Evaluation of a self-administered questionnaire on hand dermatitis

The purpose of the study was to evaluate a self-administered questionnaire on hand dermatitis that was developed to identify persons with hand dermatitis in epidemiological studies. A total of 109 nurses were subject to dermatological examination of the hands within 1 month of returning the questionnaire. 2 types of questionnaire diagnoses were made: a 'symptom-based' diagnosis and a 'self-reported diagnosis'. These were compared to the medical diagnosis of hand dermatitis. The prevalence of hand dermatitis in the 12 months before the study, based on the medical diagnosis, was 18.3%. The prevalence according to the symptom-based diagnosis and the self-reported diagnosis was 47.7% and 17.4%, respectively. The sensitivity and specificity of the symptom-based diagnosis were 100% and 64%, respectively. It is concluded that the symptom-based diagnosis can be used as screening instrument for the detection of cases in large study populations, if followed by dermatological examination of persons with a positive diagnosis. The sensitivity and specificity of the self-reported diagnosis were 65% and 93%, respectively. It is concluded that the self-reported diagnosis can be used to obtain a rough estimate of the prevalence, although comparison of prevalence figures between study populations may be distorted due to a difference in reporting of hand dermatitis. The results of the study illustrate the size of the differences in prevalence estimates that may arise as a result of differences in the definition and method of diagnosing hand dermatitis.     

A survey-based assessment of the prevalence and severity of chronic hand dermatitis in a managed care organization

Although studies conducted outside of the United States have found a 7% to 12% prevalence of chronic hand dermatitis, no US general population-based estimates have been reported. The objective of this study was to quantify the prevalence of chronic hand dermatitis in a US managed care organization population. A 13-item self-assessment questionnaire was developed and validated, with 85% sensitivity and 95% specificity. The questionnaire was mailed to 2 random member samples from a Massachusetts managed care organization: 502 general members and 878 members with dermatitis. The questionnaire had a 36.74% overall response rate, with a chronic hand dermatitis point prevalence of 17.49% and 33.33% in the general and dermatitis populations, respectively. Among the general population, the questionnaire results identified 16.94% members who had chronic hand dermatitis but had not sought dermatitis-related medical services. After direct standardization to the 2000 US Census population with respect to age, gender, and race distributions, the projected point prevalence was estimated at 16.36% in the US general population. In conclusion, we found a higher prevalence of chronic hand dermatitis than previously reported. Approximately 1 in 6 members did not seek medical attention, suggesting that chronic hand dermatitis may be underdetected and untreated and may require more awareness and effective management.     

Increase in occupational skin diseases of dental personnel

Occupational diseases of dentists and dental nurses were compiled from the Finnish Register of Occupational Diseases. The cases were recorded during 3 3-year observation periods, namely 1982-1984, 1986-1988, and 1992-1994 (i.e., 9 observation years). The relative risk of developing occupational allergic contact dermatitis in different occupations was calculated from the statistics of the years 1986-1991, and was expressed as the age-standardized rate ratio (SRR). During the 9 observation years, the majority of registered occupational diseases of dentists and dental nurses were skin diseases (221/312; 70.8%), followed by occupational repetitive strain injuries (61/312; 19.6%) and occupational respiratory diseases (20/312; 6.4%). The incidence rate (IR) for allergic contact dermatoses/10,000 workers (contact urticaria included) increased from 26 (95% confidence interval (CI) 16-40) in 1982-1984 to 79 (95%, CI 64-97) in 1992-1994. The IR/10,000 of allergic contact dermatoses increased especially for dentists, from 5.4 (95% CI 0.7-19) in 1982 to 67 (95% CI 45-95) in 1992-1994. The increase of the IR/10,000 dental nurses was smaller: from 43 (95%, CI 26-66) in 1982-1984 to 87 (95% CI 67-111) in 1992-1994. There was no increase in the IR/10,000 cases of irritant dermatoses. The most common causes of allergic contact dermatitis were plastics, disinfectants and antimicrobials, rubber chemicals, and mercury/mercury salts. The most common causes of irritant contact dermatitis were detergents, wet and dirty work, plastic chemicals and antimicrobials. Currently, Finnish dentists have the highest risk and dental nurses have the 4th highest risk of any occupation for developing occupational allergic contact dermatitis: the risk was 6.4-fold (SRR 6.4) in dentists and 6.1-fold in dental nurses, as compared to the general working population. It is evident that safer acrylics and protective gloves, better product declarations and material safety data sheets, as well as more information about protective measures, including non-touch working techniques, are needed.     

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.     

Primary prevention in health care employees: a prospective intervention study with a 3-year training period

Irritant contact dermatitis is a mayor problem in health care employees. Because educational programs have shown convincing success in certain occupations (e.g. in hairdressers), this study investigates the effect of a special training program in health care trainees. 521 trainees from 14 nursing schools in Central Germany were randomly divided in 2 groups, (i) an intervention group with a regular teaching protocol regarding all aspects of primary prevention and (ii) a control group without any further teaching. Morphological changes of the hands, use of hand care creams and knowledge regarding skin care were evaluated regularly during their 3 years lasting training period (1999-2002). In the intervention group, we found at the end of the 3-year training period a significant better skin condition of the hands than in the control group: a 3-year prevalence of morphological skin changes of 66.7% versus 89.3%. The unteached trainees (control group) had an odds ratio (OR) of 4.8 [95% confidential interval (CI): 2.9-7.8] for developing any skin changes on the hands after 3 years. Besides the effect of the teaching, the history of hand dermatitis before the study start was an independent risk factor for development of further hand dermatitis [OR 1.9, 95% CI: 1.0-3.6). Age and sex showed no influence on the skin condition. Atopic constitution had an influence on the development of skin changes only at the evaluation after 18 month. The observed effect in the intervention group may best be explained by different behaviour of the trainees, e.g. the amount of hand washing was reduced, while procedure of hand disinfection remained unchanged compared with the control group. However, the amount of used skin care cream did not differ between the both groups. This study shows that primary prevention of skin disease by regularly teaching during the training period of medical employees can effectively reduce the risk of development of irritant skin changes of the hands. Therefore, teaching and continuous motivation regarding preventive individual and collective measures during the training of medical staff should be an obliged part of the curriculum.     

The validity of a questionnaire-based epidemiological study of occupational dermatosis

The aim of this study was to evaluate the validity of a questionnaire and medical anamnesis to identify persons with dermatitis in an occupational setting. The design was a clinical epidemiological cross-sectional study. The study was performed between the second and fourth week of January 2001. A questionnaire was followed a week later by a medical occupational interview and a clinical dermatological examination, including a comprehensive patch test with potential workplace chemicals. The anamnesis and the clinical examination were made independently by occupational and dermatological physicians, and the skin examination was performed blinded to anamnestic data. The setting was the mother plants of a Danish-based international company producing wind turbine systems. The study population was a workplace cohort, highly exposed to epoxy resin systems and other chemicals, and totalled 724 production workers at 4 facilities. The rate of participation was 84.7%. Using enquete questions of current skin rash against the clinical presence of dermatitis, we found a sensitivity of 22% and a specificity of 89%, compared to 45% and 87%, respectively, when the anamnestic work history, taken by an occupational physician, was the screening parameter. Using 'workplace periodic prevalence' of dermatitis, we found sensitivities in the range of 63-76% by a questionnaire and 70-83% by medical anamnesis. Questionnaire screening by skin symptoms gave the highest values for redness, a sensitivity of 33% and a specificity of 76%, and decreasing validity parameters as more symptoms were added to the list of screening questions. We found that the use of a questionnaire and medical anamnesis were problematic, when the purpose was screening for contact dermatitis and allergy, in this industrial cohort manufacturing reinforced plastic products. But these instruments might be useful for epidemiological surveillance, when the questionnaire has been validated in the given occupational setting.     

Evaluation of 2 self-administered questionnaires to ascertain dermatitis among metal workers and its relation with exposure to metalworking fluids

We performed an exploratory study to evaluate 2 self-administered questionnaires assessing hand dermatitis and investigate a possible exposure-response relationship between dermal exposure to semi-synthetic metalworking fluids (SMWF) and dermatitis. In a cross-sectional survey on dermatitis, a symptom-based questionnaire and a picture-based skin screening list were applied in 80 SMWF-exposed workers and 67 referents. To evaluate the accuracy of the questionnaires, 47 subjects were examined by a dermatologist. Dermal exposure levels to SMWF were assessed on hands, forearms, and face with a observational method that was validated using a fluorescent tracer method. The symptom-based questionnaire had a relatively high sensitivity (0.86) but moderate specificity (0.64), and the skin screening list had a low sensitivity (0.36) and a relatively high specificity (0.84). The skin screening list seemed to represent the more severe cases of dermatitis and showed a significant relation with exposure for dermatitis on hands, forearms, or face. In epidemiological surveys where workers are not seen by a dermatologist, the skin screening list seems to be more appropriate to detect cases of dermatitis, as its higher specificity results in less false positives. Alternatively, it would be preferable applying the symptom-based questionnaire; workers with symptoms should be seen by a dermatologist to identify false positives.     

Development and validation of a questionnaire for diagnosing atopic dermatitis.

In this paper we describe the development and validation of a questionnaire for atopic dermatitis used in population surveys in Denmark. The Danish questionnaire was developed from the UK Working Party's questionnaire for atopic dermatitis and includes a severity score. The study included 61 children aged 3 to 14 years recruited from our Department of Dermatology, two kindergartens and a primary school. A validator was appointed to evaluate whether each child had current or previous atopic dermatitis. Compared to the validator's diagnosis, the sensitivity of the UK Working Party criteria was 90% (95% CI; 74-98) and the specificity was 97% (95% CI; 82-99). The criteria for atopic dermatitis have a satisfactory sensitivity and specificity for diagnosing current atopic dermatitis, but the natural course of the disease complicates the validation of investigational instruments. We suggest that future epidemiological studies aimed at establishing new knowledge on atopic dermatitis should include history, current symptoms and findings and a severity score.     

Hand eczema in geriatric nurses in Germany – prevalence and risk factors

Background and objectives:  The aim of this cross-sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany.
Methods:  1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians.
Results:  Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86).
Conclusions:  Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease.     

Validation of the diagnostic criteria for atopic dermatitis.

OBJECTIVE: To validate the accuracy of newly proposed diagnostic criteria for atopic dermatitis (AD). DESIGN: Double-blind, cross-sectional study comparing the achievement of new criteria with the diagnosis of a dermatologist. SETTING: A private, general dermatology, outpatient clinic. PATIENTS: A sample of 416 consecutive patients attending the clinic within 2 months (146 males and 270 females), consisting of 60 patients with AD and 356 control patients with other skin diseases. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of proposed criteria in the diagnosis of AD. RESULTS: Sensitivity, specificity, and positive and negative predictive values of proposed diagnostic criteria for AD were 10.0% (95% confidence interval [CI], 4.1%-21.2%), 98.3% (95% CI, 96.2%-99.3%), 50.0% (95% CI, 22.3%-77.7%), and 86.6% (95% CI, 82.8%-89.7%), respectively. CONCLUSIONS: These diagnostic criteria for AD are highly specific and are suitable for clinical trials. However, they may not achieve enough sensitivity to be useful for large, population-based epidemiological studies or for routine clinical practice, at least in Iran.     

High body mass index, dry scaly leg skin and atopic conditions are highly associated with keratosis pilaris

BACKGROUND: In a previous study we have found that young patients with insulin-dependent diabetes mellitus had a higher prevalence of keratosis pilaris (KP) than healthy controls, with a high correlation with body mass index (BMI) and ichthyosiform skin changes of the legs. Objectives: To investigate whether BMI, dry scaly legs and atopic conditions could be associated with KP in a healthy population of adolescents. METHODS: A total of 202 Jewish adolescents chosen at random among students undergoing a routine medical examination at school participated in the study. The patients filled in a questionnaire for data on ethnic origin, the presence or history of allergic rhinitis, asthma or atopic dermatitis, the presence of thyroid disease, diabetes or dry skin. A similar questionnaire was sent to the family physician for verification. A general inspection of the skin was made for the presence of KP; the lower legs were also examined for dry scaly skin and ichthyosiform skin changes. RESULTS: KP was present in 33 examinees (16%). Factors significantly associated with were dry scaly skin (p < 0.001, odds ratio, OR = 31.3, with 95% confidence interval, CI, 6.4-153.7), BMI >25 (p < 0.001, OR = 4.9, with 95% CI 2.2-11.2) and atopy (p = 0.001, OR = 4.5, with 95% CI 1.8-11.1). Conclusion: It therefore appears that KP is associated with multiple factors, including high BMI, leg skin dryness and atopic conditions.     

A Relationship between Physical Activities and Hand Dermatitis: An Epidemiology Study of the USA Population

Background:

Hand dermatitis is a common, chronic relapsing skin disease, resulting from a variety of causes including endogenous predisposition and environmental exposures to irritants and allergens. Physical activities have been reported to be beneficial for patients with hand dermatitis.

Objectives:

We aim to evaluate the association between self-reported physical activities and hand dermatitis using the 2003-2004 National Health and Nutrition Examination Survey (NHANES) database.

Methods:

Information regarding 2,688 participants aged 20 to 59 years from the 2003-2004 NHANES cycle were retrieved and analyzed. Diagnosis of hand dermatitis was based on standardized photographs of the hands read by two dermatologists. Physical activity during leisure time for the prior 30 days was assessed using standardized questionnaire. Based on the suggested MET scores provided for each response in the questionnaire section of the NHANES methodology, the MET scores for average level of physical activities, walking/bicycling, and performing tasks around home/yard for the past 30 days was calculated.

Results:

There were 42 (1.56%) diagnosed cases of active hand dermatitis among the 2,688 participants. Those who reported recent vigorous or moderate physical activities were less likely to have a diagnosis of active hand dermatitis (OR: 0.436, 95% CI: 0.200 to 0.947, P = 0.036 and OR: 0.489, 95% CI: 0.261 to 0.916, P = 0.025, respectively). This negative association remained statistically significant even after adjusting for age, gender, ethnic groups and atopic diathesis.

Conclusions:

Moderate and vigorous levels of physical activities appeared to be beneficial for hand dermatitis. Therefore, it is important to advise patients with active hand dermatitis to remain physically active. However, clinicians should also be cognizant of the fact that the heat and sweat generated from physical activities might also exacerbate the condition.     

Occupational risk factors for hand dermatitis among professional cleaners in Spain

Background. Dermatitis is an important health outcome for workers whose jobs put them in contact with irritants or sensitizing agents. Objectives. We conducted an analysis of data from the Epidemiological Study on the Risk of Asthma in Cleaning Workers 2 (EPIASLI2) to assess worksites and cleaning products as risk factors for hand dermatitis among professional cleaning workers. Materials/methods. We distributed 4993 questionnaires to employees of 37 cleaning companies, and used data from 818 (16%) respondents who provided information about skin symptoms and cleaning‐related exposures. We assessed associations between the frequencies of worksite and cleaning product exposures and a symptom‐based definition of hand dermatitis among current cleaning workers (n = 693) and a comparison population (n = 125). Results. Hand dermatitis was reported by 28% of current cleaning workers, versus 18% of the comparison population, and was associated with cleaning outdoor areas and schools, and the use of hydrochloric acid [prevalence ratio (PR) 1.92, 95% confidence interval (CI) 1.22–3.02] and dust mop products (PR 1.75, 95% CI 1.11–2.75). Conclusions. Professional cleaning workers may not be sufficiently protected from cutaneous disease at work. Future research should further investigate the roles of multiple product exposures and personal protective equipment.     

The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia

BACKGROUND: Nonmalignant skin conditions are believed to be common in adults, although there are very few community-based studies to determine their exact frequency. OBJECTIVE: To record the prevalence of common, nonmalignant skin conditions in adults in central Victoria, Australia. METHODS: A total of 1457 respondents from a random selection of adults aged 20 years and over from Maryborough, central Victoria, were given a total body examination by a dermatologist or dermatology trainee. People with any nail or skin signs suggestive of tinea had scrapings taken for fungal culture. RESULTS: The age- and sex-adjusted prevalence of warts was 7.1% (95% confidence interval (CI), 5.8-8.4%), acne 12.8% (95% CI, 11.0-14.5%), atopic dermatitis 6.9% (95% CI, 5.6-8.3%), seborrheic dermatitis 9. 7% (95% CI, 8.2-11.2%), asteatotic dermatitis 8.6% (95% CI, 7.1-10. 0%), psoriasis 6.6% (95% CI, 5.7-7.9%), culture-positive tinea 12% (95% CI, 10.3-13.6%), seborrheic keratoses 58.2% (95% CI, 55.6-60. 7%), and Campbell de Morgan spots (cherry angiomas) 54.4% (95% CI, 51.9-57.0%). There was variation in the prevalence of many of these conditions with age. CONCLUSIONS: This study demonstrates that nonmalignant skin conditions are common in adults in Australia. Their diagnosis and management represent a considerable burden not only to those suffering from the conditions, but also to the health system which provides for their care.     

Identifying Patients Likely to Have Atopic Dermatitis

Background: A quick method to distinguish people who are predisposed to skin complaints would be useful in a variety of fields. Certain subgroups, such as people with atopic dermatitis, might be more susceptible to skin irritation than the typical consumer and may be more likely to report product-related complaints. Objective: To develop a rapid, questionnaire-based algorithm to predict whether or not individuals who report skin complaints have atopic dermatitis. Methods: A 9-item questionnaire on self-perceived skin sensitivity and product categories reportedly associated with skin reactions was administered to two groups of patients from a dermatology clinic: one with clinically diagnosed, active atopic dermatitis (n = 25) and a control group of patients with dermatologic complaints unrelated to atopic dermatitis (n = 25). Questionnaire responses were correlated with the patients’ clinical diagnoses in order to derive the minimum number of questions needed to best predict the patients’ original diagnoses. Results: We demonstrated that responses to a sequence of three targeted questions related to self-perceived skin sensitivity, preference for hypoallergenic products, and reactions to or avoidance of α-hydroxy acids were highly predictive of atopic dermatitis among a population of dermatology clinic patients. Conclusion: The predictive algorithm concept may be useful in postmarketing surveillance programs to rapidly assess the possible status of consumers who report frequent or persistent product-related complaints. Further refinement and validation of this concept is planned with samples drawn from the general population and from consumers who report skin complaints associated with personal products.     

Skin disorders in ship's engineers exposed to oils and solvents

Ship's engineers are exposed to mineral oil and solvents in their work. This study was intended to investigate if ship's engineers had an increased prevalence of skin disorders and whether any such increased risk could be linked lo exposure to mineral oils and solvents. A self-administered questionnaire was sent to 700 male seamen from 3 Norwegian ferry companies. Of the 492 respondents. 169 were currently working as ship's engineers and 295 had never worked as ship's engineers, The outcomes eczema, acne, dry skin, a in dermatitis and hand dermatitis were defined from the questionnaire. Prevalences of these skin disorders were compared between the groups. Logistic regression was used to elucidate explanatory variables further. When comparing current ship's engineers with those who had never worked as ship's engineers, the crude prevalence ratios were 1.7 (95% CI 1.1–2.7) for dry skin. 1.7 (95%CI 1.1 2.5) for any dermatitis. 1.3(95%CI 0.66–2.67) for acne and 1.2 (CI 0.61–2.27) for eczema. The risk of these symptoms increased for the engineers in the regression analysis, after controlling for age, self-reported use of Stoddard solvent, and the use of fuel oil as a hand cleansing agent. The increased prevalence of skin disorders found among ship's engineers in this investigation may be explained by direct contact with mineral oils and solvents.     

Skin disorders in chronic psychiatric illness

Background Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. Objective To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. Methods Ninety‐one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin. Results Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40–49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38–39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67–24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34–10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation. Conclusions Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.     

Prevalence of skin disease among nursing home patients in southern Taiwan

BACKGROUND: Continuing advances in medical care and nutrition have prolonged the lifespan and expanded the elderly demographic world-wide. Despite increasing elderly populations within Taiwanese nursing homes, there has been a lack of dermatologic surveys, and the prevalence of skin conditions within this group is unknown. METHODS: To establish the prevalence of skin disease within nursing homes in southern Taiwan, we undertook a dermatologic and epidemiologic investigation of 398 patients in Tainan City, southern Taiwan, between November 1999 and February 2000. RESULTS: This study revealed that more than half of all nursing home patients suffered from fungus (61.6%) and xerosis (58.3%), while other pruritic skin diseases, such as dermatitis and scabies, were less prevalent at 7.3% and 3.3%, respectively. Risk factors for fungal infection included bedridden status (risk ratio (RR), 1.2; 95% confidence interval (CI), 1.1-1.4) and male gender (RR, 1.2; 95% CI, 1.0-1.3). Xerosis was statistically correlated with an age range of 80-90 years (RR, 1.2; 95% CI, 1.0-1.4) when compared to other age ranges. Current scabies diagnosis was strongly associated with a previous history of scabies (RR, 8.9; 95% CI, 1.7-21.1). CONCLUSIONS: Our study provides clinically relevant data regarding the prevalence of skin diseases in institutionalized Taiwanese patients for the first time. The results suggest that scabies persists within some nursing homes despite treatment, and that some patients remain undiagnosed. The dermatologic needs of these Taiwanese patients are not currently being satisfied.     

Occupational hand dermatitis in hospital environments

Health care personnel form the 5th category at major occupational risk of skin disease in Italy The aim of this study was to assess the prevalence and clinical relevance of contact dermatitis in a group of 1301 employees of the Perugia Monteluce Hospital (658 females and 643 males: mean age 39.8 years) who answered a self-administered questionnaire elaborated by the authors. The subjects with anamnestic hand dermatitis and/or atopic mucosal reactions were clinically examined and submitted to skin tests (patch and/or prick tests). Contact dermatitis of the hands and/or forearms occurred in 21.2% and was significantly more frequent (P < 0.001) in women, subjects under 31 years of age, workers in internistic and surgical fields, cleaners and nurses. In the majority of cases (94.9%) the lesions were irritant in origin and mainly related to disinfectants (especially, chlorhexidine gluconate and glutaraldehyde) and gloves (latex proteins and starch glove powder. rather than accelerators and additives of rubber), Finally, atopy seemed to favour the onset of hand dermatitis, The importance of these results for preventive measures of contact dermatitis in hospital employees is discussed.     

P51Occupational contact dermatitis among operating room nurses

Background:  Occupation related dermatitis is a common problem in health care workers, especially in nurses, who are exposed to a wide variety of allergenic and irritant substances. The aim of this study was to assess the prevalence rate of skin symptoms among personnel handling chemical disinfectants and to examine which allergens were important.
Methods:  We investigated 460 randomly selected health care workers (HCW), who had constant contact with chemical disinfectants during their work. The study was performed by means of a questionnaire, a medical examination, skin patch test using Finn chambers and glutaraldehyde, benzalkonium chloride, hydrogen peroxide and chlorine compounds at 0,1, 0,5 and 1,0% wat.
Results:  241 HCW (52,5%) described various skin symptoms they attributed to disinfectant exposure. Generally, these symptoms were mild and ranged from pruritis to hand eczema. Of these 66 (14,4%) tested were skin patch test positive. Of the 460 HCW tested, 37 (8%) had positive patch test reactions to benzalkonium chloride, 22 (4,8%) to chlorine compounds, 18 (4%) to glutaraldehyde, 6 (1,2%) to hydrogen peroxide. 5 HCW (7,6%) testing positive to disinfectants gave no history of reactivity to them. History of atopic dermatitis was found in 50 (10,9%) and it was associated with diagnosis of allergic contact dermatitis and positive patch test reactions to benzalkonium chloride. Also positive patch tests reactions were associated with frequent use of latex gloves in contrast to those, which used latex gloves while working constantly or didn't use them at all.
Conclusions:  1. Skin symptoms related to work with chemical disinfectants are common, but mostly mild. 2. Benzalkonium chloride is one of the strongest sensitizing disinfectants used in health care professions, especially for atopic persons who do not take measures of protection during exposure to it.