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.

Latex allergy in women's health care.

Latex allergy in midwifery and women's health care is not a new concept, with numerous case reports documenting adverse reactions in pregnant women to natural rubber latex in the birthing room. The practising midwife, nurse and sonographer need to be aware of the signs and symptoms of latex allergy and the implications of a severe reaction to latex not only to the woman but also the unborn child.

Dirt-binding particles consisting of hydrogenated castor oil beads constitute a nonirritating alternative for abrasive cleaning of recalcitrant oily skin contamination in a three-step programme of occupational skin protection.

BACKGROUND: In occupational fields with exposure to grease, oil, metal particles, coal, black lead or soot, cleansing formulations containing abrasive bodies (e.g. refined walnut shell, corn, wood, plastic or pumice) are used. These may constitute an irritant per se. As an alternative, hydrogenated castor oil (also known as castor wax) beads have been developed as dirt-binding particles. A polar surface contributes to their mechanical cleaning effects in removal of oily grime. OBJECTIVES: Standardized examination of the in vivo effects upon the skin barrier of castor wax beads in comparison with abrasive bodies and pure detergent. METHODS: Three cleansing preparations - (i) detergent, (ii) detergent containing castor wax beads, (iii) detergent containing walnut shell powder - were each repetitively applied in vivo (four times daily for 3 weeks), mimicking workplace conditions, in 30 healthy volunteers (15 with and 15 without an atopic skin diathesis) and compared vs. (iv) no treatment. The treatment effects upon the skin barrier were monitored by repeated measurements of functional parameters [transepidermal water loss (TEWL), redness] and surface topography. RESULTS: After a 3-week treatment, a significant global treatment effect (P < 0.0001) was found in the atopic group concerning TEWL as indicator for barrier function. A significantly higher TEWL and increasing erythema in the area treated with detergent containing walnut shell powder reflected its irritant effect compared with castor wax beads dispensed in the identical detergent. Cleaning properties of the two formulas were comparably superior to detergent alone. CONCLUSIONS: Castor wax beads constitute a novel nonirritating alternative for abrasive cleaning of recalcitrant oily skin contamination appropriate for individuals with an atopic skin diathesis in a three-step programme of occupational skin protection. As the skin barrier may additionally be influenced by the composition of dirt and use of skin protection and skin care measures under real workplace conditions, this component may now be used and examined further in different occupations.

[Cooperation among clinics and practices. Integrated medical care in occupational dermatology]. / Neue Formen der Zusammenarbeit zwischen Praxis und Klinik. Integrierte Versorgung in der Berufsdermatologie.

Preventive measures in occupational dermatology have proven to be very effective in recent years, especially measures of primary and secondary prevention as components of a complex hierarchical prevention concept. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed ("tertiary individual prevention" [TIP]). TIP comprises 3 weeks inpatient treatment including intensive disease-oriented teaching and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study ("Medizinisch-Berufliches Rehabilitationsverfahren Haut--Optimierung und Qualitätssicherung des Heilverfahrens" [ROQ]) started which will further standardize TIP and evaluate long-term success and scientific sustainability in depth. This integrated concept of an inpatient/outpatient disease management reveals remarkable pertinent options for patients with severe occupational dermatoses in all high-risk professions.

Characteristics of chelation ability of chosen metal ions by protective ointments containing Na2H2EDTA.

Allergy contact dermatitis is a common occupational disease and the protective ointments are often used by the sensitized subjects. The efficacy of the chelation ability of the barrier creams containing Na2H2EDTA was evaluated. The in vitro test with the diffusion chamber and artificial membrane was performed. The effect of the Na2H2EDTA concentration (3, 5 or 10%), pH of the buffer for Na2H2EDTA dissolving and the vehicle of the ointment on the chelation of Ni2+ and Co2+ were assessed. The ointment with 10% Na2H2EDTA dissolved in the buffer of pH 7.0 or 7.4 buffer was found as optimal for the protection ability. There was no influence of the formula of the ointements on the efficiency of chelation.

Effect of aloe-vera impregnated gloves on hand hygiene attitudes of health care workers.

Following standard precautions and hand hygiene guidelines is important to health care workers and the patients they serve. The purpose of this study was to determine the effect of aloe-vera impregnated gloves on attitudes about hand hygiene among many health care workers and perceived sense of skin condition.

[New dermatologist's procedure. Research plans for improving secondary prevention of occupational dermatoses]. / Das neue Hautarztverfahren. Forschungsvorhaben zur Verbesserung der Sekundärprävention von Berufsdermatosen.

The dermatologist's procedure was introduced in 1972 by employers' liability insurance funds in the industrial, agricultural, and public sectors of Germany's statutory occupational accident insurance as a "procedure for early detection of occupational skin diseases." So far, it is still the most relevant tool for secondary prevention in occupational dermatology in Germany. According to the intention of this procedure, insured persons with a skin disease in which an occupational etiology is suspected must be offered preventive measures and, if necessary, given appropriate treatment to avoid job-loss. To improve the efficiency of the "classic" dermatologist's procedure, in 1999, on the initiative of the Central Federation of Industrial Professional Associations, a study group was founded in cooperation with the Task Force on Occupational and Environmental Dermatology of the German Dermatological Society and the Professional Organisation of German Dermatologists. In October 2002, a controlled intervention study started in North-western Germany to scientifically evaluate the "optimised" dermatologist's procedure, which was proposed by the study group and compare it to the standard ("classic") procedure. The study results should allow detailed suggestions for an improved dermatologist's procedure before it is introduced nationwide.

[Radiodermatitis in interventional radiology (hand dose measurement, screening and compensation)]. / Radiodermites en radiologie interventionnelle (doses reçues aux mains, dépistage et réparation).

It is to be feared that the expansion of interventional radiology could lead to the reappearance of chronic radiodermatitis. Only a few studies mention the doses received by the hands, however these radiation doses are always high. Whereas clinical examinations lead to a belated diagnosis, capillary microscopy, a quick and non invasive test, enables to detect vascular injuries at the subclinical stage. Radiological protection is currently based on leaded gloves and on the reduction of exposure duration. Compensation for chronic radiodermatitis depends on the practitioner's status. In spite of a better evaluation of the overall irradiation, hand exposure remains a cause for concern. Capillary microscopy can provide appropriate medical surveillance.

Natural vegetable fats in the prevention of irritant contact dermatitis.

Chronic irritant contact dermatitis (ICD) is one of the most pressing problems in occupational medicine and is common in the food processing industry. To date, protective creams that fulfil the special requirements in the foodstuffs industry have not been available. Therefore, we studied the efficacy of pre-exposure application of natural vegetable fats in the prevention of experimentally induced ICD. A panel of 20 healthy volunteers was tested with a repetitive irritation test using sodium lauryl sulfate (SLS) as a standard irritant in a randomized study. Application sites were assessed clinically and by the use of bioengineering techniques (evaporimetry, chromametry, and corneometry). Rape seed and palm fats showed significant protective potential. Gas-chromatographic analysis revealed differences in the fatty acid composition of the vegetable. Higher content of linoleic acid and lower content of oleic acid was associated with beneficial effects. Our results are a new approach in the prevention of ICD and towards the development of new protective preparations for workplaces in the foodstuffs industry.

The dental team and latex hypersensitivity. ADA Council on Scientific Affairs.

BACKGROUND: In the late 1980s, there were notable increases in reports of allergic reactions to natural rubber latex, or NRL, particularly in association with barium enema procedures and medical procedures performed on children with spina bifida. These reports also raised awareness of the growing concern about NRL allergy in both patients and health care workers. DESCRIPTION OF THE DISORDER: This report by the American Dental Association Council on Scientific Affairs summarizes the signs and symptoms of NRL protein allergy, allergic contact dermatitis and irritant dermatitis; offers information on means to diagnose these conditions definitively; and suggests means of reducing occupational exposure to the causative allergens and irritants in the dental office. CLINICAL IMPLICATIONS: Reducing health care workers' occupational exposure may assist in minimizing adverse reactions associated with frequent wearing of gloves. The Council on Scientific Affairs will address issues relating to latex hypersensitivity among patients in a future report.

Elaioconiose: revisão de 10 anos / Elaioconiose: review of 10 years

As dermatoses ocupacionais particularmente a elaioconiose constituem em nosso meio uma parcela considerável dos acidntes de trabalho. É assunto de avaliação difícil e complexa, já que geralmente não chega às estatísticas e sequer ao conhecimento dos especialistas. Com a elaioconiose é provocada pelo contato contínuo da pele com o petróleo e seus derivados, este trabalho foi direcionado para a classificação de óleos minerais, particularmente os óleos de corte, os mais empregados na nossa indústria. Para esclarecimento desta condição são abordados também o quadro dermatológico e os métodos de prevenção e proteção do trabalhador. Finalmente, são discutidos os aspectos médico-legais da dermatose, já que muitas vezes o trablhador é afastado definitivamente da sua função.

[Early diagnosis and effective prevention of occupational allergies caused by hexavalent chromium]. / Ranniaia diagnostika i éffektivnaia profilaktika professional'nykh allergozov, vyzvannykh shestivalentnym khromom.

Clinical and allergologic evaluation covered a large group of workers engaged into alumina production and exposed to chromate. Those workers were also subjected to long-standing follow-up. The studies helped to find correlation of chromium concentration in air with occurrence of the occupational allergies and latent sensibilization of respiratory tract to chromium. Immune modulator Levamisol was proved to act as a desensibilizer in prophylaxis of the occupational allergies in individuals with the latent sensibilization.

[The epidemiology, diagnosis and prevention of dermatoses in workers manufacturing alumina from different aluminum ores]. / Epidemiologiia, diagnostika i profilaktika dermatozov u rabochikh proizvodstva glinozema iz razlichnykh aliuminievykh rud.

Studies of dermatological morbidity in the workers of alumina enterprises showed a lowered incidence of skin lesions caused by common chemical harmfulness and increased incidence of allergic occupational dermatoses. Different types of such dermatoses are related to the ore used. The total level dermatologic morbidity mainly depends on the technology stage of the process but not on the type of raw material. Dermatologic screenings have shown that skin mycoses were the most incident among the dermatoses, whereas analysis of sick-leave records indicates the highest incidence of pyoderma; this necessitates adequate preventive measures.

[Protective skin ointments. Their value in preventing occupational dermatoses]. / Hautschutzsalben. Ihr Stellenwert in der Prophylaxe von Berufsdermatosen.

The application of topical skin protectant products is discussed. Their primary indication is prophylaxis of non-allergic contact dermatitis. In persons already sensitized a reliable prevention of allergic contact eczema is doubtful. The methods which have been used in the past to prove the efficacy of skin protective ointments are examined critically. Most of the model experiments are of an acute character. They do not adequately suit the practical work situation, where occupational dermatoses develop after frequent contact with relatively small doses of noxious substances. A repetitive patch-test method is presented and with the use of two skin protective agents it is demonstrated how the efficacy of such products can be proven. For effective preventive measures in industry, it is recommended that skin protection plans be set up. It has been proven that such measures reduce the morbidity rate of occupational dermatoses, which serves to show its economical importance.

Ultraviolet detection of synthetic oil contamination of skin.

A study was conducted to evaluate skin contamination occurring on coal liquefaction process workers using quantitative (Spill Spotter) and qualitative (blacklight) ultraviolet fluorescence methods. Other objectives were to determine the effectiveness of showering in removing contamination, and to determine the quantitative relationship between Spill Spotter response and skin contamination concentration. Field measurements showed wide ranges of background skin fluorescence caused by differing skin types. Visible dirt on the skin partially quenched the fluorescence response of the Spill Spotter. Fluorescent skin contamination on selected workers was quantified relative to a calibration curve developed on pigskin using a reference synfuel oil. One group of workers was shown to exhibit a two-to three-fold increase in fluorescence during the work shift. Showering removed skin contamination although residual contamination sometimes remained on workers that exhibited the greatest degree of skin contamination during the workshift. Further refinement of the ultraviolet method for absolute quantification of fluorescent skin contamination is needed.

[Alkali resistance changes from use of water-in-oil- and oil-in-water emulsions]. / Alkaliresistenzänderung durch Anwendung einer Wasser-in-Ol-und Ol-in-Wasser-Emulsion.

Metal workers who up to 4 h prior to the alkali resistance (AR) test had applied different O/W-emulsions revealed a better mean AR on the forearms than those who had used W/O-emulsions or no protective skin ointments at all. Similar test results were achieved in 9 metal workers tested in a right-left comparison under standardized external conditions as in more than 300 workers of various industries. By a right-left comparison of an O/W- and W/O-emulsion with 14 students it was shown that all subjects with a low pre-test AR revealed an increased AR after the application of the ointment. Proved differences in AR-reactivity related to occupation and skin constitution of the subject tested are considered to be due to differences in the hydration rate of the horny layer.