Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries.

BACKGROUND: Work-related skin diseases (WSD) are caused or worsened by a professional activity. Occupational skin diseases (OSD) need to fulfil additional legal criteria which differ from country to country. OSD range amongst the five most frequently notified occupational diseases (musculoskeletal diseases, neurologic diseases, lung diseases, diseases of the sensory organs, skin diseases) in Europe. OBJECTIVE: To retrieve information and compare the current state of national frameworks and pathways to manage patients with occupational skin disease with regard to prevention, diagnosis, treatment and rehabilitation in different European countries. METHODS: A questionnaire-based survey of the current situation regarding OSD patient management pathways was carried out with experts on occupational dermatology and/or occupational medicine from 28 European countries contributing to the European Cooperation in Science and Technology (COST) Action TD 1206 (StanDerm) (www.standerm.eu). RESULTS: Besides a national health service or a statutory health insurance, most European member states implemented a second insurance scheme specifically geared at occupational diseases [insurance against occupational risks (synonyms: insurance against work accidents and occupational injuries; statutory social accident insurance)]. Legal standards for the assessment of occupationally triggered diseases with a genetic background differ between different countries, however, in most European member states recognition as OSD is possible. In one-third of the countries UV light-induced tumours can be recognized as OSD under specific conditions. CONCLUSION: OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14.

BACKGROUND: Contact allergy is a common condition and can severely interfere with daily life or professional activities. Due to changes in exposures, such as introduction of new substances, new products or formulations and regulatory intervention, the spectrum of contact sensitization changes. OBJECTIVE: To evaluate the current spectrum of contact allergy to allergens present in the European baseline series (EBS) across Europe. METHODS: Retrospective analysis of data collected by the European Surveillance System on Contact Allergies (ESSCA, www.essca-dc.org) in consecutively patch-tested patients, 2013/14, in 46 departments in 12 European countries. RESULTS: Altogether, 31 689 patients were included in the analysis. Compared to a similar analysis in 2004, the prevalence of contact allergy to methylisothiazolinone went up to around 20% in several departments. In comparison, contact allergy to the metals nickel, cobalt and chromium remained largely stable, at 18.1%, 5.9% and 3.2%, respectively, similar to mostly unchanged prevalence with fragrance mix I, II and Myroxylon pereirae (balsam of Peru) at 7.3%, 3.8% and 5.3%, respectively. In the subgroup of departments diagnosing (mainly) patients with occupational contact dermatitis, the prevalence of work-related contact allergies such as epoxy resin or rubber additives was found to be increased, compared to general dermatology departments. CONCLUSION: Continuous surveillance of contact allergy based on network data offers the identification of time trends or persisting problems, and thus enables focussing in-depth research (subgroup analyses, exposure analysis) on areas where it is needed.

Occupational contact dermatitis to acrylates in a manicurist.

We report the case of a manicurist who developed an allergic skin reaction to acrylates, manifested by bullous lesions on fingertips and eczema of the hands and ears. Patch tests showed positive reactions to 2-hydroxyethyl methacrylate, 2-hydroxypropyl methacrylate, ethyleneglycol dimethacrylate, triethyleneglycol dimethacrylate, 1,6-hexandiol diacrylate, 2-hydroxyethyl acrylate and triethyleneglycol diacrylate. Because of her skin disorder, she had to give up her job. She was not correctly advised on retraining and started to work as a dental nurse. Soon after re-exposure to acrylates in dental materials, she experienced recurrence of the skin symptoms.

The effect of the working environment on occupational skin disease development in workers processing rockwool.

Our examinations involved 259 workers (46 females and 213 males) manufacturing insulation matting of rockwool and phenol-formaldehyde resin. The control group included 529 people. All of the subjects were patch-tested. The age-adjusted relative risk was used as a measure for evaluating the increase in the incidence of dermatitis and allergy to metals. An atomic absorption method was used to determine metal content in rockwool. Dermatitis was found in every fourth subject examined, oil acne in every tenth subject; 7.3% of the subjects examined were found to be allergy-positive to nickel, 6.9% to chromium, 5.0% to cobalt, 3.1% to formaldehyde, 1.5% to phenol-formaldehyde resin, 0% to phenol. Out of the 39 subjects examined twice (in 1988 and 1990), 5 were found to be allergy-positive to nickel during the second examination. A statistically significant increase in the risk of incidence of occupational dermatitis and allergy to nickel and cobalt was found in people producing insulation products made of rockwool. The latter material was found to contain 200 ppm chromium, 88 ppm nickel and 29 ppm cobalt.

Occupational skin diseases among the nurses in the region of Lódz.

We examined 223 nurses from the Lódz region, referred to the Nofer Institute of Occupational Medicine in 1995-99 because of suspected occupational dermatoses. The diagnosis of contact allergy was based on the positive results of patch tests, and immediate allergy to common allergens and latex on the results of prick tests, as well as on the determinations of specific IgE antibodies. Contact allergy was diagnosed in 66.4% of nurses. The most frequent sensitisers were quaternary ammonium compounds (benzalkonium) (23.8%), nickel (21.5%) and formaldehyde (20.6%); allergy was somewhat less frequently caused by thimerosal (14.3%), fragrances (12.1%), glutaraldehyde (10.8%), cobalt (9.9%), thiurams (6.7%) or glyoxal (4.9%). Allergy to rubber was diagnosed in 40 patients (17.9%), including 25 cases of immediate allergy to latex, 8 cases of contact dermatitis from thiuram rubber curing accelerators, and 7 cases of mixed allergy. It has been concluded that the contact with disinfectants (40.8% of allergic nurses), metals (30.9%) and rubber (17.9%) was the most frequent source of allergy in this group of medical personnel.

Occupational allergy to aldehydes in health care workers. Clinical observations. Experiments.

The incidence of allergy to aldehydes (formaldehyde, glutaraldehyde, glyoxal) was examined in 280 health care workers suffering from skin lesions. Allergy was diagnosed in 64 (22.8%) patients. The majority of them (85.9%) were sensitive only to 1 aldehyde. Formaldehyde caused allergy slightly more frequently (13.9%) than glutaraldehyde (12.4%). Only 5 (1.9%) patients were sensitive to glyoxal. The irritant effect of aldehydes to the rabbit eye and skin was tested by the Draize and OECD methods. Formaldehyde and glutaraldehyde showed stronger irritant effect than glyoxal. The sensitizing activity of aldehydes was also confirmed in guinea pigs (using the Maximization Test and the OECD methods). Formaldehyde showed the strongest and most persistent reactions. Significantly higher eosinophil and basophil counts were found in the blood samples of the sensitized guinea pigs. Cytotoxicity of glutaraldehyde and glyoxal was tested on mouse 3T3-L1 fibroblasts by the Neutral Red Uptake and MTT Reduction Assay. It was shown that both aldehydes were cytotoxic, and that the cytotoxic effect of glutaraldehyde was stronger than that of glyoxal.

[Results of patch tests using basic allergens in construction workers]. / Wyniki prób naskórkowych z podstawowymi alergenami zawodowymi u pracowników budownictwa.

A group of 853 construction industry workers exposed to irritants and allergens (mainly cement, lime, sand, water, lubricants and antiadhesive oils and a control group of 74 subjects (sawers) underwent patch tests after Jadassohn--Bloch with seven allergens most common in the construction industry working environment (compounds of chromium, nickel and cobalt, turpentine and three rubber allergens--mercantobenzothiazole, thiocarbamoyl and diphenylguanidine). Allergy was found in 25.5% of the construction industry workers, in this 7.7% were those with eczema and dermatitis, 17.8%--those with latent allergy (in 12.2% allergy was accompanied by dermatoses of non-allergic etiology, 5.6% construction workers no skin changes). The highest number of skin positive tests was that with chromium (22.4% of affected workers) and cobalt (12.4%). Most susceptible to allergy were: painters, bricklayers, carpenters, joiners, reinforcing concretors, terrazers, concretors, electricians, smiths and reinforcers. In addition, allergy was found to be dependent on age and length of employment.

[Mercury as an allergic factor]. / Rtec jako czynnik alergizujacy.

A current opinion on the allergenic effect of mercury is presented with particular reference to its organic mixtures (merthiolat, thimerosal). The contribution of preventive vaccinations to the allergy occurrence is discussed. It is suggested that the number of sensitized persons will be increasing because of routine vaccination of health service workers and medical students against viral hepatitis, very common in Poland.

[Preliminary assessment of the effect of disinfectants on skin changes in health service workers]. / Wstepna ocena wplywu srodków odkazajacych na powstawanie zmian skórnych u pracowników sluzby zdrowia.

During a five-year period (1 Jan. 1989 and 31 Oct. 1994) epidermal tests with disinfectants (formalin, sterinol, lysoformin, aldesan, septyl, chloramine, lysol, chlorhexidine) and their components (glutaraldehyd, phenol, hydroquinone) were performed on 322 health service workers examined at the Nofer Institute of Occupational Medicine due to suspected occupational dermatitis. It was found that 89 (27.6%) subjects examined were oversensitive, at least, to one disinfectant, mostly to formalin, sterinol (benzalkonium bromide), lysoformin and chloramine. Frequent occurrence of allergy to metals (nickel, cobalt, chromium, mercury) was observed in persons oversensitive to disinfectants.

[Disinfectants in health service institutions and frequency of their use]. / Srodki odkazajace w zakladach sluzby zdrowia rodzaj i czestosc stosowania.

On the basis of information obtained from sanitary and epidemiological stations places all over the country and from hospitals of the Lodz region it was found that about 60 types of disinfectants are now under use in Poland. The most frequent ones are: lysoformine, chloramine, aldesan, virkon, hypochloride, septil R, cidex, lysol, denatured alcohol, secuspet, aerodesine 2000, desoform, iodoseptane. Some of them contain well known allergenic factors (glutaraldehyde, benzalkonium, hydroquinone, phenol). Bearing in mind an increasing incidence of occupational skin diseases among health service workers it is postulated to continue studies of allergenic properties of disinfectants.

[Occupational allergy to acrylates--study of cases]. / Zawodowa alergia na akrylany--studium przypadków.

The results of patch tests with an acrylate series (29 chemical compounds) in 8 (3.4%) out of 235 patients with occupational dermatitis were presented. This group of patients consisted of four dentists--prosthodontists and four dental technicians. The following were the most frequent causes of allergy to acrylates: ethylene glycol dimethacrylate (5 positive patch tests), methyl methacrylate (4), 2-hydroxyethyl methacrylate (4), triethylene glycol dimethacrylate. Altogether there were 38 positive patch tests. Over-sensitivity to triacrylates, epoxy acrylate, N,N-methylenebis-acrylamide, urethan derivatives of acrylates and methacrylates was not observed. The most intense skin changes were observed in two prosthodontists involved as well ion general dentistry (deep fissures of digital pulp, trophic changes in nails) allergic to numerous acrylates and methacrylates (one to 14 and the other to 10).

[Occupational contact dermatitis induced by allergens present in rubber. I. Allergy to rubber accelerators]. / Zawodowe, kontaktowe zapalenie skóry spowodowane alergenami obecnymi w gumie. I. Uczulenie na przyspieszacze wulkanizacji.

During the period between January 1989 and 15 April 1994 allergy to chemical compounds present in rubber was found in 51 (15%) out of 339 patients with occupational dermatitis. In this group (20 workers of the metallurgical industry, 15 health service workers, 6 workers of the building and 3 of the rubber industries, 2 farmers and 5 drivers) the frequency of allergy to 15 accelerators of the thiuram group, thiocarbamates, thiazoles as well as derivatives of diphenylguanidine and thiocarbamide was investigated. Thiurams caused over-sensitivity in 52.9% of patients, thiocarbamates in 41.2%, thiazoles in 35.3%, guanidine derivatives in 11.8% and thiocarbamide in 9.8%. In general, allergy to thiocarbamates was concomitant with allergy to thiurams (20 out of 21 patients allergic to carbamates) and over-sensitivity to thiazoles was very often parallel to allergy to thiurams (8 out of 18 patients allergic to thiazoles). Accelerators present in the rubber of protective gloves proved to be the most frequent source of allergy especially in health service workers.

[Occupational contact dermatitis induced by allergens present in rubber. II. allergy to antioxidants]. / Zawodowe, kontaktowe zapalenie skóry spowodowane alergenami obecnymi w gumie. II. Uczulenie na antyutleniacze.

Out of 339 persons suffering from occupational dermatitis, the group of 51 patients (15%), allergic to rubber, were eligible for the study. The frequency of allergy to amine compounds and quinoline derivatives (8 chemical compounds), used in rubber mixtures to prevent rubber oxidation, was investigated. The group under study comprised of 20 workers of the metallurgic, 6 of the building and 3 of the rubber industries as well as 15 health service workers, 2 farmers and 5 drivers. Allergy to amine compounds was found in 30 persons (58.8%) and to quinoline derivatives in 5 persons (9.8%). N-isopropyl-N-phenyl-4-phenylenodiamine proved to be most allergenic (52.9% of allergic persons), then N-cyclohexyl-N-phenyl-4-phenylenodiamine (31.4%) and N,N-diphenyl-4-phenylenodiamine (23.5%). Allergy to amine antioxidants was two times higher among workers of the metallurgic and building industries as well as among farmers and drivers than in health service workers, and it was induced by contact with technical rubber.

[Allergic reaction to merthiolate (a disinfectant) based on material from the Occupational Medicine Institute in Lodz]. / Uczulajace dzialanie mertiolatu (preparat odkzzajacy) na podstawie materialu Instytutu Medycyny Pracy w Lodzi.

Incidence and causes of allergy to merthiolate (thimerosal) was studied in 685 patients, examined in the Nofer Institute of Occupational Medicine, during the period from 1 September 1993 to 15 October 1995. Allergy to thimerosal was diagnosed in 39 persons (5.7%) including 25 (6.3%) females and 14 (4.9%) males. Health service workers predominated among those sensitized (13.8% of all medical personnel examined during that period). In 19 persons only allergy to mercury was observed. Among them 7 showed no skin changes, 6 manifested symptoms of hand dermatitis, in 4 patients atopic dermatitis and in 2 dermatitis diseminata were diagnosed. Two patients suffered from allergic rhinitis. It was found that the general vaccination of health service workers against viral hepatitis as well as immunotherapy with pollen preparations containing thimerosal (Catalet, Biomed, Poland) were the main causes of allergy to mertiolate. Allergy to thiosalicyclic acid was not observed and two persons reacted positively to mercuric chloride.

[Causes of allergic occupational dermatitis diagnosed at the Institute of Occupational Medicine in Lodz during the last five years]. / Przyczyny uczuleniowego, zawodowego zapalenia skóry rozpoznanego w Instytucie Medycyny Pracy w Lodzi w ostatnim piecioleciu.

During the years 1988-1992 there were diagnosed 299 cases of allergic occupational eczema (115 females and 184 males). Among them 20.4% of patients were employed in health care and social welfare, 20.1% in the metallurgical and machine industries, 19.7% in the building industry and 9% in the textile and clothing industries. Allergy to nickel (45.2%), cobalt (40%), chromium (33.9%) and formalin (15.7%) was the most common cause of occupational allergy in females, while 63% of males were hypersensitive to chromium, 42.4% to cobalt, 17.4% to nickel and 14.7% to epidianes. When compared with the years 1972-1987 an increased incidence of occupational skin diseases was found especially in females, but also in health service workers as well as in workers employed by the metallurgical and machine industries. Chromium compounds still remain the main cause of occupational eczema, however, the number of persons sensitive to this metal has decreased. An increased allergy to nickel and formaldehyde and decreased allergy to turpentine have been also observed.

[Contact allergy caused by formaldehyde, based on materials from the Institute for medical occupations in Lodz]. / Alergia kontaktowa spowodowana formaldehydem, na podstawie materialu Instytutu Medycyny Pracy w Lodzi.

Incidence of formaldehyde allergy was analysed in 3,705 subjects with dermatitis and in 1,530 subjects with allergic dermatitis examined within the last fifteen years. Rates of increase or decrease in relative risk during that period was analysed in women, in men and in the whole group. In the whole material no differences in the incidence of allergy according to sex were found. Among women allergic to formaldehyde, dermatitis was found in 4.5 per cent and allergic dermatitis in 11.6 per cent. Among men the per cent was equal to 4.6 and 10.5, respectively. A significant upward tendency was found in the risk of formaldehyde allergy in men. The main sources of occupational allergies were: disinfectant agents, end-use finish and cloth dyes, cutting fluids and plastics.

[The role of solvents in the development of skin changes]. / Udzial rozpuszczalników w powstawaniu zmian skórnych.

The dermatological tests covered 289 rubber industry workers occupationally exposed to organic solvents and rubber. The control group involved 95 subjects. All the subjects underwent epidermal tests with routine allergens, naephtha and 11 rubber allergens. Altogether, dermatoses have been diagnosed in 32.8% of persons exposed to solvents and rubber, 12.1% of subjects developed dermatitis of hands and forearms, whereas 2.8%--trophic lesions of nails. 6.2% were sensitized to rubber allergens, 13.5%--to chromium compounds, and 3.8%--to cobalt compounds. The number of cases of hand dermatitis and nail lesions was found to increase with age and length of employment. Similarly, the allergy prevalence increased with age and duration of exposure to solvents and rubber. In 40% of dermatitis-affected subjects, sensitization to rubber allergens was an aetiological factor, in 60%--hand dermatitis resulted from irritating effects of organic solvents.

[Protective creams for prophylaxis of allergic contact dermatitis]. / Kremy ochronne w profilaktyce wyprysku kontaktowego.

Occupational medicine is interested in effective prophylaxis of skin occupational diseases. Use of protective ointments and creams makes one of prophylaxis methods of professional dermatitis. The purpose of the investigation was to evaluate both the primarily irritant and the allergic action of the two creams devised by us for protection of skin exposed to aqueous solution of electrolytes. One of these creams was composed of hydrocarbons components, the other had in addition silicone oil and cetaceum. Protective properties of these creams in patients with allergic contact dermatitis were also examined. The experiments were carried out on 10 rabbits, 75 guinea pigs, and 491 patients mainly suffering from metal (Cr, Co, Ni) and formaldehyde allergy. It was found that investigated creams do not exert primarily irritant and sensitizing effects both in animals and humans. These creams demonstrate pronounced protective action in allergy due to water soluble allergens.

[Causes of occupational allergy in dental nurses. An analysis based on the material collected at The Institute of Occupational Medicine in Lódz]. / Przyczyny uczulenia zawodowego u pomocy dentystycznych, na podstawie materialu Instytutu Medycyny Pracy w Lodzi.

The causes of occupational dermatosis were analysed in 27 dental nurses examined at The Nofer Institute of Occupational Medicine during the years 1995-99. Contact sensitisation (at least one positive epidermal test) was found in 18 subjects (66.7%). Occupational allergic dermatitis was induced most frequently by: glutaraldehyde (7 positive patch tests), nickel (7), benzalkonium (4), formaldehyde (4), fragrances (4), chromium compounds (3), glyoxal (3), and thiuram (3). In the authors' opinion, dental nurses are nowadays sensitised to other chemical compounds than it used to be in the past. The present components of disinfectants (aldehydes, quaternary ammonium bases), metals and rubber are the major etiologic agents that induce occupational allergy.

[Photosensitivity induced skin diseases]. / Choroby skóry wywolane nadwrazliwoscia na swiatlo.

The causes of skin diseases associated with photosensitivity are presented. The combined effect of light and exogenous light sensitizing substances leads to the occurrence of phototoxic and photoallergic reactions, and what is more, UVA spectrum is most active in their pathogenesis. The light sensitizing compounds are contained in cosmetic preparations, drugs and certain plants. They are characterized by a tricyclic structure and the ability to absorb ultraviolet radiation. The light sensitizing properties are exhibited primarily by non-steroid anti-inflammatory drugs, preservatives, sun filters, phenothiazine derivatives and odorants. Photoallergic reactions may be of occupational nature. The majority of reports found in the literature concern farmers, gardeners, fruit-growers and breeders, as well as representatives of other occupations. They usually emerge after the contact with pesticides of the thiocarbamide group, tetrachloroisophthalonitryl and veterinary drugs. The cases of occupational eczema in farmers and gardeners induced by the effect of light sensitizing plants have also been reported. In addition, the photoallergy diagnostic methods are discussed.