Occupational issues of irritant contact dermatitis

Occupational irritant contact dermatitis (ICD), a non-immunological cutaneous inflammatory response to a workplace substance, comprises a major portion of occupational dermatoses in industrialized societies, resulting in considerable social and economic implications. The sheer morphological variety of ICD presents a diagnostic and classification challenge; ideotypes identified to date include acute, chronic and cumulative irritant dermatitis, delayed acute irritant dermatitis, irritant reaction, pustular irritant dermatitis, suberythematous irritation, sensory irritation, friction dermatitis and airborne dermatitis. Hand dermatitis is the most frequent manifestation of occupational ICD. This article reviews the various types of ICD, the epidemiological data available to date, risk factors, pathophysiology, diagnosis and management of ICD, emphasizing occupational issues.Paper presented at the Occupational Skin Care Management State-of-the-Art Conference, 1–3 September 2000, Zurich     

Occupational protein contact dermatitis with type I allergy to different kinds of meat and vegetables

Objective: Even though occupational protein contact dermatitis is not an uncommon finding in occupational dermatology, reports about multiple sensitizations are rare. High-molecular-weight substances such as proteins can pass the epidermis only if it is damaged and cause a sensitization. In a high percentage of cases, atopic dermatitis might be the cause of this damage but cannot be regarded as the only cause. An interesting case is presented that was carefully worked up. Methods: Scratch, intracutaneous, and prick or prick-to-prick tests with native occupational allergens were performed as single tests. The patient was patch-tested with the European Standard Series. The determination of allergen-specific IgE was performed by ImmunoCAP. The results were subdivided into six classes. In addition, oral provocations with relevant allergens were performed. Results: The skin tests showed positive type I allergies to beef, lamb, horse, and pork meat, to pork and horse blood as well as to rye and wheat flour, raw potato, and pasta. Weak positive reactions could be found for fowl, duck, goose, and turkey in intracutaneous testing. The ImmunoCAP showed elevated specific IgE values for pork meat, raw potato, and rye and wheat flour. The oral provocation did not show any systemic or skin change. Conclusions: This case report demonstrates how an initial case of contact urticaria turns into protein contact dermatitis. It shows that the diagnosis can be made by means of scratch or prick tests with native occupational allergens. The determination of allergen-specific IgE by ImmunoCAP might be helpful, but a negative result does not exclude protein contact dermatitis. Received: 26 August 1997 / Accepted: 14 November 1997     

小鼠背部变应性接触性皮炎模型的建立

目的建立小鼠背部变应性接触性皮炎(allergic contact dermatitis,ACD)模型.方法用二硝基氟苯(dinitrofluorobenzene,DNFB)分别建立小鼠背部及耳廓ACD模型,比较两种模型在不同时间点皮肤肿胀度及HE染色炎细胞数量变化情况.结果①背部ACD肿胀度大于耳廓ACD肿胀度,配对t检验,t=6.39,P＜0.01,并且两种模型的肿胀度变化呈正相关. ②背部ACD较耳廓ACD单一核细胞数量少,多形核细胞数量多,前者t=8.59,P＜0 .01,后者t=6.05,P＜0.01;两模型的细胞数量变化呈正相关.结论背部ACD模型可以代替耳廓ACD模型用于评价抗炎药物.背部模型肿胀度高,适合肉眼判断皮炎程度.     

Occupational contact dermatitis in the UK: a surveillance report from EPIDERM and OPRA

Since February 1993 the EPIDERM surveillance scheme has collected data on occupational skin disease from consultant dermatologists in the UK. Reporting by occupational physicians to the scheme began in May 1994 and was superseded in January 1996 by the Occupational Physicians Reporting Activity (OPRA). The schemes currently receive reports on incident cases from 244 dermatologists and 790 occupational physicians. An estimated total of 9937 cases of contact dermatitis reported by dermatologists was calculated from surveillance data; 8129 contact dermatitis cases were estimated from reports by occupational physicians. The annual incidence of occupational contact dermatitis from dermatologist reports was 6.4 cases per 100,000 workers and 6.5 per 100,000 from reports by occupational physicians, an overall rate of 12.9 cases per 100,000 workers. Manufacturing industries account for the greatest number of cases seen by both sets of reporting physicians, with health care employment second. Reports from dermatologists also indicate high rates of dermatitis in the personal service industries (mainly hairdressers and barbers) and in agriculture. With the exception of an increase in cases seen in nurses in both schemes, the numbers and proportions of cases of contact dermatitis within occupations have remained fairly constant over the 6-year reporting period. Agents accounting for the highest number of allergic contact dermatitis cases were rubber (23.4% of allergic cases reported by dermatologists), nickel (18.2), epoxies and other resins (15.6), aromatic amines (8.6), chromium and chromates (8.1), fragrances and cosmetics (8.0), and preservatives (7.3). Soaps (22.0% of cases), wet work (19.8), petroleum products (8.7), solvents (8.0), and cutting oils and coolants (7.8) were the most frequently cited agents in cases of irritant dermatitis. The national scope of the data, together with the parallel structure by which both dermatologists and occupational physicians report incident cases, is useful in determining the extent of skin hazards in UK industry and may help in better targeting efforts to reduce the burden of skin disease at work.     

某锡冶炼厂工人职业性接触性皮炎患病情况

目的分析某锡冶炼厂工人职业性接触性皮炎的患病情况,为职业性皮肤病防治提供科学依据。方法对在2001—2010年健康检查中发现的接触性皮炎患者作回顾性分析。结果锡冶炼作业工人职业性接触性皮炎发病率与空气中砷浓度为正相关关系(r=0.956 1,P0.01),空气中砷浓度越大,发病率越高,且主要发生在粗炼、精炼、电解车间,发病率分别为5.35%、5.63%、5.88%;平均发病年龄为32.5岁,平均发病工龄为13.5 a。结论改善劳动条件,降低车间内含砷粉尘浓度,是减少职业性接触性皮炎发病的根本措施。     

Occupational ceramic fibres dermatitis in Poland

Recently, the use of asbestos has been considerably limited in Poland, with the simultaneous increase in the manufacture, processing and application of man-made mineral fibres, which includes ceramic fibres. The aims of this study were (1) to assess the type and frequency of dermal changes caused by the irritant activity of ceramic fibres among workers at the plants that manufacture packing and insulation products; and (2) to compare the irritant activity of Polish-made L-2 and L-3 ceramic fibres with that of the Thermowool ceramic fibres made in England. Workers (n = 226) who were exposed to ceramic fibres underwent dermatological examination. Patch tests with the standard allergen set, together with samples of the fibres L-2, L-3, and Thermowool fibres, were applied to all the workers. It has been shown that the Polish-made L-2 and L-3 fibres differed from Thermowool fibres in that the L-2 and L-3 fibres contained zirconium and were coarser. The proportion of filaments with diameters above 3 microns was 11.1% in the L-3 fibre and 6.3% in the L-2 fibre samples. The Thermowool fibre did not contain filaments thicker than 3 microns. Evident dermal changes, resulting from strong irritant activity of the fibres, were detected in 109 (48.2%) of the workers examined. Irritant contact dermatitis acuta (maculae, sometimes papulae and small crusts on the upper extremities, trunk, and lower extremities), disappearing after 2-3 days, was found in 50 (22.1%) workers. Irritant contact dermatitis chronica (diffuse permanent erythema with numerous telangiectasiae on the lateral portions of the face and neck, on the trunk, behind the auricles) was detected in 40 (17.7%) workers. The remaining 19 (8.4%) workers had both types of dermal change. All examined workers complained of very strong itching. The results of the patch tests confirmed the irritant activity of the ceramic fibres. Erythema without oedema, persisting for up to 96 h, appeared at the places where the fibres had been applied to the skin in 44 (19.5%) workers. In addition, the irritant activity of the fibres has been shown to be correlated with their thickness. The Thermowool fibre was the weakest irritant, because it did not contain filaments above 3 microns in diameter; the L-2 fibre containing 6.3% filaments above 3 microns caused somewhat stronger skin irritation; while the L-3 fibre, which contained 11.1% filaments thicker than 3 microns, was the strongest irritant. A few cases of allergy to nickel, chromium and colophony (rosin) were also detected.     

环境接触性因素在面部皮炎发病中的作用分析

目的研究环境接触性因素在面部皮炎发病中的作用。方法通过常见环境过敏原斑贴试验及问卷调查,对60例面部皮炎患者进行了研究。结果28例（46．7％）确诊为接触性皮炎,其中1例职业性接触性皮炎;10例其他原因皮炎;22例不能排除环境接触因素的作用,为可疑接触性皮炎。这些患者斑贴阳性率为60％,仍不能忽视接触过敏因素的作用。结论斑贴试验阳性结果与疾病的联系是寻找病因或加重因素的关键。     

三氯乙烯所致接触性皮炎小鼠免疫功能的变化

目的研究三氯乙烯(TCE)刺激BALB/c小鼠产生接触性皮炎,观察TCE对小鼠免疫功能的影响。方法采用背部皮内注射TCE染毒BALB/c小鼠,观察脾脏、胸腺脏器系数的变化情况,对脾和胸腺细胞进行体外淋巴细胞活力和增殖功能测定,腹腔巨噬细胞吞噬功能测定,NK细胞杀伤活性测定及小鼠血清中肿瘤坏死因子(TNF-α)、干扰素(IFN-γ)含量的测定。结果TCE实验组胸腺脏器系数显著低于阴性对照组(P<0.01);TCE实验组T淋巴细胞活力及增殖能力显著高于阴性对照组(P<0.01);TCE实验组的巨噬细胞吞噬率和NK细胞杀伤活性显著高于阴性对照组(P<0.01);TCE实验组小鼠血清中TNF-α的含量显著高于阴性对照组(P<0.01)。结论三氯乙烯能够诱发接触性皮炎,其中毒机制属于迟发型超敏反应。     

Occupational hand dermatitis in food industry apprentices: results of a 3-year follow-up cohort study

Objective: The aim of this prospective follow-up study was to quantify the impact of hand dermatitis (HD) in bakers, confectioners and bakery shop assistants, and to investigate related risk factors. Method: Bakers', confectioners' and bakery-shop assistants were included in a prospective follow-up study in the region of East Thuringia starting in August 1996. At the beginning of their vocational training 91 apprentices were interviewed and examined in a standardised way. Follow-up examinations and interviews were done after 6 months (n=79), 12 months (n=63) and at the end of the training (n=69) after 36 months. Results: In their case histories 3.3% (n=3) of the apprentices reported previous HD in childhood and adolescence. The first assessment after 2 to 4 weeks of vocational training revealed HD in 17.5% (n=16) of the individuals. At the follow-up examination after 6 months, point prevalence of HD was 29.1% (n=23), after 12 months 27.0% (n=17) and after 36 months 27.5% (n=19). Mild to moderate irritant contact dermatitis was the most frequent finding. Finally, an atopic skin diathesis (>10 points, “atopy score”) (OR=4.89; CI 95% 1.15–20.79), previous HD (OR=41.1; CI 95% 4.99–339.13) as well as flexural dermatitis (OR=6.8; CI 95% 1.72–27.22) proved to be predictive factors for the development of HD. No association was found to respiratory atopy (OR=1.29; CI 95% 0.35–4.7) and metal sensitisation (OR=1.1; CI 95% 0.29–4.35). Exogenous irritant factors did not show a strong association towards a risk increase. Wet work in general, as well as distinct occupational tasks showed only a tendency for being a risk factor for HD. However, leisure time activities, especially house building and rebuilding (OR=5.4; CI 95% 1.05–27.81), were associated with an elevated risk. Conclusions: Endogenous and exogenous factors contribute to the development of HD in bakers' and confectioners' apprentices. Received: 25 September 2000 / Accepted: 20 February 2001     

Occupational seafood allergy: a review

BACKGROUND—Recent years have seen increased levels of production and consumption of seafood, leading to more frequent reporting of allergic reactions in occupational and domestic settings. This review focuses on occupational allergy in the fishing and seafood processing industry.
REVIEW—Workers involved in either manual or automated processing of crabs, prawns, mussels, fish, and fishmeal production are commonly exposed to various constituents of seafood. Aerosolisation of seafood and cooking fluid during processing are potential occupational situations that could result in sensitisation through inhalation. There is great variability of aerosol exposure within and among various jobs with reported allergen concentrations ranging from 0.001 to 5.061(µg/m³). Occupational dermal exposure occurs as a result of unprotected handling of seafood and its byproducts. Occupational allergies have been reported in workers exposed to arthropods (crustaceans), molluscs, pisces (bony fish) and other agents derived from seafood. The prevalence of occupational asthma ranges from 7% to 36%, and for occupational protein contact dermatitis, from 3% to 11%. These health outcomes are mainly due to high molecular weight proteins in seafood causing an IgE mediated response. Cross reactivity between various species within a major seafood grouping also occurs. Limited evidence from dose-response relations indicate that development of symptoms is related to duration or intensity of exposure. The evidence for atopy as a risk factor for occupational sensitisation and asthma is supportive, whereas evidence for cigarette smoking is limited. Disruption of the intact skin barrier seems to be an important added risk factor for occupational protein contact dermatitis.
CONCLUSION—The range of allergic disease associated with occupational exposure to crab is well characterised, whereas for other seafood agents the evidence is somewhat limited. There is a need for further epidemiological studies to better characterise this risk. More detailed characterisation of specific protein antigens in aerosols and associated establishment of dose-response relations for acute and chronic exposure to seafood; the respective roles of skin contact and inhalational exposure in allergic sensitisation and cross reactivity; and the contribution of host associated factors in the development of occupational seafood allergies are important areas for future research.


Keywords: occupational seafood allergy; occupational asthma; protein contact dermatitis     

天津市东丽区1996—2010年职业病发病情况

目的了解天津市东丽区近年职业病发病规律和特征,为制定职业病预防控制措施提供依据。方法收集1996—2010年东丽区职业病报告卡,对职业病患者信息进行统计分析。结果 1996—2010年东丽区共报告新诊断职业病7大类259种,尘肺、职业中毒、职业性肿瘤分别占病例总数的77.22%、10.81%和10.04%,其中矽肺病例数最多;2006—2010年病例数占15年来病例总数的63.7%;男女病例性别比为7.9∶1,病例发病年龄主要集中在40～60岁,40～60岁年龄组病例数占病例总数的69.1%;病例分布在10个行业,轻工、化工行业病例数位居前2位,分别占40.15%和19.31%。结论近年来东丽区新诊断报告职业病病例数急剧增多,尘肺和职业中毒是主要职业病,职业病发生在多个行业,防治职业病刻不容缓。     

Strategies for prevention: occupational contact dermatitis

The economic consequence of occupational contact dermatitis (OCD) is considerable and impacts on an individual's quality of life. There are a range of prevention strategies, which include: elimination or substitution of harmful exposures; technical control measures; personal protection; identification of susceptible individuals; and education, training and health surveillance. Each one has been shown to have varying degrees of success in reducing OCD, but further work is required to evaluate the effectiveness of preventive measures in the workplace. OCD is not considered a high priority in most affected industries and therefore the development of health and safety policies to reduce its prevalence should be encouraged, although guidance and assistance would be required, because all employees are entitled to a safe working environment.     

1990—2019年亚洲地区接触性皮炎疾病负担研究

目的 评估中国与亚洲其他国家和地区接触性皮炎的疾病负担,以便更好地促进人类健康。方法 从全球疾病负担数据库（GBD2019）中获取接触性皮炎病例的相关数据,采用伤残调整寿命年（disability-adjusted life years,DALY）和年龄标化患病率（/10万）来描述疾病负担,采用年估计变化百分比（estimated annual percentage changes,EAPC）（%）来评估1990—2019年疾病负担的变化趋势。结果 1990—2019年亚洲48个国家和地区接触性皮炎DALY率和患病率均呈上升趋势（均EAPC>0、95%UI>0）,中国大陆DALY率和患病率均逐年增加（均EAPC>0、95%UI>0）。亚洲DALY率和患病率较全球高,中国大陆DALY率和患病率较亚洲高。女性DALY率和患病率均高于男性。2019年DALY率和患病率最高的年龄段均为70~74岁, DALY率最高的国家是菲律宾（34.94/10万）、最低的是以色列（7.28/10万）,患病率最高的国家是菲律宾（1 406.92/10万）、最低的是以色列（289.63/10万）。结论 亚洲接触性皮炎的疾病负担呈增长趋势,各国家和地区要根据实际情况提高人们对接触性皮炎的认识,预防接触性皮炎的发生。     

镍接触性皮炎的斑贴试验及其组织病理学特征

目的 探讨斑贴试验在金属过敏等环境与职业性皮炎中的诊断价值,了解镍接触性皮炎的组织病理学特征。方法 应用欧洲标准抗原系列斑贴试验检测110例疑诊为接触性皮炎患者,并对13例硫酸镍(5％)斑贴试验不同时段阳性反应皮肤进行活检。结果 39例接触性皮炎患者对硫酸镍敏感(占35．5％),其中阳性反应皮肤组织学特征为：24h时表皮轻度海绵变性和灶状空泡变性,少许嗜酸性粒细胞外渗;48-72h时表皮和真皮炎症达高峰,主要是CD45RO^ T细胞和CD68^ 巨噬细胞分布于炎症表皮及真皮血管周围。916h-5d时表皮轻度增生,不同细胞成分参与修复过程。结论 硫酸镍是引起湿疹皮炎类疾病的主要接触变应原,镍皮炎病理学改变符合变应性接触性皮炎的特征。     

The Italian system of data reporting in agriculture occupational health: a critical appraisal

Background Agriculture is one of the most hazardous sectors in both developing and industrialized countries. Agricultural workers suffer markedly higher rates of accidents and fatal injuries than other workers, with very few resources available for compensation. One of the difficulties in dealing with agriculture is that it is a very complex and heterogeneous sector. Due to inadequate and non-standardized recording and notification systems, official data on the incidence of agricultural occupational accidents and diseases are imprecise, notoriously underestimated, unsatisfactory and inadequate as an indicator for measuring the effect of interventions. Aim To explore the peculiarities of data reporting systems among agricultural sector focusing on the Italian situation. Results and conclusion In recent decades far-reaching national efforts in the sector of occupational safety and health have led to redefinitions and shifts in national policies and priorities, with wide-scale involvement of public and social bodies, field experts, companies, trade unions, public and private insurance agencies. Even so, compared to workers in other sectors, agricultural workers are still under-protected. Occupational safety and health in agriculture need to be addressed with a well-defined strategy and must be integrated into a rural development policy. Integration into the primary health care structure is strongly recommended.     

Contact dermatitis in Alstroemeria workers

Hand dermatitis is common in workers in the horticultural industry. This study determined the prevalence of hand dermatitis in workers of Alstroemeria cultivation, investigated how many workers had been sensitized by tulipalin A (the allergen in Alstroemeria) and took stock of a wide range of determinants of hand dermatitis. The 12-month period prevalence of major hand dermatitis amounted to 29.5% whereas 7.4% had minor dermatitis. Of these workers, 52.1% were sensitized for tulipalin A. Several personal and work-related determinants played a role in the multifactorial aetiology of hand dermatitis. Factors which showed a significant relationship with major hand dermatitis were: female sex, atopic dermatitis, chapped hands and the frequency of washing hands. It may be concluded that the Alstroemeria workers are a population at risk of developing contact dermatitis and it might be useful to carry out an educational campaign to lower the high prevalence.     

Irritant dermatitis among workers cleaning up a pesticide spill: California 1991

An outbreak of dermatitis occurred among county jail inmates who removed dead fish from the Sacramento River in California after a spill of metam sodium. The spilled chemical decomposes to methylisothiocyanate (MITC), a known skin irritant. A retrospective cohort study was conducted among the inmates and their crew leaders. Among 42 jail group members, 27 had dermatitis involving the feet and ankles; dermatitis was associated with lower extremity water contact (RR = 3.4, 95% CI 1.0-11.8); the attack rate increased with length of time spent in the water. For comparison, other state and federal employees who worked in the river at the same time were also interviewed. None reported dermatitis. Over three-quarters (24/31) of these other clean-up workers whose feet became wet changed to dry clothing immediately; none of the jail group changed immediately. The river concentration of MITC measured 20-40 ppb at the time of exposure. We speculate that prolonged wetness, occlusive boots, friction, and heat contributed to chemical irritation at this low concentration; the experience of the other clean-up workers suggests that this outbreak could have been prevented.     

The effect of physical and chemical properties of swimming pool water and its close environment on the development of contact dermatitis in hydrotherapists

BACKGROUND: The association between physical and chemical parameters in swimming pool water and the incidence of contact dermatitis (CD) in hydrotherapists was studied. METHODS: Chemical and physical parameters characterizing the water and air environment of swimming pools conducting hydrotherapy program were recorded. Differences between the values of these parameters associated with affected and non-affected hydrotherapists employed in 39 pools were tested statistically. RESULTS: No significant difference was found between the means of each of the physical and chemical parameters associated with the affected and the non-affected group of hydrotherapists. The prevalence ratio of the incidence of CD in pools chlorinated by gaseous chlorine was significantly higher than that in pools disinfected by other forms of chlorine compounds (PR = 1.49, CI = 1.17-1.89, P = 0.017). CONCLUSIONS: Dosing the water with larger amounts of gaseous chlorine compared to other disinfectants and a subsequent temporary decrease in the pH of the water may produce a more aggressive environment. It is suggested that combined effect of the various factors concomitantly with the irritating effect of prolonged exposure to water may trigger CD in pools treated with other chlorine-based compounds.     

Isocyanate induced allergic contact dermatitis in a university undergraduate student: An occupational dermatitis case report,review of laboratory safety regulations,and implications for campus research

A 19-year-old female college undergraduate developed an intensely swollen, erythematous and pruritic rash on the face and hands while working in an optical fabrication lab producing photosensitive polymers. She had no respiratory symptoms. The rash was consistent with contact dermatitis and there was no clinical evidence of respiratory involvement with normal spirometry. A review of the safety data sheets of chemicals used in the laboratory revealed several known sensitizers, including 6-hexamethylene diisocyanate (HDI), dibutyl phthalate, and 2,4,6-tribromophenyl acrylate. Patch testing confirmed the patient's sensitization to HDI. A subsequent worksite visit identified several hazardous chemicals that were used without appropriate hazard communication, training, standard operating procedures, or personal protective equipment. Simple exposure controls were recommended and instituted, and the patient was able to return to work in the laboratory without the recurrence of symptoms. This case demonstrates the importance of hazard identification, communication, and safety training in academic laboratories, for students and workers. A medical evaluation can identify hazards as well as lead to improvements in exposure controls and safe return to research.     

Effectiveness of skin protection creams in the prevention of occupational dermatitis: results of a randomized,controlled trial

Objectives  The aim of the trial was to investigate whether the publicized effects of skin protection creams can be replicated in a real occupational setting during activities that expose the skin. Methods  A prospective, randomized, four-tailed controlled pilot trial was performed to compare the effect of skin protection and skin care alone or in combination with cleansing against a control group (only cleansing). Two branches were selected for the investigation: the building industry and the timber industry. A total of 1,006 workers from these two branches were recruited, and out of these 485 workers were examined longitudinally for at least three time points over 1 year (lost for follow-up: 430 workers, exclusion: 91 workers). At each time point, as a primary outcome measure, we assessed the condition of the skin at both hands in a blinded manner and the individual was assigned to one of the following categories: no eczema, mild, moderate and severe eczema. As a secondary outcome measure, the worker’s transepidermal water loss (TEWL) was measured under standardized conditions at the back of both hands. In addition, the workers were asked to evaluate their skin condition during the study. Results  With regard to differences in the occurrence of eczemas, we found only in workers in building industry without application of skin protection or skin care creams a statistical significant increase in the incidence between the first and the second visit and a statistical significant decrease in the incidence between the second and third visit. When evaluating the secondary outcome-measurement changes in the TEWL values, an improvement was found for the group skin protection and skin care in combination and by skin care alone. Females in the timber industry started with better TEWL values than males, which may be due to better overall skin care. In this group we found an improvement for the group skin protection and skin care in combination and by skin protection alone. For skin protection alone, we noted a slight, but not significant improvement in all other groups. The subjective improvement of skin condition was reported from the participants who used skin protection and skin care in combination. Conclusions  Taking all these secondary-outcome measurements together, the main result of this study was that skin protection creams alone have a small effect on the skin barrier in workers in the building and timber industries compared with skin care alone or in combination with skin protection. Supported by the General Austrian Accident Insurance Institution.