Prevalence Of Occupational Contact Dermatitis Research Articles

Sensitization to Lanolin in North-Eastern Italy, 1997-2021: Prevalence, Risk Factors and the Impact of Occupation.

Background: Direct skin contact with items containing lanolin can induce sensitization and development of contact dermatitis (CD). This multi-centric study investigated prevalence of lanolin sensitization among 30,269 outpatients from North-Eastern Italy patch tested during 1997-2021. Methods: European baseline and extended Triveneto series were applied on the upper part of patients' back and removed after 48 h. Risk factors for lanolin sensitization were investigated by multiple logistic regression analysis, reporting adjusted odds ratios (aOR) with 95% confidence interval (95%CI). Results. Overall lanolin patch test positive ratio (PTPR) was 1.64% (=501/30,629), with variability over time and by research center. The body area most frequently affected by CD were hands (36.32%), followed by face (19.52%) and legs (8.09%), with a lanolin PTPR of 1.68%, 1.37% and 3.07%, respectively. Prevalence of occupational CD was 8.24%, and 1.83% patients with occupational CD patch tested positive against lanolin. Lanolin sensitization was significantly higher in males (aOR = 1.34; 95%CI: 1.08; 1.65) and among patients with leg CD aged 49-60 years (aOR = 2.34; 95%CI: 1.20; 4.57) or older than 60 (aOR = 4.21; 95%CI: 2.59; 6.85). Sub-group analysis confirmed the significantly higher sensitization rate of older patients with leg CD, with much stronger effect size in females 61+ years old (aOR = 5.33; 95%CI 2.87; 9.89) than males in the same age group (aOR = 2.92; 95%CI: 1.34; 6.39). Moreover, female house painters were more likely to test positive to lanolin. Conclusions: The variability of lanolin PTPR over time and by research center endorsed the ongoing debate on the relevance of the respective skin reaction. Clinicians assessing patients with dermatitis should collect information on potential risk factors for lanolin sensitization, particularly use of skin care products containing the hapten. Occupational exposure to lanolin-containing varnishes should also be considered.

THE RISK OF OCCUPATIONAL CONTACT DERMATITIS IN COVID-19 ISOLATION WARD SETTING

Occupational contact dermatitis (OCD) is a prevalent skin condition affecting healthcare workers, particularly those in high-risk environments such as COVID-19 isolation wards. This study aims to summarize the findings of a study conducted on patients to explore the risk factors associated with OCD development among healthcare professionals in COVID-19 isolation ward settings. This prospective observational study aimed to assess the risk of occupational contact dermatitis (OCD) among healthcare professionals working in the COVID-19 isolation ward setting. The study was conducted at Chaudhary Mohammad Akram Hospital for six months, from November 2021 to April 2022. Data was collected from 150 participants of both genders. The participants ranged from 22 to 55 years, with a mean age of 32.5 ± 6.8 years. The study population consisted of 55% females and 45% males. The occupation distribution included doctors (40%), nurses (50%), and support staff (10%). Clinical evaluations revealed that 38 healthcare professionals (25.3%) exhibited signs consistent with occupational contact dermatitis. Among them, 18 participants (47.4%) were diagnosed with irritant contact dermatitis (ICD), while 20 participants (52.6%) showed signs indicative of allergic contact dermatitis (ACD). It is concluded that this study highlights the significant prevalence of occupational contact dermatitis among healthcare professionals in COVID-19 isolation wards. Prolonged PPE usage and frequent hand hygiene practices contribute to skin irritation.

Incidence and prevalence of occupational contact dermatitis in hairdressing apprentices: A 3-year prospective cohort study.

It is known that a large number of hairdressing apprentices (HA) develop occupational contact dermatitis (OCD) during schooling, but studies that address prevalence of contact sensitization in HAs with hand eczema are missing. To assess the prevalence, incidence rate and clinical characteristics of OCD, including contact sensitization, in a sample of Croatian HAs. A total of 408 HAs from 25 Croatian towns were examined at the beginning of education and monitored at the end of each school year. Clinical evaluation of skin changes was performed using the Osnabrueck Hand Eczema Severity Index (OHSI). Standard patch test (PT) with baseline and hairdresser series of contact allergens was performed in 46 HAs with skin changes lasting ≥3 months. The overall incidence rate of OCD was 32.3/100 person-years, and the 3-year prevalence 50.3%. Contact sensitization was found in 14 out of 46 (30.3%) HAs, with 10 of these 14 HAs (71.4%) sensitized to specific hairdressing allergens. The strongest reactions were found to PPD. HAs with positive PT had higher OHSI than HAs with negative patch test (median, IQR: 3, 2-4 vs. 2, 2-4). Contact sensitization to specific hairdressing chemicals was found in 71.4% of HAs with a positive patch test, supporting evidence on the early contact sensitization to occupational allergens among HAs.

Prevalence, risk factors, and prevention of occupational contact dermatitis among professional cleaners: a systematic review.

The aim of this study was to investigate the prevalence, risk factors, and prevention of occupational contact dermatitis (OCD), as well as risk factors and consequences of OCD among professional cleaners. A systematic review following PRISMA guidelines was performed using Medline, EMBASE, and Cochrane Library. Thirty-nine studies containing over 109.000 participants were included in the review. The prevalence of OCD varied between 2.2% and 30.1%. Main occupational risk factors for developing OCD among cleaners included wet work and irritants in cleaning products (bleach, chlorine, ammonia, multi-use-cleaning) and skin contact to metal. The most common contact allergies included rubber, biocides, nickel/cobalt, and perfumes. Other risk factors were inconsistent use of protective gloves and low educational level. Consequences associated with OCD included significant impairment in quality of life, tendency to have unscheduled absence from work, sick leave, increased rate of disability, and recognized degree of injury. Only one prevention study has been published investigating the effect of an educative course in skin-protective behavior in cleaners. The study reported a higher degree of knowledge of skin protection, a decrease in the severity of hand eczema, and a shift toward fewer daily hand washings at follow-up after 3months. Our study proves that OCD is common in cleaners, and the main risk factors included wet work, irritants, and contact allergies, as well as inconsistent use of protective gloves and low educational level. More focus and a greater number of studies are needed on skin protection in this population.

Occupational Contact Dermatitis in Dental Personnel: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001 to 2018.

Dental personnel are at risk of developing occupational contact dermatitis. The aims of the study were to determine prevalence of occupational contact dermatitis in dental personnel referred for patch testing and to characterize relevant allergens and sources. The study used a retrospective, cross-sectional analysis of the North American Contact Dermatitis Group (NACDG) data, 2001-2018. Of 41,109 patients, 585 (1.4%) were dental personnel. Dental personnel were significantly more likely than nondental personnel to be female (75.7% vs 67.4%, P < 0.0001), have occupationally related dermatitis (35.7% vs 11.5%, P < 0.0001), and/or have primary hand involvement (48.6% vs 22.5%, P < 0.0001). More than one quarter of dental personnel (62/585, 27.7%) had 1 or more occupationally related allergic patch test reaction(s). There were 249 occupationally related reactions to NACDG screening allergens, most commonly glutaraldehyde (18.1%), thiuram mix (16.1%), and carba mix (14.1%). The most common sources of NACDG screening allergens were gloves (30.7%), dental materials (26.6%), and sterilizing solutions (13.1%). Seventy-three dental personnel (12.5%) had 1 or more positive patch test reactions to occupationally related allergen(s)/substances not on the screening series. Occupationally related irritant contact dermatitis was identified in 22.2% (n = 130) of dental personnel, most commonly to nonskin soaps/detergents/disinfectants (32.0%). Occupational contact dermatitis is common in dental personnel referred for patch testing. Comprehensive testing beyond screening series is important in these patients.

Occupational Contact Dermatitis in Hospital Cleaning Workers.

Health care workers and hospital cleaning workers are at high risk regarding the development of occupational contact dermatitis (OCD). To determine the prevalence and risk factors of OCD in hospital cleaning workers. A questionnaire was conducted in 245 cleaning workers in our cross-sectional study. The 236 cleaning workers formed the study group. In workers who were prediagnosed with dermatitis, physical examination was performed in the Dermatology Outpatient Clinic, and when necessary, patch test, skin biopsy, and investigation for total immunoglobulin E were conducted. Patients with definite contact dermatitis were diagnosed as having OCD by using the Mathias criteria. The prevalence rate of OCD was 21.6% and was significantly higher in female workers (26.4%) when compared with male workers (11.0%). Female sex; low educational level; cleaning the external surfaces of the medical equipment, monitors, and accessories; and mixing the cleaning products and use them while performing cleaning activities were determined as the independent risk factors for OCD. Occupational contact dermatitis was present at a high rate in hospital cleaning workers. The risk factors should be taken into consideration for prevention of OCD and improvement of the health status of hospital cleaning workers.

Prevalence of Occupational Contact Dermatitis and its related Factors among Surgical Technologists in Five Educational Centers of Mazandaran University of Medical Sciences

Introduction: Occupational skin diseases and hand contact dermatitis specifically are among the most common occupational diseases among the healthcare workers. Since surgical technologists have contact with allergens and irritant substances are more susceptible to hand contact dermatitis. Thus, the aim of this study was to evaluate the prevalence of occupational hand contact dermatitis and effective factors among surgical technologists in five educational centers affiliated to Mazandaran University of Medical Sciences.&#x0D; Methods: The present cross-sectional study was conducted over 125 surgical technologists working in the hospitals affiliated with Mazandaran University of Medical Sciences who were selected via census sampling. Later, 97 participants who met the inclusion criteria were investigated. Data were collected by Nordic Occupational Skin questionnaire (NOSQ-2002) through interview and analyzed by SPSS software version 23.&#x0D; Results: The findings indicated that 68% of the examined technologists were female and 57.7% were over 37 years old. The prevalence of hand dermatitis was 45.4% (44 people). The highest prevalence was observed at the back of hands (24.7%) and between fingers (17.5%). Contact hand dermatitis had a significant correlation with the participants’ gender (p = 0.002), work experience (p = 0.028), and frequency of hand washes (p = 0.021). Moreover, having a history of eczema and allergy (P-Value≤ 0.01) was significantly effective in increasing hand contact dermatitis.&#x0D; Conclusion: The prevalence of hand contact dermatitis is high among surgical technologists. Therefore, hospital managers are required to plan for preventive measures and control the current situation. Furthermore, future researchers are recommended to carry out more studies on allergic dermatitis.

Occupational contact dermatitis in a gender perspective: North East Italian data 1996-2016.

Background:Occupational contact dermatitis (OCD) ranks high among occupational diseases in Europe, but little is known as regards OCD and jobs in a gender perspective.Objectives:To evaluate sex prevalence of OCD according to occupational sectors and agents involved. 27381 patients (1996–2016) with suspected irritant/allergic contact dermatitis (ICD-ACD) were evaluated in North-Eastern Italy. Each patient underwent: a standardized questionnaire, a dermatologist/occupational physician evaluation and a patch test.Results:Females were younger at diagnosis (35.2 ± 11.6 years vs 37.7 ± 12.6 in males, p< 0.001) and had a lower ICD prevalence (OR 0.58, C.I. 95% 0.51 - 0.66, p < 0.001). Job categories most involved differed between sexes, with highest rank for healthcare professionals in females and machinery mechanics and filters for males. In females ACD percentage was higher in all job categories.Conclusions:OCD characteristics differ between sexes, according to intrinsic and extrinsic factors. Use of personal care products, housekeeping products and outdoor work activities may account for different sensitization profiles.

Occupational contact dermatitis in Triveneto: Analysis of patch test data of the North Eastern Italian Database from 1996 to 2016.

Occupational contact dermatitis (OCD) is frequent in the workplace. To provide recent data on the epidemiology of OCD in Italy. This multicenter retrospective study, conducted from 1996 to 2016, included patients with suspected allergic contact dermatitis (ACD) patch tested in the departments comprising the North-East Italy Contact Dermatitis Group. We studied 18 859 workers with a diagnosis of contact dermatitis (CD), of which 10.4% were recognized as being of professional origin. OCD declined from 1996 to 2011-2013 and increased in 2014-2016. The overall prevalence of both CD and OCD was higher in women compared to men, but the share of OCD of the total CD was greater for men compared to women. A history of atopic dermatitis was less frequent in workers with OCD than in non-OCD patients (5.8% vs 8.6%). Hairdressers were the youngest profession (27.1 ± 11.7 years). Hands were the primary site of involvement in patients with OCD (76.6%). The five highest risk occupations for OCD were hairdressers, cooks, metalworkers, chemical industry workers, and construction workers. OCDs have a relevant impact in our region, mainly for five job categories, and the increase in the last 3 years suggests the need to improve preventive measures.

Nurses: Workers Particularly Concerned by Contact Dermatitis in Public Hospital

Background: Contact dermatitis is common disease and represents a significant problem in healthcare sector, mainly among nurses. Many studies reported the prevalence of contact dermatitis from different parts of the world. Nevertheless, data about its frequency in Tunisia especially in public hospital seems to be insufficient. This study aims to assess the prevalence of contact dermatitis among nurses working in public hospital and identify risk factors. Patient and Methods: A cross sectional study was conducted among a representative sample of 1278 health professionals working in a public hospital matched by professional status and department. The survey was based on a questionnaire, a specialized examination and patch tests. Results: The prevalence of occupational contact dermatitis was 22% (17.5 - 27.2). The worker profile at risk of contact dermatitis was a female nurse aged 37 years working in a surgical department during 12.7 ± 9.36 years. Hands were damaged in 92.4% of cases and rhythmicity with occupational exposure was reported by 86% of affected individuals. Patch tests using European Standard Battery were performed among 33 workers and revealed a sensitization to an allergen among 26 workers. Patch test using rubber battery (if suspicion of allergic contact dermatitis to gloves) was performed among 29 agents and positive among 12. The analytical study revealed that history of atopy, job tenure, the mean daily number of hand washing, the mean daily number of worn gloves and mean duration of glove wearing were significantly higher in the affected population. Conclusion: Contact dermatitis affects particularly nurses in public hospitals. Its prevention requires a diagnostic approach based on a detailed professional investigation and patch tests.

Prevalence of occupational contact dermatitis, knowledge and adaption of preventive measures by chemical industries workers of Pune: An observational study

Objective: To study the prevalence of occupational contact dermatitis (OCD), knowledge and adaption of preventive measures by chemical industries workers in Pimpri Chinchwad, Pune. Materials and methods: Across sectional study was conducted from August 2010 to July 2011 on five hundred randomly selected participants from varnish, cement, nickel salt and oil paint industries. A semi-structured interview questionnaire was used to record details regarding socio-demographic data, knowledge and preventive measures adapted towards occupational hazards. Nordic occupational skin questionnaire and Occupational Contact Dermatitis Disease Severity Index (ODDI) were used to record the data related to the disease. Results: Overall prevalence of OCD was 5.20% (n=26/500).The prevalence in varnish, oil paint, nickel salt and cement exposed workers was 9.82% (n=11/112), 6.42%(n=7/109), 3.72%(n=6/161) and 1.69%(n=2/118) respectively. The ODDI mean(SD) score of severity index was 4.2(1.44). The prevalence regarding poor, average and good knowledge of occupational hazards was 7.22%(n=12/166), 4.24%(n=12/283) and 3.92%(n=2/51) respectively. The prevalence regarding not at all, irregularly and regularly adapting preventive measures was 11.11%(n=13/117), 4.67% (n=10/214) and 1.78% (n= 3/169)respectively. Conclusion:The workers involved in varnish chemical industry are more susceptible to OCD than workers involved in nickel salt, cement, and oil paint industries. This study clearly indicates that knowledge regarding the occupational hazards and adaption of preventive measures are prerequisite to lower the prevalence of OCD in chemical industries workers as prevalence was higher in poor knowledge workers and workers who had not adapted any preventive measures.

Recent advances in occupational dermatitis

This review examined recent advances in occupational contact dermatitis (OCD). Both genetic and environmental factors contribute to OCD. There is continuing growth in our understanding of the genetic factors, particularly related to filaggrin mutations. In spite of increased understanding of irritant exposures, the prevalence of hand eczema in workers with wet work exposures remains high at approximately 20%. Patch test database surveillance systems have documented reductions in the occurrence of sensitivity to some allergens such as chromium wherein regulatory efforts have reduced workplace exposures. These surveillance data have also documented increases in sensitivity to several allergens in particular trades, serving as an effective system to identify new exposure situations or new allergens. The impact of OCD on quality of life and mental health conditions, employment and financial aspects is increasingly documented. Progress in understanding the underreporting of OCD and the underlying reasons continues. Several groups have developed robust multidisciplinary secondary and tertiary prevention programmes and the evaluations demonstrate promise. Although several recent systematic reviews have documented the evidence for various prevention strategies, there is increasing understanding of the gaps in prevention practices in actual workplaces. Understanding of the underlying genetic and environmental agents contributing to OCD is increasing. In spite of progress with reducing exposure to some allergens, the prevalence of OCD continues to be high, particularly related to wet work. New prevention programmes are being developed and evaluated and hold promise for improved outcomes.

Prevalence of Occupational Contact Dermatitis to Mercaptobenzothiazole in a Population of Seamen and Prognosis after 3-Year Evaluation

Background: The prevalence of contact dermatitis to mercaptobenzothiazole (MBT) in the maritime work place and its prognosis have been poorly studied. Objectives: Determining the clinical presentation as well as the annual incidence rate of on set of skin allergies to MBT in the maritime workplace, and attempting to gauge the social and professional impact of this condition on affected seafarers. Materials and methods: Analysis of the medical records of the seafarers who reported a skin allergy to MBT in 2008, and calculation of the prevalence of this condition amongst the 35 563 professional seafarers exposed to MBT in France because they wear work clothes made of synthetic rubber in their occupational activities (catch handling, merchant shipping or shellfish farming). Results: We found only three cases in professional fishermen. In all cases, the dermatitis persisted despite the arrest of exposure to MBT, and made very difficult, the continuation of their professional life of these patients in the fishing sector. Conclusion: The prevalence of contact dermatitis to MBT in the maritime sector is 1/10 000. The 3-year prognosis is poor since the seafarers affected by this disease reported the persistence of lesions and the health-imposed obligation to cease working in the fishing industry.

Assessment of the Mathias Criteria for Establishing Occupational Causation of Contact Dermatitis

BackgroundDermatoses account for up to 30% of occupational diseases. Of these, 90% correspond to contact dermatitis, a disease associated with a marked economic burden and considerably impaired quality of life. In 1989, Toby Mathias proposed 7 criteria to assess the relationship between contact dermatitis and occupation. ObjectiveTo assess the Mathias criteria for establishing occupational causation of contact dermatitis in patients with dermatoses. Materials and methodsThis was a descriptive study of 103 patients with dermatoses, attended consecutively between January and March of 2009 in the immunology and skin allergy department of the Parc de Salut Mar, Barcelona, Spain. The diagnosis of an occupational cause of the skin complaint by a specialist after interviewing the patient was correlated with diagnosis according to the Mathias criteria, applied by an independent specialist. Descriptive and inferential statistics were calculated. ResultsAn occupational cause was identified in 13 patients according to the Matthias criteria and in 12 according to the judgment of the dermatologist. The sensitivity for the Mathias criteria was 100% and the specificity was 98.90%, with a positive predictive value of 92.31% and a negative predictive value of 100%. The prevalence of occupational contact dermatitis was 11.65%. ConclusionsThe Mathias criteria show a high validity and diagnostic yield, making them useful for establishing occupational causation of contact dermatitis. We believe that application of these criteria would help improve diagnostic and prognostic accuracy in occupational contact dermatitis.

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

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

Evaluación de los criterios de imputabilidad de dermatosis profesional definidos por Mathias

BackgroundDermatoses account for up to 30% of occupational diseases. Of these, 90% correspond to contact dermatitis, a disease associated with a marked economic burden and considerably impaired quality of life. In 1989, Toby Mathias proposed 7 criteria to assess the relationship between contact dermatitis and occupation. ObjectiveTo assess the Mathias criteria for establishing occupational causation of contact dermatitis in patients with dermatoses. Materials and methodsThis was a descriptive study of 103 patients with dermatoses, attended consecutively between January and March of 2009 in the immunology and skin allergy department of the Parc de Salut Mar, Barcelona, Spain. The diagnosis of an occupational cause of the skin complaint by a specialist after interviewing the patient was correlated with diagnosis according to the Mathias criteria, applied by an independent specialist. Descriptive and inferential statistics were calculated. ResultsAn occupational cause was identified in 13 patients according to the Matthias criteria and in 12 according to the judgment of the dermatologist. The sensitivity for the Mathias criteria was 100% and the specificity was 98.90%, with a positive predictive value of 92.31% and a negative predictive value of 100%. The prevalence of occupational contact dermatitis was 11.65%. ConclusionsThe Mathias criteria show a high validity and diagnostic yield, making them useful for establishing occupational causation of contact dermatitis. We believe that application of these criteria would help improve diagnostic and prognostic accuracy in occupational contact dermatitis.

The prevalence and possible causes of contact dermatitis in farmworkers

The National Agricultural Workers Survey estimates that immigrants constitute approximately 78% of the migrant and seasonal farmworkers in the United States. Migrant farmworkers, defined as those traveling at least 75 miles and establishing a temporary abode within the previous year for work, made up 42% of the crop workers in 2001–2002.1 Farmworkers are exposed to hazardous working conditions, such as exposure to pesticides, working long hours in hot climates, and working with dangerous machinery. These working conditions predispose agricultural workers to occupational skin disease, among other health problems.2 Contact dermatitis, an irritating and inflammatory skin reaction to a foreign substance, is one of the most common skin problems among farmworkers. However, there is limited research involving the prevalence and specific etiologies of contact dermatitis in migrant farmworkers. In many countries, occupational contact dermatitis is the most common reportable occupational disease, and makes up 30% of payable compensation.3 It is difficult to accurately compare data from different countries due to differences in the reporting of occupational diseases and the fact that national registries are often incomplete.4 In the United States, the Bureau of Labor Statistics acquires data regarding occupational disease from an annual survey that includes a representative random sample of business establishments in private industries. In the sector of agriculture, forestry, fishing, and hunting, the incidence of nonfatal occupational injuries/illnesses was 6.4 per 100 full time workers, second only to manufacturing in the goods producing industries.5 However, the incidence of occupational skin disease may actually be underreported of by 10 to 50 times, according to some estimates.4 Due to the paucity of data specific to skin disease in migrant farmworkers, we describe the existing knowledge on the prevalence of occupational contact dermatitis in any farmworker.

Occupational contact dermatitis: Etiology, prevalence, and resultant impairment/disability

Cutaneous irritant and allergic responses account for the vast majority of cases of occupational contact dermatitis (OCD). Although the pathophysiologic responses to these two different exposures are distinct, the clinical differentiation between chronic cumulative irritant contact dermatitis and allergic contact dermatitis can be difficult and frequently requires patch testing. This article reviews the recommended algorithms that clinicians should utilize to assess whether a worker suffers from OCD. The prevalence of OCD, its predisposing factors (both endogenous and exogenous), and prognosis are discussed in depth. Finally, issues surrounding the assessment of impairment and disability resulting from OCD are summarized.

FS13.6 Risk management for workplace dermal exposure – a practical approach

Contact dermatitis remains one of the most common forms of occupational ill health in most industrial countries. Eliminating or minimising contact can significantly reduce the incidence and prevalence of occupational contact dermatitis. However, this is often believed by managers to be associated with either expensive measures, such as constly changes in the process or in the need for expensive new equipment, or with the provision of personal protective equipment such as gloves. Frequently, however, an analysis of the actual source of exposure can lead to a simple change that can have a significant effect in elimninating or controlling exposure. In many cases not only has this led to the elimnination of the skin problems, but also to a reduction in operating costs and/or an improvement in productivity. A structured approach to the elimination or adequate control of exposure will be explained and its benefits illustrated by a number of case studies where simple intervention methods have achieved the desired results.

Incidence of work-related hand eczema during apprenticeship: first results of a prospective cohort study in the car industry.

Data on the incidence and prevalence of occupational contact dermatitis (OCD) are scarce, and most of our knowledge about OCD is derived from clinical case reports or clinical studies of in-and out-patients. Therefore, we investigated in the epidemiological, prospective Audi cohort study (PACO study) the incidences of work-related hand eczema in different apprenticeships of Audi AG. In total, 2078 apprentices were investigated at the start of their apprenticeship and systematically followed up over a 3-year period. At the end of the study, information on 2042 (98.2% follow-up) apprentices was available. The 1-year cumulative incidences of hand eczema were 9.2% (95%-confidence interval 7.8-10.7) in metalworkers, 8.8% (95%-CI 7.0-10.7) in other blue-collar workers, and 4.6% (95%-CI 2.3-8.1) in white-collar apprentices. The 3-year cumulative incidences of hand eczema were 15.3% (95%-CI 13.6-17.2) in metalworkers, 14.1% (95%-CI 11.8-16.5) in other blue-collar workers, and 6.9% (95%-CI 4.0-10.9) in white-collar apprentices. In females, the cumulative incidence of hand eczema was higher compared to men (1-year incidence 10.1%, 95%-CI 7.7-13.0, versus 8.3%, 95%-CI 7.1-9.5; 3-year incidence 16.1%, 95%-CI 13.1-19.5 versus 13.6%, 95%-CI 12.2-15.2). In some occupations, like cooks, tool mechanics, milling cutters and varnishers, the incidence of hand eczema was significantly increased. In those occupations, however, no job change was necessary, and no notifiable occupational contact dermatitis occurred. The incidence was not uniformly distributed over the 3-year period. Within the first 6 months, a particularly high rate of hand eczema occurred, which then declined and remained steady at a lower rate over the 2nd and the 3rd years. The results of our study give important suggestions for preventive measures at the workplace and effective occupational pre-employment advices.