Occupational skin diseases in Northern Bavaria between 1990 and 1999: a population-based study

Irritant Contact Dermatitis — a Review

Purpose of Review

Recent Findings

Summary

Allergic contact dermatitis caused by 2-hydroxyethyl methacrylate and ethyl cyanoacrylate contained in cosmetic glues among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications: a systematic review

Current cosmetic regulations primarily focus on protecting consumers, not the professional user who is subjected to a partly different, and certainly more intense exposure to hazardous substances. Against this background, the present systematic review aims to compile and appraise evidence regarding skin toxicity of 2-hydroxyethyl methacrylate (HEMA; CAS no. 212-782-2) and ethyl cyanoacrylate (ECA; CAS no. 7085-85-0) contained in cosmetic glues used among hairdressers and beauticians who perform nail treatments and eyelash extension as well as hair extension applications. This systematic review followed the PRISMA 2020 recommendations for reporting systematic reviews and meta-analysis. In total, 6 publications from 6 countries were eligible for this systematic review. Meta-analysis revealed that hairdressers and beauticians have a 9-fold increased risk of developing contact allergy to HEMA compared to controls who are not hairdressers and beauticians. Results for ECA are lacking. The present systematic review clearly shows that - regarding contact allergy to acrylates - it is not appropriate to apply risk assessment for consumers to hairdressers and beauticians who occupationally handle cosmetic glues. The regulations in existence do not adequately address occupational risks for hairdressers and beauticians connected with the use of acrylate-containing cosmetic substances and need reconsideration. This article is protected by copyright. All rights reserved.

Differences between hairdressers and consumers in skin exposure to hair cosmetic products: a review

Hairdressers are at high risk of developing occupational hand eczema. Opinions on the health and safety concerns of non-food consumer products, such as cosmetics and their ingredients, consider the exposure of a 'common consumer', which may not account for occupational exposure of hairdressers. As result, there is a parlous scenario in which serious safety concerns about occupational exposures are present. The purpose of this review is to compare the frequency of exposure to various types of hair cosmetic products among hairdressers and consumers. Database searches for this review yielded a total of 229 articles. 7 publications were ultimately included. The analysis showed that - dependent on the task - hairdressers were exposed 4 to 78 times more than consumers regarding a wide spectrum of hair cosmetic products used in the daily working life ranging from shampoo, conditioner, oxidative and non-oxidative hair colours, and bleaching agents. The highest frequency was found for colouring hair with oxidative hair colour. Consumer usage frequency does not appear to be appropriate for representing hairdresser exposure. The current standards do not effectively address the occupational risks associated with hairdressers' use of cosmetics. The findings of this study should cause current risk assessment procedures to be reconsidered. This article is protected by copyright. All rights reserved.

Incidence rates of occupational contact dermatitis in Denmark between 2007 and 2018: A population-based study

BACKGROUND

Recent population-based studies on the incidence rates (IRs) of occupational contact dermatitis (OCD) are sparse.

OBJECTIVES

To determine the IRs of OCD and development thereof between 2007 and 2018 in known risk occupations.

METHODS

Data on all recognized cases of OCD were used to calculate IRs as the number of recognized OCD cases per 10 000 workers per year. Asymptotic chi-square test was used to compare the IRs between 2007-2012 and 2013-2018.

RESULTS

The median age at notification of OCD was below 30 years for several of the examined occupations. Hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills had the highest overall IRs of OCD. We found a statistically significant increase in the IRs of OCD for child/nursery care workers.

CONCLUSIONS

The median age at notification of OCD was low for several of the occupations, signifying the need for further preventive strategies among young people. Based on the IRs of OCD, future preventive efforts should be directed at hairdressers and beauticians, bakers, dentists and dental assistants, and manufacturing of windmills. Furthermore, the statistically significant increase in IRs of OCD among child/nursery care workers highlights the need for further preventive strategies in this field.

Incidence of occupational contact dermatitis in healthcare workers: a systematic review

Healthcare workers (HCWs) can be considered at an increased risk of developing occupational contact dermatitis (OCD) due to repetitive hand washing with soaps and disinfectants and extended use of gloves for many hours during the day. The aim of this study was to summarize the incidence of OCD in HCWs. We searched the databases PubMed/MEDLINE (1980-present), EMBASE (1980-present) and Cochrane Library (1992-present) through May 2020 using the search term 'incidence of contact dermatitis in HCWs' according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Overall, 16 studies (six cohorts; 10 register-based) with follow-up periods between 1987 and 2013 fulfilled the inclusion criteria. The incidence of OCD reported in studies using registers of occupational diseases ranged from 0.6 to 6.7 per 10 000 person-years. The cohort studies reported incidence from 15.9 to 780.0 per 10 000 person-years; the incidence was higher in studies which included apprentice nurses. A higher incidence was also observed amongst dental practitioners, particularly dental technicians and nurses, compared to other HCWs. Studies reporting incidence data are very scarce and results differed by study design, type of contact dermatitis and investigated HCWs. Our study highlighted the dearth of high-quality data on the incidence of OCD and the possible underestimation of disease burden. Prospective cohort studies with harmonized designs, especially exposure assessment and outcome ascertainment, are required to provide more accurate, valid and recent estimates of the incidence of OCD. A high incidence amongst specific occupational groups suggests the need to undertake intervention studies with a focus on prevention, particularly during pandemics such as COVID-19.

Doppelblinde, randomisierte repetitive In‐vivo ‐Wirksamkeitsstudie zu kommerziellen Hautschutzprodukten gegen Natriumlaurylsulfat (SLS)

HINTERGRUND

In der Primär- und Sekundärprävention von Berufsdermatosen werden Hautschutzprodukte eingesetzt, die eine präexpositionelle Schutzwirkung aufweisen sollen. Insbesondere finden sich auf dem Markt zahlreiche Produkte, die zum Einsatz bei Feuchtarbeit ausgelobt werden. Eine objektive Qualitätsbeurteilung dieser Produkte für Anwender ist auf Grund fehlender vergleichender Wirksamkeitsstudien oft nicht möglich.

MATERIAL UND METHODIK

In einer doppelblinden, randomisierten und kontrollierten In-vivo-Studie wurden sechs kommerzielle Hautschutzexterna in einem repetitiven Irritationsmodell untersucht. Sie wurden hinsichtlich ihrer präexpositionellen Schutzwirkung vor dem durch Natriumlaurylsulfat (SLS) induzierten irritativen Kontaktekzem mittels hautphysiologischer Methoden getestet. Es wurde ein Wirkindex anhand des transepidermalen Wasserverlustes (TEWL) gemäß des Protokolls der multizentrischen Studie des Forschungsprojektes FP 275 der Deutschen Gesetzlichen Unfallversicherung DGUV berechnet.

ERGEBNISSE

Die untersuchten Externa zeigten eine Schutzwirkung gegen SLS im Vergleich zum unbehandelten Kontrollfeld, wiesen allerdings signifikante Wirkunterschiede auf. Die Auswertung der Nebenparameter Corneometrie und visueller Score erbrachte ebenfalls Unterschiede zwischen den Externa.

SCHLUSSFOLGERUNGEN

Die zwischen den untersuchten Externa festgestellten Unterschiede hinsichtlich der Wirkgüte ermöglichten eine Einteilung der Produkte, welche als Grundlage für die Auswahl geeigneter Schutzpräparate dienen kann.

Double blind randomized repetitive efficacy test of various occupational skin protection preparations against sodium lauryl sulphate

BACKGROUND

Skin protection products, formerly named as barrier creams, are being used as primary and secondary prevention measures against occupational dermatoses. Many of these cosmetic products are claimed by manufacturers to be efficacious against wet work-induced skin barrier impairment if applied prior to exposure. However, results of validated and standardized in vivo efficacy tests allowing the comparison of different products are lacking.

MATERIAL AND METHODS

Efficacy of six skin protection products against sodium lauryl sulphate-induced irritant contact dermatitis was investigated in a double blind, randomized and controlled repetitive irritation study in healthy volunteers using skin physiological methods. Transepidermal water loss (TEWL) results were used to calculate an efficacy index of protection by mathematical/statistical means according to a protocol developed in a German Statutory Accident Insurance (DGUV) multicenter study (research project FP 275).

RESULTS

All tested products had a demonstrable, protective effect against SLS compared to controls, but their relative efficacy varied significantly. Differences were also seen upon evaluation of other parameters such as corneometry and clinical irritation score (visual score).

CONCLUSIONS

Product ranking as a result of the established differences allows improved selection of appropriate skin protection products based on objective parameters, as compared to heterogenous product claims.

Allergic contact dermatitis and other occupational skin diseases in health care workers in the Finnish Register of Occupational Diseases in 2005-2016

BACKGROUND

Health care workers are an important risk group for occupational skin disease (OSD).

AIMS

To study diagnoses and causes of OSDs in health care workers in the Finnish Register of Occupational Diseases (FROD) in 2005-2016.

METHODS

We searched the FROD for dermatological cases (a) in health care-related occupations defined by ISCO-08 and (b) in the industrial branch of health care defined by European industry standard classification system (NACE rev. 2).

RESULTS

Health care workers comprised 19% of all OSD cases in the FROD, and irritant contact dermatitis dominated the diagnoses. Nurses and assistant nurses were the largest occupational groups with incidence rates of 3.3 and 2.7/10 000 person years, respectively. Rubber chemicals were by far the most common causative agents of allergic contact dermatitis (ACD) followed by preservatives, the latter mainly comprising isothiazolinones and formaldehyde. Acrylates were important allergens in dental professions. Metals and coconut fatty acid derivatives were the next largest causative groups for ACD. Drugs caused only 1% of the ACD cases.

CONCLUSIONS

Workers in different health care occupations do not have a uniform risk for OSD, but they share the risk for ACD due to rubber chemicals and various preservatives.

Hairdressers' occupational skin diseases in the Finnish Register of Occupational Diseases in a period of 14 years

BACKGROUND

Hairdressers have a high risk of occupational contact dermatitis caused by exposure to wet work and allergens in hairdressing chemicals.

OBJECTIVES

To examine the distribution of diagnoses of occupational skin diseases (OSDs) and their main causes in hairdressers based on a national register data on occupational diseases.

METHODS

We retrieved cases of recognized OSDs in hairdressers from the Finnish Register of Occupational Diseases (FROD) in years 2005-2018.

RESULTS

During the 14-year period, a total of 290 cases of recognized OSD in hairdressers were registered in the FROD. Allergic contact dermatitis (ACD) was diagnosed in 54%, irritant contact dermatitis in 44%, and contact urticaria (CU) in 5% of them. ACD was most commonly caused by hair dye products and their ingredients (N = 57), persulfates (N = 35), and preservatives (N = 35; mainly isothiazolinones). Acrylates emerged as hairdressers' occupational contact allergens (N = 8) probably due to introduction of structure nails into hair salons. Persulfates was the most common cause of CU.

CONCLUSIONS

ACD was the most common OSD in hairdressers. Our analysis confirms that preservatives are important causes of ACD in hairdressers in addition to hair dye products and persulfates. Acrylates emerged as hairdressers' occupational contact allergens, but contact allergy to perming agents remained rare.

Heavy metals and the skin: Sensitization patterns in Lithuanian metalworkers

BACKGROUND

Metalworkers are exposed to many sensitizing and irritant substances. There are no published data on contact allergy in this population in the Baltic countries.

OBJECTIVES

To detect skin symptoms related to occupational exposure and to describe the reactivity pattern to the European baseline series in workers from two metal plants in Lithuania.

METHODS

In this cross-sectional study 185 metalworkers (154 production workers and 31 office staff) filled an interviewer-administered questionnaire. Patch testing was performed in 135 metalworkers and office staff, as a control group.

RESULTS

Metalworkers younger than 40 years complained statistically significantly more often of skin symptoms, especially on the hands and face, than older workers. Physician-diagnosed skin diseases were reported in 1.7% of cases. Metalworkers, working <20 years in the factory, more often had skin symptoms. Contact with chemicals at the workplace was suspected as the main factor provoking skin symptoms. Metalworkers were sensitized mainly to cobalt, and nickel was the most prevalent allergen among office staff.

CONCLUSION

Younger metalworkers more often had skin symptoms suspected of being work-related compared to older ones. Sensitization to cobalt was more prevalent in the metalworkers than in the control group.

Nickel release from metal tools in the German hairdressing trade-A current analysis

BACKGROUND

Nickel is one of the most common contact allergens. Despite EU regulations concerning the maximum permissible release of nickel from metal objects, nickel release at inappropriately high levels from metal objects has been detected in various studies.

OBJECTIVES

To screen current nickel release from metal tools in the German hairdressing trade.

METHODS

Two hundred and twenty-nine metal tools from the German hairdressing trade were tested with the dimethylglyoxime (DMG) test for nickel release. Additionally, an employee survey was conducted to collect data about the metal tools.

RESULTS

The DMG test showed that 21 of 229 metal tools (9.2%) released nickel. Nickel release was detected in 8 of 45 hair clips (17.8%), 2 of 27 tail combs (7.4%), and 11 of 17 tweezers (64.7%).

CONCLUSION

It must be assumed that hairdressers in Germany have prolonged skin contact with nickel-releasing metal tools. This should prompt further testing for nickel release from metal tools, and the development of regulations to eliminate nickel-releasing metal tools in the (German) hairdressing trade.