact Dermatitis.

INTRODUCTION: Skin tissue is frequently exposed to various irritant substances in the workplace, particularly in wet work, which can lead to the development of occupational contact dermatitis. 'Barrier' creams (BCs) are well known, and their applications are still the subject of many studies and controversies. METHODS: We searched all controlled trials investigating BCs against cutaneous irritants in humans published between 1956 and December 2014 from MEDLINE, PubMed, reference lists and existing reviews. RESULTS: Thirty-nine studies about the effects of BCs against skin irritants in humans were selected. Among these, 27 trials in healthy volunteers were found to show many differences with regard to BCs and irritants used, their quantities, test locations, procedures and assessment methods. Finally, 14 patch test trials assessed by clinical scoring and evaporimetry emerged. Although the findings were generally positive, only few findings could be cross-checked from all the data, and vehicles seem to be as effective as BCs. CONCLUSION: Although this review highlights the poor quality and the lack of standardization of most studies, BCs seem to have protective effects against irritants. Further well-designed, adequately powered randomized controlled trials with clinical and biophysical assessments are required.

Pseudocheckerboard pattern: an interesting histopathological finding in mechanic's hands.

BACKGROUND: Mechanic's hands are a well-known symptom often associated with dermatomyositis and are similar to hand eczema clinically. Histopathology of them usually shows hyperkeratosis, focal parakeratosis, psoriasiform acanthosis, basal vacuolar changes and necrotic keratinocytes in the epidermis and upper dermal mucin deposition. However, there have been few comparative histopathologic evaluations of mechanic's hands and palmoplantar eczema. METHODS: We evaluated the histopathology of mechanic's hands in 6 patients with dermatomyositis who visited our hospital between 2006 and 2014 comparing with histopathology of 27 patients with palmoplantar eczema, retrospectively. RESULTS: As previously reported, hyperkeratosis, basal vacuolar change and necrotic keratinocytes were seen in all cases of mechanic's hands. Basal vacuolar change was not observed in any cases of palmoplantar eczema. Three cases of mechanic's hands demonstrated a characteristic finding, a pseudocheckerboard pattern, in the hyperkeratotic horny layer; there were areas of alternating parakeratosis and orthokeratosis in a vertical arrangement and these areas alternated with the completely orthokeratotic areas in a horizontal arrangement. This pattern has not been focused in mechanic's hands so far. Same pattern was also observed in four patients with palmoplantar eczema. CONCLUSION: 'Pseudocheckerboard pattern' was not specific but may be a possible diagnostic clue for mechanic's hands.

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

BACKGROUND: Data regarding occupational contact dermatitis (OCD) and its effect on quality of life (QOL) in India are limited. OBJECTIVES/AIMS: To evaluate patients with OCD and record the outcome of treatment. PATIENTS/MATERIALS/METHODS: All patients with OCD were evaluated for severity of disease (by the use of physician global assessment) and its effect on QOL (by use of the Dermatology Life Quality Index) questionnaire) at the first visit and after 3 months of treatment. RESULTS: Among 117 patients with OCD, hand eczema was present in 81.2%. Positive patch test reactions were found in 76%. The most common allergens were Parthenium hysterophorus and potassium dichromate. The most frequent diagnosis was occupational allergic contact dermatitis (OACD) (57%), caused by farming and construction work, followed by occupational irritant contact dermatitis (OICD) (24%), caused by wet work. Severe psychosocial distress was recorded in 62.5% of patients. After 3 months of treatment, 83% improved significantly, and 54% had improvement in QOL. CONCLUSIONS: Farmers were most frequently affected, followed by construction workers and housewives. OACD was found at a higher frequency than OICD. The most frequent allergens were Parthenium hysterophorus in farmers, potassium dichromate in construction workers, and vegetables in housewives. OCD has a significant impact on QOL. Patch testing, in addition to standard treatment, improves the outcome considerably.

S1 guideline on occupational skin products: protective creams, skin cleansers, skin care products (ICD 10: L23, L24)--short version.

Job-related hand dermatitis heads up the list of reported occupational diseases. So-called skin products - understood to mean protective creams, skin cleansers and skin care products - are used for the primary and secondary prevention of job- related hand dermatitis. In the interests of evidence-based medicine, the only preventive measures and/or occupational skin products that should be used are those whose potential uses and efficacy are underpinned by scientific research. To this end, the Arbeitsgemeinschaft für Berufs- und Umweltdermatologie e.V. (Working Group for Occupational and Environmental Dermatology, ABD) of the DDG (German Dermatological Society) and the Deutsche Gesellschaft für Arbeits- und Umweltmedizin (German Society for Occupational and Environmental Medicine, DGAUM) have summed up the latest scientific findings and recommendations in the updated guideline. The benefit of the combined application of protective creams and skin care products in the primary and secondary prevention of work-related contact dermatitis has been widely confirmed by recent clinical-epidemiological studies. The guideline clearly explains the necessity of demonstrating the efficacy of protective creams and cleansing products by means of in vivo methods in the sense of repetitive applications. Transferable standardised testing systems designed to examine the irritation potential and thus the compatibility of occupational skin cleansers and the reduction of irritation by protective skin creams have now been developed and validated by multicentre studies for skin protection creams and cleansers. The status of the current assessment of the safety of occupational skin products is also summarised.