Occupational asthma and dermatitis induced by eugenol in a cleaner

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[Information value of lipid peroxidation parameters in patients with occupational allergic dermatoses].

Evaluation of lipid peroxidation in patients with occupational allergic dermatoses revealed activation of free radical oxidation. Serum levels of diene conjugates and end products of free radical lipid peroxidation appeared to be informative parameters for assessing influences on body system and for estimating the disease severity and the individual protective means efficiency.

Hand dermatitis/eczema: current management strategy.

Ever since its inception a couple of centuries ago, hand dermatitis/eczema has been in the reckoning. Idiosyncrasies continued to loom large thereafter, till it acquired its appropriate position. Dermatitis/eczema are synonymous, often used to indicate a polymorphic pattern of the inflammation of the skin, characterized by pruritus, erythema and vesiculation. A spectrum delineated into acute sub-acute and chronic dermatitis of the hands. Pompholyx, recurrent focal palmer peeling, ring, wear and tear and fingertip eczema, apron, discoid eczema, chronic acral dermatitis, gut and patchy papulosquamous eczema are its clinical variants. Occupational dermatitis/eczema may be contributory. Etiological definitions are clinched by detailed history of exogenous and endogenous factors. However, scientific confirmation of the entity is through patch testing by using available antigens.

Occupational dermatosis.

Occupational Dermatosis is described as any alteration in the skin, mucosa or annexes that is directly or indirectly caused, conditioned, maintained or aggravated by agents present in the occupational activity or work environment. The authors of the present study describe the importance of the topic and the epidemiology and etiopathogeny of the main forms of occupational dermatoses: allergic and irritative contact dermatitis, phytodermatitis, acne (elaioconioses and chloracne), keratosis, cancers, foreign body granuloma, infections, onychias, and ulcerations. Clinical findings of occupational dermatosis are presented in relation to various professions. Laboratory tests used to diagnose this condition are analysed, with special emphasis on patch testing, which is the gold standard. Information about the treatment and prevention of this disorder is provided. Collective and individual measures, especially regarding the proper use of individual protection equipment for the prevention of occupational dermatosis, are detailed.

Dermatoses ocupacionais / Occupational dermatosis

Dermatose ocupacional é qualquer alteração da pele, mucosa e anexos, direta ou indiretamente causada, condicionada, mantida ou agravada por agentes presentes na atividade ocupacional ou no ambiente de trabalho. Os autores referem a importância do tema, a epidemiologia e a etiopatogenia das principais dermatoses ocupacionais: dermatites de contato irritativas e alérgicas, fitodermatites, acnes (elaioconiose e cloracne), ceratoses, cânceres, granulomas de corpo estranho, infecções, oníquias e ulcerações. A clínica da dermatose ocupacional é apresentada em diferentes profissões. Analisam-se os exames laboratoriais pedidos nessas dermatoses, com especial destaque para testes de contato, que são o padrão ouro, e fornecem-se dados do tratamento e prevenção; quanto à prevenção da dermatose ocupacional, informam-se as medidas coletivas e individuais, especialmente, no que respeita ao uso adequado dos equipamentos de proteção individual.

Occupational Dermatosis is described as any alteration in the skin, mucosa or annexes that is directly or indirectly caused, conditioned, maintained or aggravated by agents present in the occupational activity or work environment. The authors of the present study describe the importance of the topic and the epidemiology and etiopathogeny of the main forms of occupational dermatoses: allergic and irritative contact dermatitis, phytodermatitis, acne (elaioconioses and chloracne), keratosis, cancers, foreign body granuloma, infections, onychias, and ulcerations. Clinical findings of occupational dermatosis are presented in relation to various professions. Laboratory tests used to diagnose this condition are analysed, with special emphasis on patch testing, which is the gold standard. Information about the treatment and prevention of this disorder is provided. Collective and individual measures, especially regarding the proper use of individual protection equipment for the prevention of occupational dermatosis, are detailed.

Principles and methodology for translation and cross-cultural adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) to Spanish and Catalan.

BACKGROUND: Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. The Nordic Occupational Skin Questionnaire (NOSQ-2002), developed in English, is a useful tool for screening of occupational skin diseases. OBJECTIVES: To culturally adapt the NOSQ-2002 to Spanish and Catalan and to assess the clarity, comprehension, cultural relevance and appropriateness of the translated versions. METHODS: The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) principles of good practice for the translation and cultural adaptation of patient-reported outcomes were followed. RESULTS: After translation into the target language, a first consensus version of the questionnaire was evaluated in multiple cognitive debriefing interviews. The expert panel introduced some modifications in 39 (68%) and 27 (47%) items in the Spanish and Catalan version, respectively (e.g. addition of examples and definitions, reformulation of instructions and use of direct question format). This version was back translated and submitted to the original authors, who suggested a further seven and two modifications in the Spanish and Catalan versions, respectively. A second set of cognitive interviews were performed. A consensus version of both questionnaires was obtained after final modifications based on comments by the patients. CONCLUSIONS: The final versions of the Spanish and Catalan NOSQ-2002 questionnaires are now available at www.NRCWE.dk/NOSQ.

The hardening phenomenon in irritant contact dermatitis: an interpretative update.

Irritant contact dermatitis (ICD) is common and poses a significant problem in high-risk populations. In most cases, ICD resolves despite continued exposure in a process known as 'hardening', allowing individuals to continue with their work. Those who cannot clear ICD develop chronic ICD, which is a significant source of emotional, physical, and financial distress for affected individuals. While hardening is well known among labourers and clinicians, its mechanism remains to be elucidated. Much can be learned from the study of self-healing processes like the hardening phenomenon. This overview briefly documents the pathogenesis of ICD, focuses on the latest advances pertaining to the hardening phenomenon in ICD, and then highlights potential avenues of productive research. A better understanding of the 'hardening' process in the skin will hopefully lead to advances for the treatment of ICD.

The validity and reliability of the occupational contact dermatitis disease severity index.

BACKGROUND: The occupational contact dermatitis disease severity index (ODDI) was designed to assess the severity and importantly the functional disability caused by occupational contact dermatitis (OCD) of the hands in patients attending our occupational dermatology clinic. OBJECTIVES: To investigate the accuracy of the ODDI. PATIENTS/METHODS: Of 205 patients, 95 were assessed as having OCD of the hands. Content validity was assessed by content mapping and expert opinion. Construct validity was examined through comparing the ODDI against global clinical dermatology severity assessment (GCDSA). Intraobserver reliability, interobserver reliability, internal consistency, acceptability and convenience were also assessed. RESULTS: The ODDI was found to have content validity by the experts and was moderately correlated with GCDSA, supporting construct validity (Pearson's r = 0.54; P < or = 0.01). The ODDI was shown to be reliable with substantial agreement for both intraobserver reliability [intraclass correlation coefficient (ICC) = 0.62] and interobserver reliability (ICC = 0.75). Internal consistency within the ODDI was almost perfect (ICC = 0.94-0.99) and user survey showed the ODDI to be acceptable, easy and quick to use. CONCLUSIONS: The ODDI is a valid and reliable instrument to assess the severity and functional limitations caused by OCD, in patients who have had treatment or modified work duties, associated with some improvement of their dermatitis.

Patients with occupational contact dermatitis in Israel: quality of life and social implications.

One of the most common occupational diseases is skin disease caused as a result of contact with work-related materials or exacerbated by them. Although occupational-related skin disease is a common condition, it is not considered to be a serious one and, therefore, has not received satisfactory attention in the psycho-social literature or in the social work profession. In our study, 70 occupational contact dermatitis (OCD) patients were interviewed by telephone regarding psychological, social, economic, and subjective issues related to the disease. All patients reported to be affected in their daily living activities, self-image, economic status, and in their interpersonal relationships in the family. Our study seeks to highlight the problems of this population group and serve as a vehicle to facilitate patient's rights.

[Expert opinion on occupational skin diseases: a Munich statement regarding the Bamberg medical bulletin (Bamberger Merkblatt)]. / Begutachtung von Berufskrankheiten der Haut: Eine Münchner Stellungnahme zum Bamberger Merkblatt.

The Bamberg medical bulletin (Bamberger Merkblatt) is intended to assure as an anticipated expert opinion an objective as possible assessment of the sequels of an occupational disease. However, the Bamberg medical bulletin is not suitable for this task in form and content. In case of an allergic contact dermatitis recognized under No. 51 01 in appendix 1 of the German ordinance on occupational diseases the disadvantage for the insured person consists mainly in the live-long existing change of the immune system and not as much in the intensity of the skin condition triggered by a new exposure to the allergen. The prerequisite for compensation imposed by the regulator, i.e. that the skin condition must be so severe as to have forced the affected individual to refrain from all activities which led or could lead to the development, aggravation or recurrence of the condition, is in its function as a typing sign widely unnecessary in the case of an allergic occupational dermatosis. The omission of all activities which led or could lead to the development, aggravation or recurrence of the condition imposed on the affected individual by the regulator has to be taken in account for the calculation of the reduction in earning capacity in the Bamberg medical bulletin. The Bamberg medical bulletin is by no means an anticipated expert opinion. Even as a qualified experience it urgently needs a revision which might be done with, but not governed by, the statutory occupational accident insurance. Our critical scientific comments do not absolve the medical evaluator from the responsibility to consider existing recommendations as the Bamberg medical bulletin. Our aim is to initiate a process leading to an appropriate judgement of the sequels of an occupational skin disease in each individual case.

Osnabrueck hand eczema severity index--a study of the interobserver reliability of a scoring system assessing skin diseases of the hands.

An easy-to-use standardized instrument is needed for the clinical assessment of the severity of occupational hand eczema by dermatologists as well as occupational physicians. The Osnabrueck hand eczema severity index (OHSI) was developed for this purpose and the interobserver reliability investigated. The clinical severity was evaluated on the basis of the extension or clinical characteristics of six morphological characteristics. For the validation of the OHSI, hand eczema in 28 patients was investigated independently by one dermatologist and 2 occupational physicians. The agreement between the observers was determined by using kappa values, Kendall's coefficient of concordance, the intraclass correlation coefficient (ICC) and the 95% limits of agreement. The ICC for the total OHSI was 0.80 and the estimated limits of agreement (-3.6 and 3.0) were sufficiently small to expect that ratings according to OHSI performed by independent observers of different medical specialities should produce similar results. It could be demonstrated that the use of the OHSI is simple and practicable. The interobserver reliability for the summary score is good. OHSI seems a reliable tool for assessing the severity of occupational hand eczema.

The MOAHLFA index of irritant sodium lauryl sulfate reactions: first results of a multicentre study on routine sodium lauryl sulfate patch testing.

In a multicentre study of the German Contact Dermatitis Research Group, sodium lauryl sulfate (SLS) 0.25% and 0.5% aq. has been added to routine allergen patch tests to assess its properties as a convenient diagnostic indicator of individual susceptibility to irritation at the time of patch testing. Previous studies indicated that irritant SLS reactivity may be related to individual factors such as age and sex. As these factors are, in turn, among the important predictors of contact allergy to many allergens, e.g. summarized in the 'MOAHLFA index', the impact of the MOAHLFA factors on irritant SLS patch test reactivity, and thus a potential for confounding, was assessed in the 5971 participating patients. As a result of 2 logistic regression analyses with an irritant reaction to 0.25% and 0.5% SLS, respectively, as outcome, male sex was identified as a relatively weak but significant risk factor (OR 1.38), while age 40 years or older was an even weaker risk factor (OR 1.22 and 1.15, respectively). Upon detailed analysis, no clear age gradient could, however, be identified. 1-day exposure time almost halved the odds of an irritant SLS reaction. In conclusion, this type of SLS patch test can be regarded as robust, indicating individual irritability relatively independent from the individual factors analysed here.

Persistent post-occupational dermatitis.

Wall and Gebauer (Contact Dermatitis 1991: 24: 241-243) first described persistent post-occupational dermatitis (PPOD) as ongoing dermatitis for which there is no obvious present cause, precipitated by prior occupational contact dermatitis (OCD). We propose that individuals exhibiting PPOD lose the capacity for resolution of their condition upon removal from exposure to causative agents and subsequently develop persistent dermatitis, which can be continual or intermittent. Accordingly, we suggest modification of criterion 6 of the OCD criteria developed by Mathias (J Am Acad Dermatol 1989: 20: 842-848): 'Removal from exposure initially leads to improvement of dermatitis, however, over time there may be incomplete or no improvement, despite removal from exposures at work'. To satisfy the definition of PPOD, individuals must meet at least 4 of the 7 criteria, including the altered criterion 6. We present 6 cases of PPOD exemplifying these scenarios, which met the altered Mathias criteria. In some cases, subsequent failure to recognize the initial work relatedness of their skin conditions resulted in the termination of workers' compensation benefits. This situation is particularly relevant in the Australian context. The diagnosis of PPOD needs to be considered in all individuals with work-initiated dermatitis who present with ongoing endogenous-like eczema.

Type IV hypersensitivity from rubber chemicals: a 15-year experience in Taiwan.

BACKGROUND: Allergic contact dermatitis from rubber chemicals is frequent but has not been reported form Asia. OBJECTIVE: To study the pattern of type IV allergy to rubber chemicals in a Chinese-based population. METHODS: A retrospective study was conducted by reviewing the patch test results of 2,235 (604 men, 1,631 women) patients from January 1986 to December 2000. RESULTS: Ninety-nine patients (4.4%) had one or more positive reactions, 42 (6.9%) men and 57 (3.5%) women. The incidence did not increase throughout the study period. Among thiuram, mercapto, carba and black-rubber mix, thiuram is the most potent sensitizer, mostly for the hand and mercapto mix for the foot. Thiuram allergy is considered occupation related, while mercapto allergy, mostly from rubber slippers, is not typically related to an occupation. A negative correlation between thiuram and carba was found despite the frequent association between these two mixes. A high risk of rubber sensitization was noted in construction, health service, transportation, agriculture and hairdressing workers. A high frequency of concomitant sensitivity to cobalt was found. CONCLUSION: This is the first statistically analyzed study of rubber chemical allergy in Asia, which supports major trends concerning rubber chemical allergy from European studies. However, wearing rubber slippers in Taiwan contributes to the high percentage of foot dermatitis. Carba should still be retained in the European standard series because of the coexistence of thiuram and carba in rubber products. The concomitant sensitization to cobalt in rubber-allergic patients needs further evaluations.

Occupational dermatoses.

PURPOSE OF REVIEW: All terms referring to job-related (occupational) rashes are clearly defined. Ranking as the second most common occupational disorder, the importance of occupational dermatoses is illustrated. RECENT FINDINGS: 90-95% of occupational dermatoses result from a contact-type dermatitis. Until recently, 4/5 cases were believed to be of the irritant, rather than allergic type of contact dermatitis, however, with more extensive patch testing, more than half the cases were found to be allergic. SUMMARY: The direct causes of occupational dermatoses: chemical, mechanical, physical, and biological in nature are presented. The implications of assigning the degree and type of occupational dermatoses are explained. Workmans compensation is based on a no-fault arrangement, stating that unrestricted treatment and compensation is allowable only when negligence on the part of the employer is proven. Employee benefits are then determined by the duration and degree of disability sustained - all of which becomes litigational. Predisposing host factors, i.e. intellectual ability, anatomic site, atopy, skin pigmentation, age of skin, and immunosuppression (by disease or medication) are usually ignored. Environmental factors at the workplace must be considered conducive to occupational diseases. The full spectrum of irritant contact dermatitis is discussed with examples of each described. Allergic contact dermatitis and patch testing - the gold standard for identification of putative allergens is extensively discussed. Differentiating irritant contact dermatitis from allergic contact dermatitis is elucidated. The other non-contact type skin reactions are briefly mentioned.

An investigation of the effect of prolonged glove wearing on the hand skin health of dental healthcare workers.

OBJECTIVES: Glove wearing during patient treatment has been central to dental surgery infection control for over 15 years. However, little is known about the cutaneous effects of glove wearing on the hands of dental healthcare workers (DHCWs). The objective of this project was to assess the hand skin health of DHCWs before and after wearing gloves of two types and to compare this with a control group of non-DHCWs. METHODS: Following a mailing to all dentists in the West of Scotland, 50 DHCWs who wore gloves during dental treatment procedures for a minimum of 8h daily for at least 4 days per week were invited to participate in the project. The control group comprised 25 subjects who did not routinely use surgical or examination gloves. Hands were assessed by clinical examination and by transepidermal water loss at baseline, 1 month and 3 months. RESULTS: Of the 50 DHCWs, 26 wore a non-powdered latex glove (Microtouch Powder-free: Johnson and Johnson, Arligton, TX, US), and 24 wore a nitrile glove (Hartalega SDN BHD, Malaysia) from the time of the baseline examination until the 3-month examination. No differences were observed in hand skin health between the control group and the DHCWs at baseline, nor between those wearing the latex or nitrile gloves during the 3 month period of the study. CONCLUSION: It is concluded that the hand skin health of the DHCWs examined were no different from those of a control group of non-DHCWs, and that the wearing of the two types of gloves used in the 3 month study had no significant effect.

Infection control in South African oral hygiene practice.

OBJECTIVE: The aim was to gain information about the practice of infection control in oral hygiene practice. METHODS: A questionnaire based on OSHA and CDC guidelines was submitted to oral hygienists who attended a refresher course followed by a second posted questionnaire seeking information about hand hygiene practice. The questions were directed to observance of personal protection by oral hygienists and the application of procedures required for infection control in the surgery. RESULTS: 87.5% wore face masks but the proper use of facial protection, overcoats and disposable overcoats was reported by fewer than 50%. A total of 97% wore gloves and 88% changed gloves between patients. Skin reactions to gloves were reported by 26%. Only 7% had not been vaccinated against hepatitis B. The correct procedures for sterilising equipment and instruments were carried out by fewer than 50%, and 57% of participants wanted an improvement of infection control arrangements in their workplace. CONCLUSION: It is concluded that a need exists for proper practice of infection control by oral hygienists which can be remedied by interceptive and preventive education and peer pressure.

Efficacy of a skin-protective foam in the treatment of chronic hand dermatitis.

BACKGROUND: Irritant and/or allergic hand dermatitis in individuals who are unable to avoid causative exposures is difficult to control. Usefulness of protective creams has been generally unsatisfactory. OBJECTIVE: To determine if hand dermatitis, primarily of an occupational nature, could be improved by the use of a protective foam containing dimethicone and glycerin. METHODS: Adult male and female subjects with chronic hand dermatitis for at least 12 months, felt to be either allergic, irritant, or combined in nature were given the study foam for routine application after a 2-week observation period. At 2 and 6 weeks the skin was evaluated by the investigator and subject for parameters including redness, scaling, fissuring, blistering, and pruritus on a numerical scale. A global evaluation also was performed. Photographs were taken at each visit. Usage of topical corticosteroids was recorded. No systemic therapies other than antihistamines were allowed. RESULTS: Thirty-one subjects were enrolled in the study and 28 completed it. The physician and subject's initial global evaluations averaged 6.13 and 5.48, respectively (0-10 scale). The final scores were 3.68 and 4.75, respectively (P < .001 for physician rating; P = .259 for subject rating). Topical corticosteroid usage was reduced in 16 of 30 (53.6%) subjects. Twenty-one of 30 subjects (70.0%) had improved over the course of the study. No adverse effects were noted. CONCLUSION: This protective foam greatly or moderately improved chronic hand dermatitis in a sizable number of individuals with previously uncontrolled dermatitis despite continuing in their regular occupation.

[Skin diseases related to work: how to approach them?]. / Maladies cutanées liées au travail: comment les aborder?

Work-related skin problems are frequent and mainly affect the hands. They can be approached by looking for indications of the 3 principal underlying types of dermatitis: irritant, allergic, or chronic. Irritation and contact allergy are closely associated: the irritation facilitates the flowering of the allergy. Skin irritation due to working conditions is often multi-causal and repetitive. Cutaneous atopy--but not that which is only respiratory or mucosal--is the main genetic risk factor for the development of a work-related skin disease. The characteristics of irritation and allergy tend to merge when the lesions become chronic. An 8-step process is suggested to establish the causal relationship between potentially damaging substances in the workplace and the resulting skin problems. In Switzerland, professional dermatitis falls under the purview of the accident insurance laws. These laws recognize causal responsibility whenever the work substances or activities are preponderant over non-professional causes.