Recent Trends in Occupational Contact Dermatitis

Hand Eczema in Apprentice Nurses during the COVID-19 Pandemic after a Skin Prevention Program

BACKGROUND

Healthcare workers, particularly nurses and apprentice nurses, are at high risk of the development of hand eczema due to daily exposure to wet work. This study aimed to assess the occurrence of hand eczema in a group of first-, second-, and third-year apprentice nurses at the University Hospitals of Trieste (northeastern Italy) during the COVID-19 pandemic.

METHODS

Two hundred forty-two Nursing School students were recruited. Data were collected using a standardized questionnaire based on the Nordic Occupational Skin Questionnaire, and all patients underwent a medical examination to evaluate their skin condition based on standard scores. Transepidermal water loss was also measured. The factors associated with hand eczema were investigated using univariate and multivariate logistic regression analyses.

RESULTS

The prevalence of hand eczema was low in students both before and after the traineeship (17.9 and 21.5%, respectively), but clinical signs of mild skin damage, mainly skin dryness, were present in 52.3 and 47.2%, respectively. The factor associated with hand eczema was a personal history of atopic eczema (odd ratios 2.61, 95% confidence intervals 1.18-5.80), while exposure to irritants and glove use did not reach statistical significance.

CONCLUSIONS

Our findings might be explained by the preventive measures adopted for skin protection among healthcare workers in Trieste since the apprenticeship.

High sensitivity detection of nanoparticles permeation through polymer membranes: A physico-chemical and nuclear imaging measurement approach

Diffusion cells are devices made of donor and acceptor compartments (DC and AC), separated by a membrane. They are widely used in pharmaceutical, cosmetic, toxicology, and protective equipment tests (e.g., gloves) to measure the kinetics of permeants (molecules and nanoparticles) across biological membranes as the skin. However, rarely is the concentration of permeants in the AC measured in continuous or in real-time, and this limitation leads to significant discrepancies in the calculations of kinetic parameters that define the permeation mechanisms. In this study, a diffusion cell compatible with positron emission tomography was used to measure the permeation kinetics of nanoparticles across glove membranes. The technology allows for the measurement of nanoparticle concentration in real-time in the two compartments (DC and AC) and at a detection sensitivity several orders of magnitude higher compared with conventional spectroscopies, thus allowing a much more precise extraction of kinetic parameters. Ultra-small (<10 nm) gold nanoparticles were used as a model nanoparticle contaminant. They were radiolabeled, and their diffusion kinetics was measured in continuous through latex and nitrile polymer membranes. Permeation profiles were recorded at sub-nanomolar sensitivity and in real-time, thus allowing the high precision extraction of kinetic permeation parameters. The technology, methodology, and data extraction process developed in this work could be applied to measure in real-time the kinetics of diffusion of a whole range of potentially toxic molecules and nanoparticles across polymer membranes, including glove membranes.

Contact dermatitis

Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. Occupational CD can be of any type and is the most prevalent occupational skin disease. Each CD type is characterized by different immunological mechanisms and/or requisite exposures. Clinical manifestations of CD vary widely and multiple subtypes may occur simultaneously. The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, which can negatively affect the quality of life of patients, systemic medications may be needed.

Occupational Contact Dermatitis: An Update

Occupation contact dermatitis (CD) is a common inflammatory skin condition impacting every professional industry in the United States. It is associated with significant personal and professional distress, loss of revenue, and decreased productivity. Occupational CD is further subdivided into irritant CD and allergic CD. Frequently, workers may suffer from a combination of both types. Numerous workplace exposures are implicated, but there are several themes across professions, such as CD related to frequent handwashing and wet work. A detailed occupational history, physical examination, and patch testing can help to make the diagnosis. Treatment includes identification of the substance and avoidance, which often is quite challenging.

Impact of occupational dust exposure on dermatologic symptoms among Korean workers

Occupation-related dust exposure is common, especially with increased industrialization. While occupational dust-related health issues caused by inhalation or ingestion have been well studied, only a few studies have examined the dermatologic effects of occupational dust exposure. This study aimed to investigate the association between occupational dust exposure and dermatologic symptoms in Korean workers. Among the large-scale representative data from the fifth Korean Working Conditions Survey, 45,700 workers were selected for study. Occupational dust exposure level was categorized as none, moderate, and severe, and dermatologic symptoms were assessed using a questionnaire on health problems. We analyzed the association between occupational dust exposure and dermatologic symptoms using multivariate logistic regression. Risks of skin problems and work-related skin problems were significantly associated with the level of occupational dust exposure in a dose-dependent manner (odds ratio (95% confidence interval): moderate, 1.51 (1.14-2.01); severe, 2.39 (1.74-3.29) in general skin problems; moderate, 1.72 (1.22-2.42); severe, 3.06 (2.11-4.44) in work-related skin problems). We, thus, demonstrate an association between occupational dust exposure and skin problems. As skin absorption of dust is a major route of dust exposure at the workplace, it is necessary to determine the efficacy of continuous management of occupational dust exposure.

Scalp involvement in patients referred for patch testing: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 1996 to 2016

BACKGROUND

Scalp conditions are often multifactorial.

OBJECTIVE

To characterize patients with scalp involvement and patch-testing outcomes.

METHODS

Retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016). Study groups included patients with scalp involvement (≤3 anatomic sites coded) with or without additional sites.

RESULTS

A total of 4.8% of patients (2331/48,753) had scalp identified as 1 of up to 3 affected anatomic sites. Approximately one-third of "scalp-only" individuals had a specific primary diagnosis of allergic contact dermatitis (38.6%), followed by seborrheic dermatitis (17.2%) and irritant contact dermatitis (9.3%). When adjacent anatomic sites were affected, allergic contact dermatitis was more frequently identified as the primary diagnosis (>50%). The top 5 currently clinically relevant allergens in scalp-only patients were p-phenylenediamine, fragrance mix I, nickel sulfate, balsam of Peru, and cinnamic aldehyde. Methylisothiazolinone sensitivity was notable when adjacent anatomic sites were involved. The top 3 specifically identified sources for scalp-only allergens were hair dyes, shampoo/conditioners, and consumer items (eg, hair appliances, glasses).

LIMITATIONS

Tertiary referral population.

CONCLUSION

Isolated scalp involvement was less likely to be associated with allergic contact dermatitis than when adjacent anatomic sites were involved. Overlap with multiple diagnoses was frequent, including seborrheic dermatitis, irritant dermatitis, other dermatoses, or all 3. p-Phenylenediamine was the most common allergen.

Occupational Exposure to Metals and Solvents: Allergy and Airway Diseases

PURPOSE OF REVIEW

Occupational allergic diseases (OAD) such as occupational contact dermatitis (OCD), occupational asthma (OA), and occupational rhinitis (OR) are the most prevalent occupational diseases in industrialized countries. The purpose of this review is to provide an update about the main occupational metal and solvent exposures related to allergy and airway diseases and to discuss newly defined causative agents and industries in this field.

RECENT FINDINGS

Currently for over 400 causative agents for OA and OCD, several hundreds of agents for OR have been identified. Although many studies have reported an overall decline in OAD related to known agents after implementation of efficient and effective workplace preventive measures, the constant development of new products continuously introduces to the market potential unknown respiratory hazards. Workplace allergens are often high molecular weight (HMW) agents that are > 10 kDa molecular weight and capable of eliciting IgE sensitization. Sensitizing low molecular weight (LMW) agents are often reactive chemicals. Metals and solvents are two large causative agent groups related to OADs that mainly behave as LMW (< 10 kDa) sensitizers and/or irritants. Avoidance of causative exposures through control strategies is the primary prevention approach for OADs. These strategies must be applied and covered for all known and newly defined causative agents. This review aims to summarize current status of known occupational metal and solvent exposures related to allergy and airway diseases and to discuss newly defined causative agents and industries in this field.

Assessment of Occupational Safety and Hygiene Perception among Afro-Caribbean Hair Salon Operators in Manchester, United Kingdom

Because of exposure to a number of potential health hazards within the work environment, hairstylists experience occupational diseases that include occupational asthma, skin conditions and musculoskeletal diseases. The paucity of studies assessing occupational safety and hygiene management among Afro-Caribbean hair salon operators in the UK promoted the study. Qualtrics^TM was used to assess the participants' perception of exposure to hair products and their personal safety and hygiene knowledge, attitudes, awareness, and risk perceptions at work. In five salons, indoor air quality was monitored over one working week for selected environmental pollutants: temperature, humidity, CO, CO₂ and Total Volatile Organic Compounds (TVOCs) using a GrayWolf Direct Sense Indoor Air Quality-IAQ (IQ-610). The use of unflued gas heating to raise the indoor temperature was common among the salons' operators which explains the high carbon monoxide readings recorded. Itchy eyes and nose (44.4%) shoulder, neck and back pain (39.2%) were frequently reported. Age-stratified analysis of reported occupational ailments showed participants within an age bracket of 31-35 reported allergies (24%) and itchy eyes and nose (19.1%) as the most common of occupational ailments. Respiratory, skin and musculoskeletal symptoms ranked as major occupational ill-health experiences among the study population. The study outcome demonstrated that the type of activity and the hair products used play an important role in the level of pollutants in the working environment. The substitution of the more harmful hair products with safer alternatives is needed, as is the encouragement of health surveillance.

The Eastern European experience on occupational skin diseases. Make underreporting an issue?

BACKGROUND

While legislation in most of the Eastern European countries is nowadays widely harmonized with the legal safety and health provisions of Western countries, there is still a sustained resistance to the notification of occupational skin diseases (OSD).

OBJECTIVE

The aim of the study was to identify the main barriers in notification and recognition of OSD in 22 Eastern European countries.

METHODS

An online survey was administered to key persons in the field of occupational safety and health in 22 Eastern European countries. Multiple variables of the notification system were studied, including clinical, organizational and educational issues.

RESULTS

The main causes of underreporting OSD are ineffective enforcement of occupational safety and health legislation, contractual relationship employer-employee, long duration of the notifying process, restrictions of the notification systems in terms of who is entitled to notify an OSD, ineffective regulations in regards to the pre-employment and periodical medical examination, ineffective compensation schemes, restraints and hesitations, mainly from the doctors, inappropriate mentalities - fear of losing the jobs, fining of the employers by the authorities, stigmatization of the workers with OSD, additional costs for employers, stakeholders' lack of interest in notifying, lack of guidelines and protocols and lack of preventive programmes.

CONCLUSIONS

The most valuable method for a proper recognition of OSD is to increase the awareness of physicians involved in the management of OSD (occupational physicians, GPs, dermatologists), as well as employers and workers. There is an urgent need to improve national legislation, to develop and promote adequate preventive programmes, emphasizing ethical, legal, economical and psychological aspects in order to achieve an increased recognition and a real reporting of OSD, and to enforce an international action plan for Eastern Europe in order to improve the notification of OSD.

Occupational Allergies: A Brief Review

Occupational allergies are groups of work-related disorders that are accompanied by immunologic reaction to workplace allergens and include occupational asthma, rhinitis, hypersensitivity pneumonitis, dermatitis, and anaphylaxis. This mini review presents a brief analysis of the more important aspects of occupational allergic disorders.

New developments in work-related asthma

INTRODUCTION

Work-related asthma includes two subtypes: occupational asthma or asthma caused by specific agents (sensitizers or irritants) in the workplace, and work-exacerbated asthma or pre-existing asthma worsened by workplace exposures. Areas covered: This review provides an update on the definitions and the clinical features of the different work-related asthma subtypes as well as new insights into their etiology and the pathophysiological mechanisms involved. The diagnosis of work-related asthma should be made on objective basis using a constellation of clinical, physiologic and allergologic tests. Specific inhalation challenge with the suspected occupational agent(s) remains as the reference standard for diagnosis. A literature search was performed using the following terms: work-related asthma, occupational asthma, work-exacerbated asthma, irritant-induced asthma and etiological agents. Expert commentary: Studies focusing on the biological effects and mechanisms of environmental exposures in the development of sensitizer-induced or irritant-induced asthma in various workplace settings are of greatest interest. An integrative approach that combines clinical parameters with component-resolved diagnosis as well as inflammatory biomarkers appears to be very promising. Occupational allergy provides a good opportunity to understand the complex relationships between exposure to allergens in the workplace, interaction with genes and the co-exposures to other factors in the working environment.