Allergic contact dermatitis in dental professionals: effective diagnosis and treatment

Patch test results in dental staff with dermatitis

BACKGROUND

Dental workers are exposed to allergenic materials in the workplace.

OBJECTIVES

To summarize patch test results in dental staff with work-related dermatitis.

MATERIALS AND METHODS

Cross-sectional study of dental staff with dermatitis was conducted. Symptoms, clinical findings and results from patch tests with 40 dental allergens were summarized.

RESULTS

Of 329 participants, 155 (47.1%) had at least one positive patch reaction. The highest frequency of positive reactions was observed for metals (38.6%), acrylics (7.3%) and additives in acrylic resins (3.6%). One hundred and eighty-five (56.2%) participants were currently symptomatic; in this group, 79 (42.7%) had current dermatitis. Thirty-eight patients had at least one positive patch test considered occupationally related to their current dermatitis.

CONCLUSION

Almost half of the dental staff with dermatitis had at least one positive patch test and approximately 12% had current occupational relevance of the allergens. Our results underscore the importance of patch testing in the evaluation of dental staff with dermatitis.

Facial Personal Protective Equipment: Materials, Resterilization Methods, and Management of Occupation-Related Dermatoses

BACKGROUND

The coronavirus infectious disease 2019 pandemic has resulted in health care workers donning personal protective equipment (PPE) for extended periods.

OBJECTIVES

The aims of the study were to review facial PPE (surgical masks and N95 respirators) ingredients, to identify facial PPE resterilization techniques, and to recommend strategies for prevention and management of facial PPE-related dermatoses.

METHODS

Twenty-one facial PPE (11 N95 respirators, 10 surgical masks) were reviewed. Resterilization techniques were identified. Personal protective equipment-induced occupational dermatoses and management strategies were explored.

RESULTS

Polypropylene is the most common chemical identified in facial PPE. Most masks contain aluminum at the nosepiece. Two surgical masks released nickel. Facial PPE dermatoses include irritant contact dermatitis, allergic contact dermatitis, acne, and contact urticaria. Strategies for prevention and management of facial PPE occupational dermatoses are discussed.

CONCLUSIONS

There are increasing reports of occupational dermatoses associated with facial PPE. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial PPE dermatoses.

'Occupational dermatoses from Personal Protective Equipment during the COVID-19 pandemic in the tropics - A Review'

The COVID-19 pandemic has enveloped the world and there has been a high incidence of occupational dermatoses related to Personal Protective Equipment (PPE) amongst healthcare workers (HCWs) during this period. Prevention and management of these conditions will not only improve staff morale and quality of life, but will also minimize the risk of breaching PPE protocol due to such symptoms. The tropical climate in Singapore predisposes HCWs to more skin damage and pruritus due to intense heat, high humidity and sun exposure. The effects of friction, occlusion, hyperhidrosis and overheating on the skin in the tropics should not be neglected. Preventive measures can be taken based on our recommendations, and the working environment can be made more conducive for frontline HCWs. We review the literature and discuss various preventive and management strategies for these occupational skin diseases for our frontline HCWs, especially those working in less controlled working environments beyond the hospital in Singapore. Shorter shifts and frequent breaks from PPE are recommended. Duration of continuous PPE-usage should not exceed 6 h, with breaks in non-contaminated areas every 2-3 h to hydrate and mitigate the risk of skin reactions. Other strategies, such as teledermatology, should be considered so that consultations can remain accessible, while ensuring the safety and well-being of our clinical staff.

Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review

Background

Prolonged wear of facial protective equipment can lead to occupational dermatoses.

Objective

To identify important causes of occupational dermatoses from facial protective equipment.

Methods

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using PubMed and Embase databases. Articles were included if they reported occupational dermatoses caused by surgical/procedure masks or N95 respirators, or both.

Results

We identified 344 articles, and 16 were suitable for inclusion in this review. Selected articles focused on facial occupational dermatoses in health care workers. Allergic contact dermatitis to the elastic straps, glue, and formaldehyde released from the mask fabric was reported. Irritant contact dermatitis was common on the cheeks and nasal bridge due to pressure and friction. Irritant dermatitis was associated with personal history of atopic dermatitis and prolonged mask wear (>6 hours). Acneiform eruption was reported due to prolonged wear and occlusion. Contact urticaria was rare.

Limitations

Only publications listed in PubMed or Embase were included. Most publications were case reports and retrospective studies.

Conclusion

This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment, including potential offending allergens. This work may help in the diagnosis and treatment of health care workers with facial occupational dermatitis.

Allergic contact dermatitis in children: common allergens and treatment: a review

PURPOSE OF REVIEW

The following study reviews the recent literature pertaining to allergic contact dermatitis (ACD) in the pediatric population. This study also provides an overview of the most common allergens and discusses various therapeutic modalities.

RECENT FINDINGS

The pathophysiology of ACD is intricate and multifaceted, resulting in a characteristic, delayed inflammatory response. Although commonly recognized in adults, its existence in the pediatric population was questioned. Recent literature suggests that pediatric ACD exists and is more common than previously recognized. The diagnosis relies on the clinical presentation combined with appropriate use and interpretation of a patch test. Although many studies have investigated ACD in children, few have documented the relevance of positive patch test reactions until recently. The most current prevalence estimates of positive patch test reactions range from 14 to 70% of children patch tested. Although that range is broad, these studies have demonstrated the relevance of positive reactions and confirmed ACD as a disease entity in children.

SUMMARY

ACD is a previously underrecognized disease process in the pediatric population that can manifest as a serious dermatologic challenge for both patients and physicians. This review will address the prevalence, diagnostic methods, frequent allergens and treatment options in pediatric ACD.

Self-reported occupational health issues among Lithuanian dentists

This article describes the second phase of a large study of Lithuanian dentists' health, and focuses on self-reported physical health complaints, general health state and associations between the two. In 2006, a postal questionnaire survey of all (N=2,449) licensed dentists registered with the Lithuanian Dental Association was conducted, obtaining a response rate of 68.2%. Fatigue (94.7%) and back pain (91.0%) were the most prevalent physical complaints reported, and they were also the most likely to become chronic among all physical disorders. Hypertension, joint diseases and allergy were the most prevalent diagnosed and treated diseases during the previous 12 months. Only half of the surveyed Lithuanian dentists (50.4%) rated their health as satisfactory. Logistic regression revealed that fatigue (Odds Ratio: 0.52; 95%CI: 0.29-0.94), headache (OR: 0.62; 95%CI: 0.42-0.90), hand problems (OR: 0.62; 95%CI: 0.44-0.87), chest pain (OR: 0.51; 95%CI: 0.40-0.64) and musculoskeletal complaints (OR: 0.41; 95%CI: 0.28-0.60) had a significant negative impact on dentists' self-reported general health. Overall, this study suggests that Lithuanian dentists do experience a certain amount of occupationally-related health problems. It is therefore important to increase health knowledge on occupational hazards and also to emphasize the importance of early diagnosis and treatment for these disorders in Lithuania, as elsewhere.

Positive patch test reactions to allergens of the dental series and the relation to the clinical presentations

The clinical manifestations of contact allergic dermatitis to dental materials are not uniform. This study was performed to detect the frequent allergens in the dental series associated with contact dermatitis and to define the causal relationship between the different allergens and the relevant clinical presentations. Between the years 2000 and 2004, 134 patients, aged 20-80 years, were patch tested. 121 patients were included in the study. The most frequent oral manifestations were cheilitis and perioral dermatitis (25.6%), burning mouth (15.7%), lichenoid reaction (14.0%), and orofacial granulomatosis (10.7%). 18 (14.9%) patients were dental personnel, all of whom suffered from hand dermatitis. The common allergens detected included goldsodiumthiosulphate (14.0%), nickel sulfate (13.2%), mercury (9.9%), palladium chloride (7.4%), cobalt chloride (5.0%), and 2-hydroxyethyl methacrylate (5.8%). Positive reactions to metals were frequent in all the different clinical variants, and no specific association between a specific clinical presentation and a particular allergen was found. Allergy to mercury was not a significant factor contributing to the pathogenesis of oral lichenoid reactions. However, a strong association with contact allergy to mercury in dental fillings was found in 2 patients with orofacial granulomatosis.

Occupational allergens in dentistry

PURPOSE OF REVIEW

Dental professionals and their physicians frequently do not recognize, accurately diagnose or appropriately manage occupational allergies. Dental allergen identification, diagnostics and practical avoidance strategies are summarized in this review.

RECENT FINDINGS

Methacrylates, natural rubber latex proteins, rubber glove allergens, and glutaraldehyde are the predominant allergens in dentistry. Reactions range from cell-mediated contact allergy to urticaria and occupational asthma.

SUMMARY

Despite recent advances in allergen characterization and increased awareness of selected allergens, treatment of occupational allergies can be improved. Better information and improved cooperation between dental workers and their clinicians is needed.