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2009

CIS 09-568 Apfelbacher C.J., Soder S., Diepgen T.L., Weisshaar E.
The impact of measures for secondary individual prevention of work-related skin diseases in health care workers: 1-year follow-up study
The objective of this study was to investigate the outcome of occupational skin disease among health care workers (HCW) one year after attendance of a secondary individual prevention (SIP) course. Two hundred and fifty-three HCW participated in a secondary individual prevention course and were contacted by telephone one year after attendance. The follow-up rate was 81%. The proportion of participants reporting skin lesions decreased significantly (68% at follow-up compared with 77% at baseline). Seventy-two per cent reported that their skin lesions had improved. Nine per cent reported having left their occupation due to their skin disease. Skin care and skin protection had improved, while the frequency of reported hand washing was reduced. Twenty-seven per cent said their quality of life was impaired due to the skin disease, compared with 54% at baseline. These findings indicate a positive impact of SIP courses.
Contact Dermatitis, Mar. 2009, Vol.60, No.3, p.144-149. Illus. 18 ref.

CIS 09-567 Skudlik C., Dulon M., Wendeler D.., John S.M., Nienhaus A.
Hand eczema in geriatric nurses in Germany - Prevalence and risk factors
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. 1375 geriatric nurses from 86 nursing homes were examined. Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18%. 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 occupation. 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) and a history of allergic rhinoconjunctivitis (OR 1.50). There was no association between the amount of wet work and hand eczema (OR 1.18). The results indicate that it is necessary to provide geriatric nurses with specific skin care advice as part of their training.
Contact Dermatitis, Mar. 2009, Vol.60, No.3, p.136-143. 42 ref.

CIS 09-639 Feveile H., Christensen K.B., Flyvholm M.A.
Self-reported occupational skin contact with cleaning agents and the risk of disability pension
The objective of this study was to investigate and quantify the association between self-reported occupational skin contact with cleaning agents and subsequent transition to disability pension. A sample of 8337 employees between 18 and 59 years of age participated in the Danish Work Environment Cohort Study in 1990, 1995, or 2000. They were followed up regarding disability pension until 2006 using the DREAM register on social transfer payments for all inhabitants in Denmark. The Cox proportional hazards model was used to estimate the impact of occupational exposure to cleaning agents on subsequent disability pension. Among women, 11% of the disability pension cases were attributable to exposure to cleaning agents and/or disinfectants, suggesting a potential for prevention of work-related disabilities among the most affected job groups, those exposed to cleaning agents.
Contact Dermatitis, Mar. 2009, Vol.60, No.3, p.131-135. Illus. 20 ref.

CIS 09-534 Watkins S.A., Maibach H.I.
The hardening phenomenon in irritant contact dermatitis: An interpretative update
Irritant contact dermatitis (ICD) is common and poses a significant problem in high-risk populations. In most cases, ICD resolves despite continued exposure in a process known as "hardening", allowing individuals to continue with their work. Those who cannot clear ICD develop chronic ICD, which is a significant source of emotional, physical, and financial distress for affected individuals. While hardening is frequent, its mechanism remains to be elucidated. This overview briefly documents the pathogenesis of ICD, focuses on the latest advances pertaining to the hardening phenomenon in ICD, and then highlights potential avenues of productive research. A better understanding of the hardening process in the skin should lead to advances for the treatment of ICD.
Contact Dermatitis, Mar. 2009, Vol.60, No.3, p.123-130. 35 ref.

CIS 09-426 Suuronen K.
Metalworking fluids - Allergens, exposure, and skin and respiratory effects
It is estimated that 20,000 workers in Finland are occupationally exposed to metalworking fluids. Many studies have addressed the adverse skin and respiratory effects of these fluids. Despite the general improvements in occupational hygiene over the last decades, the health effects seem not to have disappeared. Worldwide, exposed workers still suffer from contact dermatoses and respiratory symptoms. This thesis reviews studies carried out in Finland during 2002-2005 on respiratory and skin exposure to specific components of metalworking fluids. It also examines skin and respiratory symptoms in a cross-sectional study among machinist and office workers of 64 companies.
Finnish Institute of Occupational Health, FIOH-Bookstore, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland, 2009. 106p. Illus. Bibl.ref. Price: EUR 22.95.

CIS 09-341
Health and Safety Executive
Managing skin exposure risks at work
Many materials used at work can affect the skin or can pass through the skin, potentially causing diseases elsewhere in the body. This booklet provides practical advice to employers and safety and health specialists to help prevent these diseases. It covers the protective role of the skin, ill-health arising from skin exposure, recognising potential skin exposure at the workplace and managing skin exposure to prevent disease. It can help employers comply with their legal duties by preventing or controlling exposure to the hazards by using and maintaining suitable controls.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, Jan. 2009. iv, 24p. Illus. 16 ref. Price: GBP 8.95.

CIS 09-410 Fonia A., White J.M., McFadden J.P., White I.R.
Active sensitization to chloracetamide
Chloracetamide is a preservative found in some cosmetic preparations. This article describes the case of a 21-year-old woman with a history of eczematous eruptions which she attributed to the use of a number of cosmetic products. Patch testing showed a strong positive reaction to chloracetamide.
Contact Dermatitis, Jan. 2009, Vol.60, No.1, p.58-59. 6 ref.

CIS 09-413 Stingeni L., Bianchi L., Lisi P.
Occupational airborne allergic contact dermatitis from potassium metabisulfite
This article describes the case of a 37-year-old non atopic male agricultural worker with a five-year history of erythema, swelling and scaling on the face. This condition occurred after the grape harvest and persisted through the period of grape fermentation in the wine cellar, during which the patient added potassium metabisulfite to the must to prevent the proliferation of microorganisms and wine oxidation. Patch testing resulted in positive reactions potassium and sodium metabisulfites. When away from work, the dermatitis spontaneously healed in 10 day and there were no relapses when the patient was assigned to other duties in the same vineyard.
Contact Dermatitis, Jan. 2009, Vol.60, No.1, p.52-53. 10 ref.

CIS 09-421 Johannes Geier J., Lessmann H., Reinecke S.
Occupational airborne allergic contact dermatitis in a concrete repair worker
This article describes a case of contact dermatitis in a 31-year-old bricklayer involved in the repair of concrete structures and exposed daily to epoxy systems. Despite the use of personal protective equipment including goggles, a face mask and nitrile gloves, he developed a dermatitis on the forearms, and later an eczema on the face which were diagnosed as a work-related airborne dermatitis. Patch tests resulted in positive reactions to several epoxy systems. The dermatitis ceased within weeks after he stopped working in the construction industry.
Contact Dermatitis, Jan. 2009, Vol.60, No.1, p.50-51. Illus. 6 ref.

CIS 09-408 Ackermann L., Aalto-Korte K., Jolanki R., Alanko K.
Occupational allergic contract dermatitis from cinnamon including one case from airborne exposure
This article reports cases of occupational allergic contact dermatitis and contact allergy from cinnamon based on patient records from two dermatological clinics in Helsinki, Finland. Six patients with delayed contact allergy to cinnamon were identified. Five of the patients showed positive reactions to cinnamal alone and in fragrance mix I in skin tests. Occupational contact allergy to cinnamon is rare but needs to be considered in workers handling food. Cinnamal is likely to be the main allergen in cinnamon.
Contact Dermatitis, Feb. 2009, Vol.60, No.2, p.96-99. 24 ref.

2008

CIS 11-0349 Cummings K.J., Boylstein R.J., Cox-Ganser J.
Report on respiratory and dermal conditions among machine shop workers
In 2007, the National Institute for Occupational Safety and Health (NIOSH) received a confidential Health Hazard Evaluation (HHE) request from workers of a machine shop, reporting recurrent pneumonias, asthma and other respiratory symptoms as well as rashes and skin irritation that they related to the metalworking fluid (MWF). NIOSH investigators conducted telephone interviews with workers, treating physicians, company management and safety officials, and the director of the company's referral occupational health clinic. They reviewed medical records and environmental monitoring conducted by the company. They also conducted microbiological tests on samples of MWF collected from the machine shop. The investigators found that workers' symptoms and diagnoses were consistent with those associated with exposure to MWF. Workers in the machine shop reported not receiving training on the health hazards of MWF and not being provided respiratory protection; furthermore, they are not included in a medical surveillance program. As a result of this investigation, NIOSH made a number of recommendations with respect to training, exposure surveillance, ventilation, and supply of personal protective equipment.
Publications Dissemination, National Institute for Occupational Safety and Health (NIOSH), 4676 Columbia Parkway, Cincinnati, OH 45226-2001, USA, July 2008. v, 52p. Illus. 19 ref.
HETA_2007-0263-3069.pdf [en inglés]

CIS 10-0661 Horiuchi N., Oguchi S., Nagami H., Nishigaki Y.
Pesticide-related dermatitis in Saku District, Japan, 1975-2000
A total of 394 cases of dermatitis caused by pesticide exposures recorded from 1975 to 2000 at the dermatology department of a Japanese hospital are described. Dermatitis cases gradually decreased from 1975 to 2000, presumably accelerated by the phase-out of dermatitis-causing pesticides, including difolatan and salithion. Cases of chronic and solar dermatitides gradually decreased, which may be explained by reductions in the use of allergenic or photosensitive sulfur agents and organophosphates. However, the ratios of chemical burns from irritant pesticides rose in those years. Chemical burns from calcium polysulfide were responsible for most of the severe cases.
International Journal of Occupational and Environmental Health, 1st quarter 2008, Vol.14, No.1, p.25-34. Illus. 38 ref.

CIS 09-1314 Trattner A., David M., Lazarov A.
Occupational contact dermatitis due to essential oils
The aim of this study was to draw conclusions based on the characteristics, diagnosis and outcome of five patients with occupational contact dermatitis due to essential oils who attended outpatient dermatology clinics in Israel over a 2-year period, together with 11 cases reported in the literature. It is concluded that patch tests with the standard series and the fragrance series should be performed, in addition to tests with the specific oils to which the patients are exposed.
Contact Dermatitis, May 2008, Vol.58, No.5, p.282-284. 15 ref.

CIS 09-332 Lan C.C., Feng W.W., Lu Y.W., Wu C.S., Hung S.T., Hsu H.Y., Yu H.S., Ko Y.C., Lee C.H., Yang Y.H., Chen G.S.
Hand eczema among university hospital nursing staff: Identification of high-risk sector and impact on quality of life
This cross-sectional study aimed to identify the specific conditions that may pose a higher risk for occurrence of hand eczema and to evaluate the impact of hand eczema on life quality. Data were collected by means of questionnaires from nursing staff at a university hospital in Taiwan. The overall response rate was 93%, equivalent to 1132 completed questionnaires. Two hundred and forty-eight (22%) subjects reported occurrence of hand eczema. Occurrence of hand eczema was significantly associated with nursing for over 10 years and working in a special care unit, with prevalences of 27% and 26%, respectively. Other findings are discussed.
Contact Dermatitis, Nov. 2008, Vol.59, No.5, p.301-306. 16 ref.

CIS 09-455 Fagrell B., Jörneskog G., Salomonsson A.C., Larsson S., Holm G.
Skin reactions induced by experimental exposure to setae from larvae of the northern pine processionary moth (Thaumetopoea pinivora)
This study aimed to evaluate the skin reactions following exposure to setae from larvae of the northern pine processionary moth (Thaumetopoea pinivora, TP). A drop of setae suspension was applied on the forearm of six volunteers. The local skin reactions were studied by microscopy and skin perfusion using laser Doppler (LD) scanning. Setae penetrated into the skin, and LD scanning showed a marked increase in blood perfusion in all subjects. In two subjects, having a history of severe symptoms, microscopic vacuoles developed around setae, followed by desquamation and severe symptoms. In the remaining individuals with only light symptoms during previous exposure, there were only mild reactions that disappeared within three weeks. No immunoglobulin (Ig) E or IgG4 antibodies to larval antigens were found in any of the volunteers.
Contact Dermatitis, Nov. 2008, Vol.59, No.5, p.290-295. Illus. 19 ref.

CIS 09-317 Clin B., Stosse-Guevel C., Marquignon M.F., Verneuil L., Letourneux M.
Professional photosensitive eczema of fishermen by contact with bryozoans: Disabling occupational dermatitis
Eczema associated with bryozoans is a form of occupational contact dermatitis caused by a living organism, occasionally associated with photosensitivity and essentially concerning fishermen. It can be extremely disabling and often giving rise to major social consequences since the eviction of the responsible allergen generally requires occupational reclassification, a measure which fishermen have great difficulty in accepting. Based on the description of three cases of photosensitive eczema associated with contact with the bryozoan Alcyonidium gelatinosum among fishermen from the English Channel coastline, this article describes the characteristics of this occupational dermatitis and its prevention.
International Maritime Health, 2008, Vol.59, No.1-4, p.45-52. Illus. 8 ref.

CIS 09-101 Gambichler T., Uzun A., Boms S., Altmeyer P., Altenmüller E.
Skin conditions in instrumental musicians: A self-reported survey
To determine the frequency and risk factors of instrument-related skin disorders in musicians, an 11-item survey was mailed to 19 German universities of music and performing arts; 412 musicians returned the completed questionnaire, among which 21.6% had an instrument-related skin disorder including callosities (58.4%), contact dermatitis (CD; 19.1%), fiddler's neck (19.1%) and erosion (3.4%). Allergic CD (76.5%) was most frequently reported in violinists and violists. Of 116 violinists and violists 14.7% suffered from fiddler's neck. String instrumentalists most frequently reported callosities (68.5%) and skin problems (86.5%). Frequencies of instrument-related skin disorders were significantly associated with high practice frequencies and a professional as opposed to an amateur status.
Contact Dermatitis, Apr. 2008, Vol.58, No.4, p.217-222. 19 ref.

CIS 09-55 Lerbaek A., Kyvik K.O., Ravn H., Menné T., Agner T.
Clinical characteristics and consequences of hand eczema - An 8-year follow-up study of a population-based twin cohort
The aim of this study was to characterize clinical symptoms and to examine occupational and medical consequences as well as persistence of hand eczema in a population-based twin cohort. A total of 274 individuals with and without hand eczema were examined, patch tested, and interviewed in 1997-1998 and 2005-2006; during the follow-up, participants were found to have hand eczema. Erythema and scaling skin were the most frequent symptoms, and fingers and palms were most often affected. Mean hand eczema severity index score in individuals with clinical symptoms was 12.0. Sick leave was reported by 12.4%; job change by 8.5%. Being in the lowest socio-economic group and atopic dermatitis were the main risk factors for sick leave (odds ratio - OR 5.6 and 2.9 respectively). The majority (63.4%) had seen a doctor at least once, and atopic dermatitis was a risk factor for more than one visit (OR 3.04). Other findings are discussed.
Contact Dermatitis, Apr. 2008, Vol.58, No.4, p.210-216. Illus. 28 ref.

CIS 09-149 Aalto-Korte K., Suuronen K., Kuuliala O., Jolanki R.
Contact allergy to 2,5-dimercapto-1,3,4-thiadiazole and phenyl-α-naphtylamine, allergens in industrial greases and lubricant oils - Contact allergy to water-insoluble greases is uncommon but needs to be considered in some workers
Components of industrial lubricants seldom cause allergic contact dermatitis. This study describes the cases of two patients with allergic reactions to 2,5-dimercapto-1,3,4-thiadiazole contained in metalworking lubricants and a case of allergy to phenyl-α-naphtylamine in grease.
Contact Dermatitis, Feb. 2008, Vol.58, No.2, p.93-96. 21 ref.

CIS 09-148 Amaro C., Goosens A.
Immunological occupational contact urticaria and contact dermatitis from proteins: A review
Protein contact with the skin can be associated with two major clinical conditions: contact urticaria and protein contact dermatitis. This article reviews the pathogenesis and clinical pictures, as well as the literature on the proteins having caused immunological occupation-related skin problems (fruit, vegetables, spices, plants, animals, grains, enzymes) in a wide variety of sectors and occupations. Several cases of protein-related skin problems observed in the contact-allergy unit of a Belgian hospital are described.
Contact Dermatitis, Feb. 2008, Vol.58, No.2, p.67-75. Illus. 122 ref.

CIS 09-77 De Craeker W., Roskams N., Op de Beeck R.
Occupational skin diseases and dermal exposure in the European Union (EU-25): Policy and practice overview
Skin diseases are one of the most important emerging risks related to the exposure to and extensive use of chemicals. This report presents an overview of dermal exposures and skin diseases. It contains the principal policies relating to the notification and recognition of occupational skin diseases, as well as the assessment and control of dermal exposure to chemical, biological and physical risk factors in the European Union. It concludes with some challenges, prospects and recommendations.
European Agency for Safety and Health at Work, Gran Vía 33, 48009 Bilbao, Spain, 2008. 107p. Illus. 75 ref.
http://osha.europa.eu/en/publications/reports/TE7007049ENC_skin_diseases [en inglés]

CIS 09-88 Apfelbacher C.J., Radulescu M., Diepgen T.L., Funke U.
Occurrence and prognosis of hand eczema in the car industry: Results from the PACO follow-up study (PACO II)
The aim of the Prospective Audi Cohort (PACO) II follow-up study was to estimate the burden and prognosis of hand eczema (HE) in an automobile industry setting in a long-term perspective (> 10 years). Eligible participants were 1909 subjects who had been examined in a previous study and had been followed through until the end of their apprenticeship. Participants were interviewed and underwent dermatological examination. An exposure assessment was carried out according to a pre-defined algorithm. The follow-up rate was 78.3%. Mean follow-up time was 13.3 years and the cumulative incidence of 29.3% for the entire study period. HE persisted after the end of apprenticeship in 40.0% of subjects who had had HE during apprenticeship. 18.0% developed HE in the follow-up period. Around 30% of subjects were affected by HE at least once during the study period.
Contact Dermatitis, June 2008, Vol.58, No.6, p.322-329. Illus. 23 ref.

CIS 09-100 Ide C.
Clean forgotten
Cleaning is generally regarded as a task carried out by women. In the United Kingdom, 84% of the 537,000 employed in cleaning are female and, about 70% work part-time. This article reviews the hazards and risks faced by cleaners, and outlines the need for proper training, maintenance of equipment and appropriate, comfortable clothing.
Safety and Health Practitioner, May 2008, Vol.26, No.5, p.55-58. Illus. 12 ref.

CIS 09-165
Inter-Organization Programme for the Sound Management of Chemicals (IOMC)
Skin sensitization in chemical risk assessment
This harmonization project activity in 2006 focused on skin sensitization in chemical risk assessment. An IPCS international workshop was convened from 17-18 October 2006, in Berlin, Germany with the aim of evaluating experimental techniques for their ability to produce data to inform risk assessment, including provision of dose-response information and information relating to sensitive sub-populations. The workshop focused on whether it is possible to distinguish between chemicals with a high potency to elicit allergic skin reactions and those with a low potency. Emerging approaches, such as structure activity relationships (SAR), were explored. The meeting also explored whether assessment approaches for skin sensitization could inform approaches for the respiratory tract.
World Health Organization, Distribution and Sales Service, 1211 Genève 27, Switzerland, 2008. iv, 85p. Illus. Bibl.ref.
http://www.who.int/ipcs/methods/harmonization/areas/skin_sensitization.pdf [en inglés]

CIS 08-1308 Kaatz M., Ladermann R., Stadeler M., Fluhr J.W., Elsner P., Bauer A.
Recruitment strategies for a hand dermatitis prevention programme in the food industry
An interdisciplinary Skin Disease Prevention Programme (SDPP) in the baking, hotel, and catering industries was established in Germany. However, only 30% of the eligible employees suffering from occupational hand dermatitis (OHD) participated in the programme. The objective of this study was to examine alternative ways of increasing participation. Employees were invited to take part in the SDPP using one of the four alternative methods: a standard invitation letter; a personalized and targeted invitation letter; the personalized invitation letter and a case report; the personalized invitation letter, the case report and additional information. The commitment of the employees to join the SDPP increased significantly from 30% to 54% in the group receiving the personalized invitation letter. Neither the additional case report nor the additional information concerning the SDPP had any effect on increasing the recruitment.
Contact Dermatitis, Sep. 2008, Vol.59, No.3, p.165-170. Illus. 26 ref.

CIS 08-1294 Curr N., Dharmage S., Keegel T., Lee A., Saunders H., Nixon R.
The validity and reliability of the occupational contact dermatitis disease severity index
An occupational contact dermatitis disease severity index (ODDI) was designed to assess the severity and functional disability caused by occupational contact dermatitis (OCD) of the hands in patients attending an occupational dermatology clinic in Australia. The objective of this study was to assess the intra-observer reliability, inter-observer reliability, internal consistency, acceptability and convenience of this instrument, based on the clinical assessment of 95 patients with OCD. The ODDI was found to be a valid and reliable instrument to assess the severity and functional limitations caused by OCD.
Contact Dermatitis, Sep. 2008, Vol.59, No.3, p.157-164. Illus. 42 ref.

CIS 08-1293 Chou T.C., Chang H.Y., Chen C.J., Yu H.S., Wu J.D., Sheu S.C., Shih T.S.
Effect of hand dermatitis on the total body burden of chromium after ferrous sulfate application in cement among cement workers
Ferrous sulfate has been added to cement to reduce the prevalence of dermatitis in workers. The objective of this study was to compare the urinary chromium levels before and after ferrous sulfate addition among cement workers with or without hand dermatitis. Thirty-five male workers were recruited in this study for two consecutive years: 2003 without using ferrous sulfate and 2004 after adding ferrous sulfate. Urinary chromium was used as a biomarker to estimate the total body burden of chromium. Urinary chromium concentration showed significant decreases after ferrous sulfate addition. Furthermore, a larger decrease of urinary chromium was observed among workers with hand dermatitis. It is concluded that ferrous sulfate decreases the total body burden of chromium, especially among workers with severe hand dermatitis.
Contact Dermatitis, Sep. 2008, Vol.59, No.3, p.151-156. 25 ref.

CIS 08-1312 Dulon M., Kromark K., Skudlik C., Nienhaus A.
Prevalence of skin and back diseases in geriatric care nurses
This cross-sectional study examined the prevalence of hand eczema, low back disorders (LBD) and neck/shoulder disorders (NSD) in 1390 geriatric nurses and nursing aides, and their association with work-related risk factors. Data were collected by means of questionnaires and clinical examinations. Odds ratios and 95% confidence intervals for common risk factors were calculated by logistic regression. The prevalence of hand eczema was 18.0%. Hand cleaning and hand care were not predictive for hand eczema. LBD was observed in 47.9% and NSD in 16.6% of the nurses. Increasing age and years in the nursing profession, prior treatment of back disorder and psychological stress were significant risk factors for LBD and NSD. Other findings are discussed.
International Archives of Occupational and Environmental Health, Aug. 2008, Vol.81, No.8, p.983-992. 36 ref.

CIS 08-1424 Barruyer C.
Solar radiation risks: A danger that is much underestimated in the construction sector
Risque solaire: un danger largement sous-estimé dans le BTP [en francés]
Skin cancers are increasingly frequent. Certain types of outdoor construction work such as roofing, carpentry and civil engineering are particularly at risk. This article describes the three types of skin cancer, discusses the basic precautions to be taken (wearing a T-shirt, a helmet and sunglasses) and comments a study carried out on solar radiation risks in the construction sector.
Prévention BTP, July-Aug. 2008, No.109, p.48-50. Illus.

CIS 08-1463 Seitz C.S., Bröcker E.B., Trautmann A.
Occupational allergy due to seafood delivery: Case report
Sensitization to fish or crustaceans requires intensive skin contact and/or airway exposure. This article presents the case of a truck driver delivering seafood for 10 years, and who neglected preventive measures such as wearing gloves and protective clothing. Despite his sensitization to fish and crustaceans, he tried to remain in his job but with ongoing allergen exposure: his symptoms progressed from initial contact urticaria to generalized urticaria, anaphylaxis and finally asthma. Among predisposed atopic individuals, even minor exposure to seafood allergens may lead to occupational allergy. With ongoing allergen exposure, progression to potentially life-threatening symptoms may occur.
Journal of Occupational Medicine and Toxicology, May 2008, Vol.3, No.11, 3p. 14 ref.

CIS 08-1072 Suneja T., Belsito D.V.
Occupational dermatoses in health care workers evaluated for suspected allergic contact dermatitis
Occupational skin diseases, including allergic contact dermatitis (ACD) and allergic contact urticaria (ACU), commonly occur among health care workers (HCWs). The objective of this study was to evaluate the aetiology of the various skin diseases afflicting HCWs and to identify the most common allergens among patients found to have ACD and/or ACU. A total of 1434 patients underwent patch testing. The demographic data and most common allergens for 100 HCWs and 1334 non-HCWs were compared. HCWs were statistically more likely to be female, have hand dermatitis, and have a history of atopy. HCWs were also more likely to have work-related ACD especially to quaternium-15, thiuram, carba mix, glutaraldehyde and benzalkonium chloride, and to have ACU to latex. The results confirm the importance of thoroughly evaluating HCWs for ACD and ACU with the use of the expanded standard allergen series and latex.
Contact Dermatitis, May 2008, Vol.58, No.5, p.285-290. 39 ref.

CIS 08-834 Vallejos Q.M., Schulz M.R., Quandt S.A., Feldman S.R., Galvan L., Verma A., Fleischer A.B., Rapp S.R., Arcury T.A.
Self report of skin problems among farmworkers in North Carolina
The objective of this study was to estimate the prevalence of self-reported skin problems among Latino farm workers and to identify the associated risk factors. A longitudinal surveillance design was used. A total of 304 participants were interviewed several times over a period of five months on their skin problems and on personal and occupational factors. Frequencies and counts were calculated for 13 skin problems. More than one-third of participants reported various skin problems. A number of work and environmental factors were found to be associated with higher rates of skin problems. One of the strongest predictors was working in wet clothes or shoes. Programmes are needed to educate farm workers about measures they can take to decrease their risk of skin problems. Changes in work practices and personal protective equipment provided could help decrease the prevalence of skin problems within this population.
American Journal of Industrial Medicine, Mar. 2008, Vol.51, n°3, p.204-212. 31 ref.

CIS 08-833 Arcury T.A., Vallejos Q.M., Schulz M.R., Feldman S.R., Fleischer A.B., Verma A., Quandt S.A.
Green tobacco sickness and skin integrity among migrant Latino farmworkers
Green tobacco sickness (GTS) affects approximately one-quarter of all tobacco workers. The primary aim of this analysis was to expand existing knowledge of GTS risk factors among Latino farm workers. Data were taken from a longitudinal study of skin disease among 304 North Carolina Latino farm workers conducted in 2005 (see CIS 08-834). It was found that 18.4% of the farm workers met the GTS case definition. Self-reported rash increased the odds ratio (OR) of having GTS in the bivariate (OR 2.29), and multivariate analyses (OR 3.30). Self-reported itch (OR 3.54) and superficial wounds (OR 2.49) had a significant relationship to GTS in the bivariate analysis. These findings confirm that GTS risk factors include skin integrity. Farm workers with rash and other skin conditions should protect affected areas from exposure to tobacco plants.
American Journal of Industrial Medicine, Mar. 2008, Vol.51, No.3, p.195-203. 36 ref.

2007

CIS 09-826 Müller M., Pföhler C., Paredes B.E., Mestres P., Buchter A.
Argyroses - Case description and overview
Argyrosen - Kasuistik und Übersicht [en alemán]
The case of a female silversmith with skin discolorations identified as silver impregnation and thus as a local argyrosis is described. A brief overview of argyroses (toxic effects of silver, systemic and local argyrosis, prevention and treatment) is also presented. Depending on its severity, argyrosis may be recognised as an occupational disease in Germany.
Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie, Dec. 2007, Vol.57, No.12, p.391-397. Illus. 22 ref.

CIS 09-198 Conde J.F., Feldman S.R., Vallejos Q.M., Quandt S.A., Whalley L.E., Brooks T., Cabral G., Fleischer A.B., Arcury T.A.
Cutaneous larva migrans in a migrant Latino farmworker
Migrant farmworkers experience a high incidence of skin disease. This report provides information on the case history of cutaneous larva migrans in a Latino migrant farmworker. Treatment options are reviewed, and information for prevention is discussed.
Journal of Agromedicine, 2007, Vol.12, No.2, p.45-48. Illus. 10 ref.

CIS 08-1310 Kampf G., Löffler H.
Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: A review
Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore suggests that the skin barrier is already damaged. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with blood or other body fluids. The overall compliance rate in hand hygiene was only found to be around 50%, and mostly consisted of washing hands with soap and water. Consequences of these findings are discussed.
Industrial Health, Oct. 2007, Vol.45, No.5, p.645-652. Illus. 52 ref.
http://www.jniosh.go.jp/en/indu_hel/pdf/IH_45_5_645.pdf [en inglés]

CIS 08-1323 Semple S., Graham M., Cowie H., Cherrie J.W.
Health and Safety Executive
The causative factors of dermatitis among workers exposed to metalworking fluids
Exposure to metalworking fluids (MWFs) is known to cause irritant contact dermatitis. In a first phase, the MWF parameters linked with skin irritation were investigated in laboratory trials. These studies suggested that MWFs are only mildly irritating over short time periods. It was concluded that improvements in the management of MWF concentration, pH, metal fines and bacteriological contamination were unlikely to have much impact on dermatitis risk and that the main effort should be placed on reducing exposure. A second phase consisted of a questionnaire survey among workers in six engineering plants concerning their skin condition and the existence, within their enterprise, of guidance on working with MWFs and on reducing dermatitis risk. This survey was followed by site visits. Findings are discussed.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, 2007. vi, 69p. Illus. 48 ref.
http://www.hse.gov.uk/research/rrpdf/rr577.pdf [en inglés]

CIS 08-1057 Santos R., Goossens A.
An update on airborne contact dermatitis: 2001-2006
Reports on airborne contact dermatitis are mainly published in the context of occupational settings. Hence, in recent years, dermatologists and occupational physicians have become increasingly aware of the possibilities of airborne sources of irritant or allergic contact dermatitis. However, their occurrence is still underestimated, because reports often omit the term "airborne" when referring to causal agents. For the present update, several leading journals were screened from 2000 to 2006, resulting in an updated list of airborne dermatitis causes.
Contact Dermatitis, Dec. 2007, Vol.57, No.6, p.353-360. Illus. 180 ref.

CIS 08-1063 Verma G., Sharma N.L., Shanker V., Mahajan V.K., Tegta G.R.
Pesticide contact dermatitis in fruit and vegetable farmers of Himachal Pradesh (India)
In this case-control study on pesticide allergic contact dermatitis conducted in Himachal Pradesh, an Indian state with an important fruit and vegetable production, cases included 30 farmers with dermatitis on the face, neck, hands and feet, while controls consisted of two groups of 10 subjects each: group 1 had a history of exposure to pesticides but no dermatitis while group 2 had neither dermatitis nor history of exposure to pesticides. All subjects were patch tested with the 10 most common pesticides used in the region. Positive patch test reactions from pesticides were observed in eight cases, while three group 1 subjects also showed sensitization to several pesticides. No reactions were observed among group 2 subjects. Captan was the most common sensitizer (five patients), two patients were sensitive to propargite. Chlorpyrifos, tree spray oil and thiuram gave a positive reaction in one patient each. Other findings are discussed.
Contact Dermatitis, Nov. 2007, Vol.57, No.5, p.316-320. 25 ref.

CIS 08-1062 Abraham N.F., Feldman S.R., Vallejos Q., Whalley L.E., Brooks T., Cabral G., Earp P., Fleischer A.B., Quandt S.A., Arcury T.A.
Contact dermatitis in tobacco farmworkers
Occupational skin disease is highly prevalent among agricultural workers. Tobacco cultivation and harvest are particularly hazardous for farmworkers. This article describes cases of five migrant Latino farmworkers in North Carolina with contact dermatitis related to tobacco work. These cases showed a characteristic distribution of contact dermatitis: the flexural and medial surfaces of the upper extremities were affected in each case, whereas most cases showed some involvement of the torso and axilla. This pattern most likely reflects a common occupational practice of holding the tobacco leaves under the arm and pressed against the body during harvesting.
Contact Dermatitis, July 2007, Vol.57, No.1, p.40-43. Illus. 14 ref.

CIS 08-962
World Health Organization (WHO)
IARC monographs on the evaluation of carcinogenic risks to humans - Human papillomaviruses
Human papillomaviruses (HPVs) are common sexually-transmitted infectious agents. Although most infections are asymptomatic and are cleared within a period of two years, genital HPV infection can lead to clinical disease, including anogenital warts, cervical neoplasia, cervical cancer and other anogenital cancers. Of the many types of HPVs, some are classified as carcinogenic to humans (Group 1), others as probably carcinogenic to humans (Group 2A) and yet other as possibly carcinogenic to humans (Group 2B). Recent data includes strong evidence of carcinogenicity at sites other than the cervix. Vaccination can reduce the incidence of HPV-related genital diseases. However, such prophylactic treatments require that such vaccines be provided women for whom access to cervical cancer screening services is problematic. Therefore, the development of vaccines that are cheaper and easier to deliver remains highly desirable. Update of the IARC Monograph No.64 on the same subject (see CIS 96-1096).
World Health Organization, Distribution and Sales Service, 1211 Genève 27, Switzerland, International Agency for Research on Cancer (IARC), 150 cours Albert Thomas, 69372 Lyon Cedex 08, France 2007. viii, 670p. Illus. Bibl.ref. Index. Price: CHF 55.00 (CHF 38.50 in developing countries). Downloadable version free of charge.
http://monographs.iarc.fr/ENG/Monographs/vol90/mono90.pdf [en inglés]

CIS 08-591 Skin protection in dental laboratories - Suddenly an allergy appeared
Hautschutz im Dentallabor - Und plötzlich war die Allergie da [en alemán]
This article describes the case of a female dental assistant working without gloves or skin protection. After about 30 years of practicing this occupation, she developed eczema on the hands for the first time, followed by clacks on the fingertips and on the palms. Her fingers then swelled to such an extent that she was no longer able to work. Skin examinations revealed allergies to various allergens typically found in the plastics used in dentistry. Recommended measures included wearing two superposed protective gloves, namely a plastic film glove under a nitrile rubber glove, together with the use of a skin protective cream and skin care. After an adaptation period of a few weeks for getting used to working with the gloves, she was able to work again. This case clearly shows that allergies can declare themselves after many years of daily contact with a substance, and highlights the need to adopt protective measures right from the first day of work.
Arbeit und Gesundheit, 2007, No.12, p.14-15. Illus.

CIS 08-601 McGregor D.
Risk of multiple myeloma and cancers of the respiratory system, oesophagus, stomach, pancreas, prostate, testes and skin in firemen
Risque de myélome multiple et de cancers des voies respiratoires, de l'œsophage, de l'estomac, du pancréas, de la prostate, des testicules et de la peau chez les pompiers [en francés]
The objective of this literature survey was to evaluate the risk of developing certain types of cancer among firemen. It resulted in the publication of several reports. This report addresses the risk of multiple myeloma and cancers of the respiratory tract, oesophagus, stomach, pancreas, prostate, testicles and skin. It concludes that available epidemiological data do not indicate that the cancers examined in this analysis can be assumed to occur in firefighters as a result of their occupation. This conclusion is based on the absence of a significant increase in risk in most of the studies and the minimal increase in risk in the cases where it is present. See also CIS 08-598/600.
Institut de recherche Robert-Sauvé en santé et en sécurité du travail du Québec (IRSST), 505 boul. de Maisonneuve Ouest, Montreal (Quebec) H3A 3C2, Canada, 2007. i, 37p. 79 ref. Price: CAD 8.40. Downloadable version (PDF format) free of charge.
http://www.irsst.qc.ca/files/documents/PubIRSST/R-522.pdf [en inglés]
http://www.irsst.qc.ca/files/documents/PubIRSST/R-521.pdf [en francés]

CIS 08-648 Cabrera Fernández E., Moreno Manzano G., Barchino Ortiz L., Pérez García V., Heras Mendaza F., Conde Salazar L.
Isotiazolinas: importancia en el desarrollo de dermatitis de contacto profesional
The purpose of this study was to highlight the effect of Kathon, a mixture of two isothiazolines, in the development of contact dermatitis in certain occupations. Medical files of 2333 patients having consulted the INHST dermatology services between 2004 and 2006 were examined. A total of 110 cases of Kathon sensitization were identified, of which 32 clearly had occupational causes while 13 were doubtful. Some patients also showed positive reactions to several sensitizing agents other than Kathon. Occupations within which the highest numbers of cases of contact dermatitis were found were hairdressing, perfume manufacture, mechanical goods manufacture, the cosmetics industry and cleaning.
Medicina y seguridad del trabajo, Sep. 2007, Vol.LIII, No.208, p.1-8. Illus. 26 ref.

CIS 08-333 Crépy M.N.
Occupational contact urticaria
Urticaire de contact d'origine professionnelle [en francés]
This review article on contact urticaria explains why, although they are less frequent than eczemas, they must be included in the clinical examinations in view of their potential severity and the fact that they often go unreported. The main occupations and sectors concerned include health care, food industry, agriculture, veterinarians, laboratory workers and hairdressers. The allergens responsible are animal and vegetable proteins. Low-molecular-weight chemicals may also be involved. Aetiological diagnosis is confirmed by immediately-readable skin tests, mostly by prick tests, and occasionally by testing for specific IgEs. Prognosis is dependant on the possibility of anaphylactic shock, which can be life-threatening in cases of re-exposure to the causal agent. Prevention is therefore essential. It requires the elimination of all contact with the causal agent, both at work and in the patient's environment.
Documents pour le médecin du travail, 3rd Quarter 2007, No.111, p.399-410. Illus. 101 ref.
http://www.dmt-prevention.fr/inrs-pub/inrs01.nsf/IntranetObject-accesParReference/TA%2076/$File/TA76.pdf [en francés]

CIS 08-265
Health and Safety Executive
Preventing contact dermatitis at work
Aimed at workers, this leaflet explains that contact dermatitis can be caused by contact with a wide range of substances including detergents, toiletries, chemicals and even some natural products. While it can concern all parts of the body, the hands are most commonly affected. Contents: definition and description of contact dermatitis; high risk-jobs and workplaces (health care personnel, hairdressers, printers, cleaners, metal workers); prevention (substitution, automation, enclosure, protective gloves); legal aspects (compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH, see CIS 03-1023). Replaces CIS 06-6.
HSE Books, P.O. Box 1999, Sudbury, Suffolk CO10 2WA, United Kingdom, Mar. 2007. 6p. Illus.
http://www.hse.gov.uk/pubns/indg233.pdf [en inglés]

CIS 08-341 Lind M.L., Albin M., Brisman J., Kronholm Diab K., Lillienberg L., Mikoczy Z., Nielsen J., Rylander L., Torén K., Meding B.
Incidence of hand eczema in female Swedish hairdressers
The occurrence of hand eczema among Swedish female hairdressers was estimated in a longitudinal retrospective cohort study including all graduates from vocational schools for hairdressers from 1970 to 1995. A stratified sample from the general population acted as controls. A self-administered questionnaire including questions on the occurrence of hand eczema, skin atopy, working periods and number of hair treatments performed per week was sent to the participants. Incidence rate ratios (IRRs) of hand eczema were estimated. Findings are discussed. Hairdressers are highly exposed to skin-damaging substances. The self-reported incidence of hand eczema was substantially higher in female hairdressers than in controls from the general population and than that reported in previous studies. For many individuals, the onset of hand eczema occurs during training or early in the working life. Only about 10% of the cases can be attributed to atopy.
Occupational and Environmental Medicine, Mar. 2007, Vol.64, No.3, p.191-195. Illus. 35 ref.

CIS 08-383 Crépy M.N.
Occupational skin diseases caused by rubber
Dermatoses professionnelles au caoutchouc [en francés]
Occupational allergies to rubber are common. They are mostly caused by gloves. Occupational skin diseases are either of the "immediate allergy" type with urticaria, rhinitis, asthma and risk of anaphylaxis, or of the "delayed allergy" type, with contact allergic eczema. The main allergens are latex proteins, as well as various sulfur-containing vulcanization agents. IPPD-type antioxidants also have a strong allergic potential. They are found in black rubber, mainly in the automobile sector and in the rubber goods industry. Prevention is based on a more widespread use of latex substitutes and less-allergenic additives. When the wear of latex gloves cannot be avoided (such as in cases of infection risks), gloves with a low latex protein content should be favoured, with little or no powder.
Documents pour le médecin du travail, Mar. 2007, No.109, p.73-86. Illus. 87 ref.
http://www.dmt-prevention.fr/inrs-pub/inrs01.nsf/IntranetObject-accesParReference/TA%2075/$File/TA75.pdf [en francés]

CIS 08-380 Jolly H.
Cement: guidance for improved protection
Ciment: des consignes pour une meilleure protection [en francés]
Fresh cement is an irritant that can cause rash, skin erosion, crevasses and burns. It is also an allergen, giving rise to skin diseases known as cement dermatitis, mainly due to impurities containing hexavalent chromium. Overall, cement is believed to be responsible for 10% of occupational skin diseases. This article reviews the precautions to be taken for avoiding these diseases, essentially consisting of hygiene measures and the use of suitable work clothing and personal protective equipment. A box mentions relevant French regulations.
Prévention BTP, Apr. 2007, No.95, p.48-50. Illus.

CIS 08-156 Flyvholm M.A., Bach B., Rose M., Frydendall Jepsen K.
Eczema de las manos autodeclarado en una población de trabajadores de hospitales
Self-reported hand eczema in a hospital population [en inglés]
El presente estudio tenía por objeto recopilar datos acerca de la prevalencia de eczema de las manos entre trabajadores hospitalarios. Se remitió un cuestionario a 1909 empleados de un hospital danés. La tasa de respuestas fue del 65,3%. La tasa de frecuencia global de eczema declarado en el curso de los últimos doce meses fue del 23%. Las frecuencias por categorías de profesiones oscilaron entre un 8% y un 32%, siendo significativamente mayores entre las auxiliares de enfermería (32%), las enfermeras (30%), y los auxiliares sanitarios (27%). Respecto de los departamentos del hospital, la frecuencia de eczema en las manos variaba entre un 7% y un 50%, correspondiendo las frecuencias más altas a los de medicina y cirugía. El eczema de las manos era más frecuente entre el personal que utilizaba guantes de protección, los que se lavaban las manos mas de 20 veces al día, las mujeres y los grupos de edades mas bajas
Contact Dermatitis, Aug. 2007, Vol.57, No.2, p.110-115. Illus. 25 ref.

CIS 08-164 Laukkanen A., Ruoppi P., Remes S., Koistinen T., Mäkinen-Kiljunen S.
Dermatitis de contacto a proteínas y rino-conjuntivitis alérgica inducidas por lactasa
Lactase-induced occupational protein contact dermatitis and allergic rhinoconjunctivitis [en inglés]
Este artículo presenta un caso de dermatitis de contacto a proteínas y de rino-conjuntivitis alérgica a proteínas inducidas por una exposición profesional a lactasa en una trabajadora de un laboratorio farmacéutico en Finlandia. La paciente presentó intensas respuestas positivas a la lactasa durante las pruebas de escarificación. En una prueba de aplicación abierta, la lactasa provocó pápulas urticariantes, en tanto que las pruebas de escarificación provocaron una reacción eczematosa. Las inmunoglobulinas E (IgE) específicas de la lactasa sérica se evidenciaron mediante los tests RAST e immunospot, y las fracciones donde la lactasa estaba unida a las IgE se examinaron mediante pruebas immunoblot e inhibición de immunoblot. Se realizó una prueba de provocación en cámara con el fin de detectar una posible asociación entre la sensibilización a la lactasa y los síntomas de rino-conjuntivitis. Las observaciones confirmaron los resultados de estudios anteriores según los cuales la lactasa puede provocar una sensibilización respiratoria y de las conjuntivas mediadas por las IgE, demostrándose, además, que puede provocar reacciones cutáneas por contacto
Contact Dermatitis, Aug. 2007, Vol.57, No.2, p.89-93. Illus. 19 ref.

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