RESULTS OF THE COMPARATIVE STUDY ON THE ONSET AND FREQUENCY OF OCCUPATIONAL ALLERGIC CONTACT DERMATITIS AMONG WORKERS IN THE RUBBER AND CONSTRUCTION INDUSTRIES

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

Published in the series Occupational Toxicants , Vol. 16 (2001) The article contains sections titled: Allergenic Effects Effects in man Animal studies Manifesto (sensitization)

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

Epidemiological Survey of Contact Dermatitis in Italy (1984-1993) by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali)

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

Construction workers have a substantial risk of developing irritant and/or allergic contact dermatitis. Unfortunately, however, there is little population-based epidemiological data relating to occupational skin diseases (OSD) in the European construction industry that allow assessment of preventive measures. In this investigation, the yearly incidence rates and causes of OSD in the construction industry were analysed on the basis of our register in Northern Bavaria. From 1990 until 1999, all incidences of OSD in the construction industry were recorded prospectively. This enables the calculation of incidence rates of OSD in relation to the employed population in Northern Bavaria as recorded by the German Federal Employment Office. In the construction industry, a total of 335 OSD were registered. These comprise 9.0% of all OSD in the register. We classified them into four relevant groups: (A) tile setters and terrazzo workers (incidence per 10 000 employees = 19.9); (B) painters (7.8); (C) construction and cement workers (5.2); and (D) wood processors (2.6). The overall incidence was 5.1 per 10 000 employees over 10 years, which is a little below average for the entire register (6.7). Of these, 43.6% were at least 40 years old. Allergic contact dermatitis (61.5%) occurred more often than irritant contact dermatitis (44.5%). Potassium dichromate caused roughly half of all cases of sensitization found to be occupationally relevant in the construction industry (152 cases) followed by epoxy resin (40) and cobalt chloride (32). The results indicate that potassium dichromate is still the most important allergen in the construction industry of Northern Bavaria; there has been no significant decline during the 1990s. This contrasts with the Scandinavian countries, where the prevalence of potassium dichromate sensitization declined following the reduction of chromium VI levels resulting from the addition of ferrous sulphate to cement. Within the construction industry, tile setters and terrazzo workers have a strikingly high incidence of OSD.

Professional musicians have prolonged and intense physical contact with their instruments. This can lead to occupational skin diseases, particularly irritant and allergic contact dermatitis. To assess the skin diseases and sensitization patterns common among professional musicians. A retrospective analysis of the data of the Information Network of Departments of Dermatology (IVDK) was performed, including data from 1997 to 2017. We identified 236 professional musicians. In this group, male sex (58.6%) and younger age (60.6% aged < 40 years) were common. The musicians suffered more frequently from facial dermatitis (23.7% vs 15.7%) and less often from leg dermatitis (5.1% vs 10.7%) than the control group (the non-musicians in the IVDK database). The most frequent diagnoses were allergic contact dermatitis, atopic dermatitis, and irritant contact dermatitis. The sensitization profile of the professional musicians was similar to that of the control group. In 8.9% of cases, an occupational background of skin disease was confirmed. Severe occupational skin diseases among professional musicians are not as common as in classic "skin-damaging" professions. However, as these skin conditions can mostly be controlled with simple preventive measures, we recommend that this group should be patch tested and treated by a specialist.

To evaluate sensitization to chemicals present in work environment after an outbreak of contact dermatitis in workers of vehicle equipment factory, exposed to polyurethane foam, based on 4,4'-diphenylmethane diisocyanate (MDI). From among 300 employees, 21 individuals reporting work-related skin and/or respiratory tract symptoms underwent clinical examination, patch testing, skin prick tests, spirometry and MDI sIgE measurement in serum. Patch tests included isocyanates series, selected rubber additives, metals, fragrances, preservatives, and an antiadhesive agent. Clinical examination revealed current eczema in the area of hands and/or forearms in 10 workers. Positive patch test reactions were found in 10 individuals, the most frequent to diaminodiphenylmethane and 4-phenylenediamine (7 persons). Reactions to an antiadhesive agent were assessed as irritant (5 workers). Except for sensitization to common aeroallergens, no significant abnormalities were found in the remaining tests. Occupational allergic contact dermatitis was diagnosed in 7 workers, irritant contact dermatitis in 10 and coexisiting allergic and irritant contact dermatitis in 3 workers. In workers manufacturing products from polyurethane foam, attention should be paid to the risk of developing contact dermatitis. Skin problems in our study group were attributable probably to insufficient protection of the skin.

Occupational contact dermatitis is the most frequent type of occupational skin diseases. It can be broadly classified into irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). The dermatitis in occupational cases is mostly localized on the hands. The typical clinical feature is dermatitis at the site of contact with the causative agent and a close relationship with work activities. Numerous irritants and contact allergens are involved in the pathogenesis of occupational contact dermatitis and are often highly specific for a particular specific profession. Major irritants are water, detergents, and alkalis and acids. Major allergens in occupational settings are rubber additives, biocides, plastics, metals, allergens of cosmetics and fragrances, dyes, and plants. The diagnosis of occupational contact dermatitis is based on medical history, clinical examination of the entire skin integument, performance of skin provocation tests, and assessment of exposure. Occupational irritant and allergic contact dermatitis can be difficult to distinguish clinically. Allergy testing, primarily patch testing, is necessary to confirm a diagnosis of allergic contact dermatitis and to support a diagnosis of irritant contact dermatitis. Exposure assessment (including ingredient labels and safety data sheets, type of protective equipment) is therefore fundamental in the diagnosis work-up of patients with occupational contact dermatitis and in the implementation of specific preventive measures.

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.

Differentiating between eczema caused by atopic dermatitis (AD), allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD) remains clinically challenging. Histopathology and immunophenotyping often lack specificity, while skin cytokine profiling shows promise for molecular characterization.1 ICD results from exposure to irritants and activates the innate immunity, inducing cytokines such as IL-1α/β, IL-6 and tumour necrosis factor alpha (TNFα). ACD involves sensitization to allergens and triggers both innate and adaptative responses, with mixed T helper (Th)1/Th2 involvement.2, 3 AD, a chronic inflammatory skin disease marked by recurrent eczema and itching, is typically Th2/Th22-driven. Although IL-20 family cytokines have been implicated in ACD and AD models,4, 5 their role in ICD remains unclear. This study aimed to evaluate skin expression of Th-associated (IFNγ, IL-4, IL-9, IL-13 and IL-17), IL-20 family (IL-19, IL-20, IL-22 and IL-24) and inflammatory cytokines (IL-6 and TNFα) in differentiating AD, ACD and ICD. Forty-two patients were included: (i) 20 with ACD confirmed by positive patch tests to nickel, fragrance mix I, and/or methylisothiazolinone; (ii) 12 patch tested with sodium lauryl sulphate (SLS) to reproduce ICD; and (iii) 10 with AD presenting with untreated acute lesions. AD patients had a median age of 35 years, were mostly male (60%), with severe disease (median SCORAD 55.0) and classical AD phenotype (90%). ACD and ICD participants had no history of atopy. Cytokine mRNA expression in lesional and non-lesional skin was quantified using qRT-PCR. Study methods, statistical analyses, cohort details and patch tests results (Tables S1–S3) are provided in Online Repository (available at https://zenodo.org/records/16276888). This prospective study was conducted from 2012 to 2024 in a Belgian tertiary university hospital, with ethical approval. In non-lesional skin, only IL22 expression was significantly increased in AD compared with ACD and ICD. Other cytokines showed no significant differences across groups (Figure 1). SLS induced all cytokines, except IL4 (Figure 2; Table S4). Allergen exposure in ACD induced stronger cytokine expression than SLS in ICD, with the most notable increases in IL4, IL9 and IL22, evident as early as 24 h (Figure 2; Figure S1; Table S4). Cytokine expression was unaffected by patch test reaction severity or allergen type (Figures S2–S4). In lesional AD skin, IL4 was the only cytokine not induced compared with non-lesional skin (Figure 2; Table S5). IFNγ and IL9 induction was significantly higher in ACD than AD, while IL20 family cytokine expression was increased in both, with no significant differences (Figure 2; Figure S1). IL13 and IL17 induction did not vary significantly across groups (Figure 2; Figures S1 and S4). Our results support that ACD is characterized by strong induction of IFNγ, IL4, IL9 and IL20 family cytokines, highlighting a more complex Th response than a simple Th1/Th2 polarization.3 IL4 and IL9 emerged as key discriminatory markers between ACD and ICD. Moreover, the weak cytokine expression observed in ICD aligns with its innate-dominated nature. IL-20 family cytokines, together with Th1/Th2/Th9-associated cytokines, play a key role in ACD inflammation, supporting previous findings.4, 6, 7 In AD, IL22 was significantly increased in non-lesional skin compared with ACD and ICD, and IL20-related cytokines were increased in lesional AD skin. These results align with existing evidence implicating IL-22 and IL-24 in AD pathogenesis and support the rationale for IL-22-targeted therapies.8-10 However, because IL20 family cytokine levels were similar in AD and ACD, only IFNγ, IL4 and IL9 could differentiate them. In conclusion, combining IFNγ, IL4, IL9 and IL20 family cytokines enhances diagnostic precision in eczematous lesions. Th1/Th2/Th9 cytokines, particularly IL4 and IL9, help distinguish ACD from AD and ICD, while IL22 and IL24 differentiate ICD from AD. Skin cytokine analysis offers valuable diagnostic insight, but should always complement clinical evaluation, given the complexity of overlapping phenotypes in some patients. This study and data collection were conducted with the approval of the hospital and faculty institutional review board (Commission d'Ethique Biomédicale Hospitalo-Facultaire) of Université catholique de Louvain (UCLouvain), Belgium (NCT 340320084407). We thank Dr. Mariana Andrade, M.D., who provided editorial assistance. This work was supported by grants from the Actions de Recherche Concertées UCLouvain (A.R.C. grant 19/24–098) and from the Fonds de la Recherche Scientifique (F.R.S) – FNRS (CDR numbers J.0055.23 and 1M00524F). The funders had no role in study design, data collection and analysis, interpretation or writing of the manuscript. None. The patients in this manuscript have given written informed consent to participate and for publication of their case details. Dataset generated during and/or analysed during the current study is available from the corresponding author on reasonable request.

Allergic contact dermatitis, along with irritant contact dermatitis and immediate contact reactions, contact urticarial, are the most frequent dermatological occupational disease, but seldom reported to the National authorities. We performed a 3-year retrospective study at the allergology section in the Dermatology Clinic of the University Hospital of Coimbra to evaluate the main occupations diagnosed as occupational allergic contact dermatitis, most common allergens and the effect of the modification of the work station in the evolution of the disease. During 2012 - 2014 among the 941 patch tested patients, 77 (8.2%) were diagnosed with occupational allergic contact dermatitis, with 169 positive patch tests related to occupational exposure, 55 detected within the baseline and 114 in complementary test series. In most cases allergic contact dermatitis involved the hands (88.3%), main professional activities were nail estheticians and hairdressers due to the manipulation of (meth)acrylates, the most common allergen in the study. After the diagnosis, 27.3% abandoned the work, 23.4% changed the work station, 49% avoided exposure to the responsible allergen. Contact dermatitis resolved in 39% of the patients, improved in 39% but had no change in the remaining 22%. This study, although including only patients from the center of Portugal, evaluates a large sample of patients with different occupations studied with a larger variety of allergens. Apart from classical allergens and professions responsible for occupational allergic contact dermatitis that we found in lower numbers (thiuram mix, paraphenylenodiamine, chromium and cobalt in health care workers, hairdressers and in the building industry), (meth)acrylates tested outside the European and Portuguese Baseline Series were the main cause of occupational allergic contact dermatitis, namely in nail estheticians. Methylisothiazolinone, the second more frequent occupational contact allergen in the present study was identified in different occupations as a result of the widespread use of this preservative that is causing a real 'epidemics' of allergic contact dermatitis all over Europe in the last years. Nail estheticians are not usually referred as an occupation with a high risk of developing allergic contact dermatitis. Nevertheless, the current fashion combined with professionals poorly informed about the risk of their activity and the high sensitizing potential of (meth)acrylates, leads to a higher frequency of allergic contact dermatitis in recent years.

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').

Contact dermatitis is an eczematous eruption caused by external agents, which can be broadly divided into irritant substances that have a direct toxic effect on the skin (irritant contact dermatitis,...