Contact dermatitis and sensitization in professional musicians.

Allergic skin diseases

Occupational skin diseases (OSDs) are the second most common occupational diseases worldwide. Occupational contact dermatitis (OCD) is the most frequent OSD, and comprises irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), contact urticaria and protein contact dermatitis. There are many endogenous and exogenous factors which affect the development of OCD, including age, sex, ethnicity, atopic skin diathesis, certain occupations and environmental factors. One of the most important contributing causes is skin barrier dysfunction. The skin provides a first-line defense from environmental assaults and incorporates physical, chemical and biological protection. Skin barrier disturbance plays a crucial role in various skin diseases such as atopic dermatitis (AD), ichthyosis, ICD and ACD. Genetic factors, such as filaggrin gene (FLG) mutations, and external factors, such as skin irritants interfering with stratum corneum structure and composition, may lead to abnormalities in skin barrier function and increased vulnerability to skin diseases. FLG encodes the cornified envelope protein, filaggrin, which is involved in skin barrier function. FLG mutation is associated with the development of OCD. High-risk occupations for OCD include health care workers, hairdressers and construction workers. There are often multiple contributing causes to OCD, as workers are exposed to both irritants and allergens. AD is also associated with skin barrier disruption and plays an important role in OCD. ICD often precedes and facilitates the development of ACD, with impairment of the skin barrier contributing to the concurrence of ICD and ACD in many workers with OCD.

T helper and IL-20 cytokine signatures distinguish atopic dermatitis from contact dermatitis subtypes.

Irritant contact dermatitis (ICD), provoked by work materials or workflows, is believed to be a frequent cause of occupational skin disease (OSD). Data of incidence rates of ICD within different occupations are inadequate. We conducted a population-based study to identify occupational groups at risk for irritant and allergic contact dermatitis (ACD). The data are based on all workers' compensation claims reported to our register of OSDs in Northern Bavaria [Berufskrankheitenregister Haut-Nordbayern (BKH-N)], Germany. From 1990 to 1999, 5285 patients had their cases completely assessed and recorded by government-employed physicians. We calculated the incidence rates of ICD and ACD in various occupations, divided into 24 occupational groups, in co-operation with the German State Institute of Labor and Occupation; there were a known total number of employees in each of the occupations. In these groups 3097 (59%) patients with OSD were observed, with an overall annual incidence rate of 4.5 patients per 10,000 workers for ICD, compared with 4.1 patients per 10,000 workers for ACD. The highest ICD annual incidence rates were found in hairdressers (46.9 per 10,000 workers per year), bakers (23.5 per 10,000 workers per year), and pastry cooks (16.9 per 10,000 workers per year); at the same time ICD was the main diagnosis of OSD in pastry cooks (76%), cooks (69%), food processing industry workers and butchers (63%), mechanics (60%), and locksmiths and automobile mechanics (59%). The results of a questionnaire showed frequent skin contact with detergents (52%), disinfectants (24%), and acidic and alkaline chemicals (24%) in the workplace. Based on the incidence data of the BKH-N, this study identified occupational groups with a high risk of ICD. Different frequencies of ICD and ACD within a single group are demonstrated. The frequent usage of detergents is being addressed because of the introduction of German legislation of recent date (the Approved Code of Practice 531 on 'wet work').

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

Contact dermatitis is the most frequent occupational dermatosis and non-specific irritants in addition to specific Type IV sensitization are involved. We reviewed our database for data from 1994 to 1998 and selected 360 consecutive patients working in healthcare environments and experiencing contact dermatitis at their hands, wrists and forearms. We found that allergic contact dermatitis and irritant contact dermatitis were considered to be work-related in 16.5% (72/436) and 44.4% (194/436) of diagnoses, respectively. Occupational irritant contact dermatitis is due to exposure to a wide range of irritants in the workplace, such as soaps, solvents, cleansers and protective gloves, which conspire to remove the surface lipid layer and/or produce cellular damage. In this study the major relevant aetiological agents that induced occupational allergic contact dermatitis were: nickel sulphate (41 patch positivities), components of disinfectants [glutaraldehyde (5) and benzalkonium chloride (7)] and rubber chemicals [thiuram mix (15), carba mix (9) and tetramethylthiuram monosulphide (6)]. The best treatment for allergic contact dermatitis is to avoid those allergens causing the rash. Whenever this is not possible, contact with them needs to be reduced using properly selected protective gloves. Finally, subjects with atopic dermatitis should avoid 'wet work' and contact with irritants, because atopic dermatitis is significantly associated with irritant contact dermatitis.

Objectives:Contact dermatitis (CD) is a common skin disease. Occupational contact dermatitis (OCD) is the most frequently seen occupational skin disease and includes both occupational allergic CD (OACD) and occupational irritant CD (OICD). One of the most common sources of OACD is textile products. Individuals with atopic dermatitis (AD) have an increased risk for development of allergic contact dermatitis (ACD). However, the role of AD in the etiopathogenesis of the development of OACD among textile industry workers is not well known. The aim of the present study was to determine the prevalence of AD among textile workers with OACD and to analyze contact antigenic diversity between the workers with and without AD.Methods:A prospective, cross-sectional study was conducted with 352 textile workers who had previously been diagnosed with OACD. The patients were questioned and examined with respect to AD criteria, demographic features, disease duration, duration of employment until first symptoms, phototype, workplace (subsectors), and location of lesions at control visits. Immediate skin test reactivity was evaluated with a commercial skin prick test panel. The data obtained and the patients’ previously recorded patch test results were compared in OACD groups with and without a diagnosis of AD. The results were statistically evaluated with a significance level of p value <0.05.Results:The study population consisted of 124 males and 227 females. The mean age was 35.69±13.65 years. The most commonly seen employment duration, phototype, subsector, and location were 4 to 8 months (26.14%), 9 to 12 months (34.66%), Fitzpatrick type-III (37.50%), dyeing (33.52%), and exclusively the hands (60.51%), respectively. In all, 193 patients (54.83%) met the criteria for the diagnosis of AD. In the OACD group with AD, there was a significant number with 4 major and 16 minor criteria, as well as positivity for 14 contact allergens.Conclusion:Most AD criteria, or a diagnosis of AD, are highly detectable among workers with textile-related OACD. The results for patch test allergens may be significantly higher than those of individuals without AD. Textile workers with AD should be warned about the possibility of the early development of OACD.

Occupational skin diseases are among the most common occupational diseases in Europe, although this number could be higher, given a large number of unrecognized and unreported cases. The most common occupational skin disease is contact dermatitis, which includes allergic and irritant contact dermatitis and contact urticaria. In Croatia, occupational skin diseases make up to 8% of the total number of all recognized occupational diseases. Most are allergic contact dermatitis, followed by irritant contact dermatitis. Most cases of occupational skin diseases are found in manufacturing, craftwork, healthcare, and construction. This chapter summarizes the European standards used in Croatia, as well as data on the use and allergies associated with latex gloves and current outreach activities related to the protection of workers.

Epidemiological survey of contact dermatitis in Italy (1984–1993) by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali)

Background: The Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali (GIRDCA) resolved to obtain the most relevant data regarding contact dermatitis (CD) in Italy by means of a multicenter epidemiological study, involving research units (RU) throughout the country. The survey was performed with the collaboration of Generale Per I'Informatica, Rome (GEPIN) over the periods 1984 to 1988 and 1989 to 1993. The analytical study (of a transverse kind) was aimed at supplying prevalence measures. Materials and methods: The number of subjects taking part in the survey was 42,839. All patients underwent patch testing with the GIRDCA standard series and were included in the survey only if the final diagnosis was either CD or eczematous dermatitis caused by contact. The main anamnestic, clinical data, and allergological test results of all patients were codified into a chart, and subsequently transcribed into a data bank. The data were then processed cumulatively and were statistically analysed by a chi-square for trend test. Results: The four most frequent diagnoses (which, when considered together, make up 39,496 cases, or about 92% of all cases) proved to be nonoccupational allergic contact dermatitis (ACD), nonoccupational irritant contact dermatitis (ICD), occupational ACD, and occupational ICD. The haptens most frequently causing positive reactions in the total number of cases over the first 5 years were, in order of frequency: nickel sulphate, potassium dichromate, cobalt chloride, fragrance mix, balsam of Peru, and, in the second 5-year period, nickel sulphate, cobalt chloride, potassium dichromate, fragrance mix, and thimerosal. Occupational CD (ACD and ICD) was present in 11,694 cases overall, corresponding to approximately 27% of the total number of cases examined, and approximately 29% of all CD (including forms of nonoccupational CD). Regarding distribution by sex, a substantial equivalence of males and females for ACD, and a prevalence of females with ICD can be observed. Five occupations were reputed to be responsible for over 60% of total cases of occupational CD (housewives, bricklayers, workers in the metallurgic and mechanical industries, hairdressers, and healthcare personnel). Regarding the pathogenesis, a clearly dominant percentage of ACD may be observed among bricklayers and hairdressers, and of ICD among housewives. The haptens most frequently noted over the entire decade as the cause of positive reaction in occupational ACD were, in order of frequency, potassium dichromate, nickel sulphate, cobalt chloride,p-phenylenediamine and thiuram mix. Nonoccupational CD (ACD and ICD) was present in 27,802 cases overall, corresponding to about 65% of all cases under examination and over 70% of all CD (also including forms of occupational CD). In regard to distribution by sex, a clear dominance of females, as opposed to males, can be noted for ACD and also (although to a lesser extent) for ICD. The main products and materials (ie, components and relative substances) that are pinpointed as being responsible for nonoccupational ACD, were, in order of frequency, clothing accessories, cosmetics, topical pharmaceuticals, and clothing. The haptens most frequently recognized as the cause of positive reactions were, in order of frequency, nickel sulphate, fragrance mix, cobalt chloride, balsam of Peru, potassium dichromate, ethylenediamine, and diaminodiphenylmethane.

Healthcare workers (HCW) have an increased risk of suffering from occupational skin diseases (OSDs). Therefore, we established special prevention and skin protection courses for HCW. Medical aims are to optimize diagnostic procedures and individual therapy, educational aims are to improve individual skin protection/skin care habits of the patient and also to influence the participants' attitudes towards health. Participants are patients that have been suspected to suffer from an OSD and are insured with the German Accident Prevention Insurance Association for Health Care Workers (BGW). Teaching units mainly focus on the texture and functioning of the skin, general aspects of OSDs, general information concerning skin protection, instructions about the correct use of skin cleansing and skin protection products. Besides, every participant is clinically examined by a dermatologist and a precise patient's history is obtained. Individually adapted skin protection strategies are developed. Patients can ask the dermatologist questions in confidence. 504 patients (mean age: 36.9 years, SD = 11.7) participated in the skin protection courses. 94.6% (n = 477) suffered from hand eczema frequently caused by a mixture of atopic, irritant and allergic contact dermatitis, but irritant contact dermatitis was the most frequent diagnosis (55.4%, n = 279). The participants rated the course as good to excellent. Health education and advisory services in occupational dermatology are still fragmentary. Prevention of OSD and maintenance of health through education are important complementary measures for dermatological care. In the future, similar educational programmes should be offered for employees of other professions with an increased risk for OSD.

Contact dermatitis is an inflammatory skin disease induced by direct contact of a external agent to the skin. It can be classified into two main types: Irritant contact dermatitis and Allergic contact dermatitis. Irritant contact dermatitis represents a non-specific cutaneous response to the toxic or physical effects of environmental agents, while Allergic contact dermatitis represents a specific type IV hypersensitivity reaction to specific haptens. Both types are characterized by a highly variable clinical presentation that includes erythema, papules, vesicles, bullae, scaling and erosions in acute cases, and papules, plaques, lichenification, hyperkeratosis and fisures in the chronic. Pruritus is a very common symptom most frequently associated with Allergic contact dermatitis but also frequent in Irritant contact dermatitis. Furthermore, occasionally pruritus may be the leading or only symptom that guides the clinician to suspect the diagnosis of Contact dermatitis, as it is in the case of Allergic contact dermatitis of the anogenital region or when the process occurs in the elderly. Although the mechanisms underlying the pathogenicity of the inflammatory cutaneous response in irritant and allergic contact dermatitis has been widely studied, little is known about the mechanisms leading to pruritus. This chapter summarizes the most important aspects of contact dermatitis in these specific situations as well as the last insights into the pathogenicity of pruritus in contact dermatitis.

Of a total of 3731 patients investigated between 1974 and 1990, 1844 (49.4%) had an occupational skin disease. Of them 142 (7.7%) had an occupational skin disease caused by epoxy compounds--135 patients (95%) had allergic contact dermatitis, five had irritant contact dermatitis, and two had contact urticaria. Apart from dermatoses, two patients had IgE-mediated asthma from exposure to DGEBA epoxy resins. Thus epoxy compounds are one of the main causes of occupational allergic contact dermatoses and can be considered potential causes of occupational asthma. The most frequent causes were epoxy resin compounds, which together induced 93% (132 cases) of all epoxy compound dermatoses. The three most common causative products were epoxy paints and their raw materials (31%, 41 cases), epoxy resin compounds used in electrical insulation (29%, 38 cases) and epoxy glues (18%, 24 cases). Fewer cases were caused by products containing epoxy acrylate and EPTMAC. The present study found that, in addition to contact allergy to DGEBA epoxy resins, contact allergy to epoxy hardeners, non-DGEBA resins and reactive diluents is common. Polyamine hardeners, most frequently MDA, DETA and TETA, rarely IPDA, tris-DMP, EDA, TMD and XDA, were the second commonest causes of contact allergy induced by epoxy resin compounds, after DGEBA epoxy resins. Cycloaliphatic epoxy resins and other non-DGEBA epoxy resins, including heterocyclic dimethyl hydantoin, phenol novolak and brominated epoxy resins, were the third commonest causes, and reactive diluents the fourth commonest cause of allergic dermatitis due to epoxy resin compounds. Most patients sensitized to reactive diluents were allergic to PGE, ortho-CGE, HDDGE and BDDGE, whereas fewer patients were sensitized to AGE, NPGDGE and BGE. Cross-sensitization between reactive diluents was common. Cardura E 10 and Epoxide 8 provoked no reactions. The present study also indicated that DGEBA epoxy resins with a high average MW ought to be regarded as potential sensitizers, and organic solvents probably promote sensitization to DGEBA, even if the amount of DGEBA is low in the causative products. When contact dermatitis induced by epoxy compounds is suspected, an accurate diagnosis is made with the use of detailed data on the patient's exposure and extensive patch testing, including tests with the patient's own products. No chemical can be used alone to screen for sensitization to all different contact allergens of epoxy compounds.(ABSTRACT TRUNCATED AT 400 WORDS)

Irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) are inflammatory skin diseases accompanied by itch and pain. Irritant contact dermatitis is caused by chemical irritants eliciting an innate immune response, whereas ACD is induced by haptens additionally activating an adaptive immune response: After initial exposure (sensitization) to the hapten, a subsequent challenge can lead to a delayed-type hypersensitivity reaction. But, the sensory and inflammatory effects of sensitization (ICD) vs challenge of ACD are insufficiently studied. Therefore, we compared itch- and pain-like behaviors and inflammatory reactions evoked in mice during the sensitization (ICD) vs challenge phase (ACD) of application of the hapten, squaric acid dibutylester (SADBE). Our aim was to compare itch- and pain-like behaviors and inflammatory reactions evoked in mice during the sensitization (ICD) vs challenge phase (ACD) of application of the hapten, squaric acid dibutylester (SADBE). Mice were sensitized on the abdomen with 1% SADBE (ACD) or vehicle treated (ICD, control). Spontaneous and stimulus-evoked itch- and pain-like behaviors were recorded in mice before and after 3 daily challenges of the cheek with 1% SADBE (ACD, ICD). Cutaneous inflammation was evaluated with clinical scoring, ultrasound imaging, skin thickness, histology, and analyses of selected biomarkers for contact dermatitis, IL-1β, TNF-α, CXCL10, and CXCR3. Allergic contact dermatitis vs ICD mice exhibited more spontaneous site-directed scratching (itch) and wiping (pain). Allergic contact dermatitis-but not ICD-mice exhibited allodynia and hyperalgesia to mechanical and heat stimuli. Inflammatory mediators IL-1β and TNF-α were upregulated in both groups as well as the chemokine receptor, CXCR3. CXCL10, a CXCR3 ligand, was upregulated only for ACD. Inflammatory responses were more pronounced in ACD than ICD. These findings provide new information for differentiating the behavioral and inflammatory reactions to hapten-induced ICD and ACD.

Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.