Occupational irritant and allergic contact dermatitis among healthcare workers

Contact dermatitis is the most frequent occupational dermatosis and non-specific irritants in addition to specific Type IV sensitization are involved. We reviewed our database for data from 1994 to 1998 and selected 360 consecutive patients working in healthcare environments and experiencing contact dermatitis at their hands, wrists and forearms. We found that allergic contact dermatitis and irritant contact dermatitis were considered to be work-related in 16.5% (72/436) and 44.4% (194/436) of diagnoses, respectively. Occupational irritant contact dermatitis is due to exposure to a wide range of irritants in the workplace, such as soaps, solvents, cleansers and protective gloves, which conspire to remove the surface lipid layer and/or produce cellular damage. In this study the major relevant aetiological agents that induced occupational allergic contact dermatitis were: nickel sulphate (41 patch positivities), components of disinfectants [glutaraldehyde (5) and benzalkonium chloride (7)] and rubber chemicals [thiuram mix (15), carba mix (9) and tetramethylthiuram monosulphide (6)]. The best treatment for allergic contact dermatitis is to avoid those allergens causing the rash. Whenever this is not possible, contact with them needs to be reduced using properly selected protective gloves. Finally, subjects with atopic dermatitis should avoid 'wet work' and contact with irritants, because atopic dermatitis is significantly associated with irritant contact dermatitis.     

Dermatoses in cement workers in southern Taiwan

Construction workers are known to have occupational dermatoses. The prevalence of such dermatoses was unknown in Taiwanese construction workers. The objective of this study was to determine the work exposure, prevalence of skin manifestations, and sensitivity to common contact allergens in cement workers of southern Taiwan. A total of 1147 current regular cement workers were telephone-interviewed about skin problems during the past 12 months, work exposure, and personal protection. Among those interviewed, 166 were examined and patch tested with common contact allergens. A high % of cement workers reported skin problems in the past 12 months. More men (13.9%) reported skin problems possibly related to work than women (5.4%). Prevalence was associated with lower use of gloves, duration of work as cement worker, and more time in jobs involving direct manual handling of cement, especially tiling. A high % of dermatitis was noted in the 166 workers examined, which correlated with reported skin problems. On patch testing, construction workers had a high frequency of sensitivity to chromate. Sensitivity to chromate or cobalt was associated with reported skin problems, or dorsal hand dermatitis on examination. These workers'dermatitis was under-diagnosed and inadequately managed. It is concluded that cement workers in southern Taiwan had a high prevalence of skin problems related to cement use. Protective measures, work practice, and physician education should be improved to prevent or manage such problems.     

Occupational allergic contact dermatitis in construction workers

We report the patch test results of 449 con in met ion workers who came as patients to tine Occupational Dermatology Service of the Instituto National de Medicina y Seguridad del Trabajo in Madrid between 1989 and 1993. 90.8%. of them were patch tested, because they had cutaneous lesions or a clinical history suggestive of occupational dermatitis. 65.5% (268) of those patch tested showed one or more reactions connected with their work. Chromate at 411 was the main allergen. followed by cobalt, 20.5% nickel. 10%, and epoxy resin. 7.5%. 25.9% (106) of patients showed sensitization to rubber components, the majority at 20.7%, to thiuram mix, with TETD being the main allergen.     

Contact sensitivity to chromate: comparison at a London contact dermatitis clinic over a 10-year period

It has been argued that for chromate sensitivity to be reduced, then ferrous sulfate should be added to cement. This has not yet been done in the UK. To explore this further, we have looked at the comparative sensitization rates of patients attending the St. John's Institute of Dermatology Contact Dermatitis Clinic between the years 1982–3 and 1992–3. Patch-test-positive rates for females were not significantly different between the 2 populations studied (1982–3, 1.59% and 1992–3, 1.99% p NS). Similarly, there was no significantly different rate between the males (1982–3, 3.99% and 1992–3, 4.25% p NS) in the same time period. There was no difference in the distribution of eczema in chromate-positive subjects, nor of cobalt co-sensitization, a crude indicator of sensitization via cement. This work demonstrates no appreciable difference in the frequency of chromate sensitivity between the early 1980s and 1990s in London. Adding ferrous sulfate to cement may help to lower the frequency in the future.     

Allergic contact dermatitis among maintenance and clerical workers in a military population

Contact dermatitis is one of the leading causes of occupational morbidity and absenteeism and has become an intolerable cause of missed workdays and health problems in the Israeli military. The aim of this study was to determine the rate of contact dermatitis in maintenance and clerical workers, the common allergens causing it, and the background of atopy in the subjects in order to design preventive measures. Medical records of all recruits to the Israel Defense Forces from 2000 to 2003 were reviewed for contact dermatitis. The 102 cases found were further assessed for job assignment, atopic background, and allergens. Of the 102 cases, 60 had irritant contact dermatitis and 42 had allergic contact dermatitis, of which 33 (78.6%) were maintenance workers, mainly mechanics. 13 soldiers in the maintenance job category (39%) and 2 soldiers in the clerical group (22.2%) had atopic background. There were 55 positive reactions in patch tests, 25 of them to oil and cooling fluids, with 14.5% attributed to methylchloroisothiazolinone/methylisothiazolinone) (Kathon CG). Atopy was found to be a risk factor for allergic contact dermatitis in our study and should be screened for in job assignment procedures in the military. Oil and greases contain significant allergens, especially their preservatives.     

Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries

Background. Tannery workers are at considerable risk of developing occupational contact dermatitis. Occupational skin diseases in tannery workers in newly industrialized countries have been reported, but neither the prevalence of occupational allergic contact dermatitis nor the skin‐sensitizing agents were specifically examined in those studies. Objectives. To assess the prevalence of occupational allergic contact dermatitis in Indonesian tanneries, identify the causative allergens, and propose a tannery work series of patch test allergens. Patients/methods A cross‐sectional study in all workers at two Indonesian tanneries was performed to assess the prevalence of occupational contact dermatitis via a questionnaire‐based interview and skin examination. Workers with occupational contact dermatitis were patch tested to identify the causative allergens. Results. Occupational contact dermatitis was suspected in 77 (16%) of the 472 workers. Thirteen (3%) of these 472 workers were confirmed to have occupational allergic contact dermatitis. Potassium dichromate (9.2%), N,N‐diphenylguanidine (5.3%), benzidine (3.9%) and sodium metabisulfite (2.6%) were found to be the occupationally relevant sensitizers. Conclusions. The sensitization pattern showed some differences from the data in studies reported from other newly industrial countries. We compiled a ‘tannery work series' of allergens for patch testing. A number of these allergens may also be considered for patch testing in patients with (leather) shoe dermatitis.     

Occupational dermatoses in health care workers evaluated for suspected allergic contact dermatitis

Background:  Occupational skin diseases, including allergic contact dermatitis (ACD), irritant contact dermatitis, and allergic contact urticaria (ACU), occur commonly among health care workers (HCWs).
Purpose:  To evaluate the aetiology of the various skin diseases afflicting HCWs evaluated for suspicion of ACD and/or ACU and to identify the most common allergens among HCWs found to have ACD and/or ACU.
Methods:  A total of 1434 patients underwent patch testing. The demographic data and most common allergens for HCWs ( n  = 100) and non-HCWS ( n  = 1334) were compared.
Results:  HCWs were statistically more likely than non-HCWS to be female, have hand dermatitis, and have a history of atopy. HCWs were also more likely to have work-related ACD especially to quaternium-15, thiuram, carba mix, glutaraldehyde and benzalkonium chloride, and to have ACU to latex.
Limitations:  This study was retrospective and is subject to the resultant biases of all such investigations. Only patients suspected of having ACD and who underwent patch testing are included in our database. The prevalence of ACD and ACU is likely to be higher than that seen in the general HCW population.
Conclusions:  Our results underscore the importance of thoroughly evaluating HCWs for ACD and ACU with the use of expanded standard allergen series and prick or radioallergosorbent testing to latex.     

Review of biologics in allergic contact dermatitis

The resistant and recalcitrant nature of severe allergic contact dermatitis (ACD) makes its management challenging. With advances in the understanding of the cellular and molecular pathogenesis of ACD, newer therapeutic targets are becoming apparent. In particular, the use of biologics has gained momentum, given the specificity of their action. This article aims to review the presently available data on the use of biologics in ACD. English-language–based literature available on the use of biological therapy was thoroughly probed in the following databases as on October 14, 2019: PubMed, Google Scholar, The Cochrane library, Embase, Scopus, and EBSCO. The following keywords were used: “contact dermatitis”, “allergens”, “delayed-type hypersensitivity reaction”, “biologics”, “biological therapy”, “monoclonal antibodies”, “patch testing”, “TNF-α inhibitors”, “infliximab”, “adalimumab”, “etanercept”, “dupilumab”, “omalizumab”, “secukinumab”, “ustekinumab”, “rituximab”.