Hazard identification and the prevalence of occupational skin disease in Indonesian Batik workers.

Batik, a resist-dyeing technique to decorate a special cotton fabric, has been practiced for centuries in Indonesia. Unfortunately, as an informal enterprise, batik industry activities lack work safety and health regulations. This study aimed to identify potential health hazards, including inventorying the chemicals to which the workers are exposed, the PPE profile, and investigating the prevalence of occupational skin diseases (OSD) in the batik industry. A cross-sectional study and an inventory of exposure to the chemicals were done in traditional batik workplaces in 5 districts in Yogyakarta province, Indonesia. The chemicals were classified as potential sensitizers/irritants, and the workers were examined and interviewed using the Nordic Occupational Skin Questionnaire-2002/LONG. Of 222 traditional batik workers, OSD were diagnosed in 61 (27.5%) workers, with occupational contact dermatitis was the most common OSD encountered (n = 23/61; 37.7%) (allergic contact dermatitis n = 7/23; irritant contact dermatitis n = 16/23). A smaller portion of other OSD was also encountered including callus, miliaria, and nail disorder (9%, 6.3%, and 5.9%, respectively). During each step of the traditional batik manufacturing process, the workers are exposed to substances that act as irritants and/or as potential contact allergens. However, only one-fourth of the workers used PPE regularly, particularly during the coloring process and wax removal (wet processes). Traditional batik manufacturing process exposes the worker to various physical and chemical hazards, resulting in a high prevalence of occupational skin diseases, especially contact dermatitis among the employees.

Hairdressers' occupational skin diseases in the Finnish Register of Occupational Diseases in a period of 14 years.

BACKGROUND: Hairdressers have a high risk of occupational contact dermatitis caused by exposure to wet work and allergens in hairdressing chemicals. OBJECTIVES: To examine the distribution of diagnoses of occupational skin diseases (OSDs) and their main causes in hairdressers based on a national register data on occupational diseases. METHODS: We retrieved cases of recognized OSDs in hairdressers from the Finnish Register of Occupational Diseases (FROD) in years 2005-2018. RESULTS: During the 14-year period, a total of 290 cases of recognized OSD in hairdressers were registered in the FROD. Allergic contact dermatitis (ACD) was diagnosed in 54%, irritant contact dermatitis in 44%, and contact urticaria (CU) in 5% of them. ACD was most commonly caused by hair dye products and their ingredients (N = 57), persulfates (N = 35), and preservatives (N = 35; mainly isothiazolinones). Acrylates emerged as hairdressers' occupational contact allergens (N = 8) probably due to introduction of structure nails into hair salons. Persulfates was the most common cause of CU. CONCLUSIONS: ACD was the most common OSD in hairdressers. Our analysis confirms that preservatives are important causes of ACD in hairdressers in addition to hair dye products and persulfates. Acrylates emerged as hairdressers' occupational contact allergens, but contact allergy to perming agents remained rare.

Allergic contact dermatitis and other occupational skin diseases in health care workers in the Finnish Register of Occupational Diseases in 2005-2016.

BACKGROUND: Health care workers are an important risk group for occupational skin disease (OSD). AIMS: To study diagnoses and causes of OSDs in health care workers in the Finnish Register of Occupational Diseases (FROD) in 2005-2016. METHODS: We searched the FROD for dermatological cases (a) in health care-related occupations defined by ISCO-08 and (b) in the industrial branch of health care defined by European industry standard classification system (NACE rev. 2). RESULTS: Health care workers comprised 19% of all OSD cases in the FROD, and irritant contact dermatitis dominated the diagnoses. Nurses and assistant nurses were the largest occupational groups with incidence rates of 3.3 and 2.7/10 000 person years, respectively. Rubber chemicals were by far the most common causative agents of allergic contact dermatitis (ACD) followed by preservatives, the latter mainly comprising isothiazolinones and formaldehyde. Acrylates were important allergens in dental professions. Metals and coconut fatty acid derivatives were the next largest causative groups for ACD. Drugs caused only 1% of the ACD cases. CONCLUSIONS: Workers in different health care occupations do not have a uniform risk for OSD, but they share the risk for ACD due to rubber chemicals and various preservatives.

12-year data on skin diseases in the Finnish Register of Occupational Diseases II: Risk occupations with special reference to allergic contact dermatitis.

BACKGROUND: Detailed epidemiological studies on occupational skin diseases (OSDs) are scarce. OBJECTIVES: To analyze risk occupations for OSDs in the Finnish Register of Occupational Diseases (FROD). METHODS: We retrieved numbers of OSD cases (excluding skin infections) for different occupations from the FROD in 2005-2016. In the FROD, Finnish ISCO-08-based classification of occupations was used since 2011, and the preceding ISCO-88-based version until 2010. We combined cases from the earlier and the later period using conversion tables provided by Statistics Finland. We included occupations with at least five cases and analyzed them in detail. We calculated incidence rates for OSDs and separately for allergic contact dermatitis (ACD) in different risk occupations using national labor force statistics. We also studied causes of ACD in these occupations. RESULTS: Risk occupations with the largest number of OSD cases included farmers, hairdressers, assistant nurses, cooks, cleaners, machinists, and nurses. Occupations with the highest incidences of OSDs comprised spray painters (23.8/10 000 person years), bakers (20.4), and dental technicians (19.0). Epoxy compounds and acrylates were prominent causes of ACD in occupations with the highest incidences of ACD. CONCLUSIONS: Uniform use of International Standard Classification of Occupations (ISCO) would facilitate comparisons of OSD figures in different countries.

12-year data on dermatologic cases in the Finnish Register of Occupational Diseases I: Distribution of different diagnoses and main causes of allergic contact dermatitis.

BACKGROUND: Skin diseases are among the most common occupational diseases, but detailed analyses on their epidemiology, diagnoses, and causes are relatively scarce. OBJECTIVES: To analyze data on skin disease in the Finnish Register of Occupational Diseases (FROD) for (1) different diagnoses and (2) main causes of allergic contact dermatitis (ACD). METHODS: We retrieved data on recognized cases with occupational skin disease (OSD) in the FROD from a 12-year-period 2005-2016 and used national official labor force data of the year 2012. RESULTS: We analyzed a total of 5265 cases, of which 42% had irritant contact dermatitis (ICD), 35% ACD, 11% contact urticaria/protein contact dermatitis (CU/PCD), and 9% skin infections. The incidence rate of OSD in the total labor force was 18.8 cases/100 000 person years. Skin infections concerned mainly scabies in health care personnel. Twenty-nine per cent of the ACD cases were caused by plastics/resins-related allergens, mainly epoxy chemicals. Other important causes for ACD were rubber, preservatives, metals, acrylates, and hairdressing chemicals. Cases of occupational ACD due to isothiazolinones reached a peak in 2014. CONCLUSION: Our analysis confirms that epoxy products are gaining importance as causes of OSD and the isothiazolinone contact allergy epidemic has started to wane.

Sociodemographic and clinical profile of patients with occupational contact dermatitis seen at a work-related dermatology service, 2000 - 2014

Abstract: BACKGROUND: Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES: To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS: It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS: Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS: The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS: It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.

The association of smoking with contact dermatitis and hand eczema - a review.

Given the high prevalence of allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), hand eczema (HE), and smoking, and the impact that smoking has on skin disease, the authors reviewed the existing literature to assess the association between smoking and contact dermatitis or hand eczema. Using the PubMed and SCOPUS databases, a literature search identified articles related to allergic contact dermatitis, irritant contact dermatitis, and hand eczema and a possible association with smoking. The search period included articles prior to and including April 2016. Seven of eight articles described a positive relationship between smoking and allergic or irritant contact dermatitis, while nine of nineteen articles found a positive association between smoking and hand eczema. Published studies document that smoking may be an important risk factor for both allergic and irritant contact dermatitis as well as hand eczema.

Occupational skin disease in Victoria, Australia.

OBJECTIVES: To describe the characteristics of patients with occupational skin disease (OSD) in a tertiary referral clinic in Victoria, Australia. METHODS: A retrospective review was conducted of records from patients seen at the Occupational Dermatology Clinic in Melbourne, Australia between 1 January 1993 and 31 December 2010. RESULTS: Of the 2894 people assessed in the clinic during the 18-year period, 44% were women and 56% were men. In all, 2177 (75%) were diagnosed with occupational skin disease (OSD). Of the patients with a work-related skin condition, 45% (n = 979) were considered to be atopic. The most common diagnosis in those with OSD was irritant contact dermatitis (ICD) (44%), followed by allergic contact dermatitis (33%) and endogenous eczema (11%). Women were significantly more likely to have soaps and detergents (P < 0.001) and water/wet work (P < 0.001) as causes of their ICD than men. Men were significantly more likely to have oils and coolants (P < 0.001) and solvent exposures (P < 0.001) as causes of their ICD. Occupational groups with the highest incidence of OSD were the hair and beauty professions (70 per 100 000), followed by machine and plant operators (38 per 100 000) and health-care workers (21 per 100 000). CONCLUSION: We confirm the importance of occupational contact dermatitis as the most common cause of OSD, with ICD being the most common diagnosis. There are differences in the causes of ICD between our group of male and female workers. For the first time in Australia, rates of OSD in certain industries have been calculated.

Incontinence-associated dermatitis and pressure ulcers in geriatric patients.

The key characteristics of geriatric patients are advanced age, multimorbidity, a decrease of psychical performance and care dependency. In addition, advanced age, chronic and acute diseases and treatments (e.g. polypharmacy) lead, either directly or indirectly, to a wide range of skin and tissue problems. Incontinence-associated dermatitis and pressure ulcers (PUs) belong to the most prevalent in geriatric settings. Prolonged exposure of the skin to urine and/or stool can cause an irritant contact dermatitis. Skin surface 'wetness', increased skin surface pH, digestive intestinal enzymes, repeated skin cleansing activities, and a possible occlusive environment contribute to irritation and inflammation. Prevention and treatment includes activities to maintain and to enhance continence and to limit, to reduce exposure of the skin to urine and stool, and to promote healing and reepithelialisation. In frail aged skin, it is recommended to use incontinence products with smooth and breathable materials with maximum absorption capacity. Immediate skin cleansing after soiling using mild cleansers and protective and caring leave-on products are recommended. PUs are localized injuries to the skin and/or underlying tissue caused by sustained deformations of skin and underlying soft tissues. PUs management includes risk assessment, repositioning and mobilization, and the use of appropriate support surfaces. Patients must be never positioned directly on an existing PU. Especially at end of life, the PU closure and wound healing may not be the primary therapeutic goal.

Prevalence of foot eczema and associated occupational and non-occupational factors in patients with hand eczema.

BACKGROUND: Foot eczema often occurs in combination with hand eczema. However, in contrast to the situation with hand eczema, knowledge about foot eczema is scarce, especially in occupational settings. OBJECTIVE: To evaluate the prevalence of foot eczema and associated factors in patients with hand eczema taking part in a tertiary individual prevention programme for occupational skin diseases. PATIENTS/MATERIALS/METHODS: In a retrospective cohort study, the medical records of 843 patients taking part in the tertiary individual prevention programme were evaluated. RESULTS: Seven hundred and twenty-three patients (85.8%) suffered from hand eczema. Among these, 201 patients (27.8%) had concomitant foot eczema, mainly atopic foot eczema (60.4%). An occupational irritant component was possible in 38 patients with foot eczema (18.9%). In the majority of patients, the same morphological features were found on the hands and feet (71.1%). The presence of foot eczema was significantly associated with male sex [odds ratio (OR) 1.78, 95% confidence interval (CI) 1.29-2.49], atopic hand eczema (OR 1.60, 95%CI: 1.15-2.22), hyperhidrosis (OR 1.73, 95%CI: 1.33-2.43), and the wearing of safety shoes/boots at work (OR 2.04, 95%CI: 1.46-2.87). Tobacco smoking was associated with foot eczema (OR 1.79, 95%CI: 1.25-2.57), in particular with the vesicular subtype. CONCLUSIONS: Foot eczema is common in patients with hand eczema, and is related to both occupational and non-occupational factors.

Smoking is associated with combined allergic and irritant hand eczema, contact allergies and hyperhidrosis.

BACKGROUND: The pathogenesis of chronic hand eczema (CHE) is multifactorial. Certain life-style factors have been suggested as potential triggers of the disease, among them tobacco smoking. However, the few studies addressing the influence of smoking on CHE have been more or less limited to occupational hand eczema. OBJECTIVE: The aim of our study was to investigate the association of smoking status with clinical features like contact sensitization, irritant exposure, atopy and hyperhidrosis in a thoroughly characterized cohort of CHE patients. METHODS: A total of 153 patients with CHE underwent clinical examination and an interview about their history and course of disease. RESULTS: Significantly more smokers suffered from combined allergic and irritant hand eczema (25/86) than non-smokers (7/67; P < 0.05). Nickel sensitization and palmar hyperhidrosis tended to be more frequent among smokers than among non-smokers (nickel: 17/86 smokers, 6/67 non-smokers; hyperhidrosis: 21/84 smokers, 8/64 non-smokers). Among the smoking CHE patients with palmar hyperhidrosis, a significant proportion had contact allergies relevant contact allergies (16/21, P < 0.05). CONCLUSION: Our results reveal a predominance of smokers among patients with combined allergic and irritant hand eczema as well as with hyperhidrosis and relevant contact sensitizations.

Occupational skin hazards and prevalence of occupational skin diseases in shoe manufacturing workers in Indonesia.

PURPOSE: Shoe manufacturing workers are exposed daily to an extensive range of potential physical and chemical occupational hazards. Shoe manufacturing in Indonesia is one of the industrial sectors that has shown sustained growth amongst the newly industrialized countries (NICs). In this study, we investigated the possible potential exposure of the workers to physical and occupational hazards and determined the prevalence of occupational skin diseases at a shoe manufacturing factory in Indonesia. METHODS: A cross-sectional study on the observation of the working process and an inventory and risk assessment of exposure to the chemicals used. Classification of chemicals as potential sensitizers/irritants and qualitative assessments of these chemicals were done. Workers were examined and interviewed using the Nordic Occupational Skin Questionnaire-2002/LONG. RESULTS: The risk of Occupational skin diseases (OSD) at the shoe factory was mainly related to the exposure of the workers' skin to potential physical and chemical hazards in hot and humid environmental conditions. From a total of 514 workers, 8.5 % reported current OSD and 4.8 % reported a history of OSD. Occupational skin diseases were diagnosed in 29 % of the workers by dermatologists and 7.6 % had an occupational contact dermatitis (OCD). Of the 39 workers with contact dermatitis, 33 consented to being patch tested, 14 (3 %) workers showed a positive results and considered as having an occupational allergic contact dermatitis (OACD) and 25 (4.9 %) had an occupational irritant contact dermatitis (OICD). CONCLUSION: We observed a repeated and prolonged exposure of the workers to numerous physical and chemical skin hazards at this factory.

Occupational skin diseases in Czech healthcare workers from 1997 to 2009.

BACKGROUND: The healthcare sector ranked in second place among economic sectors in the Czech Republic, with about 11.4 % of all occupational diseases in 2009. Skin diseases constituted about 20 % of all occupational diseases. OBJECTIVES: The aim of this study was to analyze the causes and trends in allergic and irritant-induced skin diseases in the healthcare sector. METHODS: The data concerning occupational skin diseases (Chapter IV of the Czech List of Occupational Diseases, non-infectious skin illnesses) in the healthcare sector were analyzed from the Czech National Registry of Occupational Diseases from 1997 until 2009. The trends in the total counts and most frequent causes were evaluated. RESULTS: During the past 13 years, a total of 545 skin diseases were acknowledged in healthcare workers. Allergic contact dermatitis was diagnosed in 464 (85 %), irritant contact dermatitis in 71 (13 %) and contact urticaria in 10 subjects (2 %). Ninety-five percent of the patients were females. The overall incidence in individual years varied between 1.0 and 2.9 cases per 10,000 full-time employees per year. Disinfectants were the most frequent chemical agents causing more than one third of all allergic skin diseases (38 %), followed by rubber components (32 %) and cleaning agents (10 %). CONCLUSION: A general downward trend of diagnosed cases of occupational skin diseases in heath care workers in the Czech Republic over the past 13 years was demonstrated.

Occupational respiratory and skin diseases among Finnish machinists: findings of a large clinical study.

PURPOSE: Machinists are exposed to many sensitizing and irritant substances, but no previous study has assessed the occurrence of clinically verified occupational diseases in an unselected large workforce of machinists. Our aim was to study the occurrence of clinically verified occupational respiratory and skin diseases cross-sectionally in a large sample of machinists in southern Finland. METHODS: A computer-assisted telephone interview on occupational exposures and health was carried out in a sample of 961 machining workers from 64 metalworking companies. Of these, 757 (79%) answered the interview. A total of 245 subjects reported work-related respiratory or skin symptoms and were invited to clinical examinations; 138 of these underwent a clinical interview and examination by an occupational health physician. On the basis of this examination, 32 subjects were further examined at the Finnish Institute of Occupational Health (FIOH) for occupational skin or respiratory diseases. RESULTS: One case of occupational asthma (OA) and seven cases of occupational dermatoses (OD) were diagnosed, giving a prevalence of 0.13% (95% CI 0-0.39) for OA, and 0.92% (95% CI 0.24-1.16) for OD. The OA was induced by the patient's own MWF. Additional five cases of newly diagnosed non-occupational asthma (0.79%, 95% CI = 0.16-1.42) were detected. No cases of occupational rhinitis or COPD were diagnosed. The dermatoses diagnoses consisted of four cases of allergic contact dermatitis and three cases of irritant contact dermatitis. The most common causes of the ODs were MWFs. CONCLUSION: This large clinical study of machinists representing metalworking in South Finland showed a prevalence of 0.13% of OA and 0.92% of OD. This relatively low occurrence of occupational diseases may reflect the strict Finnish criteria for the diagnosis of these occupational diseases and the relatively good level of occupational hygiene in machining workshops in Finland. Reported respiratory and skin symptoms were common, and these milder conditions may be linked to irritant rather than sensitizing exposures.

Evaluating interventions aimed at reducing occupational exposure to latex and rubber glove allergens.

OBJECTIVE: Concerns over occupational exposures to blood-borne viruses resulted in increased protective glove use; consequentially latex allergy became a hazard for some occupational groups. Interventions aimed at managing this problem included substitution measures (eg, non-powdered/non-latex gloves), but such changes may not occur simultaneously across occupational sectors. This study evaluated whether the incidence of occupational dermatoses fell after interventions aiming to reduce exposure to 'latex and rubber glove allergens' ('latex') were introduced, and whether these interventions were more effective for healthcare workers (HCWs), compared with non-HCWs. METHODS: Incidence rate ratios (IRRs) comparing cases reported to EPIDERM (a UK-wide surveillance scheme) during post versus pre-intervention periods were calculated, both where 'latex' was cited and for cases associated with other exposures ('controls'). RESULTS: Among HCWs, cases of contact urticaria and allergic contact dermatitis (ACD) where 'latex' was cited showed significant downward trends post-intervention, with IRRs of 0.72, 95% CI; 0.52 to 1.00 and 0.47, 95% CI; 0.35 to 0.64 respectively. For HCWs, this fall in 'latex' associated ACD was significantly greater (p=0.02) than for other exposures ('controls') IRR=0.85, 95% CI; 0.57 to 1.28, and greater than that among non-HCWs (IRR 0.75, 95% CI; 0.61 to 0.93). Increases over time were seen for irritant contact dermatitis (ICD) reporting for HCWs, both for cases associated with 'latex' (IRR 1.47, 95% CI: 1.02 to 2.13) and for other exposures ('controls') IRR 1.36, 95% CI 1.06 to 1.76, but not for non-HCWs. CONCLUSIONS: A reduction in overall ACD, particularly in HCWs, coincided with interventions aimed at managing workplace contact dermatoses associated with 'latex' exposure. A coincidental rise in ICD reporting is also important, both for hand care and for infection control strategies.

Management of irritant contact dermatitis and peripherally inserted central catheters.

Cutaneous skin changes are common in patients undergoing treatment for cancer. However, changes in central line care, maintenance practices, and chemotherapy protocols in the early 2000s may have led to the development of a common problem of irritant contact dermatitis (ICD) at peripherally inserted central catheter (PICC) insertion sites. Repeated exposure to chlorhexidine gluconate topical antiseptic solution, used in the general dressing care and maintenance with PICCs, may be the leading contributor to the development of ICD at the insertion site. A number of additional factors theoretically contribute to the development of ICD at the PICC insertion site in patients receiving chemotherapy. In this article, ICD will be defined, incidence and potential risk factors will be identified, and diagnostic framework will be explored; in addition, pathophysiology, onset, presentation, evaluation, and differential diagnosis of ICD at PICC sites will be analyzed. Finally, a synopsis of three different treatment approaches from healthcare facilities in Canada as well as implications for nursing practice and research will be presented.