Evaluation of detergent-induced irritant skin reactions by visual scoring and transepidermal water loss measurement

Transepidermal water loss measurements proved to be more accurate and sensitive than visual scoring in discriminating the irritating action of detergents on the skin. Further, the baseline transepidermal water loss might be a reliable indicator of an individual's susceptibility to weak irritants.     

Characteristics of wet work in nurses

Background objectives: Nursing is known for its high prevalence of hand dermatitis, mainly caused by the intense exposure to wet work in nursing activities. We aimed to study the characteristics of wet work exposure in nursing. Method: Trained observers monitored the duration and frequency of different wet work activities in 45 randomly chosen nurses from different wards during a morning shift, using a method of continuous observation based on labour-observation techniques. Results: Wet work in intensive care units accounted for 24% of the overall morning shift duration, with a frequency of 49 incidents. This was 16% in dialysis wards, with a frequency of 30 incidents, and 9% on regular wards, with a frequency of 39 incidents. The wet work activities had short mean duration cycles. The mean duration of occlusion by gloves was 3.1 min on regular wards and 6.7 min in intensive care units. Discussion: The characteristics of wet work in nurses differed substantially, depending on the ward. According to the German regulation TRGS 531, our observations classify nursing as a wet work occupation, due to the frequency of wet work rather than its duration. The mean duration of occlusion in our observations was short, which makes an occlusion-induced irritating effect doubtful. Reduction in wet work exposure in nursing on regular wards could focus on the reduction of the frequency of hand-washing and patient-washing. We suggest increasing the use of gloves for patient washing. Although this will increase exposure to occlusion from gloves, it may reduce the frequency of exposure to water and soap by about a quarter.     

The Impact of Coronal Plane Alignment on Polyethylene Wear and Damage in Total Knee Arthroplasty: A Retrieval Study

Background

Coronal plane alignment is one of the contributing factors to polyethylene wear in total knee arthroplasty.

Formaldehyde‐releasers: relationship to formaldehyde contact allergy. Formaldehyde‐releasers in clothes: durable press chemical finishes. Part 1

This is one of a series of review articles on formaldehyde‐releasers and their relationship to formaldehyde contact allergy and in this paper formaldehyde‐releasers used as durable press chemical finishes (DPCF) in textiles are discussed. The literature on allergy to DPCF since 1980 is presented in two parts. Part 1 (this article) presents a short historical overview of the problems with formaldehyde in clothes and discusses the chemistry of durable press chemical finishes, legislation in various countries, and studies on the amount of formaldehyde present in clothes. In addition, the DPCF that have caused contact allergy are presented with CAS, synonyms, molecular formula, chemical structure, applications, and patch test studies. In the forthcoming part 2, the frequency of sensitization to DPCF, occupational contact sensitization, relevance of patch test reactions, and relationship to formaldehyde contact allergy will be reviewed, followed by a discussion of both parts of the article together.     

Prevalence, incidence and course of eczema on the hands and forearms in a sample of the general population

In 1979, the inhabitants of a geographically defined area were examined for skin disorders of the hands and forearms. In 1982 this cohort was invited for re-examination. In persons with eczema, patch testing was performed. Irritant factors were found to play a rôle in 73% of the cases, whereas a contact allergy could be detected in 30%. The must frequent allergens were nickel sulphate (20%), potassium dichromate (6%), land cobalt chloride (4%). In some persons with a definite history of allergy to metals, no positive patch test with nickel, chromate or cobalt could be obtained; other mechanisms may be involved. Significantly more positive patch tests were found among persons with an eczema of longer than 2 years duration compared with persons, with eczema present for a shorter period of time, indicating that many cases of eczema are primarily of irritant nature, but later complicated by sensitisation. In 41%, the eczema was healed. A poor healing tendency was observed in those with a combination or irritant and allergic eczema. Relatively few ascribed healing to medical treatment.     

Type IV hypersensitivity to sodium metabisulfite in local anaesthetic

Milia are small sub epidermal keratin cysts. They may be seen following bullous diseases disrupting the dermo‐epidermal junction. They may occur rarely as a complication to contact allergic reactions. An oak moss allergic patient participated in a dose response ROAT with chloratranol, shown to be a potent allergen in oak moss. The patient reacted to choratranol at patch testing down to 0.0063 ppm, and started a ROAT by application of 2 drops of a 5 ppm solution to an area of 3 × 3 centimetres on the volar aspect of one forearm. After 1 day severe oedematous dermatitis was observed and blistering was seen at day 2. The test was stopped and the patient treated with systemic prednisolone. At a 3 month control visit milia were seen at the application site on the forearm but not on the back where the patch tests were applied. The patient had no subjective symptoms and the milia were easily removed with a sterile needle. The presence of milia as sequelae seems to reflect the depth and severity of the allergic contact dermatitis developed months earlier. This observation underlines the potency of chloratranol as a very strong allergen.