Patch test informed consent form: position statement by European Academy of Dermatology and Venereology Task Force on Contact Dermatitis.

BACKGROUND: To our knowledge, an international consensus is lacking regarding the development of an adequate informed consent form for a patch test (PT) and the information that should be included in such document. OBJECTIVES: The aim of the study was to reach a consensus on the specific points that need to be addressed in a PT consent form. METHODS: A Delphi survey, comprising 2 rounds and 1 final discussion, was used to gather and analyse data, which was conducted over the Internet. Each statement that reached a consensus with the respondents (9 expert dermatologists from Europe) was defined as a median consensus score (MED) of ≥7 and agreement among panelists as an interquartile range (IQR) of ≤3. All study participants were members of the EADV task force on contact dermatitis. RESULTS: The expert panel addressed several topics that should be included in an informed consent form for a PT: introduction, preparation for PT, testing procedure, allowed activities, adverse events and additional authorizations. CONCLUSIONS: Our results assess recommendations regarding points to be contained in an informed consent form for a PR. Future actions towards standardization and harmonization of this specific consent form are needed.

Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe - position paper of the COST Action StanDerm (TD 1206).

BACKGROUND: Skin diseases constitute up to 40% of all notified occupational diseases in most European countries, predominantly comprising contact dermatitis, contact urticaria, and skin cancer. While insufficient prevention of work-related skin diseases (WRSD) is a top-priority problem in Europe, common standards for prevention of these conditions are lacking. OBJECTIVE: To develop common European standards on prevention and management of WRSD and occupational skin diseases (OSD). METHOD: Consensus amongst experts within occupational dermatology was achieved with regard to the definition of minimum evidence-based standards on prevention and management of WRSD/OSD. RESULTS: By definition, WRSDs/OSDs are (partially or fully) caused by occupational exposure. The definition of OSD sensu stricto additionally includes diverging national legal requirements, with an impact on registration, prevention, management, and compensation. With the implementation of the classification of WRSD/OSD in the International Classification of Diseases (ICD) 11th Revision in future, a valid surveillance and comparability across countries will be possible. Currently, WRDS and OSD are still under-reported. Depending on legislation and regulations, huge differences exist in notification procedures in Europe, although notification is crucial to prevent chronic and relapsing disease. Facilities for early diagnosis, essential for individual patient management, should be based on existing guidelines and include a multidisciplinary approach. Patch testing is essential if contact dermatitis persists or relapses. Workplace exposure assessment of WRSD/OSD requires full labelling of product ingredients on material safety data sheets helping to identify allergens, irritants and skin carcinogens. Comparable standards in primary, secondary and tertiary prevention must be established in Europe to reduce the burden of WRSD/OSD in Europe. CONCLUSION: The adoption of common European standards on prevention of WRSD/OSD will contribute to reduce the incidence of OSD and their socio-economic burden.

The European Status Quo in legal recognition and patient-care services of occupational skin cancer.

BACKGROUND: Skin cancer is the most common malignancy in Caucasian populations worldwide and ultraviolet radiation (UVR) is known for being the number one carcinogen. As, especially in outdoor workers, UVR is an inevitable carcinogen, the prevention and management of UVR-related skin cancers in these at-risk populations represent a collective challenge for dermatologists and healthcare policymakers likewise. OBJECTIVE: To provide an overview on the current regulations on the acknowledgement and management of work-related skin cancer in 11 European countries. METHODS: Dermatologists from 11 countries networking within the EU Horizon 2020 COST Action TD1206 'StanDerm' contributed to a standardized survey regarding current national regulations, implemented for the recognition, prevention and management as well as possible compensation regulations in their individual country of residence. RESULTS: Ten of 11 participating countries in this survey reported the existence of an established programme available on certain occupational diseases; work-related skin diseases were only specifically recognized in eight countries. Seven of 11 countries recognize cutaneous squamous cell carcinoma in outdoor workers as 'occupational skin cancer'. Basal cell carcinoma (6 of 11), actinic keratosis (5 of 11), Bowen's disease (5 of 11) and malignant melanoma (5 of 11) are not as regularly approved as potentially 'work-induced'. Only a few of the countries included into this survey established a general documentation system (national registry) on occupational skin diseases. So far, representatives of only three countries of this survey referred to a specific established national programme for the prevention, management or compensation of occupational skin cancers acquired during work-related UVR exposure. CONCLUSION: This survey highlights the need for mandatory regulations on the prevention, management and potential compensation of work-related UV-induced skin cancer across Europe. Against the background of a joint European domestic market, equal standards of occupational safety across Europe should include binding regulations for the protection and management of work-related skin cancer. The design of a common regulation to meet the increasing incidence of skin cancers in outdoor workers should become part of the European agenda, ensuring equal working and living conditions in the member states.

Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P).

BACKGROUND: Occupational contact urticaria (OCU) is an occupational contact dermatitis that can cause serious health consequences and disability at work. OBJECTIVES: To describe OCU and its temporal trends by the main causal agents and activity sectors in a nationwide scheme in France. METHODS: Using data from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P), we described OCU reported during the period 2001-10 and analysed the temporal trends of OCU and OCU attributed to the most frequent agents over the study period. Trends analyses were supported by reporting odds ratios using a logistic regression model with reference to 2001, or with time as a continuous variable. RESULTS: During the study period, 251 cases of OCU were reported in RNV3P, half of which were due to natural rubber latex, in particular in the health and social work activity sector (HSW). The number of these cases declined significantly over the study period (19% per year), and particularly after 2006. Conversely, the other causes of OCU did not decrease. CONCLUSIONS: Using surveillance data from a French national network, this study has found that there was a significant decline in OCU due to natural rubber latex, particularly in the HSW, when powdered latex gloves were banned from French hospitals. Our results show the effectiveness of this preventive measure, and suggest that this practice should be extended to other sectors.

[Therapeutic patient education in chronic hand dermatitis]. / Éducation thérapeutique du patient dans l'eczéma chronique des mains.

Hand dermatitis (HD) is usually due to a combination of various interacting factors. It involves significant impairment of the quality of life with psychological and socioeconomic impact. A therapeutic education program in HD.was elaborated by 19 health professionals (dermatologists, occupational clinical physicians, nurses, psychologists, environmental medical advisor) with experience in therapeutic education or skills in HD, according to the recommendations of Haute Autorité de Santé. The program includes an individual medical consultation to perform educational diagnostic, two collective workshops and a medical evaluation consult. Two group workshops "the disease, irritant factors and its treatments" and "the experiences and feelings" were elaborated with learning objectives and educative tools. Different scores were proposed to evaluate the program and acquired skills. Therapeutic education is an efficient way to help patients to adopt skin protection measures essential to healing. We propose a guideline of therapeutic education in HD including skills and educative tools and intended for health professionals to serve as working basis.

Occupational allergic contact dermatitis and major allergens in France: temporal trends for the period 2001-2010.

BACKGROUND: Occupational allergic contact dermatitis (OACD) is one of the most common occupational skin diseases in developed countries, but data about its temporal trends in incidence remain sparse. OBJECTIVES: The aim of this study is to describe OACD trends in terms of industrial activities and main causal agents in France over the period 2001-2010. MATERIALS AND METHODS: Data were collected from the French National Network of Occupational Disease Vigilance and Prevention (RNV3P, Réseau National de Vigilance et de Prévention des Pathologies Professionnelles). All OACD considered probably or certainly associated with an occupational exposure were included in the study. Trends were examined (i) on annual crude numbers of OACD and (ii) on reported odds ratios of OACD calculated using logistic regression models. RESULTS: Overall, 3738 cases of OACD were reported and the mean age of OACD cases was 35 years, 52% being women. The most frequent occupations were hairdressers, health care workers, cleaning staff and masons. The total number of OACD cases remained stable over the study period, but increases in OACD related to isothiazolinones (P = 0·002), epoxy resins (P = 0·012) and fragrances (P = 0·005) were observed. Conversely, decreases were noted for cement compounds (P = 0·002) and plant products (P = 0·031). These trends highlight specific sectors and exposures at risk of OACD. CONCLUSIONS: Trends in OACD depend on the nature of exposure. Observed decreases were consistent with prevention measures taken during the study period, and the increases observed serve to highlight those areas where preventative efforts need to be made to reduce skin allergies in the workplace.

[Occupational dermatitis in cleaning and maintenance workers. Analysis of 769 cases declared to the Caisse Nationale d'Assurance Maladie des Travailleurs Salariés between 2004 and 2007]. / Les eczémas professionnels chez les travailleurs du secteur du nettoyage et de l'entretien. Étude de 769 déclarations à la Caisse nationale d'assurance maladie des travailleurs salariés entre 2004 et 2007.

BACKGROUND: Employees active in the cleaning and maintenance industry (CMI) are particularly exposed to occupational eczema (OE), which affects the hands in 80 to 90% of cases. This risk of OCE in France was evaluated using data collected by the Occupational Risks Division of the French National Health Insurance Fund for Salaried Workers (CNAMTS). PATIENTS AND METHODS: All cases of OE among CMI employees declared to and recognized by the CNAMTS between 1st January 2004 and 31st December 2007 were selected. The following parameters were noted in each case: age, gender, trade in question, National Health Insurance Office of residence, causal agent and number of days of sick leave. The incidence per 100,000 employees could be determined from the total number of employees followed up by occupational medicine and the numbers working in the CMI. RESULTS: For the 4 years studied, 769 cases of OE were reported in CMI workers representing 2.6% of the salaried employee population. The annual incidence of OE was 43.5 per 100,000 employees. There was a marked female predominance (75.7%). OE led to loss of 32,714 workdays. CONCLUSION: This is the first study conducted in France about OE among NIS employees. It highlights the socioeconomic impact of OE. The difficulties of interpretation show the limits of recognition of occupational disease. Analysis of cases of OE in France and monitoring require the development of a specific database to clarify risk situations and identify priority regional and national preventive actions.

Occupational contact dermatitis in 10,582 French patients reported between 2004 and 2007: a descriptive study.

BACKGROUND: Limited epidemiological data are available in France for occupational contact dermatitis (OCD), a non- infectious inflammatory skin condition arising from direct skin contact with substances used in the workplace. OBJECTIVE: To estimate the occurrence of, and number of workdays lost to, OCD in France. METHODS: Descriptive study of all OCD declared by salaried workers and recognised as occupational disease in France over a 4-year period. RESULTS: 10,582 OCD cases were reported, representing 9.6% of all occupational diseases recognised. The estimated annual incidence of OCD recognised was 15.72/100,000 salaried workers (i.e. 146.87/100,000 employees for all occupational diseases). OCD cases were mainly in the construction and public works industries with 3,057 (36.7%) salaried workers affected. In the services sector, OCD predominantly affected employees aged less than 30 years (41%), particularly hairdressers (69%). OCD accounted for the loss of 395,069 working days. CONCLUSION: OCD represents a significant public health problem in France, particularly for construction workers and hairdressers.

Comparison of three chromogenic agar plates for isolation and identification of urinary tract pathogens.

OBJECTIVE: To comparatively assess the performance of three chromogenic agar plates, CPS ID2, Chromogenic UTI, and USA, for the detection and enumeration of all urinary tract pathogens and the direct identification of Escherichia coli, Proteus mirabilis and Enterococcus spp. METHODS: Two hundred and forty-three urine specimens prospectively collected from hospitalized patients were randomly inoculated in parallel on the three media. RESULTS: Of the 243 urine specimens, 235 yielded positive cultures, of which 151 were pure cultures and 84 were mixed cultures. CPS ID2, Chromogenic UTI and USA agar gave detection rates of 99.1%, 97.1% and 96.6%, respectively. The main difference in non-detection between CPS ID2 agar and the two new media concerned Staphylococcus spp. strains. Based on the total number of strains detected (n = 348), the total identification rates of E. coli, P. mirabilis and Enterococcus spp. on CPS ID2 agar, Chromogenic UTI agar and USA agar were 60.3%, 61.2% and 59.2%, respectively. CONCLUSION: The detection rates and identification rates of the three media were very close and only minor differences were noted. The lower detection rates for Chromogenic UTI and USA were mainly due to their lesser ability to support growth of Staphylococcus spp.

Identification of Candida glabrata by a 30-second trehalase test.

Rapid (30-s) trehalase tests done with material from colonies of 482 yeasts suspended in a drop of trehalose solution on a commercially supplied glucose test strip were positive for 225 (99.1%) of 227 Candida glabrata isolates grown on either of two differential media, Candida ID medium or CandiSelect medium. The test was positive for only 3 (1.2%) and 12 (4.7%) of 255 isolates of other medically important yeast species grown on the same two media, respectively. A rapid maltase test done with a subset of 255 yeast isolates was negative for all but 1 of 64 trehalase-positive C. glabrata isolates, raising the specificity of the rapid testing for C. glabrata to 98.4 to 100%, depending on the isolation medium used. Rapid trehalase and maltase tests done independently in two laboratories with 217 yeast isolates showed sensitivities of 96.0 to 98.0% and specificities of 98.2 to 99.4% for identification of C. glabrata from colonies grown on Candida ID medium. The specificity was much lower because of frequent false-positive trehalose test results when the source of colonies was Sabouraud agar formulated with 4% glucose. We conclude that direct recognition of C. albicans as blue colonies on Candida ID isolation medium coupled with the performance of the 30-s trehalase and maltase tests for C. glabrata among the white colonies on this medium will allow the rapid presumptive identification of the two yeast species most commonly encountered in clinical samples.