Occupational hand dermatoses of hairdressers in Tainan City

Nickel release from hairdressing tools in the United States

BACKGROUND

Hairdressers have a high prevalence of contact dermatitis, especially to nickel. The presence of nickel in hairdressing tools has been evaluated in the European Union, where the government limits nickel release levels from objects.

OBJECTIVES

The aim of this study is to qualitatively investigate nickel release in hairdresser tools in both rural and urban United States, a country without nickel release legislation.

METHODS

Hairdressers and individuals with hairdressing tools were invited to participate. Metallic parts of each tool were tested with dimethylglyoxime (DMG), which detects nickel release. Data on tool cost were recorded.

RESULTS

A total of 89 tools from 9 salons and 2 over-the-counter sets were tested. Twenty-four (27%) tested positive: trimmers (100%), curling irons (100%), clippers (50%), hair clips (36%), texturizing shears (26%), and trimming shears (4%). Nickel was detected in both salon and over-the-counter tools, and rural and urban salons. Nickel-releasing tools were cheaper than DMG-negative tools of the same type.

CONCLUSIONS

Our findings help explain the high prevalence of contact dermatitis among hairdressers, alert clinicians to consider occult occupational nickel when assessing patients with allergic contact dermatitis, reinforces the importance of using barrier protection including gloves when handling hairdressing tools including at home, and augments impetus for more legislation regulating common allergens.

Time-trends for eczema prevalences among children and adults from 1985 to 2015 in China: a systematic review

Background

Several studies have reported that childhood prevalence of eczema has been increasing worldwide. However, none study quantitatively evaluated prevalence trends of eczema among children and adults in the last 30 years in China.

Methods and Findings

Via a systematic review of literature databases in English and Chinese, we summarized all studies reporting eczema prevalences from 1985 to 2015 in China as well as diagramed prevalence and eczematous population trends against year for different age groups. A total of 93 studies and 17 studies (16 for children and one for adults) were selected for qualitative and quantitative synthesis, respectively. Childhood lifetime-ever eczema prevalences ranged from 10.0% to 30.0%. Prevalences among 3-12-year-olds children showed increasing trends in most specific cities, but national lifetime-ever eczema prevalences among 13-14-year-olds children decreased from 10.6% in 2001 to 8.6% in 2009 in mainland China. We estimated that about 1.5 million children aged 13-14-year-olds in 2009 and 15.5 million children aged 3-6-year-olds in 2012 had lifetime-ever eczema in mainland China. Similar studies were too few to ascertain time-trends of eczema prevalence among adults. About 39.4, 20.0, and 11.6 million adults aged 15-86-year-olds in 2010 had contact dermatitis, seborrheic dermatitis, and atopic dermatitis in the mainland China, respectively.

Conclusions

The burden of eczema became heavier in young children, whereas perhaps had been reduced in adolescent in China. More studies for eczema prevalence in adults are warranted.

Causes of irritant contact dermatitis after occupational skin exposure: a systematic review

PURPOSE

Irritant contact dermatitis (ICD) is a major cause of occupational disease. The aim was to review the relation between exposure to occupational irritants and ICD and the prognosis of ICD.

METHODS

Through a systematic search, 1516 titles were identified, and 48 studies were included in the systematic review.

RESULTS

We found that the evidence for an association between ICD and occupational irritants was strong for wet work, moderate for detergents and non-alcoholic disinfectants, and strong for a combination. The highest quality studies provided limited evidence for an association with use of occlusive gloves without other exposures and moderate evidence with simultaneous exposure to other wet work irritants. The evidence for an association between minor ICD and exposure to metalworking fluids was moderate. Regarding mechanical exposures, the literature was scarce and the evidence limited. We found that the prognosis for complete healing of ICD is poor, but improves after decrease of exposure through change of occupation or work tasks. There was no substantial evidence for an influence of gender, age, or household exposures. Inclusion of atopic dermatitis in the analysis did not alter the risk of ICD. Studies were at risk of bias, mainly due to selection and misclassification of exposure and outcome. This may have attenuated the results.

CONCLUSION

This review reports strong evidence for an association between ICD and a combination of exposure to wet work and non-alcoholic disinfectants, moderate for metalworking fluids, limited for mechanical and glove exposure, and a strong evidence for a poor prognosis of ICD.

Use of protective gloves by hairdressers: A review of efficacy and potential adverse effects

Occupational hand eczema is common among hairdressers, and protective gloves are important in limiting exposure to irritants and allergens. Various glove types may differ in their protective ability, and their use may lead to hand eczema due to skin irritancy and allergy. MEDLINE was searched for studies investigating permeation of gloves to irritants and allergens used in the hairdressing trade, as well as adverse effects of glove use affecting hairdressers. Forty-four studies were identified; nine reported on permeation. Of those, two in vitro studies found nitrile rubber (NR) gloves to give the best protection when handling hair dyes. Polyethylene (PE) gloves had the lowest reported break-through time. The prevalence of sensitization to rubber materials in European hairdressers was as follows: thiuram mix, median 2.5% (range 0%-8.2%), weighted average 3.0% (95% confidence interval [CI] 3.0%-3.1%); mercapto mix, median 0.4% (range 0%-3.3%), weighted average 0.5% (95% CI 0.47%-0.50%), mercaptobenzothiazole, median 0.6% (range 0%-6.6%), weighted average 0.7% (95% CI 0.6%-0.7%), NRL-type I allergy, median 1.3% (range 1%-16.4%), weighted average 4.0% (95% CI 3.6%-4.5%). In conclusion, NR gloves provide the best skin protection for hairdressers, although natural rubber latex (NRL) and polyvinylchloride (PVC) gloves may be sufficient in most cases. PE gloves are not recommended. Synthetic rubber gloves with low or no levels of accelerators are preferred.

Occupationally Related Nickel Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 1998-2016

BACKGROUND

The epidemiology of nickel allergy in occupational settings is not well understood.

OBJECTIVE

The aim of the study was to characterize occupationally related nickel allergy (ORNA).

METHODS

This is a retrospective cross-sectional analysis of 44,378 patients patch tested by the North American Contact Dermatitis Group from 1998 to 2016. Characteristics of individuals with ORNA were compared with those with non-ORNA (NORNA).

RESULTS

A total of 7928 (18.2%) individuals were positive to nickel sulfate 2.5%. Two hundred sixty-eight (3.4%) had ORNA. As compared with NORNA, ORNA was statistically associated with the male sex (41.0% vs 12.9%, P < 0.001), a diagnosis of irritant contact dermatitis (22.4% vs 12.0%, P < 0.001), and no history of eczema (81.7% vs 75.7%, P = 0.0217). The most common sites of ORNA dermatitis were hand (39.9%) and arm (18.1%), which were significantly more common than in NORNA (P < 0.0001). Sixteen industry categories and 22 occupation categories were identified for ORNA; the most common industries were durable goods manufacturing (24.6%) and personal services (15.7%), and the most frequent occupations were hairdressers/cosmetologists/barbers (14.3%), machine operators (9.3%), and health care workers (7.1%). Overall 30% of ORNA occupations were in metalworking. Of 215 ORNA sources identified, instruments/phones/other equipment (16.3%), vehicles/machinery (15.8%), and tools (15.3%) were the most common.

CONCLUSIONS

Occupational nickel allergy is distinct from nonoccupational nickel allergy.

Occupational skin disorders in a subset of Nigerian hairdressers

Introduction

Hairdressing is associated with a wide range of disorders. This is particularly true in the African hairdresser, who is saddled with the responsibility of ‘taming’ the rather difficult-to-manage African hair, and is thus exposed to a wide range of chemical, biological and physical materials in the hair grooming process. We therefore sought to determine the prevalence and pattern of occupational skin disorders among hairdressers in Ibadan, one of the oldest and largest cities in Nigeria.

Methods

This was a cross sectional study of hairdressers conducted in 2013 in Ibadan, Nigeria. Hairdressers and their apprentices were interviewed using a structured questionnaire, following which a thorough physical examination was performed to identify any skin disorder.

Results

A total of 226 hairstylists were recruited. The prevalence of occupational skin disorders in the study was 68.13%. The prevalence of specific skin disorders was 32.74% for nail disorders; 28.75% for traumatic skin disorders; and 2.64% for hand dermatitis.

Conclusion

There is a high prevalence of occupational skin disorders among hairdressers, and this may have personal and public health implications.

Exposure of hairdressers to the main cosmetics used in hairdressing salons in France: A preliminary study

In recent years, more attention has been given to chemical exposure in hairdressers. This increasing interest is largely due to the various respiratory and skin symptoms observed in hairdressers. According to these symptoms, hairdressers are in contact with various sources of exposure. Particularly in France, little information is available to assess professional exposure of hairdressers. In order to gather information to assess exposure in hairdressers, 11 hairdressing salons were visited. All the salons were located in Brest City (France). Preferentially, small hairdressing salons were visited. Observations were performed to obtain salon characteristics and to record workers' practices. Calculations revealed that in the worst-case scenario, dermal professional exposure reaches 14.68 and 13.67 mg/kg/day for hair coloring and highlighting mixtures, respectively. Inhalation exposure represents 14.2 and 18.1 mg/kg/day for hair coloring and highlighting mixtures, respectively. These exposure values represent baseline values for exposure of French hairdressers working in small hairdressing salons.

Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria

BACKGROUND

Occupational contact dermatitis is the most frequently reported work-related skin disease in many countries. A systematic review was commissioned by the British Occupational Health Research Foundation in response to a House of Lords Science and Technology Committee recommendation.

OBJECTIVES

The systematic review aims to improve the prevention, identification and management of occupational contact dermatitis and urticaria by providing evidence-based recommendations.

METHODS

The literature was searched systematically using Medline and Embase for English-language articles published up to the end of September 2009. Evidence-based statements and recommendations were graded using the Royal College of General Practitioner's three-star system and the revised Scottish Intercollegiate Guidelines Network grading system.

RESULTS

Three thousand one hundred and fifty-five abstracts were identified and screened. From these, 786 full papers were obtained and appraised. One hundred and nineteen of these studies were used to produce 36 graded evidence statements and 10 key recommendations.

CONCLUSIONS

This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification and occupational management of occupational contact dermatitis and urticaria, based on and using the best available medical evidence.

Skin disease among staff in a large Korean nursing home

Although previous studies have documented reasonably high rates of skin disease among nursing home staff, the prevalence among Korean workers is not well known. For this investigation we selected a large Korean nursing home and distributed a skin disease questionnaire to all staff. Questions included job title, job description, employment history, working hours, patient contact and the occurrence of skin disease over the past 12 months. Workers who reported a dermatological problem then underwent skin examinations conducted by specialist occupational physicians and a dermatologist. Contact dermatitis was the most common skin disease detected, with 4.8% of staff currently suffering from it and 6.0% reporting it in the previous 12-month period. Tinea pedis was another common condition, affecting 3.6% on our examination day. However, only two-thirds of them (2.4%) recounted a past history of tinea pedis. Scabies was diagnosed among 2.4% of staff and reported as a previous infection by 6.0%. Overall, the prevalence of dermatitis and scabies were quite low when compared to previous studies, while fungal infection rates were similar to other investigations. Further research into this growing occupational demographic is indicated.

Prevalence of skin disease among nursing home patients in southern Taiwan

BACKGROUND

Continuing advances in medical care and nutrition have prolonged the lifespan and expanded the elderly demographic world-wide. Despite increasing elderly populations within Taiwanese nursing homes, there has been a lack of dermatologic surveys, and the prevalence of skin conditions within this group is unknown.

METHODS

To establish the prevalence of skin disease within nursing homes in southern Taiwan, we undertook a dermatologic and epidemiologic investigation of 398 patients in Tainan City, southern Taiwan, between November 1999 and February 2000.

RESULTS

This study revealed that more than half of all nursing home patients suffered from fungus (61.6%) and xerosis (58.3%), while other pruritic skin diseases, such as dermatitis and scabies, were less prevalent at 7.3% and 3.3%, respectively. Risk factors for fungal infection included bedridden status (risk ratio (RR), 1.2; 95% confidence interval (CI), 1.1-1.4) and male gender (RR, 1.2; 95% CI, 1.0-1.3). Xerosis was statistically correlated with an age range of 80-90 years (RR, 1.2; 95% CI, 1.0-1.4) when compared to other age ranges. Current scabies diagnosis was strongly associated with a previous history of scabies (RR, 8.9; 95% CI, 1.7-21.1).

CONCLUSIONS

Our study provides clinically relevant data regarding the prevalence of skin diseases in institutionalized Taiwanese patients for the first time. The results suggest that scabies persists within some nursing homes despite treatment, and that some patients remain undiagnosed. The dermatologic needs of these Taiwanese patients are not currently being satisfied.

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

BACKGROUND

Occupational skin diseases (OSDs) account for a large portion of occupational diseases in Europe, but population-based epidemiological studies are missing.

OBJECTIVES

We analysed the initial reports of OSDs in our register of OSDs in Northern Bavaria (BKH-N).

METHODS

A total of 5285 cases were assessed prospectively and registered from 1990 to 1999. As the German Federal Employment Office provides specific occupational data in relation to the total employed population of Northern Bavaria, it was possible to conduct a population-based study that investigated the trend in incidence rates between two study periods (1990-92 and 1993-99) in 24 different occupational groups.

RESULTS

A total of 3097 cases of OSD (median age 25 years) were recorded in the 24 occupational groups. There was a significant decline (P < 0.001) in the overall incidence rate of OSD with 10.7 cases per 10,000 workers per year for the first study period and 4.9 cases per 10,000 workers per year for the second study period. This general trend in incidence rates was also significant for hairdressers and barbers, bakers, health-care workers, cooks and metal processors.

CONCLUSIONS

The BKH-N provides national data based on the notification of OSDs in Germany. The results demonstrate the rank of occupations hazardous for the skin and are helpful for defining target groups for prevention.

Prevalence of dermatoses and skin sensitisation associated with use of pesticides in fruit farmers of southern Taiwan

OBJECTIVES

Agricultural workers are known to have occupational skin diseases. The prevalence and pattern of skin diseases are unknown in Taiwanese fruit farmers. The objective of this study is to determine the work exposure, prevalence of skin diseases, and sensitivity to common skin allergens and agricultural chemicals in fruit farmers of southern Taiwan.

METHODS

122 fruit farmers who regularly prepared and sprayed pesticides and a group of 63 printing press workers with no known exposure to pesticides were examined and patch tested with common skin allergens and agricultural chemicals. The farmers were also interviewed for their work habits, use of protective clothing, and exposure to pesticides.

RESULTS

Most farmers reported regular use of hat, boots, and mask, but not gloves, raincoat, and goggles. This resulted in frequent skin contact with pesticides especially on the hands and face. About 30% of farmers had hand dermatitis, and more than two thirds had pigmentation and thickening on the hands. Fungal infection of the skin was noted in a quarter of subjects. By patch test, farmers and the printing press workers had a similar rate of sensitivity to common skin allergens. 40% of farmers were sensitive to agricultural chemical allergens, which was about twofold higher than that of the comparison group. Farmers were most frequently sensitive to Captofol, Folpet, and Captan which were associated with dermatitis on the volar aspects of the hands.

CONCLUSIONS

Fruit farmers in southern Taiwan had a high prevalence of skin diseases related to use of pesticides, and appropriate protective measures and work practices should be taken to prevent such problems.

Occupational hand dermatitis in a tertiary referral dermatology clinic in Taipei

Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.