FS10.5Occupational allergic contact dermatitis from isothiazolines

Several employees of a construction adhesives‐producing plant developed skin problems. Within few weeks, 4 out of 12 workers got itchy eczematous lesions at the face, lower arms and hands. All of them reported on a work‐relationship with recoveries during holidays and sick‐leaves. This prompted the responsible occupational physician to contact our occupational dermatological clinic for further examination. First, we got an overview of the chemicals and pathways used for the production of the highly specialized plastic products. After working place examination, extended medical histories of the employees were taken. All affected workers were patch tested with the European Standard series, epoxy resins, preservatives and own working materials. After an occlusion time of 48 hours, skin tests were read at day 2 and 4 according to the ICDRG guidelines. Examination of the plant revealed that all affected workers were employed at the blending unit where, in particular dusty, ingredients were mixed. Few months prior to the development of skin problems, 2‐n‐octyl‐4‐isothiazolin‐3‐one (OIT) preservative had been introduced in the production pathway in partial exchange for chloro/methylisothiazolin‐3‐one (CIT/MIT). Personal protection measures were rarely provided.
All 4 tested workers were found patch test positive to CIT/MIT, 3/3 positive to OIT and 1/3 positive to 1,2‐benzisothiazoloin‐3‐one (BIT) and methyldibromoglutaronitril. Industrial usage of preservatives can result in frequent sensitisation of exposed employees. Adequate protection and prevention advices are required. This study highlights the need for extended (occupational) medical histories and working place examination to identify individual risk factors and to trace potential hazards at the working place.     

FS12.1Allergic contact dermatitis from plastic gloves

Plastic gloves are made of polymers including polyvinylchloride, polyvinylalcohol, polyethylene and polyvinylacetate. Additives such as plasticizers, stabilizers, UV light absorbers, fungicides, bactericides, flame retardants and colourants are added to the polymer, and these are potential allergens. Contact allergy to plastic gloves is rare. The allergen responsible for the sensitization usually remains unknown. An organic pigment, Irgalite Orange F2G, and bisphenol A have both caused contact allergy from household‐type PVC gloves. 1 patient with allergic contact dermatitis from his PVC gloves reacted also to tricresyl phosphate and triphenyl phosphate, chemicals known to be used as plasticizers in PVC. A plasticizer, di(2‐ethylhexyl) phthalate (DOP), caused 1 case of contact urticaria from the vinyl chloride slip guard of cotton gloves. 1 patient with contact urticaria from his polyethylene gloves reacted to 3 antioxidants, octadecanoic acid methyl ester and di‐tertiary butyl phenol of the gloves on scratch testing. We report 3 additional cases of allergic contact dermatitis from PVC gloves due to bisphenol A. 2 of the patients reacted also to para‐tertiary butyl catechol, a polymerization inhibitor in PVC. In chemical analysis, the connection between sensitization to para‐tertiary butyl catechol and the use of vinyl gloves could not be proven. We analysed 16 brands of disposable PVC gloves for medical use, covering at least 80% of the Finnish market. We found a very small amount of bisphenol A in 1 brand, and no para‐tertiary butyl catechol in any of the gloves. However, bisphenol A should be remembered as a possible allergen in PVC gloves.     

FS10.2Occupational contact dermatitis in health care workers

Objectives: Occupational skin diseases (OSDs) account for a large number of occupational diseases in Europe. Population‐based epidemiological studies concerning certain occupations (e.g. Health care workers), however, are missing. Aim of our study was to analyse the reports of OSD in Health care workers (HCW) in the register of OSDs of Northern Bavaria and to assess the annual incidence in this occupational group in relationship to the total employed population in Northern Bavaria. Further, we investigated the spectrum of sensitizations with and without occupational relevance in this group. Methods: A total of 5285 cases of OSD were assessed prospectively and registered from 1990–1999. Data of total employment were provided by the German Federal Employment office. Results: A total of 3097 cases were confirmed as OSD in 24 occupational groups, of which 482 were confirmed in the group of HCW. The average annual incidence of OSD in this group accounted for 7.3 per 10,000 workers. In 1990 the incidences in this occupational group accounted for 11.4%, in 1999 for 5.0% per 10,000 workers with highest incidences in younger age groups. In the evaluated health care workers from the register of OSD in Northern Bavaria 54%(n = 260) had irritant and 51%(n = 244) had allergic contact dermatitis including 19%(n = 89) who suffered from both. Of the 482 HCW 13% had occupational relevant Type IV allergy to glutaraldehyde, 12% to thiurams, 6% to nickel (II) sulfate, 4% to formaldehyde or fragances, respectively, 2% to thimerosal, potassium (II) chloride, chloromethyl‐isothiazolone and p‐phenylendiamine (free base) each. Conclusions: HCW belong to the occupational groups at exceedingly high risk for OSD. Higher frequencies of OSD occur in younger age groups. Irritant and allergic contact dermatitis are equally common causes of OSD in HCW. Sensitization to certain allergens (e.g. glutaraldehyde, thiurams and latex) are most often of occupational relevance, whereas others although frequently found (e.g. sensitization to nickel‐II‐sulfate, cobalt‐II‐chloride, fragance‐mix) rarely are of occupational relevance.     

FS13.5Occupational contact dermatitis: printer worker's viewpoints

Introduction:  Occupational contact dermatitis (OCD) is very common in the printing industry due to contact with chemicals, paper, and wet work. It can be avoided by adequate protective measures, but the effectiveness of intervention depends heavily on the employer's and employee's awareness of this health risk.
Objectives:  The study aimed to collect information on the knowledge, attitudes and beliefs of print workers about the risk of OCD and methods of prevention.
Methods:  A series of focus groups were held with print workers, health and safety officers and managers to discuss their awareness of dermal risk factors, risk behaviour at work, attitudes to health and safety and options on possible preventive measures. A number of companies were also visited to observe, overtly and covertly, the normal work practices.
Results:  OCD was not perceived to be either a major problem or a health and safety priority. There was general agreement about the processes and work practices that could cause skin problems. However, work practices varied considerably and did not always reflect this awareness. There was general concern about the type and availability of personal protective equipment, especially gloves and after‐work skin cream. The provision of an occupational health service was generally felt to be inadequate, and no company had a policy in place that specifically addressed skin care.
Conclusions:  These findings highlight the urgency to intensify health and safety education on skin care within the printing industry. Recommendations were developed for the evaluation of a series of risk reduction strategies.     

FS10.4Colophony allergy as a cause of occupational dermatitis

Occupationally‐induced reactions to medicaments occur in two exposed groups. The group that we discuss consists of employees of pharmaceutical and chemical companies involved in the production of drugs. We describe some patients who developed allergic contact dermatitis to specific drugs. Two of them we related to occupational exposure to simvastatin and other to n‐acetyl‐cysteina. Also one to diphendiprone. The diagnosis of airborne contact dermatitis was confirmed by patch test in all cases. We will do a review in this aspect on occupational contact dermatitis to foccus attention on the increasing importance of this aspect in pharmaceutical workers.     

Essentials of occupational contact dermatitis.

Occupational skin disease constitutes a disproportionately large percentage of all occupational illnesses. It is beneficial for the nurse to have a clear understanding of the relationship between the worker and occupational contact dermatitis. This article describes background information, diagnostic testing, and preventive measures.     

Leukoderma following occupational allergic contact dermatitis

We describe 2 cases of occupational allergic contact dermatitis followed by leukoderma. The 1st case was a 49-year-old wood machinist who developed leukoderma in areas of contact dermatitis involving his lips, neck, hands and forearms and was found to be allergic to colophony and pine sawdust on patch testing. The 2nd case involved a 44-year-old man who worked as an epoxy applicator in a ceramics factory. He developed depigmentation in areas of contact dermatitis involving his face, hands, forearms, back, thighs and legs and was found on patch testing to be allergic to epoxy resin. The appearance of contact leukoderma may be indistinguishable from idiopathic vitiligo. However the prognosis for repigmentation may be better in contact leukoderma than in idiopathic vitiligo.     

Career counsellors and occupational contact dermatitis

Career counsellors are in a unique position to provide timely preventive advice to young people at risk of developing occupational contact dermatitis. Career counsellors need to be aware of risk factors for this condition, including atopic eczema, and of high-risk occupations, such as hairdressing. A cross-sectional survey of 82 career counsellors was conducted at an Australian career counsellors' conference. 24 (29%, 95% confidence interval (95% CI) 19-40%) correctly identified eczema as a risk factor. 25 (30%, 95% CI 21-41%) indicated consideration of past skin problems during career counselling. 30 (36%, 95% CI 25-47%) correctly reported at least 1 high-risk occupation, with hairdressing being most frequently identified. Only 3 of the 82 (4%, 95% CI 0-7%) correctly answered all 3 questions.     

U.K. standards of care for occupational contact dermatitis and occupational contact urticaria

The diagnosis of occupational contact dermatitis (OCD) and occupational contact urticaria (OCU) is a process that involves fastidious clinical and occupational history taking, clinical examination, patch testing and skin‐prick testing. A temporal relationship of work and/or the presence of a rash on the hands only raises suspicion of an occupational cause, and does not necessarily confirm an occupational causation. The identification of allergy by patch or prick tests is a major objective, as exclusion of an offending allergen from the environment can contribute to clinical recovery in the individual worker and avoidance of new cases of disease. This can be a complex process where allergens and irritants, and therefore allergic and irritant contact dermatitis, may coexist. This article provides guidance to healthcare professionals dealing with workers exposed to agents that potentially cause OCD and OCU. Specifically it aims to summarize the 2010 British Occupational Health Research Foundation (BOHRF) systematic review, and also to help practitioners translate the BOHRF guideline into clinical practice. As such, it aims to be of value to physicians and nurses based in primary and secondary care, as well as occupational health and public health clinicians. It is hoped that it will also be of value to employers, interested workers and those with responsibility for workplace standards, such as health and safety representatives. Note that it is not intended, nor should it be taken to imply, that these standards of care override existing statutory and legal obligations. Duties under the U.K. Health and Safety at Work Act 1974, the Management of Health and Safety at Work Regulations 1999, the Control of Substances Hazardous to Health Regulations 2002, the Equality Act 2010 and other relevant legislation and guidance must be given due consideration, as should laws relevant to other countries.     

Importance of epidemiologic surveillance in contact dermatitis: Spanish surveillance system on contact allergies

The high prevalence of contact dermatitis means that this common medical problem has considerable personal, societal, and economic impact. Clinical and epidemiologic research is needed if we are to shed light on the real situation of contact dermatitis in Spain. In this article we will look at epidemiologic research from a practical point of view and analyze the role of the dermatologist in planning and designing studies. The advantages of multicenter studies are discussed, along with the roles of national and international surveillance networks. We present the Spanish Surveillance System on Contact Allergies, which serves as a bridge between Spanish dermatologists and the European Surveillance System on Contact Allergies. The present and future aims of the Spanish network are described.     

Dermatologist and family practitioner practice patterns for occupational contact dermatitis

Medical practitioners have a role in the recognition of occupational contact dermatitis. The longer the duration of symptoms before diagnosis, the poorer the outcome. Our objective was to understand practice patterns, barriers and needs for early diagnosis of occupational contact dermatitis. A survey to obtain information on practice patterns was developed based on the literature and interviews with dermatologists and family practitioners. The survey was sent to all dermatologists and a random sample of 600 family practitioners in Ontario. Fifty-seven per cent of dermatologists and 9% of family practitioners report seeing more than 20 patients per year with occupational contact dermatitis. The majority of practitioners report taking a workplace exposure history. Barriers to taking a workplace exposure history include time constraints and lack of knowledge. Reasons for referral to specialists include a lack of expertise, testing facilities and knowledge about workers' compensation, time constraints and inadequate reimbursement, whereas lack of access to specialists is a barrier for referral. Although most practitioners identify a need for further education, a low volume of patients and time constraints are key barriers to continuing education. Opportunities are identified to improve educational initiatives and health services delivery for occupational contact dermatitis, tailored to each practitioner group.