A prospective study of the development of hand eczema in an automobile manufacturing industry

We have not been able to find any prospective study of the risk of developing occupational dermatitis in the car manufacturing industry. To try to define individual predictive risk factors for the development of hand eczema and to determine the prevalence of hand eczema within 1 year in an automobile manufacturing industry, we investigated prospectively 1564 new employees during one year of employment. Only persons with previous atopic dermatitis or hand eczema were restricted to dry and clean workplaces. The employees were personally interviewed and examined before their employment. Written questionnaires were used at 3 and 12 months to obtain information on type of work, exposure, protection and hand dermatitis. All patients developing hand eczema were examined, patch tested and followed to determine the course and consequence of their eczema. The risk turned out to be only 4% on average, but significantly higher in females (6%). Certain sections within the factory such as wet work (canteen/kitchen and cleaning) and work in the paint shop with high exposure to organic solvents carried significantly higher risks. Heavy exposure to mineral oil, a known risk factor, was effectively counteracted by the extensive use of protective gloves to yield a lower than average prevalence in the press and body shop. Individual risk factors for the development of hand eczema were previous hand eczema, atopic dermatitis, but also wool intolerance and hay fever as isolated phenomena. Most cases of hand eczema were mild, of irritant contact type and only 1 employee developed an allergic contact dermatitis due to the working environment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hand eczema in car mechanics

To estimate the prevalence of hand eczema, a questionnaire was distributed to 901 male car mechanics. Of the 801 persons who responded, 15% reported hand eczema on some occasion in the previous 12 months, and 57% admitted dry skin on the hands. In a 2nd part of the study, those who reported hand eczema were examined and patch tested with a standard series and a special "car mechanics' series". The most common diagnosis was irritant contact dermatitis, 55%, and 2nd was allergic contact dermatitis, 19%. 35/105 (33%) had a total of 51 positive patch test reactions, all to substances in the standard series, except for 2 persons who reacted to oxidized d -limonene. The most frequent reactions were to thimerosal (9%), nickel (8%) and colophony (5%). One plausible explanation for the high prevalence of nickel allergy was the common use of nickel-plated tools. 5 individuals had a history of contact urticaria, but scratch tests were negative. It was concluded that car mechanics are at high risk for contact dermatitis on the hands, irritant as well as allergic.     

Occurrence and prognosis of hand eczema in the car industry: results from the PACO follow-up study (PACO II)

Background:  Only a few epidemiological studies on hand eczema (HE) in the metalworking industry have been conducted, and no study has attempted a long-term follow-up.
Objectives:  In the Prospective Audi Cohort (PACO) II follow-up study, we aimed to estimate burden and prognosis of HE in a car industry setting (follow-up > 10 years).
Patients/Methods:  Eligible participants were individuals who had been examined in the original PACO study (1990–1998) and had been followed through until the end of their apprenticeship ( n  = 1909). Participants were interviewed and underwent dermatological examination. An exposure assessment was carried out according to a pre-defined algorithm.
Results:  The follow-up rate was 78.3% (1494/1909). Mean follow-up time was 13.3 [standard deviation 1.3] years. The period prevalence of HE in the follow-up period was 21.0% [95% confidence interval (CI) 19.0–23.1%], yielding a cumulative incidence of 29.3% (95% CI 26.9–31.6%) in the entire study period. HE persisted after the end of apprenticeship in 40.0% (95% CI 33.3–46.7%) of subjects who had had HE during apprenticeship ( n  = 205). 18.0% (95% CI 15.9–20.1%) developed HE in the follow-up period ( n  = 1289).
Conclusions:  Around 30% of subjects were affected by HE at least once during the study period. HE persisted in 40% of the participants affected during apprenticeship.     

Hand dermatitis in a prospectively-followed cohort of hairdressing apprentices:nal results of the POSH study

The incidence of hand dermatitis is high in the hairdressing trade; the individual disease burden is substantial, as are the costs of treatment, workers compensation and retraining programs. To evaluate the risk of developing occupational irritant hand dermatitis associated with several potential risk factors, namely constitution (atopy) and occupational exposure, an observational prospective population-based cohort study set in vocational training schools in northwest Germany, recruiting 2352 hairdressing apprentices, was performed. Unprotected wet work of more than 2 h per day is the major significant risk factor; low ambient absolute humidity is equally associated with a significantly increased risk. Compared to the youngest age group, risk diminishes with increasing age. Constitutional risk factors are difficult to evaluate because of selective dropout of atopic participants. For primary prevention, a population approach, improving working conditions and skin protection for all exposed, appears to be the most beneficial.     

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.     

Transepidermal water loss and incidence of hand dermatitis in a prospectively followed cohort of apprentice nurses

The purpose of the study was to evaluate the incidence of hand dermatitis, the impact of potential risk factors and the efficacy of skin bioengineering in a prospectively followed cohort of apprentice nurses. 104 participants were prospectively followed for 3 years. Before the start of training, after about 1 year and in the third year of occupational exposure, a standardized questionnaire was distributed, and a clinical examination with skin bioengineering of the dorsum of hand and forearm was performed. The 12-month period prevalence of self-reported symptoms of hand dermatitis was 36.5%[95%-confidence interval (CI) 27.3-46.6] at intermediate follow-up and 43.3% (95%-CI 33.6-53.3) at the final examination. Apprentices with self-reported symptoms at the final examination showed a significant increase of transepidermal water loss (TEWL) at the dorsal hand from 10.15 g/m2h to 13.55 g/m2h. TEWL at this site did, at the initial examination, not differ significantly between persons who later reported symptoms of hand dermatitis at the final examination and those who did not (10.50 g/m2h versus 10.15 g/m2h, respectively). Our results do not support the notion that an increased basal TEWL is a good indicator for hand dermatitis risk.     

The incidence of cutting fluid dermatitis among metalworkers in a metal fabrication factory: a prospective study

We compared the incidence of occupational dermatitis and transepidermal water vapour loss (TEWL) changes from cutting fluids (neat mineral oils) in 24 new machinists with 27 armed forces paramedics (controls) over a 6-month period. The cumulative incidence of occupational dermatitis in positive controls increased from 38% at week 3 to 77% at week 6. It then decreased to 50% at week 9 and thereafter remained constant at about 50% throughout the remaining study period. 2 workers sought medical treatment for their dermatitis. Only 1 worker had a job transfer because of his dermatitis. None of the paramedics developed dermatitis during the study period. The mean basal TEWL values on the hands of machinists and controls were 17.6 and 14.5 g/m²/h (n.s.) respectively. The mean TEWL values of machinists increased to 22 g/m²/h by week 3 and then remained fairly constant throughout the remaining study period. The mean TEWL of negative controls remained fairly constant (at about 14 g/m²/h) from the beginning to the end of the study period. The mean TEWL value of machinists was significantly higher than that of negative controls throughout the study period. There was no significant difference in the prevalence of cutting fluid dermatitis between machinists with high basal TEWL values (17 g/m²/h) and those with low basal TEWL values (< 17 g/m²/h).     

Exposures related to hand eczema: a study of healthcare workers

Background. Hand eczema is common in healthcare workers, owing to intensive exposure to wet work and skin irritants. Targeted interventions and vocational guidance based on documented exposures and risk factors are needed. Objectives. The aims of the study were to investigate the relationship between exposures (domestic and at work) and prevalence and severity of hand eczema. Methods. Self‐administered questionnaires were sent to 3181 healthcare workers in Denmark. Results. Two thousand two hundred and sixty‐nine (71%) workers responded to the questionnaire. Frequent hand washing was significantly related to the presence of hand eczema. Having children < 4 years old in the household was also related to the presence of hand eczema. A lower prevalence of hand eczema was found among those using moisturizers at work, and a higher prevalence was found among those using moisturizers at home. Conclusions. Although healthcare workers are recommended to use disinfectants when the hands are not visibly dirty, hand washing is still significantly related to hand eczema. Frequent hand washing may be a question of behavioural habits, and a focus for future guidance should be on changing hand washing habits. Attention should also be paid to healthcare workers with small children at home. The preventive effect of moisturizers used during working hours should be tested in future follow‐up studies.     

Hand eczema: prevalence and risk factors of hand eczema in a population of 2274 healthcare workers

Background. Healthcare workers are at increased risk of developing hand eczema. Objectives. To investigate the prevalence and severity of self-reported hand eczema, and to relate the findings to demographic data, occupation, medical speciality, wards, shifts, and working hours. Patients/materials/methods. A survey of 3181 healthcare workers was performed. Data were analysed with logistic regression. Data on sick leave and notification to the authorities were obtained. Results. The response rate was 71% (2274 of 3181). The 1-year prevalence of hand eczema was 21%, and was positively associated with atopic dermatitis, younger age, male sex (male doctors), and working hours. Eighty nine per cent of subjects reported mild/moderate lesions. Atopic dermatitis was the only factor significantly related to severity. Sick leave was reported by 8% of subjects, and notification to the authorities by 12%. Conclusions. The 21% prevalence of hand eczema in healthcare workers is double the prevalence in the background population. Eleven per cent of hand eczema patients reported severe/very severe eczema. No significant differences were found between professions or medical specialities with respect to prevalence or severity, but cultural differences between professions with respect to coping with the eczema were significant. Atopic dermatitis was related to increased prevalence and severity, and preventive efforts should be made for healthcare workers with atopic dermatitis.     

Efficacies of a barrier cream and an afterwork emollient cream against cutting fluid dermatitis in metalworkers: a prospective study

We compared the point prevalence of cutting fluid dermatitis and transepidermal water vapour loss (TEWL) changes in groups of new machinists who (a) used a barrier cream; (b) used an afterwork emollient cream; and (c) did not use any cream (controls) over a 6-month period. All machinists handled cutting fluid (neat mineral oil) during their work. There was no significant difference in the prevalence of cutting fluid dermatitis in the 3 groups throughout the study period. The prevalence of cutting fluid dermatitis in all groups increased rapidly during the first 6 weeks and thereafter remained steady throughout the remainder of the study period. The prevalence of cutting fluid dermatitis was slightly lower in machinists using afterwork emollient cream compared to those using barrier cream and controls (not significant). The differences in the mean TEWL changes during the study period among the 3 groups were also not statistically significant. The mean TEWL values in the 3 groups increased rapidly during the first 6 weeks of exposure to cutting fluids and thereafter remained fairly constant throughout the remainder of the study period. Barrier cream and afterwork emollient cream did not appear to have any significant effect against either cutting fluid dermatitis or TEWL changes in machinists exposed to cutting fluid. However, afterwork emollient cream appeared clinically to help reduce the prevalence of cutting fluid irritation.     

Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow‐up period of 1 year

Background We recently found a very low adherence to a generally recommended skin protection regimen in a sample of 1355 metalworkers. Objectives The present study assessed the effectiveness of skin protection as presently recommended, especially the differential contribution of skin care and skin protection, to the prevention of occupational hand eczema. Methods Of 1355 metalworkers screened, 1020 male volunteers, all fit for work, were recruited for a prospective intervention study with four arms (skin care, skin protection, both combined, and control group, i.e. no recommendation). The study was performed from winter 2006/2007 to spring 2008, following each subject for up for 12 months. Both hands were examined using a quantitative skin score, and a standardized personal interview was performed three times. The change of the objective skin score from baseline to 12 months was used as primary outcome measure. Results After 12 months 800 subjects were included (78·4% of those recruited). The compliance to follow the randomized measure depended on the recommended measure and ranged from 73·7% to 88·7%. While in the control group a significant deterioration was found, the largest and significant improvement was noted in the group following the generally recommended skin protection programme (skin care + skin protection) followed by skin protection alone as second best. Conclusions The generally recommended skin protection regimen seems to provide effective prevention of occupational skin disease. Therefore, the compliance to follow the skin protection regimen, especially the use of skin protection, should be enhanced.     

Filaggrin null mutations increase the risk and persistence of hand eczema in subjects with atopic dermatitis: results from a general population study

Summary Background Hand eczema is prevalent in the general population. It remains unclear whether or not filaggrin gene (FLG) null mutations increase the overall risk of hand eczema or only increase the risk of hand eczema in subjects with atopic dermatitis. Objectives To investigate the association between FLG null mutations and hand eczema. Methods A random sample of 3335 adults from the general population in Denmark was patch tested, FLG genotyped for R501X and 2282del4 null mutations and questioned about hand eczema. Results Participants with combined presence of atopic dermatitis and FLG null mutation status had a significantly higher prevalence of hand eczema, an earlier onset of hand eczema and a higher persistence of hand eczema compared with subjects with normal FLG status and absence of atopic dermatitis. Logistic regression analyses revealed positive associations between hand eczema within the past 12 months and FLG null mutation status in participants with a history of atopic dermatitis [odds ratio (OR) 2·98; 95% confidence interval (CI) 1·27–7·01], but not in subjects without atopic dermatitis (OR 0·82; 95% CI 0·41–1·67). Conclusions FLG null mutations were significantly associated with hand eczema (< 12 months) in subjects with atopic dermatitis. Combined atopic dermatitis and filaggrin null mutation status was strongly associated with early onset of hand eczema and hand eczema persistence.     

Etiology and prognosis of hand eczema in a dermatology clinic in China: a follow-up study

Background:  Prognosis of hand eczema (HE) has not been reported in China.
Objectives:  To investigate the etiology and outcome of HE in 655 consecutive patients patch tested with European standard series in Peking University Hospital in a 2-year period.
Methods:  All patients were re-examined at 1 year after patch testing, and prognosis of dermatitis was evaluated by the rate of clearance of skin symptoms for at least 3 months without relapse before the evaluation.
Results:  Of 599 patients examined, 82 (13.7%) were HE. Allergic, irritant, and unclassified HE accounted for 23.2%, 17.1%, and 51.3% of HE, respectively. The overall clearance rate of HE was much lower than that of eczema elsewhere (18.3% versus 29.6%, P  < 0.05, chi-squared test). 35.7% of patients with allergic HE and 26.3% with irritant HE cleared their lesions, of those with unclassified HE only 11.9% ( P  < 0.05, chi-squared test). The lowest healing rate (5.7%) was found in unclassified HE patients with disease duration over 6 months.
Conclusions:  The outcome of HE was worse than eczema elsewhere. Allergic HE had a better prognosis than unclassified HE. Longer disease duration was the main risk factor for poor prognosis of unclassified HE.