An outbreak of 268 cases of Paederus dermatitis in a toy-building factory in central China

Objective  To evaluate the clinical features of and to identify the pathogen responsible for an outbreak of acute dermatitis in a toy-building factory in Chibi city, central China.
Methods  Physical examinations were carried out on all the factory staff. Records were made. The factory district, its surrounding environment and the accommodation conditions were investigated. The insects collected in the area were identified by a parasitologist at the Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
Results  Two hundred and sixty-eight cases of Paederus dermatitis were diagnosed in a total of 316 staff at the toy-building factory. The total incidence rate was 84.81%. The incidence rates in administrators and workers were 43.75% and 87%, respectively. The face and neck were the most common sites of involvement. The most common lesions consisted of linear erythema and papulopustules. In 71.27% of patients, more than one lesion was present.
Conclusion  This outbreak of acute dermatitis was diagnosed as Paederus dermatitis caused by Paederus fuscipes . The favorable environment, lighting, humidity, and poor accommodation may have been responsible for the outbreak. Increased public awareness of this condition may decrease the incidence of Paederus dermatitis.     

Epidemiological Study of Insect Bite Reactions from Central India

Introduction:

The physical effects of the arthropod bites on human skin receive less attention, especially in the rural areas where the per capita income is less. Ours is a rural-based hospital, the vicinity having more of plants, trees, and forests; we undertook the study to find out the relation of insect bite dermatitis in a rural area.

Materials and Methods:

The study was carried out in the Dermatology outpatient department of our institute on 100 subjects of insect bite dermatitis who were questioned retrospectively about the sequence of events besides their environmental and living conditions. They were examined thoroughly and the relevant clinical findings were noted, also taking into account the prior treatment taken by them, if any.

Results and Conclusions:

It was found that insect bite dermatitis has no age or gender preponderance, and the protective factors for the same are use of full sleeve clothes and keeping the doors and windows closed at night. On the contrary, the risk factors are residence in areas of heavy insect infestation, use of perfumes and colognes, warm weather in spring and summer and the lack of protective measures. However, there was no direct association of atopy with increased risk of developing insect bite dermatitis.     

Topical herbal extract (Huangdang mixture) exhibits both preventive and therapeutic effects in murine acute irritant contact dermatitis

Background Contact dermatitises, including allergic contact dermatitis and irritant contact dermatitis, are among the most common skin disorders in humans. Chinese herbal medicines (CHM) have been used in treating contact dermatitises for centuries. Systemic administration of CHM, including ingredients in Huangdang mixture containing Chinese angelica, Radix Paeonlae rubra, cat nut, and phelloden dron, rhizoma alismatis, rhizoma smilacis glabrae, and rhizome of swordlike, improves allergic contact dermatitis induced by l‐fluoro‐2,4‐dinitrobenzene. Whether topical applications of these herbal extracts display preventive and/or therapeutic effects on contact dermatitis, thereby avoiding the potential side effects of systemic CHM, remains largely unknown. Aims To determine whether this topical CHM extract exerts preventive and/or therapeutic effects, we assessed its efficacy in both allergic contact dermatitis and irritant contact dermatitis murine models. Materials and methods Allergic contact dermatitis and irritant contact dermatitis murine models were established by topical oxazolone and a phorbol ester (12‐O‐tetradecanoylphorbol‐13‐acetate; TPA), respectively. Ear thickness was assessed in both dermatitis models. Results Our results demonstrate that this topical CHM extract exhibits both therapeutic and preventive effects in acute irritant contact dermatitis but no demonstrable efficacy in murine allergic contact dermatitis. Conclusion These results suggest that this topical CHM extract could provide an alternative regimen for the prevention and treatment of irritant contact dermatitis.     

Expression of CD30 on T helper cells in the inflammatory infiltrate of acute atopic dermatitis but not of allergic contact dermatitis

Abstract  The CD30 molecule has been proposed as a marker for a subset of CD4⁺CD45RO⁺ (memory) T cells with potent B cell helper activity producing IL-5 and IFN-γ and as a specific marker for Th2 cells. Recently, an association has been demonstrated between elevated serum levels of soluble CD30, which is shed by CD30⁺ cells in vitro and in vivo, and atopic dermatitis but not respiratory atopic disorders or allergic contact dermatitis. We studied the expression of CD30 in the inflammatory infiltrate of atopic dermatitis compared with that of allergic contact dermatitis, with special regard to skin disease activity (acute vs subacute/ chronic). Biopsies were obtained from 16 patients suffering from atopic dermatitis (acute n = 6, subacute/ chronic n = 10), from 7 patients with acute allergic contact dermatitis and from 5 positive patch-test reactions. Paraffin-embedded as well as snap-frozen material was stained with anti-CD30 and anti-CD45RO mAbs according to standard procedures. Double-staining procedures for CD30CD3, CD30CD4, CD30CD45RO and CD30CD68 were also performed. Abundant CD45RO⁺ cells were detected both in atopic dermatitis and in allergic contact dermatitis lesions. We found scattered CD30⁺ cells in only one of six formalin-fixed paraffin-embedded acute atopic dermatitis biopsies, but in all of the respective snap-frozen specimens, possibly because CD30 expression on atopic dermatitis infiltrating cells is weak and sensitive to formalin fixation and paraffin embedding. CD30CD3 and CD30CD4 double staining identified CD30⁺ cells to be helper T lymphocytes. No significant CD30 expression (either in paraffin-embedded or in frozen material) could be found in subacute/chronic atopic dermatitis lesions or in any of the specimens of allergic contact dermatitis. The results suggest a specific regulatory function of CD30⁺ T cells in acute atopic dermatitis. With respect to the view that CD30 is a marker for Th2 cells, our observations confirm previous findings that Th2 cells predominate in the infiltrate particularly of acute atopic dermatitis. CD30 expression in acute atopic dermatitis but not in acute allergic contact dermatitis might be helpful in the histological differentiation of these disorders and in the further characterization of atopy patch testing. Received: 1 April 1998 / Received after revision: 28 May 1998 / Accepted: 3 July 1998     

Referral pattern of skin diseases in an acute outpatient dermatological clinic in Copenhagen

The referral pattern of acute dermatologic conditions is not well described in either outpatients or hospitalized patients. The aim of this study is to describe in more detail the skin diseases that were referred for evaluation in an acute outpatient clinic at Bispebjerg Hospital, Copenhagen. In a 3-month period in 2003 a total of 428 consecutive new patients were referred for various skin diseases that needed subacute and acute dermatological evaluation in a university hospital setting. Referral pattern, age ratio and sex ratio were examined retrospectively. Two hundred and twenty-five (53%) of the 428 patients were referred from other hospital clinics in the local area. Sixty-six (15%) were referred from private practising dermatologists and 64 (15%) from general practitioners in the City of Copenhagen. Referral information was not noted in 35 (8%) of the 428 patients. The most prevalent diagnoses were: unspecified eczema (10.7%), drug eruptions (6.3 %), psoriasis (6.3%), atopic dermatitis (5.6%), bacterial skin infections (4.0%), inflammatory skin disorders (3.7%), seborrhoeic dermatitis (3.5%), urticaria (3.0%), seborrhoeic keratosis (3.0%), toxic contact dermatitis (2.8%), ulcus cruris (2.8%), autoimmune diseases (2.8%), malignant skin tumours (2.5%), candidiasis (2.5%), pruritus/prurigo (2.5%) and viral skin infections (2.5%). The fact that drug eruptions are one of the leading causes of acute referral conditions probably reflects the proximity to other hospital settings, where a large number of patients receive several systemic medicaments for various conditions.     

Correlation of nipple eczema in pregnancy with atopic dermatitis in Northern India: a study of 100 cases

BackgroundNipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis.ObjectiveTo evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis.MethodsThis was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis.ResultsOut of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant.Study limitationsLack of long term follow-up and no large studies in literature to compare results.ConclusionNipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.     

The syndrome of chronic photosensitivity dermatitis and actinic reticuloid

In a Study of thirty-four male subjects suffering from the syndrome of chronic photosensitivity dermatitis and actinic reticuloid the clinical, histological and photobiological features were such as to suggest that they were in fact examples of a single entity in which the degree of response to ultraviolet and visible light varied. Although a wide action spectrum involving UV and visible wavelengths invariably occurred with the classical clinical and histological features of actinic reticuloid (Ive et al., 1969) a broad action spectrum with similar histological appearances was also noted in some of the subjects in whom the morphological changes were those of a chronic dermatitis confined to exposed sites.     

Clinical features of atopic dermatitis in a hospital‐based setting in China

Background Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. There have been few detailed reports of the clinical evaluation of Chinese patients with AD. Objectives To give a profile of the clinical features of Chinese AD patients in a university hospital setting. Methods A total of 1008 cases met Hanifin and Rajka diagnostic criteria of AD were recruited at Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China. Results In our survey, 22.7% patients were mild, 66.6% were moderate and 10.7% were severe according to the SCORAD index. Both the frequency and severity of the male patients were slightly higher. The frequency of asthma among the AD patients was 16.7% and it was increased with the age (χ² = 205.20, P = 0.000). The frequencies of objective minor signs were demonstrated with age‐related changes. Besides, three localized variants including eyelid eczema (49.8%), scalp dermatitis (49.7%), infra‐auricular and retroauricular fissuring (44.8%) were commonly observed, especially in the infantile phase (P < 0.01). It was showed significant differences in serum total immunoglobulin E (IgE) and eosinophil cationic protein (ECP) levels of different age groups. The positive rate of Phadiatop was raised after 3 years old and that of the common food allergens were decreased after 6 years old. Conclusions More males than females had ongoing AD in our survey. Most AD debuted in the first year of the cases. High incidence of the three clinical signs: eyelid eczema, scalp dermatitis and infra‐auricular and retroauricular fissuring among the patients suggests it can be a potential valuable diagnostic clue to AD.     

Skin diseases in Greek and immigrant children in Athens

Objectives This study aimed to characterize the spectrum of skin diseases affecting children in Greece. Methods We retrospectively studied data for 4071 children, aged 0–12 years, who were examined and diagnosed with dermatoses at the outpatient clinic of a university dermatological hospital between December 2005 and August 2007. To evaluate changes in disease patterns, these data were compared with data for a cohort of 12,700 children diagnosed with skin diseases at the same clinic two to three decades earlier (in 1977, 1980, and 1983). Results The most frequent disease was dermatitis/eczema (34.7%), with atopic dermatitis found in 20.7% of children, contact dermatitis in 6.9%, pityriasis alba in 2.1%, and seborrheic dermatitis in 1.8%. Infections (19.3%), nevi (5.6%), scabies (4.8%), and insect bites (4.3%) followed. More viral (12%) than bacterial (3.7%) and fungal (3.6%) infections were noted. Warts constituted 53.2% of viral infections. Immigrants had an increased risk for bacterial infections and scabies. Conclusions Children diagnosed with skin diseases 24–30 years earlier were younger; exhibited lower prevalences of dermatitis/eczema (P = 0.01), viral infections (P < 0.001) and nevi (P < 0.001); higher prevalences of bacterial and fungal infections (P < 0.001) and insect bites (P < 0.01); and similar rates of scabies (P = 0.17). This study documents the high prevalence of atopic dermatitis in the region, the increasing incidence of viral infections and nevi, and the continuing problem of scabies, especially in immigrants.     

COVID‐19 knowledge prevents biologics discontinuation: Data from an Italian multicenter survey during RED‐ZONE declaration

SARS‐CoV‐2 become pandemics and there is still a dearth of data about its the potentially among dermatological patients under biologics. We aimed to assess health literacy, disease knowledge, treatment dissatisfaction and biologics attitudes toward COVID‐19. We performed a cross‐sectional, questionnaire‐based survey on 98/105 consecutive dermatological patients treated with biologics—51 suffering from plaque psoriasis, 22 from atopic dermatitis, and 25 from hidradenitis suppurativa. An ad hoc, validated questionnaire has 44 items investigating the following domains: knowledge of COVID‐19 related to (a) epidemiology, (b) pathogenesis, (c) clinical symptoms, (d) preventive measures, and (e) attitudes. Patients data and questionnaires were collected. Despite only 8.1% thought that biologics may increase the risk of COVID‐19, 18.4% and 21.4% of the patients were evaluating the possibility to discontinue or modify the dosage of the current biologic therapy, respectively. Globally, male patients (P = .001) with higher scholarity level (P = .005) displayed higher knowledge of COVID‐19. Patients with lower DLQI (P = .006), longer disease duration (P = .051) and lower scholarity (P = .007) have thought to discontinue/modify autonomously their biologic therapy. At the multivariate logistic regression, only the knowledge of epidemiology and preventive measures resulted independent predictors of continuation vs discontinuation and modification vs no modification, respectively. Dermatologists should promote COVID‐19 knowledge to prevent biologics disruption.     

Diltiazem-associated photodistributed hyperpigmentation: report of two Japanese cases and published work review

Scherschum et al. proposed diltiazem‐associated photodistributed hyperpigmentation as a novel type of drug‐induced photosensitive lichenoid eruption. The characteristic clinical features were slate‐gray reticulated hyperpigmentation on sun‐exposed areas, while lichenoid dermatitis with prominent pigmentary incontinence was noted histologically. Although the clinical and histological features were similar to those of lichen planus pigmentosus, the histological features did not show either compact hyperkeratosis or wedge‐shaped hypergranulosis, which are typical histological features of lichen planus. We describe two Japanese cases of diltiazem‐associated photodistributed hyperpigmentation, who were successfully treated with topical tacrolimus, and review the published work.     

Tertiäre Prävention von Berufsdermatosen

Background: Inpatient tertiary prevention of occupational skin diseases is indicated when the employee is threatened with loosing their job. Earlier studies have shown that with intensive tertiary preventive measures, 2/3 of such individuals can continue their jobs long‐term. Data on the effectiveness of tertiary prevention for various occupational groups has not been previously available. Patients and Methods: The outcome of all participants treated in the year 2002 was analyzed according to occupational groups with respect to diagnosis, medical intervention prior and during the inpatient period. Results: In 91 % of 296 cases contact dermatitis of the hands was diagnosed (75 % primary irritant contact dermatitis (37 % chronic irritant contact dermatitis, 38 % irritated atopic hand eczema, 16 % allergic contact dermatitis). Clinically relevant Type IV‐delayed hypersensitivity (allergic contact dermatitis) reactions were identified in 42 % of cases; in most cases, the delayed hypersensitivity followed irritant contact dermatitis. In more than 83 % of cases, a complete or nearly complete remission was achieved. Clinical relevant Type IV sensitization was most frequent in hairdressers (66 %). Cleaning and housekeeping personnel most frequently used corticosteroids on a regular basis (60 %) and most often experienced corticosteroid withdrawal (53 %) and atrophy of the skin of the hands (23 %). Conclusion: The data from studies on the tertiary prevention of occupational skin diseases reveal strategies for the optimization of outpatient care indicate specific occupational risk factors. The variance between professions may reflect differing approaches to secondary prevention.     

Disease severity and quality of life in a follow-up study of patients with occupational contact dermatitis

Background Few studies have investigated how occupational contact dermatitis and its severity affect patients' quality of life (QoL). Objectives To investigate the impact of occupational contact dermatitis and its severity on patients' QoL, and to examine the association between different QoL measures. Method Patients previously diagnosed with occupational contact dermatitis completed the Short Form Health Survey (SF‐36) and Dermatology Life Quality Index (DLQI). Disease severity was rated both by the patient and by the physician. Results Of a possible 725, a total of 119 patients (16.4%) were included in the study, and, at follow‐up, just over 21% had normal skin and 18.3% had progressed to persistent dermatitis. The SF‐36 median physical component summary score was 52 [interquartile range (IQR): 43–56] and the mental component summary median score was 51 (IQR: 44–57). The correlation between patient‐rated and physician‐rated disease severity was moderate (r = 0.708, p < 0.00001). The correlation between the disease severity measures and DLQI was moderate, whereas the SF‐36 correlated poorly with both the DLQI and disease severity measures. Conclusions QoL was generally reduced in this group of patients with occupational contact dermatitis, with some correlation between severity and DLQI. The DLQI was a more sensitive measurement of QoL than the SF‐36 in this patient population. Incorporating disease severity rating with a QoL questionnaire is valuable in occupational contact dermatitis and is recommended.     

Very late antigen-1 in psoriasis: an immunohistochemical study

Background Currently, psoriasis is thought to be an inflammatory response to an antigenic stimulation, in which angiogenesis plays a fundamental role. Very late antigen‐1 (VLA‐1) is a β₁ integrin collagen receptor that is up‐regulated in many angiogenic processes. Data on its role in psoriasis are sparse. Objective In a prospective study, we evaluated the staining of VLA‐1 in lesional skin from patients with psoriasis and atopic dermatitis. Material and methods Frozen sections from skin biopsies of patients with chronic plaque‐type psoriasis (n = 18) and chronic atopic dermatitis (n = 7) were stained with a monoclonal antibody to VLA‐1. The number of blood vessels stained with VLA‐1 and the staining intensity were evaluated. These were correlated with the histologic features. Results The absolute number of blood vessels was found to be similar in the atopic and psoriatic samples. However, the number of vessels stained with anti‐VLA‐1, as well as the staining intensity, was shown to be significantly higher in the psoriasis group (P < 0.05). Differences between psoriatic lesions showing typical histological features of psoriasis and those showing features that overlap with dermatitis were found as well. Conclusions Expression of VLA‐1 was found significantly higher in lesional dermal blood vessels of psoriatic patients compared with atopic patients. These findings suggest a possible role for VLA‐1 in the pathological angiogenesis of psoriasis. It may be an additional tool for establishing the diagnosis of psoriasis and provide a basis for new strategies in the treatment of psoriasis.     

ROLE OF EMOTIONAL FACTORS IN ADULTS WITH ATOPIC DERMATITIS

Background. The role of anger in the onset or perpetuation of episodes of atopic dermatitis in adults has long been considered an important factor. The objective was to investigate whether atopic patients feel ineffective in dealing with anger and assertiveness when compared with psoriasis patients and control patients. Methods. Thirty-four adult patients with atopic dermatitis were compared to 28 patients with psoriasis and 32 controls, dental patients without major skin disease. Standard measures of anxiety, anger, assertion, depression, and locus of control as well as a measure of anger effectiveness, designed for this study, were used. Results. There were significant differences between atopic dermatitis patients and controls in that atopics felt angry more readily but were less likely to express it, were more anxious and less assertive, and felt less effective in expressing anger. The only difference between psoriasis patients and controls was less ability to express anger. Atopic patients were more chronically anxious than those with psoriasis. Conclusions. Adult atopic dermatitis patients are often chronically anxious and feel ineffective in handling anger which suggests that psychological interventions may prove helpful.     

Paederus dermatitis in Egypt: a clinicopathological and ultrastructural study

Background Outbreaks of paederus dermatitis (PD) have been observed in different parts of the world, yet the histopathological and ultrastructural changes and their relationship to pederin toxin have not been described. Objective To describe the clinical presentations of PD in Egypt and to study the effects of pederin toxin on the skin by evaluating the histopathological and ultrastructural changes of some representative cases. Methods One hundred and thirteen patients with PD were studied clinically and epidemiologically. Skin biopsies were taken from 40 patients for histopathological examination and from 20 patients for electron microscopic (EM) examination. Results Clinically, the most common presentation comprised erythematous plaques with micropustules. Blisters exhibited a linear configuration in 40% of the patients and kissing lesions were observed in 13%. Multiple lesions occurred in 78% of the patients and the face was the most commonly involved site (48%). The insect was identified as Paederus alfierii. Histopathological examination revealed features of acute irritant dermatitis in the upper epidermis. Mitotic figures and apoptotic changes such as chromatin condensation and DNA fragmentation were identified in the basal and suprabasal layers. These features were confirmed by EM. Conclusions Clinical, histopathological and, for the first time, ultrastructural characteristics of paederus dermatitis are described. The pathological abnormalities of the upper epidermis are caused by the irritant effect of pederin toxin. The presence of apoptosis within the lower epidermis can be related to this toxin, a point that needs further research, hoping for its future implications in the management of hyperproliferative disorders.     

Ingestion of Rhus chicken causing systemic contact dermatitis in a Korean patient

Rhus chicken is a common traditional remedy used to cure gastrointestinal diseases and as a health food in Korea. Unfortunately, systemic contact dermatitis (SCD) due to the ingestion of Rhus occasionally occurs. In this study, the clinical and laboratory findings were reviewed and analysed for 30 Korean patients with SCD developing after ingestion of Rhus chicken. Summer was found to be the commonest period for hospital visits because of this condition. The mean period of incubation for SCD, was 4 ± 1.5 days. The commonest skin features were generalized maculopapular eruptions. Of the 30 patients, 10 had a known history of allergy to Rhus chicken. Many of the patients developed neutrophilia and leucocytosis. All the patients responded well to standard treatments. The commonest reason for their ingestion of Rhus chicken was indigestion. We conclude that SCD often occurs in Koreans after ingestion of Rhus chicken. Patients should be educated about the harmful effects of Rhus chicken and advised not to ingest it.     

Heterogeneity of dermal deposition of eosinophil granule major basic protein in acute lesions of atopic dermatitis

Abstract Deposition of eosinophil granule major basic protein (MBP) often occurs in acute and chronic lesions of atopic dermatitis, but it is not clear what the factors may be that are related to the MBP deposition in some skin lesions of the disease. The purpose of this study was to determine whether a personal or family history of respiratory atopy is related to the intensity of MBP deposition in acute lesions. We immunohistochemically stained biopsy specimens from acute, non-oozing indurated erythematous lesions of atopic dermatitis with BMK-13, a monoclonal antibody which recognizes MBP. The subjects were 40 adult patients with atopic dermatitis. Of the 40 patients, 22 had a personal history of respiratory atopy, 8 had a family history of respiratory atopy, and 10 had neither a personal nor a family history of respiratory atopy. Deposition of MBP was observed in the specimens from 24 (60%) of the 40 patients examined. Furthermore, there were great individual differences in the intensity of MBP deposition. A strong MBP deposition was often seen in specimens from patients with atopic dermatitis who had a personal or family history of respiratory atopy, but was absent in specimens from those patients with atopic dermatitis who had neither a personal nor a family history of respiratory atopy. We conclude that a strong MBP deposition seems to occur in acute lesions of those patients with atopic dermatitis who have a predisposition to respiratory atopy. Received: 13 July 1999 / Revised: 2 November 1999 / Accepted: 12 November 1999     

Irritant contact dermatitis in healthcare workers as a result of the COVID‐19 pandemic: a cross‐sectional study

COVID‐19 healthcare workers (HCWs) require frequent handwashing and use of personal protective equipment (PPE) to prevent infection. However, evidence is emerging that these practices are causing adverse effects on their skin integrity. A single‐centre, cross‐sectional study of HCWs from an Irish hospital was undertaken to evaluate the degree of COVID‐19‐related irritant contact dermatitis (ICD) between April and May 2020. Of 270 participants surveyed, 223 (82.6%) reported symptoms of ICD. The hands were the most commonly affected site (76.47%) and the most frequently reported symptom was dry skin (75.37%). Nearly all (268; 99.26%) HCWs had increased hand‐washing frequency, but 122 (45.35%) did not use emollients. In the ICD group, 24.7% cited a history of dermatitis compared with 4.3% of unaffected staff (P < 0.001). The ICD group recorded PPE usage for an average of 3.15 h compared with the non‐ICD group at 1.97 h (P = 0.21). Promoting awareness of COVID‐19‐related ICD is vital to highlight prevention and treatment for frontline staff.     

Occupational skin disease in hospital cleaning and kitchen workers

Skin disorders were reported in 33% of catering staff and 35% of women cleaners who returned a questionnaire, and were employed in a large hospital. Hand dermatitis occurred in 15% of the caterers and 12% of the cleaners. In the majority, the dermatitis was irritant in origin and related to their wet work occupations. Cleaners had a high prevalence of jewellery dermatitis. Limited patch testing revealed a majority positive to nickel, but a third were negative, indicating that jewellery reactions often but not invariably predict nickel sensitivity. Few subjects were atopic, but some psoriatic patients with hand problems were encountered. Most workers were able to carry on in their occupations despite having hand dermatitis.