Alérgenos en la dermatitis de contacto alérgica de origen laboral / Allergens in occupational allergic contact dermatitis

Introducción: Las dermatosis profesionales tienen una alta incidencia, lo que conlleva considerables consecuencias médicas y laborales. Objetivos: Describir las características de la población afectada por dermatitis de contacto alérgica de origen laboral y los alérgenos responsables. Material y Métodos: Durante cinco años se incluyó a todos los pacientes diagnosticados de Dermatitis de Contacto Alérgica en una consulta de Dermatología en un hospital de referencia, con positividad a al menos un alérgeno presente en su puesto de trabajo. Resultados: En sector de cosmética el 93,7% fue causada por acrilatos, en peluquería un 72,7% fue causada por PPDA, en alimentación un 63,3% de los alérgenos fueron productos alimentarios, en construcción el 60% fueron causadas por cemento y en industria PPDA causó un 30%. Las manos fueron la principal área corporal afectada en todos los grupos laborales. Conclusión: parece recomendable mejorar la coordinación entre los facultativos de Medicina del Trabajo y de atención primaria con los facultativos dermatólogos, estableciéndose protocolos de actuación conjuntos que permitan disponer de un diagnóstico definitivo en el menor tiempo posible (AU)

Introduction: The occupational dermatosis have a high incidence, leading to considerable medical and occupational consequences. Objectives: Describe the characteristics of the population affected by allergic contact dermatitis of labor origin and allergens responsible. Methods: During 5 years, all Allergic Contact Dermatitis were includedat the time of diagnosis, on a Dermatology outpatient department in a tertiary hospital, with positivity for at least 1 allergen present in their workplace. Results: In Cosmetics a 93.7% was caused by acrylates, in Hairdressing a 72.7% was caused by PPDA in Food Workers 63.3% of allergens were food products, in Construction a 60% were caused by cement and in Industry PPDA caused a 30%. The hands were the main body area affected in all labor groups. Conclusions: it seems to need an improvement about the communication and protocols between Occupational Medicine, Family Medicine and Dermatology to short the time of the diagnosis of these occupational diseases (AU)

[The fate of 20 sea breams. Mycobacterium marinum infection]. / Das Schicksal von 20 Brassen. Mycobacterium-marinum-Infektion.

Cutaneous infections with Mycobacterium marinum are rare. They also are known as swimming pool or fish tank granulomas. Often the history of contact with contaminated water associated with microtrauma of the upper extremities leads to the correct diagnosis. Since chlorination of swimming pools has become standard, cases of swimming pool granuloma have become rare. Contact with fish tanks now is the most common route of infection. Positive culture of skin biopsy leads to the correct diagnosis. Moxifloxacin in combination with other antibiotics is often effective.

Management of occupational dermatitis in healthcare workers: a systematic review.

OBJECTIVES: This systematic review informed evidence-based guidelines for the management of occupational dermatitis, with a particular focus on healthcare workers. METHODS: A multidisciplinary guideline group formulated questions about the management of healthcare workers with dermatitis. Keywords derived from these questions were used in literature searches. We appraised papers and developed recommendations using the Scottish Intercollegiate Guideline Network (SIGN) methodology. RESULTS: Literature searches identified 1677 papers; 11 met the quality standard (SIGN grading ++ or +). A small body of evidence indicated that dermatitis is more likely to be colonised with micro-organisms than normal skin, but there was insufficient evidence about the risk of transmission to patients. There was limited evidence that using alcohol gel for hand decontamination is less damaging to skin than antiseptics or soap. A small body of evidence showed that conditioning creams improve dermatitis, but are not more effective than their inactive vehicle. A small inconsistent body of evidence showed that workplace skin care programmes improve dermatitis. CONCLUSIONS: Healthcare workers should seek early treatment for dermatitis and should be advised about the risk of bacterial colonisation. Work adjustments should be considered for those with severe or acute dermatitis who work with patients at high risk of hospital-acquired infection. Healthcare workers with dermatitis should follow skin care programmes, and use alcohol gel where appropriate for hand decontamination. Further research should explore whether healthcare workers with dermatitis are more likely to transmit infection to their patients, and whether health surveillance is effective at reducing dermatitis.

Dermatitis among farmers engaged in peri-urban aquatic food production in Hanoi, Vietnam.

OBJECTIVE: To assess whether exposure to wastewater is a risk factor for dermatitis (eczema) among farmers engaged in peri-urban aquatic food production in Hanoi, Vietnam. METHODS: A cross-sectional study with two follow-ups was conducted from April to December 2005 in two peri-urban communes in Hanoi, one using wastewater and another using river, rain and well water for aquatic food production. In each commune, 100 households were randomly selected and adult household members engaged in farming field work were interviewed in three surveys. Farmers who reported skin problems at the time of interviews were examined and treated by a dermatologist. Data were analysed for one farmer per household. RESULTS: The overall prevalence of dermatitis from 592 interviews was 6.3%. The commune which used wastewater had a much higher overall prevalence of dermatitis (10.4%) than the commune that did not (2.1%; P-value < 0.001). Multivariable logistic regression analyses showed that occupational wastewater contact was an important risk factor for dermatitis (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.1-7.7). Duration of daily wastewater contact was not significantly associated with dermatitis. Aquaculture work in the wet season carried an increased risk of dermatitis in both communes (OR 2.8; 95% CI 1.02-7.6). The use of personal protective measures during field work and washing hands and feet after work did not reduce the risk for dermatitis. However, observations showed that these practices were applied in such a way that they were unlikely to provide effective protection against wastewater contact. CONCLUSION: Contact with wastewater is an important risk factor for dermatitis among farmers engaged in wastewater-fed peri-urban aquatic food production. Additional studies should test preventive and mitigating measures such as improved personal protection and hygiene.

Forma cutánea difusa de erisipeloide / Diffuse cutaneous form of erysipeloid

El erisipeloide es una infección ocupacional causada por Erysipelothrix rhusiopathiae. El organismo es ubicuo, pero el reservorio más común es el cerdo. Existen tres formas clínicas principales descritas en humanos: el erisipeloide, la forma cutánea difusa y la sistémica. Es importante considerar la posible existencia de endocarditis asociada. Presentamos el caso de una forma cutánea difusa de erisipeloide en un varón de 63 años, ganadero, que presentaba lesiones cutáneas anulares en dorso de mano derecha y región dorsolumbar (AU)

Microorganism-induced skin disease in workers exposed to metalworking fluids.

BACKGROUND: An outbreak of skin disorders among workers potentially exposed to metalworking fluids prompted the present study. Few studies have described skin disorders associated with microbe-contaminated metalworking fluids. METHODS: Samples of materials contaminated with metalworking fluids were obtained from two manufacturing facilities in Ohio. Pathogenic bacteria and yeasts, in concentrations sufficient to cause skin disease, were cultured from 9 of 12 (75%) sampled materials. RESULTS: Allergic patch testing of five affected people produced negative results for standard allergens, augmented by fluids and items from their workplace. This ruled out allergies as the cause of the skin disease. Improper handling and disposal of cotton gloves, inappropriate use of scouring pads and ineffective hand wiping were apparently responsible for the microbiological contamination. The hands and forearms were most commonly affected. CONCLUSION: Improper handling of soluble, synthetic and semi-synthetic metalworking fluids provides an excellent environment for the growth of a range of microorganisms, including bacteria and fungi. If allowed to grow because of poor occupational hygiene, these microorganisms can cause skin disorders among workers. Soiled protective clothing (gloves, coveralls and work boots) should be cleaned or discarded on a regular basis. When washing up, workers should not use metalworking fluids and items used to clean machinery.

A Japanese case of tinea corporis caused by Arthroderma benhamiae.

We report a case of tinea corporis in Japan caused by Arthroderma benhamiae. A 53-year-old female scientist, who had been working on dermatophytes in a laboratory, noticed pruritic erythema on the outer corner of her left lower eyelid. She used a steroid ointment for three days, but the lesion continued to expand. When she visited our clinic, the erythema was 15 mm in diameter and clearly demarcated with a slightly depressed center. A scale from the periphery of the erythema was positive with direct KOH examination, and T mentagrophytes was isolated from the lesion. The erythema was successfully treated with topical application of butenafine hydrochloride. The isolate was mated with a (+) strain of the Americano-European race of A. benhamiae. Using the most sensitive molecular typing method, restriction exzyme analysis of the non-transcribed spacer region of the ribosomal DNA, the restriction profile of the isolate was the same as that of strains used in her laboratory but different from those of any Japanese isolates associated with pet animals. The results suggest that the patient became infected during her experiment.

Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers.

CONTEXT: Many health care workers suffer severe hand irritation, with cracking and bleeding, as a consequence of frequent handwashing and glove use. Integumentary breakdown has major implications for nosocomial infection control and promotes the spread of bloodborne viruses. The potential benefits of scheduled use of hand-care agents-lotions or creams-in health care workers has not been established by controlled trial. OBJECTIVE: To compare the value of an oil-containing lotion with a novel barrier skin cream in health care workers with severe hand irritation. DESIGN: Prospective, randomized, double-blind trial. SETTING: University medical center. PARTICIPANTS: Fifty-four health care workers from multiple departments with severe hand irritation, 74% with one or more full-thickness cracks or other integumentary breaks. MAIN OUTCOME MEASURES: Objective and subjective parameters for scaling, cracking, weeping, bleeding, and pain were scored by two blinded investigators weekly for 4 weeks, and the hands of subjects were cultured quantitatively at the onset and after 2 weeks and 4 weeks. RESULTS: Subjects in both groups experienced marked improvement in overall hand condition (each, P <.02), particularly in scaling, cracking, and pain. Persons randomized to use of the oil-containing lotion showed greater improvement (mean score, from 6.5 to 2.7 vs 6.8 to 4. 7, P =.006). In 18 (69%) of 26 persons who used the control lotion, all full-thickness integumentary breaks were healed and pain was totally resolved, compared with 14 (52%) of 27 persons who used the barrier cream (P =.26). Use of the two agents in a scheduled fashion had no effect on the levels or profile of the transient hand flora. However, by the fourth week of use, handwashing frequency was 50% higher in subjects randomized to use the control lotion than it was in subjects randomized to use the barrier cream (17.8 vs 11.7 times per day, P =.04). CONCLUSION: Use of an oil-containing lotion or a barrier cream on a scheduled basis can substantially protect the hands of vulnerable health care workers against drying and chemical irritation, preventing skin breakdown and promoting more frequent handwashing.

The presence of some yeasts species in occupational dermatitis.

The samples of skin lesions were collected from forearms, palms and phalanges of ten females working in a manufacturing section (clothes tailoring and assemblage) using imported textiles. The samples were examined for bacteriological and mycotic flora by using classical methods. The textile fragments of 1-2 square centimeters from four samples were investigated using the same classical methods. The gauze fragments were used as toxic negative control samples. In 6 out of 10 samples from cutaneous lesions, Candida albicans was isolated and in 5 samples Rhodotorula species was identified. The yeasts species were identified by cultural and biochemical characteristics. All C. albicans strains were positive for the germ tube test and produced spherical chlamydospores on corn meal agar. The Rhodotorula strains grew on Sabouraud agar pure orange-red pigmented and mucoid colonies of 2-3 mm diameter. The textile samples incubated on blood--agar (10% sheep blood) demonstrated a high toxic activity producing a surrounding beta-hemolysis area of 3-5 cm. This lysis of the sheep red cell was caused by an unidentified chemical agent. In our cases, dermatites were associated with chemical and yeasts agents. The chemical agents irritated and made the derma sensitive, favouring C. albicans and Rhodotorula species multiplication.

Changes in bacterial flora associated with skin damage on hands of health care personnel.

In a prospective observational study of 40 nurses (20 with diagnosed hand irritation and 20 without), nurses with damaged hands did not have higher microbial counts (P = .63), but did have a greater number of colonizing species (means: 3.35 and 2.63, P = .03). Although numbers were small, nurses with damaged hands were significantly more likely to be colonized with Staphylococcus hominis (P = .03). Fifty-nine percent of S hominis isolates from nurses with damaged hands were resistant to methicillin compared with 27% of isolates from those with healthy skin (P = .14). Twenty percent of nurses with damaged hands were colonized with Staphylococcus aureus compared with none of the nurses with normal hands (P = .11). Nurses with damaged hands were also twice as likely to have gram-negative bacteria (P = .20), entercocci (P = .13), and Candida (P = .30) present on the hands. Antimicrobial resistance of the coagulase-negative staphylococcal flora (with the exception of S hominis) did not differ between the 2 groups, nor did a trend toward increasing resistance exist when compared with other studies during the past decade. Skin moisturizers and protectant products were used almost universally by nurses at work, primarily products brought from home. Efforts to improve hand condition are warranted because skin damage can change microbial flora. Such efforts should include assessment or monitoring of hand care practices, formal institutional policy adoption and control of use of skin protectant products or lotions, and prudent use of latex gloves or more widespread use of powder-free and nonlatex products.

[Pustular dermatitis in veterinarians following delivery in farm animals; an occupational disease]. / Pustulaire dermatitis bij dierenartsen na verlossingen van landbouwhuisdieren; een beroepsziekte.

OBJECTIVE: To assess the prevalence of contact dermatitis after deliveries in cattle or sheep among veterinarians. DESIGN: Retrospective. SETTING: Provinces of Groningen, Friesland, and Drenthe, The Netherlands. METHODS: By means of a short inquiry 310 veterinarians were asked whether and how often they had experienced pustular dermatitis after deliveries in cattle and sheep and what course the dermatitis had run. They were also asked about details of the deliveries (type of animal, condition of the foetus, course of the partus), about microbiological investigation, preventive measurements and therapy. RESULTS: The response to the questionnaires was 24.5%. One or more episodes of pustular dermatitis on an arm after a delivery in cattle or sheep was noticed by 62 (81.5%) of the 76 respondents. Sometimes it was associated with secondary symptoms like headache, fever and lymphadenitis. Listeria monocytogenes (7 times out of 13) and Salmonella dublin (4/13) were the agents cultured most often. CONCLUSION: Contact dermatitis after deliveries in cattle or sheep occurs frequently as an occupational disease of veterinarians.

[Pustular dermatitis in veterinarians following delivery in domestic animals; an occupational disease]. / Pustulaire dermatitis bij dierenartsen na verlossingen van landbouwhuisdieren; een beroepsziekte.

OBJECTIVE: To assess the prevalence of contact dermatitis after deliveries in cattle or sheep among veterinarians. DESIGN: Retrospective. SETTING: Provinces of Groningen, Friesland and Drenthe, The Netherlands. METHODS: By means of a short inquiry 31O veterinarians were asked whether and how often they had experienced pustular dermatitis after deliveries in cattle and sheep and what course the dermatitis had run. They were also asked about details of the deliveries (type of animal, condition of the foetus, course of the partus), about microbiological investigation, preventive measurements and therapy. RESULTS: The response to the questionnaires was 24.5%. One or more episodes of pustular dermatitis on an arm after a delivery in cattle or sheep was noticed by 6(2) (81.5%) of the 7(6) respondents. Sometimes it was associated with secondary symptoms like headache, fever and lymphadenitis. Listeria monocytogenes (7 times out of 13) and Salmonella dublin (4/13) were the agents cultured most often. CONCLUSION: Contact dermatitis after deliveries in cattle or sheep occurs frequently as an occupational disease of veterinarians.