Prognosis of contact dermatitis in epoxy resin workers

Between January 1993 and February 2002, 40 of 1354 (3%) workers who attended a tertiary referral occupational dermatology clinic were diagnosed with allergic contact dermatitis (ACD) from epoxy resin systems (ER). 20 of these patients were followed up at least 2 years post-diagnosis to establish prognosis. Characteristics collected at diagnosis, including age, atopic status and severity, were compared between the follow-up and not followed-up groups. No significant differences were observed. A clinician contacted patients and administered a telephone questionnaire based on variables identified from the literature, which were considered of importance for prognosis. All patients reported improvement of their skin condition since diagnosis. 12 of the 20 {60%[95% confidence interval (CI) 56-94%]} patients had applied for workers' compensation; all of these claims were successful. 16 had ceased working with ER. Of these, 9 [56% (95% CI 29-80%)] reported complete healing and 7 [44% (95% CI 19-70%)] reported ongoing dermatitis. Although no conclusions could be drawn because of the small sample size, factors that may be associated with a poor prognosis were age, atopy, duration of symptoms and severity at diagnosis. The prognosis of ACD from ER is not always favourable, even if a worker ceases exposure.     

Medical and psychosocial outcome of patients with occupational contact dermatitis in Israel

BACKGROUND: Although the medical, financial and prognostic factors of occupational contact dermatitis (OCD) have been addressed, studies on the social outcome of OCD are sparse. OBJECTIVE: To define the medical and psychosocial outcome of patients with OCD. METHODS: Workers with OCD were interviewed by telephone using a questionnaire that included questions about the occupation, dermatological disease, sick leave, present working status and disability claims, and questions related to the subjective perceptions of OCD in all areas of psychosocial functioning and quality of life. RESULTS: Seventy workers (64.3% males and 35.7% females) were interviewed. Forty per cent had stopped working and one-third had taken sick leave because of OCD. Forty-seven (67.1%) were currently working while 23 (32.8%) were unemployed. Disability compensation was claimed by only 41.4% and was received by 24.3%. Eight workers (11.4%) had persistent postoccupational dermatitis (PPOD). Loss of employment affected the occupational area of the workers' lives (100%), and also interpersonal relationships (45.7%), relationships within the family (18.6%), daily functioning (45.7%) and mental health (24.3%). CONCLUSIONS: Considerable working time is lost because of unemployment or sick leave due to OCD. Only a small proportion of eligible patients with OCD apply for disability compensation and an even smaller proportion receive it. Our study demonstrates the significance of OCD to the psychosocial aspects of workers' lives and emphasizes that the assessment of OCD outcome should relate not only to the medical but also to the psychosocial aspect of the disease.     

The validity and reliability of the occupational contact dermatitis disease severity index

Background:  The occupational contact dermatitis disease severity index (ODDI) was designed to assess the severity and importantly the functional disability caused by occupational contact dermatitis (OCD) of the hands in patients attending our occupational dermatology clinic.
Objectives:  To investigate the accuracy of the ODDI.
Patients/Methods:  Of 205 patients, 95 were assessed as having OCD of the hands. Content validity was assessed by content mapping and expert opinion. Construct validity was examined through comparing the ODDI against global clinical dermatology severity assessment (GCDSA). Intraobserver reliability, interobserver reliability, internal consistency, acceptability and convenience were also assessed.
Results:  The ODDI was found to have content validity by the experts and was moderately correlated with GCDSA, supporting construct validity (Pearson's r  = 0.54; P  ≤ 0.01). The ODDI was shown to be reliable with substantial agreement for both intraobserver reliability [intraclass correlation coefficient ( ICC )  = 0.62] and interobserver reliability (ICC = 0.75). Internal consistency within the ODDI was almost perfect (ICC = 0.94–0.99) and user survey showed the ODDI to be acceptable, easy and quick to use.
Conclusions:  The ODDI is a valid and reliable instrument to assess the severity and functional limitations caused by OCD, in patients who have had treatment or modified work duties, associated with some improvement of their dermatitis.     

Irritant contact dermatitis and chrome-passivated metal

An outbreak of hand dermatitis is reported amongst employees working on a new assembly line of an electronics factory. 24 out of 41 employees had signs of irritant contact dermatitis. The fingertips and the dorsal parts of the hands were especially affected. Mechanical factors in combination with zinc-chromium compounds from galvanised steel seemed to be responsible for the dermatitis and the dry skin. The use of an emollient solved the problem.     

Occupational dermatitis in dental personnel: contact dermatitis with special reference to (meth)acrylates in 174 patients

Between 1995 and 1998, 174 dental personnel were referred as patients to the Department of Occupational and Environmental Dermatology, Stockholm. After clinical examination, 131 were patch tested with the Swedish standard series and 109 with a dental screening series. Furthermore, 137 were tested for IgE-mediated allergy to natural rubber latex (NRL). Hand eczema was diagnosed in 109/174 (63%), 73 (67%) being classified as irritant contact dermatitis and 36 (33%) as allergic. Further diagnoses included other eczemas, urticaria, rosacea, psoriasis, tinea pedis, bullous pemphigoid or no skin disease. 77/131 (59%) had positive reactions to substances in the standard series and 44/109 (40%) to substances exclusive to the dental series. 24/109 (22%) patients had positive reactions to (meth)acrylates, the majority with reactions to several test preparations. Reactions to HEMA (2-hydroxyethyl methacrylate), EGDMA (ethyleneglycol dimethacrylate) and MMA (methyl methacrylate) were most frequent. 9 of the 24 were positive only to (meth)acrylates, the remaining 15 also had reactions to allergens in the standard series. 23 of these had hand eczema and 1 facial eczema. In 17 of the 24 allergic to (meth)acrylates, the dermatitis had started in 1995 or later, in 15 within the previous 12 months. Of 8 who had been sick-listed, 7 also had a history of atopy and 6 were allergic to nickel. The most frequent allergens besides (meth)acrylates were nickel, cobalt, palladium, fragrance mix, colophonium and thiuram mix. Allergy to natural rubber latex was diagnosed in 14/137 (10%). In conclusion, irritant hand dermatitis was the dominant diagnosis. Contact allergy to (meth)acrylate was seen in 22% of the patch tested patients, with reactions to 3 predominant test substances. 1/3 of the patients with allergy to (meth)acrylates had been sick-listed for dermatitis, but in all these cases the (meth)acrylate allergy was seen together with atopy and/or further contact allergies.     

Formaldehyde-negative allergic contact dermatitis from melamine-formaldehyde resin

Melamine-formaldehyde resin (MFR) is used as a textile finish, in tableware, in surface coatings, and in glues in the furniture and wood industry. MFR is considered to be an infrequent sensitizer. Contact allergy to MFR is often combined with formaldehyde allergy. Patients allergic to textile finish often react to MFR, although other finishes are nowadays more commonly used. Besides allergy to textile finish, allergic contact dermatitis from MFR has been described in workers in composite production and in an orthopaedic plaster technician. To our knowledge, there are no previous reports of contact allergy in the plywood industry from MFR. We describe 3 cases of occupational allergic contact dermatitis from MFR without contact allergy to formaldehyde, 1 in the plywood industry, 1 in the production of melamine-laminated chipboard and 1 in laboratory work.     

Irritant contact dermatitis from diallylglycol carbonate monomer and its prevention

We report an outbreak of irritant contact dermatitis from diallylglycol carbonate monomer among factory employees making optical plastic lenses. Symptoms lessened after simple preventive methods were introduced. Further upgrading of production methods lessened symptoms still further and also restored the company's economic viability.     

Occupational allergic contact dermatitis from bisphenol A in vinyl gloves

Allergic contact dermatitis caused by polyvinyl chloride gloves is rarely reported, and in only 2 cases was bisphenol A considered to be the responsible sensitizer. We report a patient with occupational hand dermatitis after the use of a new type of high-density vinyl (HDV) gloves. Patch tests showed positive (++) reactions to both used and new HDV gloves and to bisphenol A. Chemical analysis by gas chromatography-mass spectrometry demonstrated the presence of bisphenol A in the HDV gloves. Replacement by nitrile rubber gloves resulted in complete clearance of the hand dermatitis.     

Allergic contact dermatitis in dentistry

Allergic contact dermatitis (ACD) in dentistry may affect dentists and orthodontists, technicians, nurses and patients. Changes to dental practice in recent years have altered the reported frequencies of allergens causing ACD in both dental personnel and patients. Allergic contact dermatitis to medicaments, metals and glutaraldehyde were previously common allergens in dentistry; however, widespread adoption of rubber gloves by staff has resulted in a significant increase in ACD to glove allergens in both dental staff and their patients, while affording protection against the traditional allergens. Both public concerns about potential toxicity of metals in oral restorations and a greater demand for cosmetic dentistry, have resulted in greater use of acrylics and resins by dental personnel, exposing them to highly allergenic materials. Dermatologists need to be aware of the newer allergenic materials used in dentistry in order to correctly manage skin diseases in this high-risk group.     

Descriptive epidemiology of hand dermatitis at the St John's contact dermatitis clinic 1983-97

For 15 years, hand dermatitis accounted for a quarter of patients seen in this clinic. The highest proportion occurred in women aged 17-30 years. Overall, the male to female ratio was 0.8, which contrasts with population-based studies. Catering was most frequently associated with occupational hand dermatitis. Other frequent occupational associations included metalworking, hairdressing, healthcare and mechanical work.