Current understanding of frictional dermatoses: A review

Human skin is continually exposed to internal and external forces, dynamic as well as static. The skin is normally flexible and can resist mechanical trauma due to friction, pressure, vibration, suction and laceration to a considerable degree. However, an excess of these forces can abnormally affect the structure and function of the skin, setting the stage for the development of a skin disorder. Repetitive trauma can cause lichenification, hyperpigmentation, erythema, scaling, fissuring, blisters, ulceration and chronic alterations. Frictional dermatoses is an under-recognised entity with no clear-cut definition and encompasses a variety of terms such as frictional dermatitis, frictional melanosis, frictional pigmentary dermatoses and certain other named entities, many of which are confusing. The authors propose to define frictional dermatoses as ‘a group of disorders caused by repetitive trauma to the skin as a result of friction of varied aetiology which can have a wide range of cutaneous manifestations depending on the type of insult.’ The exact prevalence of frictional dermatoses as a separate entity is unknown. Authors who conducted this review include a group of dermatologists and post graduate students from various institutions. Literature was reviewed through PubMed, Medscape, Medline, ResearchGate and Google Scholar using the terms ‘frictional dermatitis,’ ‘friction and skin,’ ‘dermatoses and culture,’ ‘clothing dermatitis,’ ‘friction melanosis,’ ‘PPE induced dermatoses in COVID-19 era,’ etc. A total of 122 articles were reviewed and 100 articles among them were shortlisted and included in the study, after removing duplications. The review was followed up with further deliberation which resulted in the formulation of a new definition and classification of frictional dermatoses taking into account the morphology, histopathological characteristics, anatomical region affected and the major predisposing factors. The rising incidence of mechanical dermatoses in the COVID-19 era was also emphasised.

Occupational Dermatosis- A Neglected Entity.

Skin is our primary interface with the external environment. Occupational dermatosis is defined as any pathological condition of the skin for which job exposure can be a major direct or contributory factor. The commonest is work-related contact dermatitis (~90%). The other 10% includes infections, urticaria, chemical burns, photodermatitis, cutaneous malignancies etc. It is not only a health problem but also an economic issue. Aim of the study was to examine the epidemiological and clinical characteristics of workers with occupational skin disease.METHODSData on demography, age, sex, education, type of occupation, type of dermatosis, and possible etiological factor were collected based on a pre-tested, semi structured questionnaire. This is a cross-sectional study conducted in a tertiary care centre during the period of June 2017 to May 2018.RESULTSIncidence among males and females was almost the same and majority were from rural areas and had finished primary schooling. Mean age was between 25 to 44 years. Majority of patients were farmers and were having intertrigo, moniliasis, photodermatitis, or contact dermatitis. Contact dermatitis was the most common disease in our study, with cement being the most common causative factor in males and soaps/detergents in females.CONCLUSIONSTo conclude, most of the patients were farmers as agriculture is one of the main occupations in our country and among the dermatoses, contact dermatitis was the most common in our study with cement being the most common causative factor among males.

Occupational Dermatoses by Type of Work in Greece

BACKGROUND: To elucidate the relationship between seven occupational dermatoses (ODs) and 20 types of work in Greece. METHODS: This was a prevalence epidemiologic study of certain ODs among 4,000 workers employed in 20 types of enterprise, in 104 companies, in 2006-2012, using data from company medical records, questionnaires, occupational medical, and special examinations. The chi2 test was applied to reveal statistically significant relationships between types of enterprises and occurrence of ODs. RESULTS: A high percentage (39.9%) of employees included in the study population suffered from ODs. The highest prevalence rates were noted among hairdressers (of contact dermatitis: 30%), cooks (of contact dermatitis: 29.5%), bitumen workers (of acne: 23.5%), car industry workers (of mechanical injury: 15%), construction workers (of contact urticaria: 29.5%), industrial cleaning workers (of chemical burns: 13%), and farmers (of malignant tumors: 5.5%). We observed several statistical significant correlations between ODs (acute and chronic contact dermatitis, urticaria, mechanical injury, acne, burns, skin cancer) and certain types of enterprises. There was no statistically significant correlation between gender and prevalence of ODs, except for dermatoses caused by mechanical injuries afflicting mainly men [chi2 (1) = 13.40, p < 0.001] and for chronic contact dermatitis [chi2 (1) = 5.53, p = 0.019] afflicting mainly women. CONCLUSION: Prevalence of ODs is high in Greece, contrary to all official reports by the Greek National Institute of Health. There is a need to introduce a nationwide voluntary surveillance system for reporting ODs and to enhance skin protection measures at work.

Skin in aviation and space environment.

The aerospace environment is a dynamic interaction between man, machine and the environment. Skin diseases are not particularly significant aeromedically, yet they could permanently affect an aviator's status for continued flying duty. A number of dermatological conditions lend themselves to flying restrictions for the aviator. Aircrew and ground crew are exposed to a myriad of elements that could also adversely impact their flying status. Inflight stresses during flights as well as space travel could impact certain behaviors from a dermatological standpoint. With the advent of space tourism, dermatological issues would form an integral part of medical clearances. With limited literature available on this subject, the review article aims to sensitize the readers to the diverse interactions of dermatology with the aerospace environment.

Occupational Dermatoses of Health Care Workers in Korea / 대한피부과학회지

No statistics for occupational dermatoses of health care workers are available in Korea. Therefore, a survey, using a questionnaire, was conducted to evaluate the prevalence of occupational skin diseases among the health care workers employed at two large hospitals. A total of 1138 (55.8%) out of 2041 hospital workers answered the questionnaire, and 465 (40.9%) indicated that they had experienced one or more skin diseases. Of the reported skin diseases among the health care workers, contact dermatitis showed the highest prevalence (41.0%). Nurses had a higher incidence of contact dermatitis than any other health care worker group. In addition to the questionnaire survey, we also reviewed recent reports in the Korean literature to understand our current situation.

Occupational Dermatoses in Foundry Workers at an Automobile Manufacturing Plant / 대한피부과학회지

BACKGROUND: Many employees working in cast iron foundry process at an automobile production plant suffered from similar dermatoses due to occupational exposure. But data on the occupational dermatoses in foundry workers at an automobile production plant have not been reported in Korea. OBJECTIVE: The aim of this study was to evaluate the prevalence of dermatoses in relation to occupational exposure in cast iron foundry process at an automobile production plant. METHODS: 188 workers working in the foundry process were investigated for the presence of dermatoses using a questionnaire and a dermatological examination. The questionnaire included the past or present history of occupational exposure, dermatoses and atopy and so on. Patch test with Korean standard allergen and additional related allergen was performed in 38 workers who were suspected to have contact dermatitis in relation to occupational exposure. RESULTS: The results are summarized as follows; The most common 5 dermatoses were dermatophytoses(40), contact dermatitis(18), folliculitis (11), atopic dermatitis(9) and hand eczema(5). The determined risk factors to the skin were hot environmental condition, silica, organic solvent nickel and chrome. The incidence of irritant contact dermatitis was much higher than that of allergic contact dermatitis. The frequency of irritant contact dermatitis was much higher in atopics than in non-atopics. Contact sensitization was found in 6 workers and sensitizing substances were cobalt, nickel, colophony, quinoline mixture and balsam of Peru. CONCLUSION: Based on these clinical and epidemiological observations, it is suggested that the health and safety educational programs about the occupational dermatoses are needed for workers.

The Survey of Occupational Dermatoses in a Semiconductor Industry(II) (1996.6 - 2000.5) / 대한피부과학회지

BACKGROUND: Occupational dermatoses are the most prevalent of all occupational diseases. Over the past few decades, the incidence of occupational dermatoses in Korea is increasing with rapid growth in industry. However, there have been only a few reports about occupational dermatoses in Korean dermatologic literature. OBJECTIVE: The purpose of this article is to study the prevalence of occupational dermatoses in a semiconductor industry and to compare these with previous reports. METHODS: A dermatologist attended regularly at the clinic in a semiconductor industry once a week from June 1995 to May 2000. 4, 985 workers diagnosed with skin disease were analyzed. RESULTS: The results can be summarized as follows: Annual incidences are 6.5%(1995.6-1996.5), 5.3%(1996.6-1997.5), 5.2%(1997.6-1998.5), 5.7%(1998.6-1999.5), 5.8%(1999.6-2000.5) and average incidence is 5.7%. In the distribution of dermatoses as disease groups, eczema(28.8%), fungal infection(19.2%), disease of skin appendage(17.6%), erythema, urticaria and drug eruption(9.4%), viral infection(4.9%), constituted 79.9% of the total. Ten most common dermatoses include contact dermatitis(13.1%), acne(12.5%), tinea pedis(11.2%), urticaria(7.5%), hand eczema(6.6%), seborrheic dermatitis(6.2%), onychomycosis(3.0%), alopecia(2.9%), tinea cruris(1.7%) and lichen simplex chronicus(1.6%). Diseases which shows high seasonal distribution in summer are contact dermatitis, tinea pedis, urticaria, tinea cruris. Contact dermatitis(1.7%), acne(1.6%), chemical burn(1.3%) and hand eczema(1.1%) were the most important occupational dermatoses in this survey. The occupational contact dermatitis and acne mainly came from the mask, hood and dust preventing clothes which the workers must wear for 8 hours a day at their work place. Hydrofluoric acid(1.0%) was the main cause of chemical burn. Hand eczema was primarily due to kitchen work, cleaning work and gloves. The other dermatoses related to occupation were trauma, seborrheic dermatitis, atopic dermatitis, xerosis cutis, urticaria, etc. CONCLUSIONS: Comparing these results about occupational dermatoses with previous report (1992.6-1995.5) in a semiconductor industry before, there was relatively low incidence of hydrofluoric acid burn and high incidence of contact dermatitis, acne and hand eczema.

Occupational dermatoses in the Philippines

We are presenting this paper in the hope that it will awaken the interest of the medical profession in the Philippines in the little known--or, at least, little publicized--disease known as industrial dermatoses. To Dr. Gregorio Dizon goes the credit of having first reported, so far as we know, cases of industrial dermatoses in the Philippines. Illustrative cases are presented, and their compensability under our Workmens Compensation Law is discussed. Prevention and treatment are also touched upon. (Summary)

The Survey of Occupational Dermatoses in a Semiconductor Industry for 3 years / 대한피부과학회지

BACKGROUND: Occupational dermatoses are increasing tendency in Korea. But there were only a few reports about occupational dermatoses in Korean dermatologic literatures. OBJECT: For the effective preventive method and having interest in occupational dermatoses, we have done wide ranged basic study about the occupational dermatoses for 3 years in a semiconductor industry. METHODS: The number of workers of the semiconductor industry was 10,500(male 5,000, female 5,500) and finally the number of analysed patients in this survey was 2,736. A dermatologist attended regularly at the clinic in a semiconductor industry once a week for the duration of 3 years from June 1992 to May 1995. Diagnosis was made by clinical findings and investigation about the working environment. RESULTS: 1. The most common dermatoses are contact dermatitis(14.3%), acne(14.0%), seborrheic dermatitis(7.1%) and tinea pedis(6.9%). Urticaria, hand eczerna, abscess, onychomycosis, t.inea versicol or and chemical burn were also observed frequently. 2. Chemical burn(2.0%), contact dermatitis(1.4%) and acne(0.8%) were the most important occupation related dermatoses in this survey. Hydrofluoric acid(1.4%) was the main cause of chemical burn. The occupationa contact dermatitis and acne in this survey were mainly came from the mask, hood and dust preventing clothes which the workers must wear for 8 hours a day at working place. 3. The other dermatoses related to occupation were hand eczema, trauma, nummular eczema, atopic dermatitis, etc.. CONCLUSION: This study regardless of insufficient inspection equipment was done for a relatively long period in the semiconductor industry. In the future, many studies like this will be reported and the studies will give a model of management of occupational dermatoses in Korea.

A Study on the Establishment of Management Methods about Occupational Dermatoses / 예방의학회지

Occupational dermatosis is one of the most prevalent occupational disorders. However, the extent of the occupational dermatoses including incidences and prevalencies of each disease entity, and etiologic materials are not yet well stated in Korea. Authors reviewed the literatures on the statistic data and reports on the occupational dermatoses, and surveyed on the occupational dermatoses in two factories, and surveyed the physicians responsible to the occupational dermatoses with formed questionnaire. The results are as follows; 1. Among medical journals published since 1964, there were 31 articles on the occupational dermatoses. Of 31 articles, 18 were case reports and all others were review articles. Of 18 case reports, 9 were epidemiologic survey. The Workers' Periodic Health Examinations revealed that prevalence of the occupational dermatoses was highest(4.36 per 10,000 workers) in 1974, but number of the cases reported were decreased sharply since 1978 with some tendency to increase since 1987. There were 2,240 reported cases of occupational dermatoses between 1966 and 1992, which is 1.90% of all the reported occupational diseases. Skin infection and injuries due to chemicals were most frequent and there were 6 cases of skin cancer. 2. In an epidemiological survey on the dermatoses among 995 workers in a metal product manufacturing factory and 225 workers with acne, 130 workers with scar, 123 workers with deformity of toe nails. Scars, photosensitivity dermatitis, deformity of finger and toe nails, and acne were more prevalent in the metal product manufacturing factory(p<0.05). In the metal product manufacturing factory, workers treating organic solvents and oils had more dermatoses than those without treating the materials(p<0.05). On the skin patch performed on 16 workers in the metal product manufacturing factory, there were 8 cases of irritation dermatitis and 5 cases of contact dermatitis. Prevalence of contact dermatitis in the metal product manufacturing factory was 1.3%. 3. On the questionnaire survey, 34 dermatologists, 29 doctors of preventive medicine, and 22 family physician replied. The proportion of occupational etiology among all dermatoses assumed by the physicians were below 9%, and the most important occupational dermatosis in Korea was contact dermatitis. Main etiologic materials related to the occupational dermatosis were organic solvent, acid and alkali, and metals. The reason for the scarcity of report of occupational dermatoses were difficulty in diagnosis and physician's ignorance of the occupational etiology. They replied that to prevent the occupational dermatosis in the workplace, the use of protective devices was most important, and development of diagnostic criteria on the occupational dermatoses is urgent. Above results shows us that there is many workers with occupational dermatoses, but they are mostly unreported. Measures to prevent and manage the occupational dermatoses are not satisfactory at present. Hence, authors suggest measures for the precises diagnosis, report and prevention of the occupational dermatoses. a. Dernatikigustm orevebtuve physician, and industrial hygienist should work as a team to examine the high risk group and establish the preventive measures. b. Disease entities, diagnostic criteria of occupational dermatoses should be listed, criteria for the compensation and job fitting at recruitment should be established, and manual for the proper treatment and effective prevention of each occupational dermatosis should be developed. c. Patch test antigens against each occupational category should be developed and it should be available to any physicians responsible. d. To facilitate the diagnosis of occupational dermatoses by the doctors responsible for the Workers' Periodic Health Examination, development of standardized questionnaire, education on the techniques of the patch test, and cooperation with the dermatologist in diagnosis of occupational dermatoses is essential.