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Abstract
Apart from endogenous factors, hand eczema is often caused by irritant or allergic contact dermatitis related to occupational or non-occupational exposure to skin hazards. This enables several complementary approaches on the level of primary, secondary and tertiary prevention. A high priority is set on identification and subsequent reduction or elimination of causative exposures. Important preventive approaches include legal regulations, technical and organizational measures as well as correct use of adequate personal protective equipment (e.g. protective gloves). Interventions based on health education are conducted to improve individual protective behaviour. Even though evidence-based proof of effectiveness is limited, preventive measures are considered of particular importance for avoidance of occupational hand eczema and its adverse sequelae. Therefore, a complex, step-wise approach to occupational skin diseases has been established in Germany. In recent years, the positive impact of secondary and tertiary preventive measures of this approach has been demonstrated.
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Affiliation(s)
- R Brans
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland.
| | - C Skudlik
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm), Universität Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Deutschland
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Brans R, Schröder-Kraft C, Skudlik C, John SM, Geier J. Tertiary prevention of occupational skin diseases: Prevalence of allergic contact dermatitis and pattern of patch test results. Contact Dermatitis 2018; 80:35-44. [DOI: 10.1111/cod.13098] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Richard Brans
- Department of Dermatology; Environmental Medicine and Health Theory, University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück; Osnabrück Germany
- Lower-Saxonian Institute of Occupational Dermatology at the Georg-August University, Göttingen, Germany, and at the University of Osnabrück; Osnabrück Germany
| | - Claudia Schröder-Kraft
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), BG Hospital Hamburg; Hamburg Germany
| | - Christoph Skudlik
- Department of Dermatology; Environmental Medicine and Health Theory, University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück; Osnabrück Germany
- Lower-Saxonian Institute of Occupational Dermatology at the Georg-August University, Göttingen, Germany, and at the University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), BG Hospital Hamburg; Hamburg Germany
| | - Swen M. John
- Department of Dermatology; Environmental Medicine and Health Theory, University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück; Osnabrück Germany
- Lower-Saxonian Institute of Occupational Dermatology at the Georg-August University, Göttingen, Germany, and at the University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), BG Hospital Hamburg; Hamburg Germany
| | - Johannes Geier
- Lower-Saxonian Institute of Occupational Dermatology at the Georg-August University, Göttingen, Germany, and at the University of Osnabrück; Osnabrück Germany
- Information Network of Departments of Dermatology (IVDK), Georg-August University; Göttingen Germany
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Wilke A, Bollmann U, Cazzaniga S, Hübner A, John S, Karadzinska-Bislimovska J, Mijakoski D, Šimić D, Simon D, Sonsmann F, Stoleski S, Weinert P, Wulfhorst B. The implementation of knowledge dissemination in the prevention of occupational skin diseases. J Eur Acad Dermatol Venereol 2017; 32:449-458. [DOI: 10.1111/jdv.14653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
Affiliation(s)
- A. Wilke
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); Osnabrück Germany
| | - U. Bollmann
- Institute for Work and Health (IAG) of the German Social Accident Insurance (DGUV); Dresden Germany
| | - S. Cazzaniga
- Centro Studi GISED; Bergamo Italy
- Department of Dermatology; Bern University Hospital; Inselspital; Bern Switzerland
| | - A. Hübner
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); Osnabrück Germany
| | - S.M. John
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); Osnabrück Germany
| | | | - D. Mijakoski
- Institute of Occupational Health of RM; Skopje FYR Macedonia
| | - D. Šimić
- Department of Dermatology and Venereology; University Clinical Hospital Mostar; Mostar Bosnia and Herzegovina
| | - D. Simon
- Department of Dermatology; Bern University Hospital; Inselspital; Bern Switzerland
| | - F. Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); Osnabrück Germany
| | - S. Stoleski
- Institute of Occupational Health of RM; Skopje FYR Macedonia
| | - P. Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm); Osnabrück Germany
| | - B. Wulfhorst
- Faculty of Human Sciences; Department of Educational Sciences; MSH Medical School Hamburg; University of Applied Sciences and Medical University; Hamburg Germany
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Schwensen JF, Johansen JD, Veien NK, Funding AT, Avnstorp C, Østerballe M, Andersen KE, Paulsen E, Mortz CG, Sommerlund M, Danielsen A, Andersen BL, Thormann J, Kristensen O, Kristensen B, Vissing S, Nielsen NH, Thyssen JP, Søsted H. Occupational contact dermatitis in hairdressers: an analysis of patch test data from the Danish Contact Dermatitis Group, 2002-2011. Contact Dermatitis 2013; 70:233-7. [DOI: 10.1111/cod.12176] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/28/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jakob F. Schwensen
- National Allergy Research Centre, Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Jeanne D. Johansen
- National Allergy Research Centre, Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | | | | | | | | | - Klaus E. Andersen
- Department of Dermatology and Allergy Centre; Odense University Hospital; 5000 Odense C Denmark
| | - Evy Paulsen
- Department of Dermatology and Allergy Centre; Odense University Hospital; 5000 Odense C Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre; Odense University Hospital; 5000 Odense C Denmark
| | - Mette Sommerlund
- Department of Dermatology; Aarhus University Hospital; 8000 Aarhus Denmark
| | | | | | | | | | | | | | | | - Jacob P. Thyssen
- National Allergy Research Centre, Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
| | - Heidi Søsted
- Research Centre for Hairdressers and Beauticians, Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; 2900 Hellerup Denmark
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Dulon M, Peters C, Wendeler D, Nienhaus A. Trends in occupational airway diseases in German hairdressers: frequency and causes. Am J Ind Med 2011; 54:486-93. [PMID: 21360727 DOI: 10.1002/ajim.20947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hairdressers are exposed to several allergens and irritants known to cause obstructive airway diseases (OAD). In the early 1990s, high incidence rates of OAD were observed in German hairdressers. It was expected that modification of formulations would resolve the problem of high OAD rates in hairdressers. METHODS The numbers of confirmed cases are reported of allergen-, latex- and irritant-induced OAD in German hairdressers, as registered by the responsible compensation board during 1998 and 2007. Hairdressing components reported as causative for OAD in hairdressers were analyzed. The incidence rates of OAD in hairdressers were compared with rates in healthcare professionals, as both occupations had high rates of OAD in the 1990s. RESULTS From 1998 until 2003, the total number of confirmed cases of allergen-, latex- and irritant-induced OAD stayed at a plateau of 60 cases annually in hairdressers, after which a downward trend was apparent. The number of irritant-induced OAD cases did not fall during this overall downward trend. Hair dyes and acid perms were most often identified as the substances causing OAD in hairdressers. In healthcare professionals, the downward trend in OAD is more pronounced than in hairdressers, mainly due to a decrease in latex-induced cases. CONCLUSIONS The number of allergen- and irritant-induced cases of OAD in German hairdressers is still high. Exposure to known airway irritants is still occurring in spite of modification of the formulations. Continuous medical surveillance of hairdressers is recommended, in order to detect individual susceptibility, especially in apprentices.
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Affiliation(s)
- Madeleine Dulon
- BGW (Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services), Hamburg, Germany.
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8
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Abstract
Contact dermatitis can be severe and lead to sick leave as well as significant healthcare expenses. The aim of this review is to present the published knowledge on 6 historical epidemics of contact allergy to apply this knowledge on the prevention and control of future contact allergy epidemics. A historical review is performed on nickel, chromium, methyl-chloro-iso-thiazolinone/methyl-iso-thiazolinone, methyl-di-bromo glucaro-nitrile, formaldehyde, and para-phenylenediamine. The first cases of contact dermatitis are mostly occupational, whereas consumer cases appear later. There is often a latency period from the first cases are observed until an epidemic occurs, and the problem is recognized. Finally, no one seems to take responsibility of dealing with the situation, and there are no attempts of regulation until an epidemic is consolidated among consumers for many years. Steps should be taken to prevent contact allergy epidemics. It is essential that dermatologist, scientists, administrators, and consumers organize and structure known methods to accelerate the control of emerging contact allergens.
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Affiliation(s)
- Jacob Pontoppidan Thyssen
- Department of Dermato-venerology, National Allergy Research Centre, Gentofte University Hospital, Ledreborg Allé 40, 2820 Gentofte, Denmark.
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Uter W, Geier J, Lessmann H, Schnuch A. Is contact allergy to glyceryl monothioglycolate still a problem in Germany? Contact Dermatitis 2007; 55:54-6. [PMID: 16842556 DOI: 10.1111/j.0105-1873.2006.0847b.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany.
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10
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Abstract
With almost 65 million women in the workforce, their representation in various occupational sectors is crucial, as is their health and safety. Female-dominated occupations in health care and cosmetology along with their potential cutaneous exposures are reviewed. Proper evaluation and management are necessary to minimize the disability that can result from these illnesses.
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Affiliation(s)
- Antoine Amado
- Department of Dermatology, Desk A-61, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Uter W, Hegewald J, Aberer W, Ayala F, Bircher AJ, Brasch J, Coenraads PJ, Schuttelaar MLA, Elsner P, Fartasch M, Mahler V, Belloni Fortina A, Frosch PJ, Fuchs T, Johansen JD, Menné T, Jolanki R, Krêcisz B, Kiec-Swierczynska M, Larese F, Orton D, Peserico A, Rantanen T, Schnuch A. The European standard series in 9 European countries, 2002/2003 - First results of the European Surveillance System on Contact Allergies. Contact Dermatitis 2005; 53:136-45. [PMID: 16128752 DOI: 10.1111/j.0105-1873.2005.00673.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.
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Affiliation(s)
- W Uter
- Department of Medical Informatics, Biometry & Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany.
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Hollund BE, Moen BE, Egeland GM, Florvaag E. Prevalence of airway symptoms and total serum immunoglobulin E among hairdressers in Bergen: a four-year prospective study. J Occup Environ Med 2004; 45:1201-6. [PMID: 14610402 DOI: 10.1097/01.jom.0000094992.18110.c0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined changes in the self-reported prevalence of respiratory symptoms and total serum immunoglobulin E (IgE) among hairdressers after local exhaust ventilation was installed in some hairdresser salons. We also examined differences in these variables between current and former hairdressers. The survey was a prospective study on 91 female hairdressers and a control group of 80 female office workers. Total serum IgE remained high in the hairdresser groups both in 1995 and 1999 (101 vs. 105 IU/mL blood). The IgE levels among office workers were low in 1995 and 1999. Forty percent of the hairdressers in 1995 had left their profession by 1999, 5.7 times the rate among office workers. The frequency of wheezing in the past year decreased significantly among current and former hairdressers. Our data suggest that hairdressers who remained in their profession were a highly selected and healthy group of workers. The improvement in symptoms might be explained by the reduced exposure resulting from the installation of local exhaust ventilation.
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Schnuch A, Lessmann H, Geier J, Frosch PJ, Uter W. Contact allergy to fragrances: frequencies of sensitization from 1996 to 2002. Results of the IVDK*. Contact Dermatitis 2004; 50:65-76. [PMID: 15128316 DOI: 10.1111/j.0105-1873.2004.00302.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Increasing frequencies of sensitization to the fragrance mix (FM) have been acknowledged as a serious problem for many years. It is well known that the single compounds (SCs) of the FM contribute differently to the FM patch rest reactions. In this study, we were interested in the time trends of the FM, the SCs, Myroxylon pereirae resin (MP; balsam of Peru) and oil of turpentine (OT) as possible further indicators of perfume allergy and analysed the data collected by the Information Network of Departments of Dermatology multicentre project from 1996 to 2002. During the study period (1996-2002), the FM [8% petrolatum (pet.)], MP (25% pet.) and OT (1% pet.) were tested in 59,298, 59,334 and 59,478 patients, respectively. SCs were tested in a selected group of patients, ranging from n = 1083 to n = 1924 per year. A significant increase in the proportions of patients with positive reactions to FM, MP and OT between 1996 and 1998 is noted, and a significant decline from 1999 to 2002 (Cochrane Armitage trend test, P < 0.0001). The highest frequency of sensitization to the FM was 13.1% in 1999, and the lowest 7.8% in 2002. The number of concomitant reactions to OT, a surrogate marker for terpenes, in FM-positive patients was significantly increased between 1997 and 1999. Reactions to SCs in FM-positive patients were observed in 29.9% (oak moss absolute) to 5.9% (geraniol). There was no time trend in reactions to SCs, although the relative share was increased for isoeugenol, cinnamic aldehyde and geraniol in 1999. In summary, we report for the first time, a significant decline in sensitization to the FM, very probably due to a reduced exposure (less potent allergens used in fine fragrances, possibly less use of natural ingredient-based cosmetics and lowered use concentration of important fragrance allergens). The differences in ranking of SCs could stimulate (a) a redefinition of the FM and (b) a differentiated preventive and regulatory approach, with oak moss and isoeugenol being regulated strictly by prohibition, concentration limits further reconsidered and/or health warnings and clearly less noxious substances like geraniol treated less restrictively.
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Affiliation(s)
- Axel Schnuch
- Information Network of Department of Dermatology (IVDK), University of Göttingen, Göttingen, Germany.
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Uter W, Lessmann H, Geier J, Schnuch A. Contact allergy to ingredients of hair cosmetics in female hairdressers and clients - an 8-year analysis of IVDK* data. Contact Dermatitis 2003; 49:236-40. [PMID: 14996045 DOI: 10.1111/j.0105-1873.2003.0233.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Not only hairdressers, but also their clients or home-users of hair cosmetic products may become sensitized to one of the product constituents. The present analysis addresses the question whether the pattern of sensitization is different in these 2 groups and includes female patients who consulted with the participating centres of the IVDK (http://www.ivdk.org) between 1995 and 2002, and in whom hair cosmetics have been considered as being causative of their contact dermatitis. Among these, 2 subgroups were identified: (i) patients, currently or previously working as hairdressers, diagnosed with occupational skin disease (H, n = 884) and (ii) patients who never worked as hairdressers, i.e. clients (C, n = 1217). Previous atopic eczema was twice as common among H, who were also much younger (median age 24 versus 46 in C). Analysis of sensitization frequencies and patterns showed the well-known decline of contact allergy to glyceryl monothioglycolate (GMTG) in H from 31.2% to 8.5%. Among the C, 1.7% were allergic to GMTG. Concerning p-phenylenediamine, a steady decline from 27.6% to 17.2% was observed in H, while no trend was found in C (12.6% and 16.6% in the first and the last 2-year period, respectively). Conversely, a very slight decline of p-toluenediamine sensitization was observed in H (from 29.5% to 24.8%), while at the same time a significant increase was noted in C (from 8.7% to 16.7%). A slighter increase was also noted with ammonium persulfate in C (3.1-6.8%), while the proportion of H sensitized remained largely constant at about 26%.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nürnberg, Erlangen, Germany.
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Wesley NO, Maibach HI. Decreasing allergic contact dermatitis frequency through dermatotoxicologic and epidemiologic based intervention? Food Chem Toxicol 2003; 41:857-60. [PMID: 12738190 DOI: 10.1016/s0278-6915(03)00036-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Allergic contact dermatitis (ACD) affects millions of people worldwide. In an attempt to decrease the incidence of contact dermatitis, several countries have implemented legislations to reduce the population's exposure to known sensitizers. To determine whether these legislations have been effective, we reviewed several studies examining trends in patch test reactivity before and after implementation of these legislations. Common sensitizers studied include nickel, gluceryl monothioglycolate fragrances, chromate, and thiuram. Overall, the evidence suggests a decreasing trend of ACD with appropriate formulation changes, however some of the data may be confounded by biases, and additionally, exposure to the sensitizer may still exist via non-compliance to regulations by small manufacturers. In the future population based studies should be conducted to more accurately assess trends in ACD.
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Affiliation(s)
- Naissan O Wesley
- University of California, PO Box 0989, Surge 110, San Francisco, CA 94143-0989, USA.
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