Healthy worker effect in hairdressing apprentices

Background. Hairdressers and hairdressing apprentices have a high incidence of occupational hand eczema, owing to excessive wet work and exposure to chemical substances. Hairdressing apprentices, in particular, seem to be at high risk of developing hand eczema. Previous hand eczema and atopic dermatitis are known risk factors for the development of hand eczema in wet work occupations. Objectives. To estimate the prevalence of hand eczema, eczema on wrists or forearms and atopic dermatitis in a cohort of hairdressing apprentices at the start of their education, and subsequently evaluate any potential healthy worker effect. Methods. During the first 2 weeks of training, 382 hairdressing apprentices were enrolled in this study. All apprentices completed a self‐administered questionnaire, including previously validated questions regarding, for example, previous and present hand eczema, eczema on the wrists or forearms, and atopic dermatitis. For comparison, the questionnaire was sent to a control group matched for age, gender and city code from the general population (n = 1870). Results. Response rates were 99.7% for the hairdressing apprentices (mean age 17.5 years, range 15–39 years, 96.3% females) and 68.3% for the control group (mean age 17.4 years, range 15–39 years, 96.8% females). Previous or present hand eczema were reported by 8.0% of hairdressing apprentices and by 12.5% of the matched control group (p = 0.009), and eczema on the wrists or forearms was reported by 5.3% of the apprentices and by 11.9% of the controls (p < 0.001). We classified 21.4% of the hairdressing apprentices as having atopic dermatitis versus 29.8% of the matched control group (p = 0.001). Conclusions. These results indicate a healthy worker effect, as there was a lower reported incidence of hand eczema and eczema on wrists or forearms, and there were fewer cases classified as having atopic dermatitis, among hairdressing apprentices than in a matched control group from the general population.     

P54Prevalence of skin changes in the cleaning industry

Background: In the cleaning industry, the hands are exposed to water and irritants, resulting in dry skin and hand eczema. The prevalence and severity of skin changes is unknown. Objectives: To quantify the prevalence and the severity of skin changes of the hands. To compare questionnaire‐based self‐reported signs of hand eczema (both current and at any occasion during the last 12 months), with skin changes revealed by clinical examination. Methods: A random sample of 231 employees in the cleaning industry participated in the study. Most of them were immigrants. They had to answer a (translated) questionnaire about signs of hand eczema. Then all of them were examined and the severity of hand eczema was graded by a scoring system1. In the comparison only objective subvariables (desquamation, erythema, fissures, infiltration, vesicles) were used. Results: Clinical examination of the hands detected desquamation in 38%; erythema in 29%; fissures in 24%; infiltration in 12%; vesicles in 4%. Severity scoring of hand eczema: one point in 21%; two points in 18%; three points in 9%; four points in 4%. Signs of hand eczema reported in the questionnaire based on the current situation: desquamation in 17%; erythema in 20%; fissures in 20%; infiltration in 10%; vesicles in 12%. Signs of hand eczema reported in the questionnaire based on any occasion during the last 12 months: desquamation in 18%; erythema in 17%; fissures in 22%; infiltration in 11%; vesicles in 15%. False negative self‐reporting by the questionnaire: desquamation in 26%; erythema in 18%; fissures in 14%; infiltration in 11%; vesicles in 3%. False positive self‐reporting by the questionnaire: desquamation in 5%; erythema in 10%; fissures in 10%; infiltration in 8%; vesicles in 11%. Conclusions: Desquamation and erythema were the most common signs both in clinical examination and in questionnaire. The self‐reported prevalence (both current and over the last 12 months) of erythema and desquamation is an underestimation of the true prevalence. Scoring hand eczema revealed that most of the employees scored one or two points; indicating that most of the clinical signs of hand eczema are minor. False negative self‐reporting by questionnaire was high; indicating that these minor symptoms of hand eczema were probably not recognized by the employees. False positive self‐reporting was also high; probably because they misunderstood the questions. This study illustrates the need for a consensus about the distinction between “minor skin damage” and “true eczema”.     

Do hairdressers in Denmark have their hand eczema reported as an occupational disease? Results from a register‐based questionnaire study

Background. Occupational hand eczema is common in hairdressers, owing to wet work and chemicals. Objectives. To estimate whether hairdressers in Denmark have their hand eczema reported as an occupational disease and to clarify the reasons for not reporting. Methods. A register‐based study was performed, comprising trained hairdressers (n = 7840), using a self‐administered postal questionnaire including questions on hand eczema and it being reported as an occupational disease. A response rate of 67.9% (n = 5324) was obtained. Results. Overall, 2186 respondents ever had hand eczema; 71.3% were apprentices at the time of hand eczema onset. The majority (61.9%) had had hand eczema several times and 21.3% (almost) all of the time, but only 20.7% had reported their hand eczema as being occupational to the National Board of Industrial Injuries (Denmark). A positive association between severity of hand eczema and filing a report was found (odds ratio 19.2; 95% confidence interval 8.18–45.06). The main reasons for not reporting were ‘I thought it would eventually get better’ (40.4%) and ‘My doctor didn't tell me it was possible to report it' (26.6%). Conclusions. Hand eczema is considerably under‐reported as an occupational disease; the perception of hand eczema among hairdressers and the lack of reporting from doctors are the main reasons for this.     

Flare-up of dermatitis following patch testing is more common in polysensitized patients

Background: To estimate the prevalence of nickel allergy, self‐reports are sometimes used in epidemiological studies. Self‐reports are practical and may facilitate estimation of prevalence provided that the questions are validated. Objectives: To investigate the validity of self‐reported nickel allergy. Methods: Three hundred and sixty‐nine women, aged 30–40 years, from the general population participated in the study. The participants answered a questionnaire before a clinical examination and patch testing. The two questions being validated were ‘Are you sensitive/hypersensitive/allergic to nickel?’ and ‘Do you get a rash from metal buttons, jewellery or other metal items that come in direct contact with your skin?’ Results: Patch test showed nickel‐positive reaction in 30% of the subjects. Self‐reported prevalence of nickel allergy as indicated by the two respective questions was 40% and 35%. Positive predictive values for the two questions were 59% (95% CI 50–67) and 60% (95% CI 51–69). History of childhood eczema was over‐represented among women with ‘false‐positive’ self‐reported nickel allergy (P = 0.008). Self‐reported hand eczema or ‘high wet exposure’ did not influence the validity. Conclusions: The validity of self‐reported nickel allergy is low. The questions regarding nickel allergy overestimate the true prevalence of nickel allergy.     

Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis

Summary Background Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick‐leave periods and need for changes of work and re‐training put an economic burden on society, and there is an interest indeveloping cost‐effective epidemiological surveillance instruments such as a screening questionnaire. Objectives In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self‐reported signs. Methods Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist (‘gold standard’) were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification. Results Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the ‘gold standard’. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0·62 and a specificity of 0·87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0·87 and a specificity of 0·79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a κ‐value of 0·65 (95% CI 0·55–0·75), and the poorest was for papules with 0·47 (95% CI 0·32–0·62). Conclusions It was difficult for the individual to identify skin signs compatible with the clinical diagnosis of hand eczema. Asking ‘Do you have hand eczema?’ had high sensitivity and specificity compared to the suggested gold standard for hand eczema. However, the validity of a screening questionnaire depends on the type of population investigated.     

Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences

Background. Occupational hand eczema is common in hairdressers, owing to wet work and hairdressing chemicals. Objectives. To estimate the prevalence of hand eczema and its career consequences among hairdressers in Denmark. Methods. A register‐based study was conducted, comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self‐administered postal questionnaire including questions on hand eczema, atopic dermatitis, and career change. A response rate of 67.9% (n = 5324) was obtained. Results. Of the respondents, 44.3% no longer worked as hairdressers and had worked for an average of 8.4 years in the profession before leaving it. Hand eczema was more common among ex‐hairdressers (48.4%) than among current hairdressers (37.6%) (p < 0.0001), and significantly more ex‐hairdressers (26.8%) than current hairdressers (15.7%) had chronic hand eczema (p < 0.0001). Of the respondents with hand eczema, 75% were aged 15–24 years at onset, and 45.5% gave hand eczema as a reason for career change. In this group, logistic regression analysis showed that chronic hand eczema contributed the most to the decision to change career (odds ratio 50.12; 95% confidence interval 18.3–137). Conclusions. Hairdressers work an average of 8.4 years in the profession before leaving it, and hand eczema contributes significantly to this career change.     

Sensitivity and specificity of self‐reported acne in 18‐year‐old adolescent males

Background Self‐reporting is widely used in medical research. The objective of the present study was to evaluate the specificity and sensitivity of self‐reported lesions of acne (scars and active lesions) obtained by an interview with the examination carried out by a dermatologist. Methods A questionnaire was applied to male adolescents who registered for obligatory military service. After that, skin examination was carried out. Results Of the 2,191 adolescents examined, 474 (21.60%) showed acne scars, and 625 (28.51%) admitted to having scars. The sensitivity of self‐reported scars was 50.84%, and the specificity was 77.65%. The prevalence of active acne obtained by the dermatological examination was 85.76% and from self‐reported acne was 76.12%, with a sensitivity of 80.95% and a specificity of 52.88%. Neither schooling nor social class made any difference to sensitivity or specificity. Conclusions Our findings showed that sensitivity and specificity of self‐reported acne was very low, pointing out that, in a sample of adolescents, self‐reporting of acne shows itself as an inadequate instrument for epidemiological studies.     

Exposures and reactions to allergens among hairdressing apprentices and matched controls

Background. Early and extensive exposures to chemical substances such as are found in hair dyes, perfumes and nickel are known risk factors for allergic reactions. Hairdressing apprentices belong to a high‐risk group, as they are exposed both occupationally and personally. Objectives. To estimate the degree of exposure and adverse skin reactions to chemical substances in a cohort of hairdressing apprentices, at the start of their education, as compared with a matched sample from the general population. Materials. During their first 2 weeks of training, 382 hairdressing apprentices were enrolled in this study. All apprentices completed a self‐administered questionnaire that included questions regarding, for example, exposures and skin reactions to hair dye, perfumed products, and piercings. For comparison, the questionnaire was sent to a control group from the general population, matched on age, sex, and postal code (n = 1870). Results. Within the previous year, 95.2% of hairdressing apprentices and 66.9% of the control group had dyed their hair (p < 0.001); the apprentices dyed their hair, on average, 6.6 times per year, as compared with 3.7 times per year in the control group (p < 0.001). The mean age of the first hair dying among the apprentices was 12.1 years, as compared with 13.3 years for the matched control group (p < 0.001). The hairdressing apprentices reported more eczematous reactions to hair dye (p = 0.002) than the controls. Semi‐permanent so‐called ‘black henna tattoos' had been carried out in 48.1% of the apprentices, as compared with 31.0% of the controls (p < 0.001). Conclusions. Both hairdressing apprentices and the matched control group of young people from the general population were highly exposed to potent allergens. The hairdressing apprentices were even more exposed to products containing hair dye substances and piercings, and reported more adverse reactions to hair dye products than their matched controls from the general population.     

Validation of the U.K. Working Party diagnostic criteria for atopic eczema in a Xhosa-speaking African population

BACKGROUND: Reliable diagnostic criteria for eczema are important for epidemiological comparisons. Although the U.K. diagnostic criteria for atopic eczema have performed well in an English language setting, limited data are available from other countries where cultural and linguistic factors may affect their validity. OBJECTIVES: We sought to determine the validity of the U.K. criteria for eczema in relation to clinical assessment by a dermatologist in a Xhosa-speaking South African population. METHODS: A cross-sectional survey of 3067 children aged 3-11 years was conducted in rural, peri-urban and urban settings in South Africa. The prevalence of atopic eczema was determined using the U.K. diagnostic criteria and a clinical assessment by a dermatologist. Questions were translated into the local language (Xhosa). Trained researchers administered the questions to the children's parents or carers. The validity of the U.K. criteria was then determined by calculating the sensitivity, specificity, positive and negative predictive values, and Youden's Index in relation to the dermatologist's examination. RESULTS: The point prevalence of atopic eczema according to a dermatologist was 1.0% [95% confidence interval (CI) 0.6-1.4], while the prevalence of visible flexural eczema according to the U.K. protocol was 1.8% (95% CI 1.3-2.2). The sensitivity and specificity of the U.K. criteria in this setting was 43.7% (95% CI 26.3-62.3) and 97.9% (97.3-98.4), respectively. The positive and negative predictive values of the U.K. criteria were 18.4% (95% CI 10.4-28.9) and 99.4% (95% CI 99.0-99.6), respectively. The presence of visible flexural eczema according to the U.K. photographic protocol was the best predictor of atopic eczema, with a sensitivity and specificity of 81.2% (95% CI 63.5-92.7) and 99.0% (95% CI 98.6-99.3), respectively, and a positive and negative predictive value of 48.1% (95% CI 34.3-62.1) and 99.8% (95% CI 99.5-99.9), respectively. CONCLUSIONS: The validity of the full question-based version of the U.K. diagnostic criteria for atopic eczema in this South African setting is low, which may be due to a combination of translational and cultural issues. However, the one physical sign of visible flexural eczema performed well, suggesting that it alone might be a useful tool for future international comparative prevalence studies.     

Atopic signs and symptoms: assessing the 'atopy score' concept

BACKGROUND: Score concepts have been suggested for the standardised diagnosis of atopic dermatitis, incorporating various anamnestic and clinical minor criteria of atopy, including the 'Erlangen Score', developed in the hospital-based setting of a dermatitis clinic. OBJECTIVE: To evaluate the properties of this score in the context of a population-based epidemiological study. METHODS: The association between relevant atopic criteria and previous or current flexural eczema was evaluated in 2,352 hairdressing apprentices. RESULTS: The association was not as strong as in the patient-based studies, comparing the respective odds ratios. Accordingly, the discriminating power of the Erlangen Score was poor, resulting in low sensitivity (55.7%) and specificity (73.8%) for, e.g., 8 points as cutpoint. CONCLUSION: While the score appears useful to summarise minor criteria, the individual relevance of its point values should not be overestimated in view of a low positive predictive value in a population (compared to a clinical) setting.     

Validity of self-reports of hand eczema

The validity of questionnaire answers with respect to hand eczema was investigated. Car mechanics, dentists and office workers answered a questionnaire on the occurrence of hand eczema on any occasion during the past 12 months. "Yes"-responders and a random sample of "no"-responders were subsequently interviewed and examined by a dermatologist. 10.0% of the car mechanics, 12.0% of the dentists and 12.5% of the office workers were found to have hand eczema despite previous "no"-answers. In the same populations, 81%, 94% and 80% of the "yes"-answers were confirmed at the clinical examination. Considering false-negative and false-positive answers, the sensitivity was 53-59% and the specificity 96-99% in the 3 groups. The 1-year prevalence changed from self-reported 15% to estimated 21% in the car mechanics, from 15% to 24% in the dentists and from 15% to 23% in the office workers. It is concluded that self-reported 1-year prevalence of hand eczema considerably underestimates the true prevalence.     

Occupational hand eczema in an industrial city

Hand eczema in relation to occupation was studied in an industrial city. Questionnaires were sent to 20,000 individuals aged 20-65 years, randomly selected from the population register of the city. Those subjects (1385) considering themselves to have had hand eczema within the previous 12 months were invited to a dermatological examination including patch testing. It was found that the reported 1-year period prevalence of hand eczema in the total sample was 11.8%. The only occupational group reporting a statistically significant higher 1-year period prevalence was service work, 15.4%. Among all occupations, cleaners turned out to have the highest period prevalence, 21.3%. Hand eczema was more common among people reporting some kind of occupational exposure. The most harmful exposure turned out to be to unspecified chemicals, water and detergents and dust and dry dirt. The use of protective gloves is reported and analysed. The most common contact allergy was nickel, followed by cobalt, fragrance-mix, balsam of Peru and colophony. A statistically significant increase in contact allergy to colophony for women in administrative work was found. It is concluded that the type of hand eczema that is mostly dependent on occupation is irritant contact dermatitis.     

Is the question ‘Have you had childhood eczema?’ useful for assessing childhood atopic eczema in adult population surveys?

Atopic eczema (AE) is a major risk factor for hand eczema. In Scandinavian population‐based studies, the occurrence of AE in childhood has often been assessed by the question ‘Have you had childhood eczema?’ In the present study, this question was validated. A questionnaire was sent to 600 cases with AE and 600 controls without eczema or allergic disease, identified in school medical records from the 1960s. The response rate was 70.5%, and the mean age of the respondents was 36.7 years. The specificity of the question was 70.7% and the sensitivity 89.9%. The sensitivity was higher and the specificity lower in a subgroup with current hand eczema compared with a group without hand eczema. The results showed that the question overestimated the prevalence of AE in childhood by a factor of 1.6. When used for risk assessment, the question provided a better estimate of the risk of current hand eczema as compared with the lifetime risk of hand eczema. In conclusion, the validated question overestimated prevalence of childhood AE and may overestimate AE as a risk factor for hand eczema in adult population surveys.     

Hand eczema among Hong Kong nurses: a self-report questionnaire survey conducted in a regional hospital

Background. Hand eczema is common in the nursing profession, and has been reported widely in various parts of the world. Objectives. The aim of this study was to determine the prevalence and severity of hand eczema among nurses working in a regional hospital in Hong Kong, as well as its psychosocial impact and any possible associated risk factors. Patients/materials/methods. The study took the form of a self‐report questionnaire survey; 1240 nurses in a regional hospital were asked to participate in the survey by completing the questionnaire and returning it anonymously within 2 weeks. Results. Seven hundred and twenty‐four nurses returned the questionnaire (a response rate of 59%). The prevalence of hand eczema among the respondents was 22.1% (160/724). More than 90% had moderate to severe hand eczema. Itchiness and dryness were the most common symptoms. Occupational work, housework, mood, social activities and sleep were particularly affected. Multinomial logistic regressions showed that a personal or family history of atopy and a hand washing frequency of >20 times per day were independent risk factors for hand eczema. Conclusions. Hand eczema is common and severe among Hong Kong nurses. The results of this study suggest that hand eczema is an important problem for nurses and that preventive measures should be emphasized.     

The effect of tobacco smoking and alcohol consumption on the prevalence of self‐reported hand eczema: a cross‐sectional population‐based study

Summary Background Hand eczema is a prevalent disorder that leads to high health care costs as well as a decreased quality of life. Important risk factors include atopic dermatitis, contact allergy and wet work whereas the role of null mutations in the filaggrin gene complex remains to be clarified. It has been debated whether life‐style factors such as tobacco smoking and alcohol consumption are associated with hand eczema. Objectives The current study aimed to investigate whether self‐reported hand eczema was associated with smoking and alcohol consumption in the general population. Methods Between June 2006 and May 2008, a cross‐sectional study was performed in the general population in Copenhagen, the capital of Denmark. A random sample of 7931 subjects aged 18–69 years old was invited to participate in a general health examination including a questionnaire; 3471 (44%) participated. Data were analysed with logistic regression analyses and associations were expressed as odds ratios (ORs) with 95% confidence intervals (CI). Results The prevalence of hand eczema was higher among previous smokers (OR = 1·13; CI = 0·90–1·40), current light smokers (OR = 1·51; CI = 1·14–2·02) and current heavy smokers (OR = 1·38; CI = 0·99–1·92) compared with never‐smokers. Conclusions Tobacco smoking was positively associated with hand eczema among adults from the general population in Denmark. Apparently, current light smokers (< 15 g daily) had a higher prevalence of hand eczema than current heavy smokers (> 15 g daily) but this needs to be reconfirmed. Alcohol consumption was not associated with hand eczema.     

Nickel allergy as risk factor for hand eczema: a population-based study

Summary Background In population‐based studies using self‐reported nickel allergy, a hand eczema prevalence of 30–43% has been reported in individuals with nickel allergy. In a previous Swedish study, 958 schoolgirls were patch tested for nickel. In a questionnaire follow up 20 years later no association was found between nickel allergy and hand eczema. Objectives To investigate further the relation between nickel allergy and hand eczema. Methods Three hundred and sixty‐nine women, still living in the same geographical area, now aged 30–40 years, were patch tested and clinically investigated regarding hand eczema. Results Patch testing showed 30·1% nickel‐positive individuals. The adjusted prevalence proportion ratio (PPR) for hand eczema after age 15 years in relation to nickel patch test results was 1·03 (95% confidence interval, CI 0·71–1·50). A history of childhood eczema was reported by 35·9%, and the PPR for hand eczema in relation to childhood eczema was 3·68 (95% CI 2·45–5·54). When analysing the relation separately in women with and without a history of childhood eczema a statistical interaction was found. The hand eczema risk was doubled in nickel‐positive women without a history of childhood eczema, with a PPR of 2·23 (95% CI 1·10–4·49) for hand eczema after age 15 years. Conclusions A doubled risk for hand eczema was found in nickel‐positive women without a history of childhood eczema. When analysing all participants, there was no statistically significant difference between nickel‐positive and nickel‐negative women regarding occurrence of hand eczema. The most important risk factor for hand eczema was childhood eczema. The risk for hand eczema in nickel‐positive women may previously have been overestimated.     

Hand eczema in Swedish adults - changes in prevalence between 1983 and 1996

Hand eczema is the most frequent occupational skin disease. Our aim was to study changes in its prevalence in Swedish adults. Cross-sectional studies were performed in 1983 and 1996. Random samples from the population of Gothenburg, Sweden, aged 20-65 y, were drawn from the population register. Data were collected with a postal questionnaire, which was identical in the two studies. The response rate was 83.5% (16,708 out of 20,000) in 1983 and 73.9% (2218 out of 3000) in 1996. The reported 1 y prevalence of hand eczema decreased from 11.8% in 1983 to 9.7% in 1996 (p < 0.01), a large difference being found in the youngest age group. Reported childhood eczema increased from 10.4% to 12.4%, however (p < 0.01). Of those with childhood eczema 27.9% and 25.2% reported hand eczema, compared to 10.0% and 7.5% among those without childhood eczema. In total 76.8% were gainfully employed in 1983 and 68.3% in 1996 (p < 0.001). In 1983 23.0% were employed in "high-risk" occupations for hand eczema compared to 19.4% in 1996 (p < 0.001). Even though the increase in childhood eczema was largest in the youngest group, there was a large decrease in the prevalence of hand eczema in that age group among both sexes. The study indicates that the prevalence of hand eczema in Swedish adults had decreased between 1983 and 1996 despite an increasing prevalence of childhood eczema. Secular changes in reporting hand eczema and childhood eczema may explain some of the changes, but a decreased occupational exposure to skin irritants is a probable cause, implying that occupational factors may be important predictors of hand eczema.     

Predictive factors for hand eczema

Factors related to hand eczema were studied. Their relative importance as predictors was ranked by multiple logistic regression analysis. Questionnaires were sent to 20,000 individuals aged 20-65 years, randomly selected from the population register. Those subjects (1385) considering themselves to have had hand eczema within the previous 12 months were invited to a dermatological examination. It was found that a history of childhood eczema was the most important predictive factor for hand eczema. Second was female sex, followed by occupational exposure, a history of asthma and/or hay fever, and a service occupation. A small decrease in risk with advancing age was also found. The difference in the probability of having had eczema in a 1-year period, between individuals having the most important risk factors studied and those having none of them, proved to be for females 48% compared to 8%, and for males 34% compared to 4%. A history of childhood eczema was found to be more common among young persons, indicating an increase in the prevalence of atopic dermatitis. Of those individuals who reported childhood eczema, 27% reported hand eczema on some occasion during the last 12 months.     

A quantification of occupational skin exposures and the use of protective gloves among hairdressers in Denmark

Background. Occupational hand eczema is common in hairdressers, owing to excessive exposure to wet work and hairdressing chemicals. Objectives. To quantify occupational skin exposure and the use of protective gloves among hairdressers in Denmark. Methods. A register‐based study was conducted comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self‐administered postal questionnaire in May 2009, including questions on hairdressing tasks performed in the past week at work and the extent of glove use. A response rate of 67.9% (n = 5324) was obtained. Results. Of the respondents, 55.7% still worked as hairdressers, and they formed the basis of this study. Daily wet work was excessive; 86.6% had wet hands for ≥2 hr, and 54% for ≥ 4 hr. Glove use was fairly frequent for full head hair colouring and bleaching procedures (93–97.7%), but less frequent for highlighting/lowlighting procedures (49.7–60.5%) and permanent waving (28.3%). Gloves were rarely worn during hair washing (10%), although this was more frequently the case after hair colouring procedures (48.9%). Conclusions. Occupational skin exposure was excessive among hairdressers; the extent of wet work and chemical treatments was high, and glove use was inconsistent, especially for certain hair colouring procedures and wet work tasks.     

Ascertainment of hand dermatitis using a symptom-based questionnaire; applicability in an industrial population

In this study, the applicability of a symptom-based questionnaire on hand dermatitis was assessed in a population of rubber workers. The questionnaire was previously validated in a study among nurses. 224 subjects employed in 9 different companies completed a questionnaire on skin complaints. Subsequently, 202 workers attended the physical examination of the skin by a dermatologist. The ascertainment of skin complaints according to the questionnaire was compared to the medical evaluation. The 2 different diagnostic tools used for assessing dermatitis resulted in dissimilar estimates of the prevalence of active hand dermatitis, ranging from 6.9% to 38.1% of all workers. Using the medical evaluation as 'gold standard' we observed a moderate sensitivity and specificity (respectively 71.4%; 95% CI: 47.7-95.1 and 76.1%; 95% CI: 70.0-82.2), a low positive predictive value (18.2%; 95% CI: 8.0-28.4) and a high negative predictive value (97.3%; 95% CI: 94.7-99.9) for the classification based on the self-administered questionnaire. When evaluated against 'first symptoms of dermatitis' the sensitivity decreased, while the specificity remained almost the same. The deviant findings between the present and the original validation study of the same questionnaire among nurses hamper its applicability in populations with different occupations. Therefore, if questionnaires are to be used, validity studies have to be carried out to evaluate differences in perception of skin diseases between different (occupational) populations.