A nationwide skin protection program introduced in hairdressing vocational schools was followed by a decreased risk of occupational hand eczema.

BACKGROUND: Compliance with glove use and safe work practices are important factors in primary prevention of occupational hand eczema (OHE) in hairdressers. OBJECTIVE: To assess the risk OHE and compliance with skin protective measures in hairdressers trained before and after implementation of a nationwide skin protection program in Danish hairdressing vocational schools in 2011. METHODS: A repeated cross-sectional study was performed. A questionnaire was sent in 2009 and 2020. The Danish Labour Market Supplementary Pension Scheme provided information on yearly payments from the hairdressing profession. RESULTS: A response rate of 66.6% (305/460) was obtained in the 2009 survey and of 29.9% (363/1215) in the 2020 survey. The career time prevalence of OHE decreased from 42.8% to 29.0% (adjusted odds ratio 0.55 95% confidence interval [CI] 0.40-0.77) and the incidence rate of OHE decreased from 57.5 (95%CI 48.4-68.4) to 42.0 (95%CI 34.6-50.9) per 1000 person years (incidence rate ratio 0.73 [95%CI 0.56-0.95] between the two surveys). A statistically significant (P < .05) increase in glove use when doing wet-work and when handling hair dyes, permanent wave solutions and bleaching products was observed in the 2020 compared to the 2009 survey. CONCLUSION: Our data suggest that skin protection training during apprenticeship reduces the risk of OHE in hairdressers. The lack of primary prevention of OHE in hairdressing vocational schools may be a missed opportunity in the prevention of the disease.

Self-testing for contact allergy to hair dyes - a 5-year follow-up multicentre study.

BACKGROUND: In 2011, a multicentre study was conducted in order to determine how hair dye manufacturers instructed consumers to perform a self-test prior to dyeing their hair, in order to identify individuals who are likely to react upon subsequent hair dyeing. A number of concerns were raised concerning the variability in instructions between products and producers, and the safety and validity of this tool. OBJECTIVES: To perform a 5-year follow-up study in order to determine whether manufacturers still recommend a self-test, and if so, whether the procedures have been changed. METHODS: During March 2016, a total of 40 oxidative hair dye products from 21 different manufacturers were bought in retail stores in 8 European countries. RESULTS: The consumers were instructed to perform a self-test prior to hair dyeing for 39 of the products; however, the procedures varied greatly regarding the method of application, the amount of hair dye applied, the location and size of the application area, the number of applications, whether or not rinsing was performed after application, the reading times, and how a positive reaction was defined. CONCLUSIONS: Self-testing is still recommended by almost all manufacturers of permanent hair dyes. There are major variations in the instructions, even in products from the same manufacturer. The previously raised concerns regarding safety and validity still remain.

Difficulties in using Material Safety Data Sheets to analyse occupational exposures to contact allergens.

BACKGROUND: Information on the occurrence of contact allergens and irritants is crucial for the diagnosis of occupational contact dermatitis. Material Safety Data Sheets (MSDS) are important sources of information concerning exposures in the workplace. OBJECTIVE: From a medical viewpoint, to evaluate the information available from MSDSs, and to ascertain whether MSDS are easy to obtain, whether they serve their purpose, and whether they provide sufficient information regarding allergens to enable correct diagnosis. METHODS: MSDS and ingredients labelling were collected from consecutive patients and reviewed. If it was suspected that the MSDS were incomplete, the manufacturer, supplier, salesperson or workplace was contacted to gather more information. RESULTS: Twenty-five per cent (79/316) of patients provided material for the exposure assessment. One or more shortcomings were found in 18.6% (137/738) of the MSDS. The most frequent shortcoming was 'Missing R43/H317 while known contact allergen was present', which was observed in 63.1% (84/137). Other shortcomings were 'Names of preservatives not included in section 3 despite containing preservatives', in 48.9% (67/137), and 'Nothing about allergy in sections 2, 3, 11, 15 or 16 in the MSDS despite the content of allergens', in 20.4% (28/137). The information retrieved led to additional testing of 21 patients. CONCLUSION: Systematic exposure assessment is time-consuming. The main shortcomings are errors/omissions in the MSDS.

Occupational irritant contact dermatitis diagnosed by analysis of contact irritants and allergens in the work environment.

BACKGROUND: Irritant contact dermatitis (ICD) is a common diagnosis in patients with occupational contact dermatitis (OCD). Studies are lacking on the usefulness of material safety data sheets (MSDSs) in making the diagnosis of ICD. OBJECTIVE: To characterize irritant exposures leading to the diagnosis of occupational ICD (OICD), and to evaluate the occurrence of concomitant exposures to contact allergens. METHODS: We included 316 patients with suspected occupational hand dermatitis, referred to the Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Denmark during January 2010-August 2011, in a programme consisting of a clinical examination, exposure assessment, and extensive patch/prick testing. RESULTS: OCD was diagnosed in 228 patients. Of these patients, 118 were diagnosed with OICD. The main irritant exposures identified were wet work (n = 64), gloves (n = 45), mechanical traumas (n = 19), and oils (n = 15). Exposure to specific irritant chemicals was found in 9 patients, and was identified from MSDSs/ingredients labelling in 8 of these patients. Review of MSDSs and ingredients labelling showed that 41 patients were exposed to 41 moderate to potent contact allergens, and 18 patients were exposed to 25 weak workplace contact allergens. CONCLUSION: In the present study, the systematic exposure assessment did not reveal any new irritants. MSDSs have a limited role in the investigation of ICD.

Occupational allergic contact dermatitis diagnosed by a systematic stepwise exposure assessment of allergens in the work environment.

BACKGROUND: Information on the presence of contact allergens and irritants is crucial for the diagnosis of occupational contact dermatitis. Ingredient lists and Material Safety DataSheets (MSDSs) may be incomplete. OBJECTIVES: To evaluate the workability of a systematic exposure assessment in consecutive patients with suspected occupational contact dermatitis, and to study how it could potentially aid correct diagnostic classification. METHODS: A tool for systematic stepwise assessment of exposures in the work environment was developed, consisting of six steps spanning medical history and workplace visits. The programme included 228 consecutive patients diagnosed with occupational contact dermatitis; all patients underwent a clinical examination, the stepwise exposure assessment, and extensive patch and prick testing. RESULTS: Of the participants, 48.2% were classified as having occupational allergic contact dermatitis. The diagnosis was made at the stepwise exposure assessment for 50.0% of patients at Step 1 (medical history) and for 34.5% at Step 2 (ingredient labelling/MSDS). We found 132 different occupational allergens of relevance to the patients' eczema, of these, 78.0% were allergens not included in the European baseline series. CONCLUSIONS: Systematic stepwise exposure assessment provides information that results in the identification of occupational allergies caused by allergens not included in the European baseline series in a substantial number of patients.