Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries

Background. Tannery workers are at considerable risk of developing occupational contact dermatitis. Occupational skin diseases in tannery workers in newly industrialized countries have been reported, but neither the prevalence of occupational allergic contact dermatitis nor the skin‐sensitizing agents were specifically examined in those studies. Objectives. To assess the prevalence of occupational allergic contact dermatitis in Indonesian tanneries, identify the causative allergens, and propose a tannery work series of patch test allergens. Patients/methods A cross‐sectional study in all workers at two Indonesian tanneries was performed to assess the prevalence of occupational contact dermatitis via a questionnaire‐based interview and skin examination. Workers with occupational contact dermatitis were patch tested to identify the causative allergens. Results. Occupational contact dermatitis was suspected in 77 (16%) of the 472 workers. Thirteen (3%) of these 472 workers were confirmed to have occupational allergic contact dermatitis. Potassium dichromate (9.2%), N,N‐diphenylguanidine (5.3%), benzidine (3.9%) and sodium metabisulfite (2.6%) were found to be the occupationally relevant sensitizers. Conclusions. The sensitization pattern showed some differences from the data in studies reported from other newly industrial countries. We compiled a ‘tannery work series' of allergens for patch testing. A number of these allergens may also be considered for patch testing in patients with (leather) shoe dermatitis.     

Doctor–patient communication in a Southeast Asian setting: the conflict between ideal and reality

Doctor–patient communication has been extensively studied in non-Western contexts and in relation to patients’ cultural and education backgrounds. This study explores the perceived ideal communication style for doctor–patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching hospital in Indonesia, using a qualitative and a quantitative design. In-depth interviews were conducted with ten internal medicine specialists, ten internal medicine residents, 16 patients in two groups based on education level and ten most senior medical students. The contributions of doctors and patients to the communication during consultations were observed and rated quantitatively by thirty internal medicine residents, 393 patients with different educational backgrounds and ten senior medical students. The ‘informed and shared decision making’ is the central observation in this quantitative study. The results of the interviews showed that Southeast Asian stakeholders are in favor of a partnership style of communication and revealed barriers to achieving this: doctors and patients are not prepared for a participatory style and high patient load due to an inefficient health care system does not allow sufficient time for this type of communication. The results of the quantitative study showed a sharp contrast between observed and ideal communication styles. A paternalistic style seems to prevail, irrespective of patients’ educational background. We found a sharp conflict between ideal and reality concerning doctor–patient communication in a Southeast Asian context. Further studies should examine ways to change the prevailing communication style in the desired direction.     

A seroepidemiological study of leprosy in high- and low-endemic Indonesian villages

A seroepidemiological study was performed in three different leprosy-endemic areas in Indonesia, including two isolated villages with high endemicity in South Sulawesi (Kaluarang and Hulo) and an area with low endemicity in Java (Jepara). A total of 2430 serum samples were collected from 2672 individuals in these locations. The prevalence of leprosy in these three areas, as determined during this study, was 29/1000, 11/1000, and 7/1000 in Kaluarang, Hulo and Jepara, respectively. Two serological assays were employed in this study to detect antibodies against Mycobacterium leprae. One is an enzyme-linked immunosorbent assay (ELISA) based on the detection of antibodies to the species-specific epitope of phenolic glycolipid-I (PGL-I) of M. leprae. The second test, using inhibition of an ELISA reaction (ELISA-INH) detects antibodies to a species-specific epitope on the 36-kDa protein antigen of M. leprae. In comparison with clinical findings, the specificity of both serological tests was calculated to be 91%. The sensitivity of the ELISA was 97.6% for multibacillary (MB) cases and 56.8% for paucibacillary (PB) cases; for the ELISA-INH, it was 97.6% and 81.8% for MB and PB cases, respectively. Seropositivity rates were shown to be unrelated to sex, to Mitsuda skin-test reactivity, or to BCG vaccination status. The pattern of seropositivity was, however, clearly age-related, with high seropositivity in the age group 10-19 years and decreasing rates of positivity in the older age groups. Age-standardized seropositivity ratios were not correlated to the prevalence of leprosy when comparing the three areas. Therefore, it is not yet clear whether or not seropositivity reflects infection. If it does, other, as yet unidentified, factors may play a role in the natural history of the disease.     

Inventory of the chemicals and the exposure of the workers’ skin to these at two leather factories in Indonesia

Purpose

Tannery workers are exposed to hazardous chemicals. Tannery work is outsourced to newly industrialized countries (NICs) where attention into occupational health hazards is limited. In this study, we investigated the skin exposure to hazardous chemicals in tannery workers and determined the prevalence of occupational skin diseases (OSDs) at tanneries in a NIC.

Methods

A cross-sectional study on the observation of the working process and an inventory and risk assessment of the chemicals used. Classification of chemicals as potential sensitizers/irritants and a qualitative assessment of exposure to these chemicals. Workers were examined and interviewed using Nordic Occupational Skin Questionnaire-2002/LONG.

Results

The risk of OSDs at the investigated tanneries was mainly related to the exposure of the workers’ skin to chemicals in hot and humid environmental conditions. In 472 workers, 12% reported a current OSD and 9% reported a history of OSD. In 10% of all cases, an OSD was confirmed by a dermatologist and 7.4% had an occupational contact dermatitis (OCD). We observed that personal protective equipment (PPE) used was mainly because of skin problems in the past and not as a primary protection against OSD.

Conclusion

We observed a high frequency and prolonged exposure to many skin hazardous factors in tannery work although PPE was relatively easily available and which was generally used as a secondary preventative measure. The observed point-prevalence in this study was at the same level as that reported for other high-risk OSDs in Western countries and other tanneries in NICs. However, the observed point-prevalence in this study was lower than that reported in India and Korea. The results of our study and those of other studies at tanneries from other NICs were probably influenced by Healthy Worker Survivor Effect (HWSE).     

Association of a missense mutation of the laminin alpha2 gene with tuberculoid type of leprosy in Indonesian patients

Leprosy, an infection caused by Mycobacterium leprae, has a specific tropism for the myelinating Schwann cells of peripheral nerves. Recently, the G domain of laminin alpha2 has been shown to be a mediator for M. leprae to bind to alpha-dystroglycan in Schwann cells. In order to analyse the association of leprosy with the mediator, three genetic polymorphisms encoding the G domain of the laminin alpha2 chain were analysed by direct sequencing in 53 leprosy patients and 58 healthy contact individuals from Indonesia. There was no significant difference in the incidence of the polymorphisms between patients and non-patients. Remarkably, it was found that a missense mutation (T7809C) substituting valine with alanine (V2587A) was found to be more frequent in the tuberculoid type than in the lepromatous type leprosy. It is supposed that this missense mutation is one of the determinant factors in the early onset of peripheral nerve damage in Indonesian tuberculoid leprosy patients.     

Cellular Viability, Collagen Deposition, and Transforming Growth Factor ��1 Production Among Ultraviolet B-Irradiated Keloid Fibroblasts

Background  

A keloid is a fibrous tumor produced by fibroblast hyperproliferation and excessive collagen accumulation due to overproduction of transforming growth factor β1 (TGF-β1). High keloid incidence is found among individuals with unexposed skin, especially in Negroid and Mongoloid people with high melanin contents in their skin. Because melanin serves as an ultraviolet B (UVB) light absorber, it is assumed that lack of UVB light penetration may play a role in the keloid pathomechanism. This study aimed to evaluate the effect that UVB irradiation to monolayer keloid fibroblasts has on cell proliferation, collagen deposition, and TGF-β1 production.     

Occupational skin hazards and prevalence of occupational skin diseases in shoe manufacturing workers in Indonesia

Purpose

Shoe manufacturing workers are exposed daily to an extensive range of potential physical and chemical occupational hazards. Shoe manufacturing in Indonesia is one of the industrial sectors that has shown sustained growth amongst the newly industrialized countries (NICs). In this study, we investigated the possible potential exposure of the workers to physical and occupational hazards and determined the prevalence of occupational skin diseases at a shoe manufacturing factory in Indonesia.

Methods

A cross-sectional study on the observation of the working process and an inventory and risk assessment of exposure to the chemicals used. Classification of chemicals as potential sensitizers/irritants and qualitative assessments of these chemicals were done. Workers were examined and interviewed using the Nordic Occupational Skin Questionnaire-2002/LONG.

Results

The risk of Occupational skin diseases (OSD) at the shoe factory was mainly related to the exposure of the workers’ skin to potential physical and chemical hazards in hot and humid environmental conditions. From a total of 514 workers, 8.5 % reported current OSD and 4.8 % reported a history of OSD. Occupational skin diseases were diagnosed in 29 % of the workers by dermatologists and 7.6 % had an occupational contact dermatitis (OCD). Of the 39 workers with contact dermatitis, 33 consented to being patch tested, 14 (3 %) workers showed a positive results and considered as having an occupational allergic contact dermatitis (OACD) and 25 (4.9 %) had an occupational irritant contact dermatitis (OICD).

Conclusion

We observed a repeated and prolonged exposure of the workers to numerous physical and chemical skin hazards at this factory.