Presenteeism in a Dutch hand eczema population-a cross-sectional survey.

BACKGROUND: Presenteeism (attending work despite complaints and ill health, which should prompt rest and absence) has been overlooked in the field of hand eczema. OBJECTIVES: To examine the 1-year prevalence of presenteeism related to hand eczema in a population of hand eczema patients who visited a tertiary referral centre. Secondary objectives: to identify intrinsic/extrinsic reasons for presenteeism and to evaluate associated factors. METHODS: This was a cross-sectional questionnaire study. Presenteeism was defined as "going to work despite feeling you should have taken sick leave because of hand eczema". Respondents answered questions about socio-demographic factors, clinical features, occupational characteristics, and hand eczema related to occupational exposure. RESULTS: Forty-one per cent (141/346) of patients who had both worked and had hand eczema during the past 12 months reported presenteeism. The most often reported reasons were: "Because I do not want to give in to my impairment/weakness" (46%) and "Because I enjoy my work" (40%). Presenteeism was associated with: mean hand eczema severity; absenteeism because of hand eczema; improvement of hand eczema when away from work; and high-risk occupations. CONCLUSIONS: In this study, presenteeism was common and predominantly observed in patients with more severe hand eczema and occupational exposure. The most frequently reported reasons for presenteeism were of an intrinsic nature.

Health-related quality of life in adult dermatitis patients stratified by filaggrin genotype.

BACKGROUND: Information concerning health-related quality of life (HRQoL) and comorbidities of adult dermatitis patients stratified by loss-of-function mutations in the filaggrin gene (FLG) is limited. OBJECTIVE: To investigate HRQoL, skin symptoms and comorbidities in adult FLG mutation carriers. METHODS: This cross-sectional study included patients diagnosed with atopic dermatitis and/or hand eczema (n = 520). Patients completed questionnaires about dermatitis, skin symptoms, HRQoL, and comorbidities, including actinic keratosis, and atopic and mental disorders. RESULTS: FLG mutations (R501X, 2282del4, and R2447X) were identified in 16.9% of patients, and were significantly associated not only with atopic dermatitis, but also independently with skin fissures on the fingers and heels, and self-reported actinic keratosis. Although FLG mutations were significantly associated with reduced HRQoL, as measured by use of the Dermatology Life Quality Index (DLQI), no association with self-reported anxiety or depression was identified. Notably, the highest median DLQI score, reflecting greater impairment, was reported by patients with both FLG mutations and atopic dermatitis. Overall, 19.7% of patients with both atopic dermatitis and FLG mutations reported a 'large or extremely large' impact on their lives; this represents twice the prevalence seen in patients with atopic dermatitis and wild-type FLG (9.6%). CONCLUSION: Patients with both atopic dermatitis and common FLG mutations are more frequently affected by reduced HRQoL.

[Guidelines for the preventive health care of hairdressing apprentices]. / Wytyczne do opieki profilaktycznej nad uczniami szkól fryzjerskich.

Hairdressing is one of the most developing branch of the service industry in Poland. Providing representatives of this occupational group with preventive health care services it should be remembered that they are at risk of skin and respiratory diseases, which occur due to a quite frequent exposure to harmful agents in the work environment of hairdressers and hairdressing apprentices. Interestingly, a much lower number of researches concentrate on respiratory symptoms than on skin disorders in hairdressers. The authors of this article have carried out the first Polish follow-up study focused not only on skin disorders but also on respiratory tract symptoms in hairdressing apprentices. The results of the study have been reported in other publications while this paper presents a literature review based on EBSCO and PubMed databases, Elsevier and contained articles (on the subject discussed in this paper). On the basis of information obtained from the authors' own research evidence and from the literature review, the guidelines for the preventive health care of hairdressing apprentices were developed. It was confirmed that neither determination of allergen-specific immunoglobulin E (IgE) nor performance of skin prick tests (SPTs) and patch tests for hairdressing factors are necessary. They should be performed as a part of preventive medical examination only in those apprentice candidates and trainees in this profession who report work-related symptoms and it is suspected that they result from exposure to particular factor in the work environment. Med Pr 2017;68(5):677-687.

Skin health and safety at work in Croatian hairdressing apprentices.

BACKGROUND: The risk of developing occupational skin disease (OSD) is high in hairdressers, but may differ between countries. OBJECTIVE: To evaluate safety at work measures, and the prevalence and severity of skin symptoms and their impact on quality of life (QoL), among Croatian hairdressing apprentices. METHODS: Data on self-reported skin symptoms, safety measures and QoL were collected for 101 final-year apprentices. The presence and severity of skin lesions were assessed with the Osnabrueck Hand Eczema Severity Index (OHSI). Transepidermal water loss (TEWL) was measured on the forearm and hand. RESULTS: Ninety-one percent of apprentices reported wearing gloves while dyeing hair, 45% while rinsing hair dyes, and 4% while washing hair. A history of skin symptoms was found in 35% of apprentices, and a history of dry hands in 37%. Skin changes were clinically observed in 40% of apprentices, most frequently erythema, infiltration, and desquamation. The OHSI score ranged from 0 to 6. Only washing hands >20 times per day was positively associated with TEWL. A history of skin symptoms negatively correlated with self-esteem, and social and mental functioning, and positively with anxiety and depression. CONCLUSIONS: The results indicate the need for the continuation of efforts to establish effective primary preventive programmes for OSDs at national and EU levels.

Tertiary individual prevention improves mental health in patients with severe occupational hand eczema.

BACKGROUND: Occupational hand eczema (OHE) is associated with impaired health-related quality of life (QoL) and mental distress. Interdisciplinary inpatient rehabilitation measures in the framework of tertiary individual prevention (TIP) offered by the German employers' liability insurance associations include dermatological treatment, education and psychological interventions. OBJECTIVE: To investigate the effects of interdisciplinary inpatient rehabilitation in the framework of TIP on mental health in patients with severe OHE and the relationships between recovery of OHE and improvement of mental health and QoL. METHODS: A total of 122 patients participated in the study. A test battery consisting of the German versions of the Hospital Anxiety and Depression Scale (HADS-D), the Dermatology Life Quality Index (DLQI), the Short Form Health Survey-36 (SF-36) and the Trier Inventory for the Assessment of Chronic Stress (TICS) was applied at the time of admission (T1) and 3 weeks after dismissal (T2). Severity of hand eczema was assessed with the Osnabrueck Hand Eczema Severity Index (OHSI). RESULTS: All parameters improved significantly from T1 to T2. A relationship was established between the improvement of QoL and recovery of OHE, while there was no such relationship between the improvement of mental distress and improvement of OHE. Nonresponders had significantly more cumulative days of sickness at T1. CONCLUSIONS: Our data underscore the importance of psychological interventions in addition to dermatological treatment in the framework of prevention measures for OHE. These measures should be applied at an early stage of OHE prior to the occurrence of sick leave.

Clinical profile and quality of life of patients with occupational contact dermatitis from New Delhi, India.

BACKGROUND: Data regarding occupational contact dermatitis (OCD) and its effect on quality of life (QOL) in India are limited. OBJECTIVES/AIMS: To evaluate patients with OCD and record the outcome of treatment. PATIENTS/MATERIALS/METHODS: All patients with OCD were evaluated for severity of disease (by the use of physician global assessment) and its effect on QOL (by use of the Dermatology Life Quality Index) questionnaire) at the first visit and after 3 months of treatment. RESULTS: Among 117 patients with OCD, hand eczema was present in 81.2%. Positive patch test reactions were found in 76%. The most common allergens were Parthenium hysterophorus and potassium dichromate. The most frequent diagnosis was occupational allergic contact dermatitis (OACD) (57%), caused by farming and construction work, followed by occupational irritant contact dermatitis (OICD) (24%), caused by wet work. Severe psychosocial distress was recorded in 62.5% of patients. After 3 months of treatment, 83% improved significantly, and 54% had improvement in QOL. CONCLUSIONS: Farmers were most frequently affected, followed by construction workers and housewives. OACD was found at a higher frequency than OICD. The most frequent allergens were Parthenium hysterophorus in farmers, potassium dichromate in construction workers, and vegetables in housewives. OCD has a significant impact on QOL. Patch testing, in addition to standard treatment, improves the outcome considerably.

Evaluation of structured patient education in occupational skin diseases: a systematic assessment of the disease-specific knowledge.

PURPOSE: The aim of this study was to evaluate the effectiveness of patient education in occupational skin diseases (OSD) regarding changes of the disease-specific knowledge. METHODS: One hundred and five patients participated in structured patient education as part of an interdisciplinary outpatient prevention measure. In a prospective one-group pre-post-design, the disease-specific knowledge was assessed with the validated "Occupational Skin Diseases Knowledge Questionnaire" (OSD-KQ) before (T0) and after the intervention (T1). A subcohort (n = 68) was examined 2-3 months later (T2). RESULTS: The mean OSD-KQ score significantly improved from 38.5 (59.2% of correct answers, T0) to 55.6 (85.5% of correct answers, T1). A pronounced heterogeneity was observed among the participants regarding the pre-interventional knowledge (10.8-84.6% of correct answers, T0) and the individual knowledge gain. Patients who worked in health-related occupations scored significantly higher. Age and sex did not influence the knowledge. In a subcohort, a significantly improved disease-specific knowledge of 52.3 (80.5% of correct answers) could still be found 2-3 months after the intervention (T2). CONCLUSIONS: Structured patient education significantly improves the disease-specific knowledge in patients with OSD. The study indicates not only positive short- but also sustainable long-term effects on the knowledge gain. The OSD-KQ can serve as a tool to evaluate and improve patient education. Health educators need to be aware of the heterogeneity regarding the participants' knowledge and take this into account during educational practice. Additional counseling may be necessary to meet the individual learners' needs.

[Hand eczema : disability and impact]. / Eczéma des mains : handicap et impact.

INTRODUCTION: Hand eczema is a dermatological condition that may lead to physical and psychological disability, with psychological impact on social relationships, daily life activities and work. OBJECTIVES: Review of the literature on the impact of eczema of the hands and resulting disabilities. METHODS: Medline and Embase search from 1990 to 2013. RESULTS: Hand eczema is a disabling disease because of its poor prognosis. It has an impact on quality of life, which has been assessed using generic scales (MOS-SF36 and EQ-5D) and generic dermatological scales (DLQI and the Skindex). There are no quality-of-life scales specific to hand eczema. This dermatosis may also have repercussions on work, resulting in absenteeism and at times requiring occupational retraining. Hand eczema has economic repercussions with several factors to be taken into account such as medical consultations, medical expenses, loss of productivity, work leave, changes in job position, compensation, and the need for occupational retraining. CONCLUSION: Management of hand eczema by a dermatologist requires taking into account the importance of the physical and psychological disability and the consequences on social relations, activities of daily life, and work. In this context, measuring quality of life is important in assessing patients'perception of the disease and their experience.

[Definition and psychopathology of chronic hand dermatitis]. / Définition et psychopathologie de la dermite chronique des mains.

Psychopathology in patients with DCM is as complex as its clinical forms where the factors are numerous and often intricate. It combines psychophysiological, psychopathological factors, behavioral disorders which can be the cause or the consequence of DCM but also the negative impact on quality of life and the simplest daily activities. DCM affects the quality of life of every patient, regardless of the severity. Women are more affected by the DCM that man older age, male sex, atopy and the existence of a contact sensitization are independent risk factors of severity. Depression may affect up to 10 % of patients, should involve greater attention from dermatologists and general practitioners. Health authorities and all health actors should be aware of interactions between secondary cognitive troubles or inherent to DCM and efforts required in terms of preventive measures. Thus, the presence of psychiatric comorbidity is more common in patients with chronic dermatoses. Today it is considered that the emotional environment, built by the mother - child relationship must be optimal, otherwise the mental stability of body image may be compromised. Diminished self-esteem, affects less well managed and somatic expression of emotional content. Recently, a surprising study showed that most patients with refractory occupational dermatitis were not able to recognize the warning sign of flare or the role of psychological factors in the formation and maintenance of the dermatose. In fact, they rejected their personal responsibility in the occurrence of the new flare. To address this public health problem, health authorities, trainers and caregivers should be aware of the cognitive impact of DCM in these patients and interactions with current means of prevention. The role of obsessive-compulsive washing as part of an anxiety disorder or personality disorder is most likely a contributing or maintaining factor systematically underestimated in the pathogenesis of DCM and in the therapeutic management.

Carriers of filaggrin gene (FLG) mutations avoid professional exposure to irritants in adulthood.

BACKGROUND: Loss-of-function mutations in the filaggrin gene (FLG) are associated with xerosis, atopic dermatitis, and early onset of hand eczema. Irritant exposure is a risk factor for occupational hand eczema, and FLG mutations increase the risk of occupational irritant contact dermatitis on the hands in hospital cohorts. It is unknown whether FLG mutations affect the level of irritant exposure. OBJECTIVES: To evaluate whether exposure to occupational irritants was dependent on FLG mutations, atopic dermatitis, and age at hand eczema onset. METHODS: Randomly chosen Danish adults completed a questionnaire on general health and occupational exposures. Genotyping for FLG mutations (R501X, 2282del4, and R2447X) and patch testing were performed. RESULTS: Overall, 38.7% of subjects reported present or previous occupational exposure to irritants. Among individuals who reported hand eczema onset before entering their work life, 50.6% (45/89) of FLG non-mutation carriers became exposed to irritants, as compared with 28.6% (4/14) of heterozygous and 0% (0/6) of homozygous mutation carriers (p = 0.006). Avoidance was conspicuous among mutation carriers reporting childhood hand eczema and atopic dermatitis (odds ratio 0.08, 95% confidence interval 0.01-0.65). CONCLUSIONS: Carriers of FLG mutations who have had hand eczema onset in childhood avoid occupational exposure to irritants; the association is most marked with homozygous mutation status combined with atopic dermatitis.

Illness perception and quality of life in patients with contact dermatitis.

BACKGROUND: People's subjective perceptions of illness are important determinants of their ways of coping with health threats and the ensuing physical and mental outcomes, including quality of life (QoL), which has been consistently reported to be impaired by contact dermatitis. OBJECTIVES: To investigate the relationships of subjective illness perceptions and dermatological QoL in atopic, contact and occupational dermatitis patients and a comparison group of patients with other dermatological diseases. PATIENTS AND METHODS: Three hundred and three patients of four diagnostic groups filled in the Brief Illness Perception Questionnaire and the Skindex-16 (+ occupational impact items) Dermatological QoL questionnaire before clinical examination and patch testing. RESULTS: Perceptions of serious consequences, greater symptom burden and more uncertainty and worry were associated with lower QoL (r(s) > 0.50). Overall, patients reported low personal control over their condition and low understanding of the disease (3.5 and 4.8, respectively, on a 0-10 scale). QoL was most impaired among occupational dermatitis patients (mean = 46) and least impaired among patients who were later diagnosed as suffering from conditions other than contact dermatitis (mean = 62). CONCLUSIONS: Identifying critical components of illness perceptions in patients with atopic, contact and occupational dermatitis may enable the design of consultations and interventions to fit patients' perceptions, which could affect their QoL.

Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema.

BACKGROUND: Occupational hand eczema is one of the most frequent occupational diseases. Few data about the prevalence of mental comorbidities are available. Objectives. We aimed to investigate the prevalence of anxiety, depression symptoms, the impairment of health-related quality of life (HRQoL) and their correlates in patients with occupational hand eczema. PATIENTS AND METHODS: A test battery consisting of the German versions of the Hospital Anxiety and Depression Scale, the Dermatology Life Quality Index (DLQI) as a specific instrument and the Short Form Health Survey-36 (SF-36) as a generic instrument for HRQoL was applied in 122 patients. The severity of hand eczema was assessed with the Osnabrueck Hand Eczema Severity Index (OHSI). RESULTS: Twenty per cent of patients had a positive anxiety score, and 14% had a positive depression score. Higher anxiety levels, a greater impairment in the SF-36 mental component summary score and a higher DLQI category score for symptoms and feelings was detected in females than in males. The OHSI correlated with the impairment in HRQoL, and an association of severe hand eczema with symptoms of anxiety and depression was found in males. CONCLUSIONS: We found a high prevalence of anxiety and depression in our study population of patients with occupational hand eczema. Preventive measures should consider the psychosocial implications of occupational hand eczema.

Disease severity and quality of life in a follow-up study of patients with occupational contact dermatitis.

BACKGROUND: Few studies have investigated how occupational contact dermatitis and its severity affect patients' quality of life (QoL). OBJECTIVES: To investigate the impact of occupational contact dermatitis and its severity on patients' QoL, and to examine the association between different QoL measures. METHOD: Patients previously diagnosed with occupational contact dermatitis completed the Short Form Health Survey (SF-36) and Dermatology Life Quality Index (DLQI). Disease severity was rated both by the patient and by the physician. RESULTS: Of a possible 725, a total of 119 patients (16.4%) were included in the study, and, at follow-up, just over 21% had normal skin and 18.3% had progressed to persistent dermatitis. The SF-36 median physical component summary score was 52 [interquartile range (IQR): 43-56] and the mental component summary median score was 51 (IQR: 44-57). The correlation between patient-rated and physician-rated disease severity was moderate (r = 0.708, p < 0.00001). The correlation between the disease severity measures and DLQI was moderate, whereas the SF-36 correlated poorly with both the DLQI and disease severity measures. CONCLUSIONS: QoL was generally reduced in this group of patients with occupational contact dermatitis, with some correlation between severity and DLQI. The DLQI was a more sensitive measurement of QoL than the SF-36 in this patient population. Incorporating disease severity rating with a QoL questionnaire is valuable in occupational contact dermatitis and is recommended.

Hand eczema among Hong Kong nurses: a self-report questionnaire survey conducted in a regional hospital.

BACKGROUND: Hand eczema is common in the nursing profession, and has been reported widely in various parts of the world. OBJECTIVES: The aim of this study was to determine the prevalence and severity of hand eczema among nurses working in a regional hospital in Hong Kong, as well as its psychosocial impact and any possible associated risk factors. PATIENTS/MATERIALS/METHODS: The study took the form of a self-report questionnaire survey; 1240 nurses in a regional hospital were asked to participate in the survey by completing the questionnaire and returning it anonymously within 2 weeks. RESULTS: Seven hundred and twenty-four nurses returned the questionnaire (a response rate of 59%). The prevalence of hand eczema among the respondents was 22.1% (160/724). More than 90% had moderate to severe hand eczema. Itchiness and dryness were the most common symptoms. Occupational work, housework, mood, social activities and sleep were particularly affected. Multinomial logistic regressions showed that a personal or family history of atopy and a hand washing frequency of >20 times per day were independent risk factors for hand eczema. CONCLUSIONS: Hand eczema is common and severe among Hong Kong nurses. The results of this study suggest that hand eczema is an important problem for nurses and that preventive measures should be emphasized.

Effects of a health-educational and psychological intervention on socio-cognitive determinants of skin protection behaviour in individuals with occupational dermatoses.

PURPOSE: Occupational skin diseases are a significant public health concern. Little is known about the cognitive representations individuals with occupational skin disease have towards measures of personal skin protection and occupational safety and whether they change during an intervention. We aimed to evaluate whether social cognitions as embodied by the theory of planned behaviour become more favourable during a tertiary inpatient individual prevention programme (TIP) and whether the model's predictions hold in a setting to which the model has not been applied. METHODS: We used a longitudinal design. A questionnaire, assessing the theory of planned behaviour variables attitude, subjective and descriptive norm, perceived behavioural control and behavioural intention was developed and administered to 101 patients before (at admission) and after (at discharge) a 3-week inpatient TIP. RESULTS: The scales showed good internal consistency. Before the TIP, patients had favourable cognitions towards skin protection measures and these improved during the TIP. Attitude, perceived behavioural control and intention to perform skin protection significantly increased during TIP. Attitude and perceived behavioural control were significant predictors of behavioural intention in multiple regression analyses with perceived behavioural control being the strongest predictor in the equations. Descriptive norm was a significant predictor of intention only at admission but not at discharge. CONCLUSION: This is the first study attempting to explain the motivation to perform skin protection measures in patients with occupational skin disease by applying an otherwise well established health-behaviour theory. The results emphasise the importance of health-educational and psychological interventions for patients with occupational skin disease. Promoting personal control over and attitudes towards skin protection measures may enhance the occupational health of individuals with occupational skin disease.

[Rehabilitation for occupational dermatoses. Outpatient and inpatient measures]. / Rehabilitation bei Berufsdermatosen. Ambulante und stationäre Massnahmen.

In recent years, the number of reports of suspicions of occupational diseases, received by the public statutory employer's liability insurance bodies, has remained constant. The recognition of occupational diseases under number 5101 BKV, however, has decreased considerably. This is more than likely due to improved prevention management concepts by the public statutory employer's liability insurance bodies. Nevertheless there are still severe occupational skin diseases that are resistant to or relapse under therapy, thus threatening discontinuation of the occupation. For these cases, an interdisciplinary inpatient treatment as a tertiary individual prevention measure was introduced. This consists of a three-week inpatient period followed by a three-week outpatient sick leave for further stabilization of the skin condition. During the inpatient stay intensive dermatological diagnosis and treatment are accompanied by in-depth health education seminars and psychological interventions. The selection of individually suitable skin protection measures and their practical trial in a workplace simulation model with an ergotherapist are of particular importance. Evaluations of this program showed that two-thirds of the participants with the defined risk of having to give up their occupation were able to continue with their occupation on a long-term basis.

Self-image and quality of life of dermatology patients.

OBJECTIVES: The problems of self-image among patients with dermal problems have been seldom explored. As dermal diseases detrimentally affect well-being, functioning and adaptation of dermatology patients, they may decrease the level of self-acceptance. Self-image, on the other hand, may significantly affect the own mental health status and quality of life (QoL) in that group of patients. The aim of our research was to assess mental health status and quality of life of patients with dermal problems in respect of the level of their self-acceptance. MATERIALS AND METHODS: The participants were patients of the Occupational Diseases Outpatient Clinic and the Occupational and Environmental Allergy Centre of the Nofer Institute of Occupational Medicine (NIOM). In total, 112 patients were examined, including 37 with diagnosed urticaria, 50 with allergic contact dermatitis and 25 with atopic dermatitis. General Health Questionnaire (GHQ) was used to assess patients' mental health, a Polish version of Dermatology Life Quality Index (DLQI) was employed for the assessment of their life quality, while Self-Acceptance Scale (SAS) served to obtain patients' self-image. RESULTS: There were statistically significant differences in the assessment of mental health and quality of life, depending on the level of self-acceptance. People with high self-acceptance are characterised by better mental health condition than those with low self-acceptance (t=4.8; p=0.00). The patients with negative self-image (compared to those with positive self-image) deem also their quality of life to be poor (t=3.1; p=0.00). CONCLUSION: A relationship has been found to exist both between mental health condition and the subjective assessment of life quality, and self-image. Thus, both patient's mental health status and his/her self image constitute major determinants of the quality of life that are worth to be monitored in dermatology patients. Their treatment procedure should include also psychological consulting or psychotherapy.

Are obsessive-compulsive disorders and personality disorders sufficiently considered in occupational dermatoses? A discussion based on three case reports.

Hand dermatitis is relatively common in the general population. Among work-related diseases, it is the most common form of occupational skin disease. Irritant hand dermatitis is the most frequent type. Besides wet work and direct contact to irritating occupational substances frequent hand washing can damage the barrier function of the skin facilitating the manifestation of hand dermatitis that frequently occurs chronically. According to own observations the role of obsessive-compulsive washing as part of an anxiety disorder or personality disorders may not be considered sufficiently. A possible pathogenetic relation between hand dermatitis and psychogenic disorders is discussed in a 22-year old physician's assistant, a 50-year old male nurse working in intensive care, and a 54-year old cleaner. All three patients complained about feelings of revulsion, fear of contamination and a high frequency of hand washing. These cases may encourage dermatologists to consider psychological aspects of hand dermatitis e.g. obsessive compulsive washing, overcome their inhibitions and consider these aspects in an integrated way when planning patient's therapy.

Intervention development in occupational research: an example from the printing industry.

BACKGROUND: Intervention development research is an essential prerequisite of any study that attempts to determine whether specific interventions work to prevent work related injury and illness. METHODS: Focus groups (n = 5) and direct observational studies (n = 21) of printers were used to elicit key issues that would aid the development of subsequent interventions. Transcripts from these were analysed by standard qualitative methods to identify common and related themes. RESULTS: The views of managers differed significantly from those of print workers in a number of areas, and working practices did not always follow policy. The majority of printers did not perceive dermatitis to be a major problem, although many complained of dry hands. Other key results included: the lack of skin care policy in most companies; poor understanding of the nature, causes, and treatment of dermatitis; low priority of dermatitis within health and safety concerns; little or no provision of occupational health services, particularly skin checks; variability in provision of and access to appropriate skin protection; and lack of accessible washing facilities. CONCLUSIONS: As a result it was decided to evaluate the implementation of four INTERVENTIONS: provision of (1) skin checks and treatment advice; (2) gloves of the correct type and size, and use of an after-work cream; (3) information on dermatitis within the printing industry; and (4) development of best practice skin care policy.