Results of evaluating health care workers with prick and patch testing.

BACKGROUND: Health care workers are exposed to many agents that can cause irritant or allergic contact dermatitis. Recently, much attention has been focused on latex sensitivity, which commonly causes contact urticaria. Most studies have examined the conditions of irritant or allergic contact dermatitis and contact urticaria independently. Therefore, we have little information about the possible occurrence of these conditions in the context of combined assessment including both prick and patch testing. OBJECTIVE: To determine the prevalence of irritant and allergic contact dermatitis and contact urticaria in a group of health care workers presenting with skin problems. METHODS: Retrospective review of health care workers assessed by both prick and patch testing in an occupational health clinic. RESULTS: The diagnoses included 61% with irritant contact dermatitis, 31% with allergic contact dermatitis, and 27% with contact urticaria to latex. Eleven percent had both allergic contact dermatitis related to thiuram and contact urticaria to latex. Ninety five percent were deemed to be work-related. CONCLUSION: Health care workers presenting with skin complaints should be assessed with both prick and patch testing.     

Occupational irritant contact dermatitis and fungal infection in construction workers

We have examined 6 construction workers who developed chronic skin diseases on their hands over a period of 15 years (1970–1985). 4 developed a Trichophyton rubrum infection, and the other 2 an irritant contact dermatitis. All of them carried out jobs which caused traumatization of the skin, due to the presence of ethylene glycol and mineral oils during operation of pneumatic hammers in winter. They also suffered other types of skin trauma during their work. Construction workers may be at risk of developing an occupational skin disease involving fungal infection.     

Dermatoses among poultry workers: “Chicken poison disease”

To investigate the causes of skin eruptions affecting poultry workers, we reviewed our medical records and surveyed a southcentral Pennsylvania poultry processing plant. Examination of the records of routine patch test clinic patients seen from January, 1981, to July, 1982, revealed three poultry workers with allergic contact dermatitis and one with irritant contact dermatitis. We then examined one hundred fifty workers at a poultry processing plant, noting the presence of occupational dermatoses, with special interest in the occurrence of contact dermatitis. We found thirteen dermatoses in nine workers. These included Candida infections, irritant contact dermatitis, allergic contact dermatitis, abrasions and cuts, warts, and dyshidrotic eczema.     

Is a worker's understanding of their diagnosis an important determinant of outcome in occupational contact dermatitis?

The possible effect of an individual's knowledge of their diagnosis on their disease outcome was examined in a group of 230 workers with occupational contact dermatitis. The workers were surveyed with an interviewer-administered questionnaire for an average of 5 years following a diagnosis of occupational contact dermatitis. 48% had allergic contact dermatitis and 52% had irritant contact dermatitis. There was a poor correlation between the workers' recalled diagnosis and the actual diagnosis, but better concordance with their recollection of patch test results. Only 33% correctly identified their diagnosis. Those who could not were approximately 2 x as likely to still have active dermatitis, to have more severe dermatitis and to note that their skin problem interfered with their work and home activities. Those who had no idea of their diagnosis were 3 x as likely to have these problems. These results raise the possibility that further efforts directed at the patient's education with respect to their condition might improve the outcome of their occupational skin disease.     

Skin diseases in workers at a perfume factory

The aim of this study is to find out the causes of skin diseases in one-third of the staff of a perfume factory, in which 10 different perfume sprays were being manufactured. Site inspection, dermatological examination and patch testing of all 26 persons at risk with 4 perfume oils and 30 ingredients of them. The results showed 6 bottlers were found suffering from allergic contact dermatitis, 2 from irritant contact dermatitis, 12 workers showed different strong reactions to various fragrances. The main causes of allergic contact dermatitis were 2 perfume oils (12 cases) and their ingredients geraniol (12 cases), benzaldehyde(9), cinnamic aldehyde (6), linalool, neroli oil, terpenes of lemon oil and orange oil (4 each). Nobody was tested positive to balsam of Peru. Job changes for office workers, packers or printers to other rooms, where they had no longer contact with fragrances, led to a settling. To conclude, automation and replacement of glass bottles by cartridges from non-fragile materials and using gloves may minimize the risk.     

Contact dermatitis from dielectric fluids in electrodischarge machining

We report an outbreak of irritant contact dermatitis in the aerospace industry from electrodischarge machining (EDM). 20 workers doing EDM developed irritant contact dermatitis from the dielectric fluid used in EDM, a form of precision metal machining that is widely used in mould making and precision engineering. Dielectric fluid contains hydrocarbons that are aromatic, paraffinic or naphthenic and are skin irritants. Irritant contact dermatitis from dielectric fluid has not been reported previously. EDM will become more widespread and occupational dermatitis from dielectric fluid is likely to become more prevalent in the future. Our experience was that irritant contact dermatitis from dielectric fluid can be prevented by simple preventive measures such as personal hygiene and health education.     

Occupational allergic contact dermatitis is more prevalent than irritant contact dermatitis: a 5-year study

BACKGROUND: Irritant contact dermatitis is thought to be the leading cause of occupational skin disease in the United States. Recent reports suggest otherwise. OBJECTIVES: The purposes of this study were to determine the prevalence of allergic and irritant forms of occupational contact dermatitis in the population seen at a Midwestern dermatologic referral clinic, report professions commonly affected by occupational skin disease, and indicate which substances are frequent allergens. METHODS: A retrospective analysis of patch test data collected at the University of Kansas between 1994 and 1999 was performed. RESULTS: Of 537 patients who underwent patch testing, 135 (25%) had occupational skin disease. Allergic contact dermatitis affected 81 (60%) patients, and irritant contact dermatitis was found in 46 (34%). Health care professionals, machinists, and construction workers accounted for nearly half of all patients with occupational skin disease. Nickel sulfate, glutaraldehyde, and thiuram mix were the most common allergens. CONCLUSION: Patch tests with a wider array of allergens than those currently available in the United States are needed to prevent misdiagnosis of occupational contact dermatitis.     

Occupational contact dermatitis in the pharmaceutical industry

Occupation-induced skin reactions are not infrequently observed in the pharmaceutical industry. Workers may come in contact with irritant substances and also with chemically reactive intermediates or drugs that may be potential sensitizers. The skin lesions can be located at the site of contact, usually the hands, although airborne reactions on exposed and even nonexposed areas (eg, by particles trapped under clothing) are not uncommon. Generalized reactions may occur due to inhalation or transcutaneous absorption. An accidental exposure to a highly allergenic compound may cause a chemical burn, followed by primary sensitization and allergic contact dermatitis. The pharmaceutical contact allergens belong to many different pharmacologic classes. If several cases of contact dermatitis occur in multiple individuals in the same company, then the working conditions are implicated and should be changed to prevent their recurrence. Measures to be taken include dust control, installation of closed filter equipment, and keeping the workers informed about the potential risks associated with the manipulation of the chemicals.     

Contact sensitization among ceramics workers

139 workers from 3 ceramics factories underwent dermatological and allergological examination, using standard and occupational patch test series, in order to evaluate the prevalence of dermatitis and contact sensitization, to identify the most important sensitizing substances in the ceramics industry, and to correlate the results with possible risk factors such as atopy. Hand dermatitis had affected 37% of the subjects examined. 27% of the workers were sensitized to 1 or more allergens. Of 52 subjects with dermatitis, 37% had allergic contact dermatitis and 63% irritant contact dermatitis. 18 subjects were found to be sensitized without showing any previous or present clinical symptoms. Atopy tended towards correlation with the overall incidence of dermatitis, though not with the prevalence of sensitization.     

Allergy to latex gloves among healthcare workers in Dakar

BACKGROUND: The prevalence of latex allergy is high (to 17%) among groups at risk such healthcare workers. Our aim was to determine the prevalence and severity of allergy to latex gloves among health workers in Dakar. PATIENTS AND METHODS: The study was conducted in three of the five hospitals in Dakar (Senegal). A randomized sample was constituted. All healthcare workers required to use latex gloves in their work were included. A questionnaire was administered. The analysis was performed using the Epi-info software package (6.0). RESULTS: One hundred and forty cases were included. The median age was 39 years and the sex-ratio was 0.57. Sixty-six (47%) cases had familial atopic dermatitis, 13 (9.6%) had atopic dermatitis, and 4 (2.9%) indicated food allergy (banana, avocado). Irritant dermatitis was found in 40.7% of cases, 112 healthcare workers (81.2%) used bleach and water to clean their hands. Antiseptics were used frequently: 75.5% of those interviewed used them more than three times a day. None of the healthcare workers indicated any allergy to latex condoms. Otherwise surgical procedures and bladder/rectal catheters were noted respectively in 24% and 18% cases. Fifteen healthcare workers (10.7%), of whom 12 were women, indicated appearance of clinical signs when using latex gloves. The clinical manifestations were: contact urticaria or immediate pruritus (8 cases), combined contact dermatitis and contact urticaria (2 cases), allergic conjunctivitis (1 case), allergic rhinitis (2 cases) and asthma (2 cases). We also noted 6 cases of contact dermatitis. Rechallenge tests were performed in 7 cases and were positive, 2/3 prick-tests and 1/4 patch-tests (standard European battery). The statistical analysis shows that allergy to latex gloves was significantly associated with atopy and irritant dermatitis (p<0.03). DISCUSSION: We found a prevalence of allergy to latex gloves of 11% among healthcare workers in Dakar, reflecting reports in the literature. The classical risk factors such atopic dermatitis and irritant dermatitis were found. The correlation between irritant dermatitis and frequent use of bleach and water mean that these practices should be eradicated since they play an important role in the development of contact urticaria and anaphylactic reactions.     

Contact urticaria from mustard in fish-stick production

At a major fish factory in northern Norway, workers employed in fish-stick and fillet production participated in a survey on skin diseases. 122 (80.1%) of the workers in the fish-stick section responded, but only 60.7% of the fillet workers. Clinical examination and patch testing revealed 16 cases of occupational dermatitis among workers in fish stick production, 3 of whom had contact urticaria from mustard and 8 from fish. There were only found 6 cases of occupational dermatitis among fillet workers; 3 reacted to fish and 3 had irritant contact dermatitis. Working conditions are described for both locations. A greater exposure to irritants may in part explain the 10.7% occupational dermatitis in the fish-stick section compared to only 3.5% in the fillet section.     

Self-reported skin symptoms in metal workers

Machinists and machine maintenance men working in the metal industry use metal-working fluids capable of causing irritant and allergic contact dermatitis. The objectives of this study were to find out the frequency of skin symptoms in machinists and machine maintenance men (metal workers) and to compare the risk of their skin symptoms to that in office workers (controls). A total of 726 male metal workers and 84 controls answered a structured telephone questionnaire enquiring about work, atopy, skin symptoms, their impact on life, etc. The risk of skin symptoms compared with that in the controls was estimated using a logistic regression analysis. Of the metal workers, 20% reported recurring or prolonged dermatitis on their hands or forearms during the past 12 months. The hand or forearm dermatitis (HD) affected mostly the metal workers' mood and their activities at work. Recurring dermatitis elsewhere (DE) than in the hands and in connection with work was reported by 10%. The risk of HD was about twofold and the risk of DE was about fourfold compared with that in the controls. The HD of machinists may be severe and affect their ability to work. DE may have clinical significance in machinists.     

Dermatoses in metal workers

In an epidemiological study of 286 metalworkers exposed to metalworking fluids (MWF), the prevalence of skin problems was investigated. Minor changes, such as a dry rough skin with slight erythema, were seen in 31%, and major changes, such as more serious and widespread dermatitis, were observed in 27% of all workers. By far the most cases were of irritant origin; in only 2.8% was a contact sensitization established. Exposure to water-based MWF caused irritant contact dermatitis more often than exposure to neat oils. No influence was found of the presence of atopy on the occurrence of dermatitis. Other factors that may result in irritation of the skin are discussed, as well as measures to be taken to minimize insult of the skin.     

Epidemiology of occupational skin disease in Singapore 1989-1998

This is an epidemiologic study of occupational skin disease in Singapore. All patients diagnosed with occupational dermatoses in the National Skin Centre, Singapore, over the 10-year period 1989-1998 were studied retrospectively. Irritant contact dermatitis was found to be more common than allergic contact dermatitis. The major sources of occupational dermatitis in Singapore were the metal/engineering, building/construction, electrical/electronics and transport industries. The main irritants were detergents/wet work, solvent and oil/grease. The main allergens were chromate, rubber chemicals and nickel. We concluded that the main sources of occupational skin disease and main allergens in Singapore had remained the same compared to a similar study of occupational skin diseases in 1984-85. Weak irritants are still the predominant causes of occupational irritant contact dermatitis, though the main irritants have changed compared to the previous study, where cutting fluids, cement and solvent were the most common irritants.     

The association of smoking with contact dermatitis and hand eczema – a review

Given the high prevalence of allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), hand eczema (HE), and smoking, and the impact that smoking has on skin disease, the authors reviewed the existing literature to assess the association between smoking and contact dermatitis or hand eczema. Using the PubMed and SCOPUS databases, a literature search identified articles related to allergic contact dermatitis, irritant contact dermatitis, and hand eczema and a possible association with smoking. The search period included articles prior to and including April 2016. Seven of eight articles described a positive relationship between smoking and allergic or irritant contact dermatitis, while nine of nineteen articles found a positive association between smoking and hand eczema. Published studies document that smoking may be an important risk factor for both allergic and irritant contact dermatitis as well as hand eczema.     

Addition of ferrous sulfate to cement and risk of chromium dermatitis among construction workers

Lowering the water-soluble chromium content of cement to < 2 ppm has been suggested to diminish tile risk of allergic hand dermatitis caused by chromium among construction workers. The prevalence of chromium dermatitis was determined for a representative sample of 913 house construction workers and 707 concrete element prefabrications workers, with a questionnaire and clinical examination, before the use of cement with such H low content of water-soluble chromium was Lined on Finnish construction sites in 1987. The prevalence of allergic contact dermatitis caused by water-soluble chromium, diagnoses confirmed with patch tests among the workers with hand dermatitis, was 9/ 117 (7.7%). 4 of them were new 4/105 (4%) and 5 had been diagnosed earlier. In 1997, the prevalence of work-related hand dermatitis (allergic and irritant together) was 6.8% among the construction workers and 8.9% among the concrete element prefabrication workers. The Finnish Register of Occupational Diseases was checked for reports of chromium dermatitis and other forms of hand dermatitis from 1978 to 1992. The results indicated that, after 1987, the occurrence of allergic contact dermatitis caused by chromium decreased to less than 1/3 the previous level, whereas the occurrence of irritant contact dermatitis remained stable throughout the observation period. Regardless of some potential confounders, the addition of ferrous sulfate to cement during the production process may have reduced the number of cases of allergic contact dermatitis among construction and concrete element prefabrication workers. Our results agree with the results of Danish studies and Swedish observations.     

A preliminary report of the occupation of patients evaluated in patch test clinics.

BACKGROUND: The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. RESULTS: Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. CONCLUSION: Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.     

Delayed irritation: Hexanediol diacrylate and butanediol diacrylate

Ephemeral topical contact with hexanediol diacrylate and butanediol diacrylate may cause delayed irritant dermatitis. During 4 years' observation of 20 workers utilizing these substances in the electron beam coating department of a door factory, contact sensitization did not occur. The characteristics of delayed contact irritancy are enumerated. The disease must be distinguished from allergic contact dermatitis, acute irritant dermatitis and cumulative irritant dermatitis.     

Occupational dermatoses in a metalworking plant

In a plant producing advanced components for engines and drivelines we undertook a survey of occupational dermatoses, based on a questionnaire, clinical examination, and patch testing with a standard series and a series of samples from the working environment. The questionnaire was given to all 430 employees and it was answered and returned by 382 of these. 214 reported having had or having skin manifestations during the time of employment suspected of being work-related. 183 employees (164 metal workers, 19 office staff) participated in the clinical investigation, 182 (163 metal workers, 19 office staff) being patch tested. Occupational dermatoses were diagnosed in 23 of these 163 (14.1%) and in 1 of these 19 (5.3%). In all, irritant contact dermatitis was diagnosed in 12 metal workers, occupational allergic contact dermatitis in 11 (10 metal workers and 1 office clerk) and folliculitis in 1 metal worker. In the 11, neat oils were the cause in 4 workers, a water-based cutting fluid in 3 and various biocides in 4.     

Occupational food-related hand dermatoses seen over a 10-year period

Background. Protein contact dermatitis was originally defined in 1976 by Hjorth and Roed‐Petersen as a distinct kind of dermatitis seen in patients with occupational food contact. Even though occupational skin diseases are frequent in Denmark, little attention has been paid to protein contact dermatitis, and the frequency is unknown. Objectives. To evaluate the frequency of occupational food‐related hand dermatoses and test results in patients occupationally exposed to foods. Materials and Methods. This was a retrospective study based on examinations, including skin prick testing and patch testing, performed at the Department of Dermato‐Allergology, Gentofte University Hospital, Denmark between 2001 and 2010. Results. Of all patients (n = 372), 57.0% had irritant contact dermatitis, 22.0% had protein contact dermatitis, 2.4% had contact urticaria, and 1.8% had allergic contact dermatitis. A suggestion for diagnostic criteria is presented. Frequent risk occupations were cooking in restaurants, baking, and kitchen work. Substantially more patients reacted in skin prick testing with fresh foods than with food extracts. Conclusion. Protein contact dermatitis is a frequent disorder among patients who professionally handle foods, and should be considered to be a distinct clinical entity. When diagnosing protein contact dermatitis and in other food‐related skin prick testing procedures, it is important to include fresh foods.