Work-related Skin Research Articles

Skin and respiratory symptoms among workers with suspected work-related disease

Many workers are exposed to chemicals that can cause both respiratory and skin responses. Although there has been much work on respiratory and skin outcomes individually, there are few published studies examining lung and skin outcomes together. To identify predictors of reporting concurrent skin and respiratory symptoms in a clinical population. Patients with possible work-related skin or respiratory disease were recruited. An interviewer- administered questionnaire collected data on skin and respiratory symptoms, health history, smoking habits, workplace characteristics and occupational exposures. Predictors of concurrent skin and respiratory symptoms were identified using multiple logistic regression models adjusted for age, sex and atopy. In total, 204 subjects participated; 46% of the subjects were female and the mean age was 45.4 years (SD = 10.5). Most subjects (n = 167, 82%) had possible work-related skin disease, compared with 37 (18%) subjects with possible work-related respiratory disease. Subjects with a history of eczema (OR 3.68, 95% CI 1.7-7.8), those from larger workplaces (OR 2.82, 95% CI 1.8-7.4) and those reporting respirator use at work (OR 2.44, 95% CI 1.2-4.8) had significantly greater odds of reporting both work-related skin and respiratory symptoms. Current smoking was also associated with reporting concurrent skin and respiratory symptoms (OR 2.57, 95% CI 1.2-5.8). Workers reported symptoms in both systems, and this may be under-recognised both in the workplace and the clinic. The association between history of eczema and concurrent skin and respiratory symptoms suggests a role for impaired barrier function but needs further investigation.

Occupational skin cancer induced by ultraviolet radiation and its prevention

Skin cancer is by far the most common kind of cancer diagnosed in many western countries and ultraviolet radiation is the most important risk factor for cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Although employees at several workplaces are exposed to increased levels of UV radiation, skin cancer due to long-term intense occupational exposure to UV radiation is often not considered as occupational disease. The actually available evidence in the epidemiological literature clearly indicates that occupational UV radiation exposure is a substantial and robust risk factor for the development of cutaneous SCC and also clearly shows a significant risk for developing BCC. There is enough scientific evidence that outdoor workers have an increased risk of developing work-related occupational skin cancer due to natural UV radiation exposure and adequate prevention strategies must be implemented. The three measures which are successful and of particular importance in the prevention of nonmelanoma skin cancer in outdoor workers are changes in behaviour regarding awareness of health and disease resulting from exposure to natural UV radiation, protection from direct UV radiation by wearing suitable clothing, and regular and correct use of appropriate sunscreens.

Workers with occupational contact dermatitis: workplace characteristics and prevention practices

There are many gaps in knowledge related to prevention practices in place for workers who subsequently develop occupational contact dermatitis (OCD). To describe the workplace characteristics and the prevention practices in workplaces where workers developed hand dermatitis. Consecutive cases of probable OCD were enrolled from a specialist occupational health clinic. At the time of the initial assessment, questionnaires were administered to collect information about clinical presentation, workplace characteristics and prevention practices at work. 100 workers with hand dermatitis were enrolled in the study and 78 were considered to have OCD. Two-thirds of these had had some occupational health and safety or Workplace Hazardous Materials Information System (WHMIS) training in their workplace, however, training related to glove use and skin care was less common. Unionized workers were more likely to have received training. Workers involved in wet work were less likely to report training. These findings suggest that there are gaps in prevention programs for work-related skin disease. Research is needed on effective strategies that are sustainable in the workplace.

Occupational skin diseases

Occupational skin diseases are the most commonly reported notifiable occupational diseases. In Germany, 23 596 out of a total of 71 263 reported occupational diseases in 2010 were classified as occupational skin diseases (BK No. 5101: "severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease"). Contact dermatitis (allergic, irritant) of the hands is the most common skin disease and atopic skin diathesis is often an important co-factor. The number of work-related skin diseases is many times higher than the number of notified occupational dermatoses. This CME article explains the legal framework of occupational diseases, the tasks and obligations of the legal statutory work insurance. Typical allergens and irritants of high risk professions are also presented as are the important steps from diagnosis to compensation. Early prevention of occupational skin diseases is very important to avoid severe chronic hand eczema. Therefore the "dermatologist's report" is crucial. Other occupational dermatoses (outside of BK 5101) are briefly mentioned. In recent years the number of notifications of occupational skin cancer due to occupational UV-irradiation has increased. According to recent epidemiological findings, there is a significant and consistent positive association between occupational UV-irradiation and squamous cell carcinoma. Therefore, an important criterion for a new occupational disease is fulfilled.

Occupational respiratory and skin diseases among Finnish machinists: findings of a large clinical study

Machinists are exposed to many sensitizing and irritant substances, but no previous study has assessed the occurrence of clinically verified occupational diseases in an unselected large workforce of machinists. Our aim was to study the occurrence of clinically verified occupational respiratory and skin diseases cross-sectionally in a large sample of machinists in southern Finland. A computer-assisted telephone interview on occupational exposures and health was carried out in a sample of 961 machining workers from 64 metalworking companies. Of these, 757 (79%) answered the interview. A total of 245 subjects reported work-related respiratory or skin symptoms and were invited to clinical examinations; 138 of these underwent a clinical interview and examination by an occupational health physician. On the basis of this examination, 32 subjects were further examined at the Finnish Institute of Occupational Health (FIOH) for occupational skin or respiratory diseases. One case of occupational asthma (OA) and seven cases of occupational dermatoses (OD) were diagnosed, giving a prevalence of 0.13% (95% CI 0-0.39) for OA, and 0.92% (95% CI 0.24-1.16) for OD. The OA was induced by the patient's own MWF. Additional five cases of newly diagnosed non-occupational asthma (0.79%, 95% CI = 0.16-1.42) were detected. No cases of occupational rhinitis or COPD were diagnosed. The dermatoses diagnoses consisted of four cases of allergic contact dermatitis and three cases of irritant contact dermatitis. The most common causes of the ODs were MWFs. This large clinical study of machinists representing metalworking in South Finland showed a prevalence of 0.13% of OA and 0.92% of OD. This relatively low occurrence of occupational diseases may reflect the strict Finnish criteria for the diagnosis of these occupational diseases and the relatively good level of occupational hygiene in machining workshops in Finland. Reported respiratory and skin symptoms were common, and these milder conditions may be linked to irritant rather than sensitizing exposures.

Skin symptoms in bakery and auto body shop workers: associations with exposure and respiratory symptoms

PurposeDespite the importance of skin exposure, studies of skin symptoms in relation to exposure and respiratory symptoms are rare. The goals of this study were to describe exposure–response relationships for skin symptoms, and to investigate associations between skin and respiratory symptoms in bakery and auto body shop workers.MethodsData from previous studies of bakery and auto body shop workers were analyzed. Average exposure estimates for wheat allergen and isocyanates were used. Generalized linear models were constructed to describe the relationships between exposure and skin symptoms, as well as between skin and respiratory symptoms.ResultsData from 723 bakery and 473 auto body shop workers were analyzed. In total, 5.3 % of bakery and 6.1 % of auto body shop workers were female; subjects’ mean age was 39 and 38 years, respectively. Exposure–response relationships were observed in auto body shop workers for itchy or dry skin (PR 1.55, 95 % CI 1.2–2.0) and work-related itchy skin (PR 1.97, 95 % CI 1.2–3.3). A possible exposure–response relationship for work-related itchy skin in bakery workers did not reach statistical significance. In both groups, reporting skin symptoms was strongly and significantly associated with reporting respiratory symptoms, both work-related and non-work-related.ConclusionsExposure–response relationships were observed for skin symptoms in auto body shop workers. The lack of significant exposure–response associations in bakery workers should be interpreted cautiously. Workers who reported skin symptoms were up to four times more likely to report respiratory symptoms. Improved awareness of both skin and respiratory outcomes in exposed workers is needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s00420-012-0760-x) contains supplementary material, which is available to authorized users.

Biomarkers of exposure to polycyclic aromatic hydrocarbons (PAHs) and DNA damage: a cross-sectional pilot study among roofers in South Florida

ObjectiveThe main goal of this pilot study was to assess the technical and logistic feasibility of a future study. The research hypothesis is that occupational exposures to polycyclic aromatic hydrocarbons...

Investigating skin cancer case reporting to The Health and Occupation Reporting (THOR) network

ObjectivesIn 2008, the World Health Organisation reported that one in three cancers diagnosed is dermatological. Exposures that are associated with work-related skin malignancy include radiation (ultraviolet and ionising), polycyclic aromatic...

How to quantify skin impairment in primary and secondary prevention? HEROS: a proposal of a hand eczema score for occupational screenings

Skin scoring systems have to meet specific demands depending on their particular settings and indications, e.g. occupational screenings vs. clinical examinations, evaluating progress of treatment or supervision of preventive strategies. Until now, most scoring systems have been developed for severe cases of hand eczema. A validated quantitative scoring system for early hand eczema is still missing. The present cross-sectional study was aimed at assessing the practical value of a quantitative hand eczema score for occupational screenings (HEROS) at the workplace and its potential for identifying individuals at increased risk of work-related skin disease. Both hands of 800 male metal workers were examined for characteristic morphological patterns of hand dermatitis and quantified with HEROS. The score was validated by testing inter- and intraobserver reliability in random samples. Results of validation were compared with three already validated skin scores for distinct hand eczema (Osnabrück hand eczema severity index, hand eczema severity index, Manuscore). The score values ranged from 0 to 82 (theoretical maximum 2260), reflecting the skin condition of healthy, fit-for-work subjects. Inter- and intraobserver reliability was good to excellent. Results for reliability of the HEROS were in line with all three validated scores for hand eczema. The predictive value for identifying persons at increased risk for developing hand eczema was low. The HEROS seems to be an adequate tool for observer near-independent assessment of early hand eczema, especially for quantifying minimal skin impairment. Therefore, we propose the implementation of this scoring system for quantifying early hand dermatitis in occupational screenings.

Dermatological screening and results of patch testing among Polish apprentice hairdressers

High prevalence of occupational dermatoses among hairdressers has been confirmed in many studies, while work-related skin disorders in apprentice hairdressers are less known. The aim of the study was to investigate the frequency of work-related skin disorders among apprentice hairdressers, and to identify the factors contributing to the development of dermatoses during vocational training. One hundred thirty-nine apprentice hairdressers, aged 17-19 years, were included in the study. A questionnaire survey, personal interview, dermatological examination and patch tests were conducted. Present or past work-related skin conditions affecting the hands were reported by 43.9% of individuals, and diagnosed in 25.9% on dermatological examination. Positive patch test results were found in 38.1%. The most frequent allergens were nickel (29.3% of all tested) and ammonium persulfate (8.3%). Allergic contact dermatitis was recorded in 27.3%, and was of occupational origin in 87.9% of all tested individuals. Irritant contact dermatitis was diagnosed in 51.1% of participants (this prevalence was higher than that based only on an interview). Survey responses revealed inadequate knowledge of the risk of occupational skin diseases and protective measures. It is necessary to implement an educational programme for apprentice hairdressers, in order to increase their knowledge of the risk of skin damage and to promote appropriate use of protective measures, starting from the earliest stages of their training.

A Survey of Work-Related Skin Diseases in Different Occupations in Poland

Occupational skin disorders, in particular inflammations, dryness and erythema, in 80% of cases affect the skin of hands. The most frequent diagnosis, in over 90% of cases of occupational skin diseases, points to an irritant or allergic contact dermatitis. Our aim was to study the prevalence of self-reported skin symptoms on hands and forearms in different populations. The study was conducted on 581 healthcare workers, 61 hair stylists, 149 beauticians, 90 food services workers, 90 cleaners, 181 metal factory workers and 69 textile workers. Healthcare workers had greatest exposure. Eighty-six percent of dentists, 67% of midwives, 51% of nurses and 41% of physicians reported skin disorders. Problems with latex gloves were declared by 30% of healthcare workers. Thirty-four percent of food services workers, 24% of textile workers, 30% of metal factory workers, 21% of hair stylists and beauticians, and 64% of cleaners reported skin manifestations during the time of employment, which they thought could be work-related.

Improving estimates of specialist-diagnosed, work-related respiratory and skin disease

Work-related skin and respiratory disease still constitute an important part of the work-related ill-health (WRIH) burden of Great Britain (GB). It is therefore important to be able to accurately quantify the true incidence of these two groups of disease. To improve the accuracy of the methodology to estimate clinical specialist incidence rates, with a focus on skin and respiratory disease. Specifically, we sought to estimate the number of additional cases not captured by voluntary surveillance through The Health and Occupation Reporting (THOR) network and provide a better estimation of the true incidence of work-related skin and respiratory disease in GB. Cases not captured by THOR in 2005-2007 due to non-participation of eligible clinical specialists and due to <100% response rates by THOR participants were estimated, and the numerator adjusted accordingly. Adjusted incidence rates were calculated using Labour Force Survey data as the denominator. During 2005-2007, 62% of skin cases and 60% of GB respiratory cases were likely to have been captured by THOR. After adjustment, dermatologist-derived incidence rates for skin disease were raised from 9 to 14 per 100,000 employed, while those for respiratory disease were raised from 10 to 17 per 100,000 employed. We have provided a significant improvement in the surveillance-based methodology used to estimate the number of cases of WRIH captured by THOR and hence enabled more accurate estimations of GB incidence rates for clinical specialist-reported WRIH.

Evidence‐based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria*

Occupational contact dermatitis is the most frequently reported work-related skin disease in many countries. A systematic review was commissioned by the British Occupational Health Research Foundation in response to a House of Lords Science and Technology Committee recommendation. The systematic review aims to improve the prevention, identification and management of occupational contact dermatitis and urticaria by providing evidence-based recommendations. The literature was searched systematically using Medline and Embase for English-language articles published up to the end of September 2009. Evidence-based statements and recommendations were graded using the Royal College of General Practitioner's three-star system and the revised Scottish Intercollegiate Guidelines Network grading system. Three thousand one hundred and fifty-five abstracts were identified and screened. From these, 786 full papers were obtained and appraised. One hundred and nineteen of these studies were used to produce 36 graded evidence statements and 10 key recommendations. This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification and occupational management of occupational contact dermatitis and urticaria, based on and using the best available medical evidence.

10 years quality assurance of the dermatologist's procedure. ABD review board part II: 2003–2009

The dermatologist's procedure ("procedure for early detection of occupational skin diseases") enables dermatologists to conduct the relevant diagnostics at the expenses of the statutory employers' liability insurance funds (UVT) if there is a possibility of a work-related skin disorder in an employee. Acceptance of this most relevant tool for secondary prevention in occupational dermatology in Germany is high and most dermatologists make careful use of this unparalleled privilege. However, there have been occasional complaints by the UVT, concerning overly extensive diagnostics. Consequently, the Task Force on Occupational and Environmental Dermatology (ABD) of the German Society of Dermatology set up a review board in May 1999. Dermatologists' reports in question were submitted by the UVT to the review board and reviewed separately by two experienced occupational dermatologists both in the 1(st) period (1999-2003) and now in the second period (June 2003 - November 2009). The criticism of the reviewers was mostly directed towards the number of tests and an insufficient documentation in the dermatologist's report. There were 69 dermatologists' reports submitted to the review board (as compared to 155 in the 1(st) period). The decreased number of dermatologists' reports submitted could be a result of the review process itself. Other factors may include the optimization of the dermatologist's report with a better reimbursement as well as the recent publication of guidelines and continuous education in occupational dermatology with certification of more than 700 dermatologists. These measures of quality assurance are aimed to further optimize the dermatologist's procedure and to allow for improved and more rapid care for patients with occupational dermatoses by dermatologists.

Differential effects of a tertiary individual prevention programme for patients with occupational skin disease depending on diagnosis

Occupational skin disease (OSD) is common. Tertiary individual prevention programmes (TIP) aim at helping individuals with refractory OSD to remain active in the workforce. Evidence exists that these interventions improve skin protection behaviour related cognitions. However, it is not clear whether these effects generalize to all types of OSD. To evaluate whether effects on socio-cognitive determinants of skin protection behaviour vary between patients with work related atopic dermatitis (AD) and other work related skin diseases. A total of 14 inpatients with work related AD and 87 inpatients with other work related skin diseases completed measures on socio-cognitive determinants of skin protection behaviour before and after a 3-week inpatient TIP. Mixed model analyses, using maximum-likelihood estimation tested whether there were differential effects of the intervention on socio-cognitive determinants of skin protection behaviour. Although patients with AD reported more favourable cognitions towards skin protection behaviour than patients with other skin diseases at admission, these cognitions deteriorated or remained on the same level. Patients with other forms of OSD on the other hand developed more favourable cognitions during the intervention. Professionals working in the field of OSD should not cease to assist AD patients in achieving optimal skin protection behaviour. Tertiary individual prevention measures may need to pay more attention to the needs of individuals with an occupationally relevant AD. This may contribute to their being able to remain active in the workforce. The alternative would entail regular sick leave, poorer quality of life and economic hardship for the AD patient.

Exposure to poultry dust and health effects in poultry workers: impact of mould and mite allergens

The aim of the study was to evaluate exposure to moulds and house dust mite Dermatophagoides pteronyssinus in poultry farms, and related health effects in poultry workers (PW). The study involved 41 PW and 45 control office workers. Working environment was evaluated for D. pteronyssinus allergen (Der p 1), moulds and endotoxin. In workers, eye, skin and respiratory symptoms, ventilatory lung function, atopy markers (skin prick test to inhalatory allergens, total IgE) and specific IgG to moulds were assessed. Der p 1 levels ranged <0.1-3.3 microg/g, exposure to fungi was 4.9 x 10(3)-6.8 x 10(4) cfu/m(3), with prevailing Aspergillus, Penicillium and Mucor species, and endotoxin levels ranged 230-284 EU/m(3). In comparison to control subjects, significantly higher prevalence of work-related nose, asthma, eye and skin symptoms, and slight decline in ventilatory lung function was found in PW. PW had significantly higher prevalence of IgG antibodies to moulds comparing to controls (63 vs. 36%, respectively, P = 0.01), especially to Alternaria and Aspergillus species. The prevalence of atopy markers in PW was lower than in population-based studies. Hazardous levels of Der p 1, endotoxin and moulds were determined in poultry houses. High prevalence of work-related symptoms and IgG antibodies to moulds was found in PW. Healthy worker effect is proposed as an explanation of low atopy markers prevalence among PW.

Prevention of work-related skin diseases: teledermatology as an alternative approach in occupational screenings

Prevention of occupational skin diseases is of high socio-economic impact. Implementing teledermatology into preventive occupational screenings holds obvious advantages; nevertheless, studies concerning this subject are scarce. The present cross-sectional study was aimed at determining if results of a teledermatological examination are equally sensitive and specific at detecting minimal skin lesions as the conventional face-to-face examination. The skin condition of the hands of 100 male wet workers was assessed in a face-to-face examination and a tele-examination by means of a score for minimal skin lesions. The comparison of the total score values that each participant received in face-to-face examination with those obtained in tele-examination proved the skin condition to be estimated significantly worse when seen in tele-examination (P < 0.0001). The median values of the sum totals and the median values for secondary lesions were higher in the tele-examination than in the face-to-face examination. Our findings show a tendency in tele-examination to assess the skin condition more critically in comparison with face-to-face examination. The teledermatological examination is sufficiently sensitive in detecting early signs of hand eczema, whereas signs for chronicity may get overestimated.

Prévalence et facteurs de risque de gênes respiratoires et cutanées parmi le personnel soignant de différents centres de soins (publics et privés) de l’Hérault

Aim Healthcare workers (HCW) are exposed to many allergens and irritants such as latex and disinfectants. Our objective was to assess the prevalence and the risk factors of occupational asthma and skin disorders amongst HCW. Patients and Methods We conducted a multicenter survey in 11 medical centers, based on a questionnaire, skin prick-tests and spirometry. Three hundred and sixty-eight HCW were enrolled in our survey. These volunteers were separated into three groups according to the degree of latex glove and disinfectants exposures. Results Work related skin symptoms were present in 90 (46.9%) of HCW who complained with skins symptoms, work related rhinitis symptoms in 44 (19.8%) and work related lower respiratory symptoms with wheezing in 29 (17.9%). Symptoms related to latex gloves use were reported by 70 (19%) staff members, mostly cutaneous symptoms. About half of the workers interviewed (165 persons) used latex gloves, powdered in 47.8%. Concerning disinfectant use, 90 workers (24.4%) had respiratory symptoms (47 workers), skin symptoms (31 workers), sneezing (30 workers) or ophthalmologic symptoms (four workers). The overall prevalence of latex allergy was 3.3% (12 persons), and this percentage was higher (3.6%) in the most exposed departments as compared to the least exposed (2.8%). Conclusion Work related respiratory and skin symptoms are frequently reported by HCW, mostly with the use of powdered latex gloves and disinfectants. Primary and secondary preventive measures should take these risks into account.

Measurement of trends in incidence of work-related skin and respiratory diseases, UK 1996–2005

Objectives:The ability to measure temporal trends in disease incidence is important, but valid methods are needed. This study investigates UK trends during 1996–2005 in work-related skin and respiratory diseases including...

Identification of Mold and Dampness‐Associated Respiratory Morbidity in 2 Schools: Comparison of Questionnaire Survey Responses to National Data

Dampness and mold problems are frequently encountered in schools. Approximately one third of US public schools require extensive repairs or need at least 1 building replaced. This study illustrates how national data can be used to identify building-related health risks in school employees and students. School employees (n = 309) in 2 elementary schools (schools A and B) with dampness and mold problems completed standardized questionnaires. Responses were compared with participant responses from the 3rd National Health and Nutrition Examination Survey and were indirectly standardized for gender, age, smoking status, and (for school B) race. Uncontrolled comparisons were made to responses from a study of office workers, as well as between responses from school employees in different sections of the school buildings designated by decade of construction. Employees from both schools had excess work-related throat and lower respiratory symptoms, as well as eye, nasal, sinus, and wheezing symptoms. School B employees also had excess physician-diagnosed asthma and work-related fatigue, headache, and skin irritation. Employees in sections of the school buildings that were categorized as having greater dampness and mold contamination had more frequent upper and lower respiratory symptoms than employees working in other building sections. This noncostly type of analysis of indoor air quality complaints can be used to motivate and prioritize building remediation in public schools where funds for building remediation are usually limited.