[Overview of five years of occupational dermatology: The role of atopy]. / Consultation spécialisée de dermatologie professionnelle : bilan de cinq ans d'activité. Place de l'atopie.

BACKGROUND: The management of occupational dermatitis is often complex and relies on skills in both dermatology and occupational medicine. A bidisciplinary occupational dermatology consultation was set up in 2002 at Brest CHU. The aim of this study is to provide an assessment of 5 years of activity and to discuss the role of atopy. PATIENTS AND METHODS: From October 2002 to October 2007, 245 patients attended this consultation. 145 files concerning proven occupational dermatosis were studied (age, sex, occupation, dermatosis, allergens and history of atopy). One hundred and five patients completed a telephone questionnaire concerning their feelings about the consultation, the course of their dermatosis and the medicosocial outcome. RESULTS: The main forms of dermatosis were contact eczema (41%), irritant dermatitis (26%), exacerbation of atopic dermatitis (10%), associated eczema and irritant dermatitis (9%), and other (14%). DISCUSSION: The occupations of subjects (healthcare, building and civil engineering work, food and catering, agriculture, mechanics, hairdressing, cleaning, printing) and the allergens involved were similar to those described in the literature. The prognosis was poor (48% cure rate). Differential diagnosis between allergic eczema and irritant dermatitis was sometimes difficult and was based on clinical features and allergology tests. A history of atopy was found in 32% of patients and was particularly frequent among patients presenting allergic eczema associated with irritant dermatitis: this may be explained by the physiopathological mechanisms of atopic dermatitis (impairment of barrier function causing contact sensitization to potential allergens). CONCLUSION: Such a bidiscipinary occupational dermatology consultation has the advantage of optimizing management of these patients. Wider notification of occupational dermatosis would increase our knowledge of the causes of this condition and enable better prevention.

Frequency of aquagenic palmoplantar keratoderma in cystic fibrosis: a new sign of cystic fibrosis?

BACKGROUND: Aquagenic palmoplantar keratoderma (APPK), also known as aquagenic wrinkling of the palms, is characterized by oedema of palms and/or soles, whitish papules, hyperwrinkling and sometimes pruritus or pain after water immersion. Its frequency in the general population is unknown. About 40 cases have been reported to date, including some among patients with cystic fibrosis (CF) or CF heterozygotes. OBJECTIVES: To determine the frequency of APPK among patients with CF. METHODS: Twenty-seven patients from the Centre of Competence on Cystic Fibrosis of Roscoff were examined by a dermatologist after immersion of the palms in water for 2-3 min. RESULTS: The frequency of APPK was 41% (11 of 27 patients). Some patients had not previously noticed the lesions. The frequency was higher among inpatients than outpatients. We suspect that occlusion (caused by the gloves worn by inpatients) can explain this difference. The number of patients included in this study is not sufficient to draw any conclusions concerning the type of CF mutation and its impact on the frequency of APPK. CONCLUSIONS: APPK is frequent among patients with CF and, thus, should be considered a sign of CF. APPK is underdiagnosed because physicians usually do not look for it. CF screening should be considered for any patient presenting with these symptoms, followed by genetic counselling if necessary.