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Sedeh FB, Ullum AG, Christensen KB, Mortensen OS, Michaelsdóttir TE, Stückler SG, Jemec GBE, Ibler KS. Evaluation of Health Education Based on Pictograms and Video Sequences in the Prevention of Hand Eczema Among Hospital Cleaners: A Cluster-Randomised Controlled Trial With 24 Weeks Follow-Up. Contact Dermatitis 2025; 92:367-379. [PMID: 39777738 DOI: 10.1111/cod.14741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 12/09/2024] [Accepted: 12/10/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Hand eczema (HE) is common among hospital cleaners, yet no specific prevention programme exists for this group in Denmark. OBJECTIVES To evaluate the effectiveness of visual aids (pictograms and video scenes) based on evidence-based skin care and protection recommendations on HE outcomes, focusing on disease severity, point prevalence and skin care and protection knowledge. METHODS A cluster-randomised controlled trial was conducted in professional cleaners from three Danish hospitals. Intervention Group A received pictograms, video clips and a short group-based educational session. Intervention Group B received only pictograms and video clips. The control group received treatment as usual. HE severity and prevalence were assessed clinically, while knowledge was measured using self-reported data. RESULTS Out of 234 invited cleaners, 224 (96%) participated (Intervention Group A: 73, Intervention Group B: 78, Control Group: 73). After 24 weeks, both intervention groups showed significant reductions in HE severity and prevalence compared to the control group. Knowledge of skin care and protection also improved significantly in both intervention groups. CONCLUSION Visual aids effectively reduced HE prevalence and severity in hospital cleaners. Pictograms are a cost-effective strategy that can be widely implemented, addressing the substantial burden of HE in the cleaning industry across diverse settings.
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Affiliation(s)
| | - Anna Glenn Ullum
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbæk University Hospital, Holbæk, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Leskur D, Bročić I, Mićanović M, Lozić M, Rušić D, Perišin AŠ, Maleš I, Modun D, Bukić J. Introducing the model of repeated exposure of skin to antiseptics: Randomised pilot trial. Contact Dermatitis 2024; 90:585-593. [PMID: 38417425 DOI: 10.1111/cod.14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Intensified hand hygiene measures were recommended for preventing the spread of SARS-CoV-2. However, these measures can lead to skin damage and the development of hand eczema, particularly among health professionals. OBJECTIVES This pilot study aimed to evaluate the effects of repeated antiseptic use on healthy skin under controlled conditions and to assess the emollient use. METHODS Twelve healthy volunteers (nine females, age = 22.3 ± 2.8 years (mean ± SD), Fitzpatrick phototypes II and III) with no skin diseases were recruited. Antiseptic was applied daily for 3 weeks on the volar sides of forearms. Emollient cream was also applied daily. Skin assessments were performed using non-invasive methods (transepidermal water loss-TEWL, skin hydration, erythema and melanin content). RESULTS Prolonged antiseptic use increased TEWL, decreased hydration and elevated erythema and melanin levels. Emollient cream significantly reduced TEWL and improved hydration on antiseptic-treated sites, and also enhanced hydration on intact skin. CONCLUSIONS Prolonged use of antiseptics can have adverse effects on the skin, including barrier disruption and inflammation. Emollient showed promise in improving skin hydration and reducing the damage caused by antiseptics. Further research with a larger sample is needed to confirm these findings and assess emollient efficacy during frequent antiseptic use.
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Affiliation(s)
- Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ivana Bročić
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Mislav Mićanović
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Mirela Lozić
- Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, Split, Croatia
| | - Doris Rušić
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ana Šešelja Perišin
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Ivanka Maleš
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
| | - Josipa Bukić
- Department of Pharmacy, University of Split School of Medicine, Split, Croatia
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Symanzik C, Heratizadeh A, Skudlik C, John SM. [Prevention and health promotion in dermatology]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:377-385. [PMID: 38600365 DOI: 10.1007/s00105-024-05329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/12/2024]
Abstract
The term prevention includes measures that are used to avoid illnesses or damage to health as well as to reduce the risk of illness or to delay its occurrence. Preventive measures can be classified based on various criteria: temporal differentiation (primary, secondary, and tertiary prevention), context (behavioral and relational prevention), and recipient (general and individual prevention). Health promotion is used when appropriate measures are intended to strengthen and increase human health potential and resources. This includes, among other things, measures to develop health-promoting behavior (empowerment) and measures regarding the planning and implementation of health-promoting behavior (participation). One goal of these measures is generally to increase health literacy. This article describes examples of prevention and health promotion measures for occupational skin cancer (counseling approach for individual sun protection for outdoor workers; "individuelle Lichtschutzberatung" [ILB]) as well as occupational hand eczema within the meaning of German occupational disease number 5101 (outpatient and inpatient individual prevention measures). These are supplemented by the example of outpatient age-adapted small group trainings for patients with atopic dermatitis according to the multicenter evaluated concept of AGNES e. V. ("Arbeitsgemeinschaft Neurodermitisschulung") and ARNE ("Arbeitsgemeinschaft Neurodermitisschulung im Erwachsenenalter"). These examples also address aspects of sustainability and digitalization (eHealth, eLearning) in the areas of prevention and health promotion.
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Affiliation(s)
- Cara Symanzik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
| | - Annice Heratizadeh
- Niedersächsisches Institut für Berufsdermatologie (NIB), Osnabrück, Deutschland
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Christoph Skudlik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
- Niedersächsisches Institut für Berufsdermatologie (NIB), Osnabrück, Deutschland
| | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland.
- Niedersächsisches Institut für Berufsdermatologie (NIB), Osnabrück, Deutschland.
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Yüksel YT, Symanzik C, Christensen MO, Olesen CM, Thyssen JP, Skudlik C, John SM, Agner T, Brans R. Prevalence and incidence of hand eczema in healthcare workers: A systematic review and meta-analysis. Contact Dermatitis 2024; 90:331-342. [PMID: 38186085 DOI: 10.1111/cod.14489] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/02/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
Healthcare workers (HCWs) are considered a high-risk group for developing hand eczema (HE), mainly owing to wet work and contact with allergens at work. To meta-analyse the prevalence and incidence of HE in HCWs, as well as mapping the prevalence of atopic dermatitis (AD) and HE severity in HCWs. A systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines. Published literature from 2000 to 2022 was eligible based on predefined inclusion and exclusion criteria. A total of 18 studies were included. Pooled life-time, 1-year and point prevalence of self-reported HE in HCWs was 33.4% (95% confidence interval [CI]: 28.3-38.6), 27.4% (95% CI: 19.3-36.5) and 13.5% (95% CI: 9.3-18.4), respectively. AD prevalence was 15.4% (95% CI: 11.3-19.9). Overall, the majority of HCWs reported mild HE. One included study assessed HE incidence reporting 34 cases/1000 person years. Most studies scored low-moderate using the New Ottawa Scale and the pooled point prevalence data showed broad CIs. In conclusion, the high prevalence of HE in HCWs underlines the increased risk and need for preventive measures for this professional group. There is, however, a need of further standardized high-quality studies.
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Affiliation(s)
- Yasemin T Yüksel
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Cara Symanzik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - Maria O Christensen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline M Olesen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - Swen M John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - Tove Agner
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Richard Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück University, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
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Symanzik C, John SM. [Skin cancer from solar ultraviolet radiation exposure at work]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:104-111. [PMID: 37964134 DOI: 10.1007/s00105-023-05254-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
Due to their professional activities, outdoor workers are exposed to an increased risk of developing occupational skin cancer caused by solar ultraviolet (UV) radiation as defined by occupational disease (OD) number 5103. Since the amendment to the Occupational Diseases Ordinance ("Berufskrankheitenverordnung", BKV) in 2015, squamous cell carcinomas or multiple actinic keratoses of the skin caused by natural UV radiation in outdoor workers in Germany can be recognized as occupational disease in the sense of OD number 5103. The main cause of nonmelanoma skin cancer (NMSC) is solar UV radiation; it is the most relevant occupational carcinogen in terms of the number of exposed workers (i.e., outdoor workers). Circumstances associated with climate change include increased terrestrial UV radiation, an increase in the number of cloudless days and therefore the number of hours of direct sunshine, adverse meteorological effects to the stratospheric ozone layer, and so-called low ozone events and associated more intense UV radiation. In the future, comprehensive considerations will have to be made as to how prevention concepts can be effectively designed to avoid the development of occupational skin cancer in outdoor workers. The treatment of future cases of skin cancer will be a particular challenge due to their high number and only a limited number of dermatologists available. Hopefully, prevention of skin cancer will become even more important in the future.
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Affiliation(s)
- Cara Symanzik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), an der Universität Osnabrück, Osnabrück, Deutschland
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland
| | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), an der Universität Osnabrück, Osnabrück, Deutschland.
- Abteilung Dermatologie, Umweltmedizin und Gesundheitstheorie, Universität Osnabrück, Osnabrück, Deutschland.
- Niedersächsisches Institut für Berufsdermatologie (NIB), Osnabrück, Deutschland.
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Veronese F, Esposto E, Airoldi C, Gramaglia C, Bestagini L, Zavattaro E, Zeppegno P, Savoia P. A prospective randomized controlled trial of Psychodermatology on the efficacy of Rilastil Difesa Sterile® cream in the hand eczema of healthcare workers during the COVID-19 pandemic. J DERMATOL TREAT 2023; 34:2245080. [PMID: 37558217 DOI: 10.1080/09546634.2023.2245080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
Hand eczema is one of the most frequent dermatological diseases, with an incidence increased during the COVID-19 pandemic. The impact on life quality is considerable, giving rise to the need for a psycho-dermatological approach. This is a Randomized Control Trial (RCT) evaluating, either by the dermatological or psychological point of view, the effectiveness of an emollient and rehydrating topical product (Rilastil Difesa Sterile® cream) versus a standard treatment (i.e. moisturizing basic cream) in a group of 51 healthcare workers suffering from hand eczema during the COVID-19 pandemic. The enrolled subjects were randomized into a treatment or a control arm, treated for 8 weeks, and monitored through a clinical score (HECSI) and questionnaires evaluating the impact of the pathology and treatment on quality of life (DLQI and QOLHEQ). A psychometric evaluation was performed using the SCL-90 R, OCI-R, and CPDI scales. Our data, despite not reaching the statistical significance, demonstrated that both the clinical and psychological scores decreased mostly in patients treated with Rilastil Difesa Sterile® cream when compared to those treated with simple topical emollients. Moreover, we observed a high level of psychic suffering in dermatological patients and a parallel change in dermatological and psychological indicators, thus confirming their connection.
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Affiliation(s)
| | - Elia Esposto
- SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Lucia Bestagini
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elisa Zavattaro
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paola Savoia
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
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Sonday Z, Baatjies R, Mwanga HH, Jeebhay MF. Prevalence of work-related skin symptoms and associated factors among tertiary hospital workers exposed to cleaning agents in Southern Africa. Contact Dermatitis 2023; 89:178-189. [PMID: 37401107 PMCID: PMC10530256 DOI: 10.1111/cod.14374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Working with cleaning products is associated with occupational contact dermatitis in health workers (HWs), but information on predictors for these outcomes is limited. OBJECTIVES This study investigated the prevalence of work-related skin symptoms (WRSS) and associated factors in HWs exposed to cleaning agents in two Southern African tertiary hospitals. METHODS A cross-sectional study of 697 HWs used an interviewer-administered questionnaire and assessed for atopy using Phadiatop. RESULTS HWs' median age was 42 years, 77.0% were female and 42.5% were atopic. The prevalence of WRSS in the last 12 months was 14.8%, 12.3% had probable contact dermatitis (PCD) and 3.2% had probable contact urticaria (PCU). Technicians (ORadj 3.91) and tasks involving cleaning and disinfection of skin wounds (ORadj 1.98) were associated with WRSS in the past year. Factors associated with PCD included sterilizing instruments, disinfecting skin before procedures and use of wound adhesives. Factors associated with PCU included specimen preparation using formalin, medical instrument sterilization tasks, and skin/wound cleaning and disinfection. Appropriate glove use when performing patients' skin/wound care was protective against WRSS. CONCLUSIONS Tasks involving cleaning and disinfecting patients' skin and wounds were associated with WRSS in HWs, especially when performed without gloves.
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Affiliation(s)
- Zahida Sonday
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Roslynn Baatjies
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of Environmental and Occupational Studies, Faculty of Applied SciencesCape Peninsula University of TechnologyCape TownSouth Africa
| | - Hussein H Mwanga
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
- Department of Environmental and Occupational Health, School of Public Health and Social SciencesMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Mohamed F Jeebhay
- Occupational Medicine Division, School of Public HealthUniversity of Cape TownCape TownSouth Africa
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Symanzik C, Brans R, Skudlik C, John SM, Dicke K. Skin picking: A problem among healthcare workers? Health Sci Rep 2023; 6:e1348. [PMID: 37324250 PMCID: PMC10267424 DOI: 10.1002/hsr2.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Cara Symanzik
- Department of Dermatology, Environmental Medicine and Health TheoryOsnabrück UniversityOsnabrückGermany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück UniversityOsnabrückGermany
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health TheoryOsnabrück UniversityOsnabrückGermany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück UniversityOsnabrückGermany
| | - Christoph Skudlik
- Department of Dermatology, Environmental Medicine and Health TheoryOsnabrück UniversityOsnabrückGermany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück UniversityOsnabrückGermany
| | - Swen M. John
- Department of Dermatology, Environmental Medicine and Health TheoryOsnabrück UniversityOsnabrückGermany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück UniversityOsnabrückGermany
| | - Katja Dicke
- Department of Dermatology, Environmental Medicine and Health TheoryOsnabrück UniversityOsnabrückGermany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at Osnabrück UniversityOsnabrückGermany
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Questionnaire-Based Study Evaluating the Hand Hygiene Practices and the Impact of Disinfection in the COVID-19 Pandemic on Hand Skin Conditions in Poland. J Clin Med 2022; 12:jcm12010195. [PMID: 36614996 PMCID: PMC9821516 DOI: 10.3390/jcm12010195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
During the COVID-19 pandemic, disinfection became an integral part of everybody's life in order to avoid spreading the coronavirus. In 2021, an original anonymous online survey was carried out. The questions concerned the usage of disinfectants. The study population included 56 subjects diagnosed by a physician with hand eczema (HE-derm group) and 114 subjects with no hand skin disease diagnosed by a specialist (non-derm). The HE and non-HE groups were distinguished. Nearly 80% of the HE group, and 10% of the non-HE group, experienced worsening of hand skin lesions caused by increased skin disinfection. HE-group respondents more often declared the occurrence of new hand skin symptoms, over 80% of the subjects of this group had more than 1 new symptom (compared to nearly 40% of the non-HE group). Exacerbations of the skin disease were more frequently observed by the HE group during the pandemic. There was a statistically significant decrease of the quality of life in the HE group compared to the non-HE group during the pandemic. The COVID-19 pandemic caused an increase in the prevalence of hand skin symptoms and deterioration of the skin condition. Education on appropriate disinfection techniques and skincare, as well as early dermatological intervention, might allow us to limit the development of hand skin diseases.
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