Exposures and reactions to allergens among hairdressing apprentices and matched controls

Different approaches and their consequences for addressing the occupational health and safety of young workers: A systematic narrative literature review

BackgroundThe last twenty years, studies have examined 'young workers' occupational health and safety (OHS). Depending on the discipline, approach and methodology, they address youth OHS in different ways. This systematic narrative review aims to provide a deeper understanding of this research landscape.ObjectiveThe first objective is to provide a systematic review of the literature on OHS of 'young workers'. It consists of reviewing the literature by disciplines, approaches, methods, data and factors, and of focusing on studies that address the contextual and social aspects of OHS. The second objective is to consider the specific situation of apprentices.MethodsSearches were conducted in five scientific databases, supplemented by three resource platforms. The criteria of literature selection were: OHS of 'young workers' aged from 15-24; explicit link between work and health; publication between 2005 and 2022 in Europe, North America and Australia. Studies have been categorised.Results193 studies were included. The review shows the diversity of the population studied under the same heading and the predominance of medical studies, which favour epidemiological approaches and quantitative data. Other disciplines (e.g., psychology, educational sciences, social sciences), approaches (e.g., organisational, risk perception), data (e.g., interviews, observations) and methods (qualitative, mixed, longitudinal) are marginal. Individual and age-related factors are predominant. The impact of working conditions and social relations on OHS is rarely considered.ConclusionResearch on OHS through organisational context and social relations, particularly employment status, should be encouraged. This provides a deeper understanding of the constraints faced by 'young workers', especially apprentices.

Twenty Years of Contact Allergy in Danish Cleaners: A Matched Cross-Sectional Study

Background: Cleaners are affected by occupational contact dermatitis, with both allergic and irritant causes. More knowledge on contact allergy in cleaners is needed for better preventive measures. Objectives: To investigate which contact allergens from the European baseline series (EBS) are associated with the cleaning profession. Method: A matched cross-sectional study using data from the Allergen database at Gentofte Hospital, Copenhagen, Denmark, in the period 2003-2023 was conducted. Patch tested cleaners were matched with patch tested noncleaners (controls) at a 1:4 ratio based on age (±4 years), sex, and the year of patch test. Results: In total, 459 cleaners and 1836 matched controls were included in the study. Being a cleaner was significantly positively associated with hand dermatitis and occupational dermatitis and significantly negatively associated with facial dermatitis and atopic dermatitis. Among the allergens from the EBS, thiuram mix and nickel were significantly positively associated with being a cleaner. Conclusion: Future prevention programs for cleaners should have a focus on contact allergy, including information on rubber accelerators and correct use of gloves.

Henna Tattoo: From Cosmetic Purposes to Dermatological Reactions

Introduction

Henna, commonly used as a hair dye, is also used for temporary tattoos. It is commonly mixed with para-phenylenediamine (PPD) to enhance color intensity, which may induce cutaneous sensitization.

Aim

This study aimed to describe the clinicodemographic features of patients with dermatological reactions to henna tattoos.

Materials and Methods

This cross-sectional study, included patients with dermatological reactions to henna tattoos. All the patients were subjected to entire medical history including clinicodemographic data and general and dermatological examinations.

Results

This study included 17 female patients with a mean age of 26.88 ± 6.6 years. Of these 17 patients; 41.2% were suburban residents, 58.8% were housewives, 70.6% were married, and 47.1% were middle socioeconomic class and 53% had type IV Fitzpatrick skin. All used black color and commercial henna for cosmetic purposes, 41.2% used market henna, and 35.3% used coiffeur henna. Many (70.6%) had localized reactions with 23.5% presenting with reaction of hands, 64.7% had acute eczematous reactions, and all had a progressive course. The mean duration of the reaction was 6.76 ± 2.6 days. The mean latency time of the reaction was 2.7 ± 0.85 days.

Conclusion

This study concluded that public awareness of possible cutaneous reactions to henna tattoos should be increased. The health authority legislation should control the use of black henna to minimize the consequences.

Hand eczema in Danish adolescents-Beyond atopic dermatitis

BACKGROUND

Hand eczema (HE) is a common inflammatory skin disease that may have serious consequences. The age of HE onset varies, but is estimated to be early- to mid-20s. However, very little is known about HE in childhood and adolescence.

OBJECTIVE

We aimed to explore the epidemiology, aetiology and severity of HE among a random sample of Danish adolescents drawn from the general population.

METHODS

The study was designed as a self-administered questionnaire study. An electronic questionnaire was sent to a random sample of 13 000 individuals aged 15-19 years.

RESULTS

The point-prevalence, 1-year prevalence and life-time prevalence of HE among Danish adolescents was 4.9%, 12.1% and 18.3%, respectively. Among patients with a history of HE, 64.6% of cases were not associated with atopic dermatitis. Of all respondents, 60.2% were either part-time or full-time employed. Among respondents with current HE, 38.2% believed that the occupational exposures either caused or exacerbated the HE.

CONCLUSION

We found a high prevalence of HE among Danish adolescents which raises concern. Knowing the potential consequences that HE may have, attention should be paid to the prevention of HE in adolescence, especially on occupational aspects and prevention of skin disease in young workers.

Occupational Exposure of Hairdressers to Airborne Hazardous Chemicals: A Scoping Review

INTRODUCTION

Exposure to hazardous chemicals released during hairdressing activities from hair care products puts hairdressers at risk of adverse health effects. Safety assessments of hair products are mainly focused on consumers, but exposure for professional hairdressers might be substantially higher.

OBJECTIVE

To identify and assess available research data on inhalation exposures of professional hairdressers.

METHODS

A systematic search of studies between 1 January 2000 and 30 April 2021 was performed in Medline, Embase, Web of Science and in Cochrane registry, toxicological dossiers of the Scientific Committee on Consumer Safety (SCCS) of the European Commission as well as the German MAK Commission. Studies reporting quantitative data on airborne concentrations of chemicals in the hairdresser's workplace were considered. The outcome was an airborne concentration of chemicals in the working environment, which was compared, when possible, with current occupational exposure limits (OEL) or guidance levels.

RESULTS

In total, 23 studies performed in 14 countries were included. The average number of hairdressing salons per study was 22 (range 1-62). Chemicals most frequently measured were formaldehyde (n = 8), ammonia (n = 5), total volatile organic compounds (TVOC) (n = 5), and toluene (n = 4). More than fifty other chemicals were measured in one to three studies, including various aromatic and aliphatic organic solvents, hydrogen peroxide, persulfate, and particulate matter. Most studies reported environmental air concentrations, while personal exposure was measured only in seven studies. The measured air concentrations of formaldehyde, ammonia, and TVOC exceeded OEL or guidance values in some studies. There was large variability in measuring conditions and reported air concentrations differed strongly within and between studies.

CONCLUSION

Hairdressers are exposed to a wide spectrum of hazardous chemicals, often simultaneously. Airborne concentrations of pollutants depend on salon characteristics such as ventilation and the number of customers but also on used products that are often country- or client-specific. For exposure to formaldehyde, ammonia, and TVOC exceeding OELs or guidance values for indoor air was observed. Therefore, occupational exposure should be taken into account by safety regulations for hair care products.

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.

Skin Characteristics of Hairdresser Apprentices at the Beginning of Vocational Training

BACKGROUND

Hairdresser apprentices (HAs) are at high risk of developing occupational contact dermatitis.

OBJECTIVES

To assess skin characteristics of HAs, using genotyping, clinically observed and self-reported skin symptoms, and skin bioengineering methods at the beginning of apprenticeship.

METHODS

During the screening phase of a prospective cohort study, we recruited 352 HAs in 24 Croatian towns. The protocol included the following: questionnaires with self-reported skin and atopy symptoms evaluation, Osnabrueck Hand Eczema Severity Index (OHSI) for clinical skin assessment, genotyping FLG (filaggrin) gene mutations, skin pH, and transepidermal water loss (TEWL) measurements.

RESULTS

Self-reported skin symptoms were reported by 12%, history of dry hands by 29%, and history of atopy by 46% of HAs. Skin changes were found at the clinical examination in 18% of the HA. The OHSI score was positively correlated with hand TEWL and hand skin pH in multiple regression linear models. An FLG gene mutation was found in 1 apprentice.

CONCLUSIONS

Significant prevalence of clinically observed skin signs on the hands was observed in HAs at the beginning of training. The OHSI score was found to be an independent predictor of higher hand TEWL and skin pH values. The need to ameliorate preventive examinations before the enrolment to hairdressing schools was indicated.

Occupational Safety and Health Among Young Workers in the Nordic Countries: A Systematic Literature Review

This review aimed to identify risk factors for occupational accidents and illnesses among young workers in the Nordic countries and to attain knowledge on specific vulnerable groups within the young working force that may need special attention. We conducted a systematic review from 1994 to 2014 using five online databases. Of the 12,528 retrieved articles, 54 met the review criteria and were quality assessed, in which data were extracted focusing on identifying occupational safety, health risk factors, and vulnerable groups among the young workers. The review shows that mechanical factors such as heavy lifting, psychosocial factors such as low control over work pace, and organizational factors such as safety climate are all associated with increased injury risk for young Nordic workers. Results show that exposures to chemical substances were associated with skin reactions, e.g., hand eczema. Heavy lifting and awkward postures were risk factors for low back pain, and high job demands were risk factors for mental health outcomes. The review identified young unskilled workers including school drop-out workers as particularly vulnerable groups when it comes to occupational accidents. In addition, apprentices and young skilled workers were found to be vulnerable to work-related illnesses. It is essential to avoid stereotyping young Nordic workers into one group using only age as a factor, as young workers are a heterogeneous group and their vulnerabilities to occupational safety and health risks are contextual. Politicians, researchers, and practitioners should account for this complexity in the education, training and organization of work, and workplace health and safety culture.

Career Advice for Young Allergy Patients

BACKGROUND

One-third of all young persons entering the work force have a history of atopic disease. Occupationally induced allergy and asthma generally arise in the first few months on the job, while pre-existing symptoms tend to worsen. Young persons with a history of an atopic disease should receive evidence-based advice before choosing a career.

METHODS

We systematically searched PubMed for cohort studies investigating the new onset of asthma, rhinitis, or hand eczema among job trainees from before the start of training and onward into the first few years on the job. The search revealed 514 articles; we read their abstracts and selected 85 full-text articles for further analysis. 24 of these met the inclusion criteria.

RESULTS

According to present evidence, atopy and a history of allergic disease (allergic rhinitis, atopic dermatitis) are the main risk factors for occupationally induced disease. The predictive value of a personal history of allergic diseases for the later development of an occupationally induced disease varies from 9% to 64% in the studies we analyzed. It follows that only young people with severe asthma or severe atopic eczema should be advised against choosing a job that is associated with a high risk of allergy, e.g., hairdressing or working with laboratory animals. Young people with a history of other atopic diseases should be counseled about their individual risk profile.

CONCLUSION

In view of the relatively poor predictive value of pre-existing atopic disease, secondary prevention is particularly important. This includes frequent medical follow-up of the course of symptoms over the first few years on the job. If sensitization or allergic symptoms arise, it should be carefully considered whether exposure reduction will enable the apprentice to stay on the job.

Side-effects of henna and semi-permanent 'black henna' tattoos: a full review

Henna, the dried and powdered leaf of Lawsonia inermis, is widely used as a dye for the skin, hair, and nails, and as an expression of body art, especially in Islamic and Hindu cultures. As it stains the skin reddish-brown, it is also called red henna. Black henna is the combination of red henna with p-phenylenediamine (PPD), and is used for temporary 'black henna tattoos'. This article provides a full review of the side-effects of topical application of red and black henna, both cutaneous (allergic and non-allergic) and systemic. Red henna appears to be generally safe, with rare instances of contact allergy and type I hypersensitivity reactions. In children with glucose-6-phosphate dehydrogenase deficiency, topical application of henna may cause life-threatening haemolysis. Black henna tattoos will induce contact allergy to its ingredient PPD at an estimated frequency of 2.5%. Once sensitized, the patients may experience allergic contact dermatitis from the use of hair dyes containing PPD. There are often cross-reactions to other hair dyes, dyes used in textiles, local anaesthetics, and rubber chemicals. The sensitization of children to PPD may have important consequences for health and later career prospects. Systemic toxicity of black henna has been reported in certain African countries.

p-Phenylenediamine and other hair dye sensitizers in Spain

BACKGROUND

Oxidative hair dyes are important skin sensitizers, causing contact allergy and dermatitis in hairdressers and consumers.

OBJECTIVES

To study the prevalence of hair dye substances, categorized as potent skin sensitizers, in consumer-available oxidative hair dye products on the market of a southern European country and to compare it with that in Sweden.

METHODS

Ingredient labels of 105 oxidative hair dye products from 19 brands were studied, and the prevalence and use pattern of hair dye substances, categorized as potent skin sensitizers, was assessed. Network diagrams were used to display results.

RESULTS

According to the labelling, all 105 products contained hair dye substances categorized as potent skin sensitizers. A total of 25 different hair dye substances categorized as potent skin sensitizers were identified. Eighty-seven per cent of the products contained at least four such substances. Either p-phenylenediamine, toluene-2,5-diamine or toluene-2,5-diamine sulfate was present in 103 products.

CONCLUSIONS

Hair dye substances categorized as potent skin sensitizers were used in all studied hair dye products on the Spanish market. The prevalence of p-phenylenediamine was higher in the present study than in a similar study in Sweden. More than 20 potent sensitizers were identified in each country. Not only p-phenylenediamine should be used to diagnose allergy to hair dyes.

Severe allergic reactions to para-phenylenediamine in children and adolescents: should the patch test concentration of PPD be changed?

BACKGROUND

Semipermanent henna tattoos containing para-phenylenediamine (PPD) are a well-known cause of severe contact dermatitis, mainly in children. Another relevant exposure source to PPD are hair dyes, which are increasingly used by children and have also been reported to cause intense facial and scalp dermatitis. German patch test guidelines for children recommend that PPD should only be tested in patients who have had a henna tattoo, and then at a reduced concentration of PPD 0.5 % for 24 hours.

PATIENTS AND METHODS

We report on patch test results in four patients, three children and one adolescent, with a history of contact dermatitis to henna tattoos or hair dye. We used the recommended or even lower patch test concentrations of PPD with 24-hours exposure in all patients.

RESULTS AND CONCLUSION

All patients showed very strong patch test reactions to PPD and cross-reactions to related compounds even after dilution of PPD to as low as 0.05 %. Therefore, we suggest that in children with a history of allergic reactions to this compound, a titration test should be performed beginning at a concentration of maximal 0.05 %. This procedure has also been proposed previously based on a larger cases series in adults.