Uso de técnicas de aprendizado de máquina para classificação de fatores que influenciam a ocorrência de dermatites ocupacionais / Using machine learning techniques to classify factors that influence the occurrence of occupational dermatitis

Resumo Introdução: realizar a predição de doenças relacionadas ao trabalho é um desafio às organizações e ao poder público. Com as técnicas de aprendizado de máquina (AM), é possível identificar fatores determinantes para a ocorrência de uma doença ocupacional, visando direcionar ações mais efetivas à proteção dos trabalhadores. Objetivo: predizer, a partir da comparação de técnicas de AM, os fatores com maior influência para a ocorrência de dermatite ocupacional. Métodos: desenvolveu-se um código em linguagem R e uma análise descritiva dos dados e identificaram-se os fatores de influência de acordo com a técnica de AM que demonstrou melhor desempenho. O banco de dados foi disponibilizado pelo Serviço de Dermatologia Ocupacional da Fundação Oswaldo Cruz e contém informações de trabalhadores que apresentaram alterações cutâneas sugestivas de dermatite ocupacional no período de 2000-2014. Resultados: as técnicas com melhor desempenho foram: neural network, random forest, support vector machine e naive Bayes. As variáveis sexo, escolaridade e profissão foram as mais adequadas para os modelos de previsão de dermatite ocupacional. Conclusão: as técnicas de AM possibilitam predizer os fatores que influenciam a segurança e a saúde dos trabalhadores, os parâmetros que subsidiam a implantação de procedimentos e as políticas mais efetivas para prevenir a dermatite ocupacional.

Abstract Introduction: to predict work related diseases is a challenge for organizations and the governmental authorities. By means of machine learning (ML) techniques it is possible to identify factors that determine the occurrence of an occupational disease, aiming at taking more effective actions to protect workers. Objective: to predict, by comparing ML techniques, the factors which highly influence the occurrence of occupational dermatitis. Methods: we developed a code in R language and a descriptive analysis of the data and identified the influence factors according to the ML technique that presented the best performance. The database was made available by the Occupational Dermatology Service of Oswaldo Cruz Foundation and assembles information of the workers who experienced cutaneous alterations suggestive of occupational dermatitis between 2000-2014. Results: the techniques which presented the best performance were: neural network, random forest, support vector machine, and naive Bayes. Sex, schooling, and profession were the most adequate variables for the occupational dermatitis prediction models. Conclusion: ML techniques allowed to predict the factors that influence the workers' safety and health, as well as the parameters that subsidize the procedures implementation, and the most effective policies to prevent occupational dermatitis.

Prevalence and Risk Factors of Occupational Skin Disease in Korean Workers from the 2014 Korean Working Conditions Survey

Sociodemographic and clinical profile of patients with occupational contact dermatitis seen at a work-related dermatology service, 2000 - 2014

Abstract: BACKGROUND: Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES: To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS: It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS: Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS: The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS: It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.

Profile of skin diseases in a community of fishermen in the northern coast of the state of São Paulo: the expected and the unusual

Abstract: Background: The fishing colony of the Picinguaba neighborhood is located at the northern end of the coast of the state of São Paulo. It has about 300 residents, of which approximately 100 are professional fishermen. Objectives: This study aimed to identify the main dermatoses of the community in comparison with other populations, and their frequency. Methods: The dermatoses were identified and tabulated for two years, in a prospective study carried out on monthly trips to the fishermen's colony in Picinguaba. Results: One hundred and eighteen patients were attended and followed up, which is equivalent to about 1/3 of the colony's inhabitants. Of these, 43 were children (under the age of 14) and 75 were adolescents and adults. The diseases observed were catalogued according to the age groups. Although most dermatoses in the community were similar with those observed in the general population, some specific cases could be seen, such as folliculitis on the legs of fishermen and an unexpected low frequency of actinic lesions in the colony, as well as dermatitis by aquatic animals. Study Limitations: The limitations were monthly attendance and the spontaneous demand of the patients. Conclusions: The finding of community-specific dermatoses and the low incidence of malignant and pre-malignant tumors associated with sun exposure needs further studies for better clarification.

Self-report occupational-related contact dermatitis: prevalence and risk factors among healthcare workers in Gondar town, Northwest Ethiopia, 2018-a cross-sectional study

BACKGROUND@#Occupational skin diseases are the second most common occupational diseases and are responsible for an estimated 25% of all lost work days. Occupational contact dermatitis (OCD) comprises 70-90% of all occupational skin diseases. In Ethiopia, information about the prevalence and factors which determine developments of contact dermatitis is not recognized. The objective of this study was to investigate prevalence and factors influencing the occurrences of occupational-related contact dermatitis among healthcare workers in Gondar town, Northwest Ethiopia.@*METHODS@#We employed a healthcare-based cross-sectional study from March to April 2018. A stratified sampling method followed by simple random sampling method was used to select 422 participants. The standardized Nordic Occupational Skin Questionnaire was pretested and interviewer-administered for data collection. We used SPSS version 20 to conduct a binary logistic regression analysis. We set ≤ 0.05 p value to ascertain significance and 95% CI with odds ratios to evaluate the strength of associations.@*RESULTS@#Response rate was 100%. The majority, 52.4% (N = 221), were males. The mean age was 22.6 (SD ± 6.3) years. The overall prevalence of self-report occupational contact dermatitis in the previous 12 months was 31.5% (N = 133) [95% CI (27, 36.2)]. The highest symptoms indicated was redness, 28.5% (n = 38), followed by burning, 17.3% (n = 23). The hand is the most commonly affected body sites, 22% (N = 93). Hand washing frequency [AOR 1.80, 95% CI (1.10, 3.20)], pairs of hand gloves used per day [AOR 3.22, 95% CI (2.05, 5.87)], personal history of allergy [AOR 2.37, 95% CI (1.32, 4.61)], and lack of health and safety training [AOR 2.12, 95% CI (1.12, 2.25)] were factors considerably associated with contact dermatitis.@*CONCLUSIONS@#The prevalence of occupational-induced contact dermatitis is common among healthcare workers in Ethiopia. Therefore, our finding indicates that intervention aiming at workers' health and safety training demands urgent public health responses to tackle the ailment. The result also demonstrates that healthcare workers should be aware of when and how hands should be washed. The number of pairs of gloves used per day should also be taken into consideration while devising prevention strategies.

Dermatoses ocupacionais registradas em sistema de notificação na região Sul do Brasil (2007 a 2016) / Occupational dermatoses registered in a notification system in the southern region of Brazil (2007 to 2016)

Introdução: As dermatoses ocupacionais são doenças de notificação compulsória no Brasil. Objetivo: Caracterizar a notificação das dermatoses ocupacionais no Sul do Brasil e descrever o perfil desses trabalhadores. Método: Descritivo, retrospectivo de 396 casos de dermatoses ocupacionais entre 2007-e 2016 no Sistema de Informação de Agravos de Notificação. Resultados: Em relação ao sexo, houve 3,6 casos a cada 10 mil trabalhadores/ano do sexo masculino e 2,2 casos a cada 10 mil trabalhadores/ano do sexo feminino. A faixa etária com maior incidência foi entre 50 e 64 anos, com 1,8 caso a cada 10 mil trabalhadores/ano. Destacaram-se os trabalhadores de manutenção e reparação, com 3,6 casos a cada 10 mil trabalhadores/ano. Em relação à raça/cor, houve predomínio de trabalhadores brancos (77%); já a escolaridade mais acometida foi entre trabalhadores com Ensino Fundamental incompleto (37,9%). O teste de contato foi realizado em apenas 11,4% dos casos. Conclusão: Torna-se necessário reforçar medidas para o uso de equipamentos de proteção individual, bem como aprimoramento das notificações e sensibilização dos profissionais de saúde para o registro correto nos sistemas oficiais

Background: Occupational dermatoses must be mandatorily reported in Brazil. Objective: To characterize the reporting of occupational dermatoses in the Brazilian South region, and describe the profile of the involved workers. Method: Retrospective and descriptive study of 396 cases of occupational dermatoses reported from 2007 through 2016 via the Information System for Notifiable Diseases. Results: 3.6 and 2.2 cases / 10,000 workers / year were of men and women, respectively. The highest incidence of occupational dermatoses corresponded to age range 50 to 64 years old, 1.8 cases / 10,000 workers / year, and to maintenance and repair workers, 3.6 cases / 10,000 workers / year. Most cases involved whites (77%) and workers not having completed elementary school (37.6%). Patch testing was only performed for 11.4% of cases. Conclusion: Reinforcing measures to promote the use of personal protective equipment is necessary, as well as to improve reporting and sensitize professionals to perform accurate reports in official systems.

Occupational dermatoses reported in Brazil from 2007 to 2014

Abstract: Background: Occupational diseases are very prevalent in the world, especially in developing countries. Occupational dermatoses are responsible for most of these cases. However, epidemiological studies are rare in Brazil. Objectives: To verify the panorama of occupational skin diseases in Brazil describing frequencies of work-related dermatoses and their sociodemographic and occupational patterns. Methods: We used retrospective data from the Notifiable Diseases Information System, (from 2007-2014) tabulated with the Tab program for Windows - TabWin12. We used intentional non-probability sampling and sequential selection, considering all notified occupational dermatoses. Results: All cases of occupational dermatoses referred to in the period were analyzed (n = 4710). Males and the age group of 35-49 years were the most affected. The most affected body area was the upper limb (34.2%) and the hand (25.4%). The "causative agent" field in the forms was not filled in 69.4% of cases, with chrome as the most prevalent cause reported (11.8%). ICD-10 codes more prevalent were L23, L24, and L25, corresponding to 34.2% of the sample. In total, 29% of patients needed to take a sick leave. No cases evolved to death and there were 0.2% of total as permanent disability. Study limitations: The amount of missing information for various items in the system draws attention. Conclusions: Treatment of patients with occupational dermatitis include the identification and removal of the causative agent and specific treatment of the disease. Diagnosis delay in cases of occupational dermatoses brings social and financial consequences to the work and life of workers.

Nickel, chromium and cobalt: the relevant allergens in allergic contact dermatitis. Comparative study between two periods: 1995-2002 and 2003-2015

Abstract: Background: Metals are common agents of allergic contact dermatitis, occupational or not, with decreasing incidence over the last years in some countries that have regulated the amount of nickel in objects. Objectives: To analyze and compare with previous studies the profile of metal sensitization between 2003-2015. Methods: Patients who underwent patch testing between 2003-2015 were evaluated retrospectively regarding the sensitization rates to metals, the associations between them, the relationship with profession and epidemiology. Results: Of the 1,386 patients tested, 438 (32%) had positive test to some metal, similar results to the 404/1,208 (33%) of the previous study (1995-2002) performed at the same service (p=0.32). The frequency of nickel (77%), cobalt (32%) and chromium (29%) changed slightly (p=0.20). Most cases of sensitization to chromium were related to the occupation (64%), in contrast to nickel and cobalt (p<0.0001). There was a predominance of females among those sensitized to metal in both studies (p=0.63) and the age group of 20-49 years old (p=0.11); the number of fair-skinned individuals increased (p<0.001), as well as the lesions in the cephalic segment (50.5%; p<0.0001) and hands (45%; p<0.0001), which are not the most frequent location anymore. The number of cleaners decreased (39% vs. 59%; p<0.0001), which still lead in front of bricklayers/painters, which increased (14% vs. 9%; p=0.013). The frequency of wet work reduced (65% vs. 81%; p<0.0001). Study limitations: The study included a single population group; only patients with positive tests to metals were considered - the others were not evaluated for the possibility of false negatives. Conclusion: The sensitization to metals, occupational or not, has been significant over the last 21 years, with few epidemiological changes.

Doença alérgica ocupacional: aspectos socioepidemiológicos em ambulatório especializado na cidade de São Paulo / Occupational allergic disease: socio-epidemiological aspects from a specialized outpatient clinic at the city of Sao Paulo

Introdução: Doença ocupacional envolvendo o sistema imunológico é considerada doença alérgica ocupacional (DAO). Das doenças ocupacionais, 15% são alérgicas. As consequências sociais do diagnóstico de DAO são importantes para o trabalhador e empregador. Objetivos: Descrever características demográficas e clínicas dos pacientes estudados com DAO e seus desfechos sociais. Métodos: Estudo descritivo, retrospectivo dos prontuários de pacientes do ambulatório de alergia ocupacional de hospital universitário em São Paulo, com diagnóstico de DAO. Resultados: 72 pacientes apresentaram DAO, com idades entre 21 e 89 anos; 52% do sexo masculino. Antecedentes atópicos foram descritos em 35% dos pacientes. A maioria dos pacientes trabalhava nas áreas de indústria química (17%), limpeza (15%), construção civil (11%) e saúde (8%). Rinite ocupacional foi vista em 26% dos pacientes; asma relacionada ao trabalho, em 18%; asma e rinite, em 25%; dermatite de contato alérgica, em 13%. Sobre o desfecho social, 36 (50%) mantiveram-se em seus cargos, 19 (26%) mudaram de função, 7 (10%) mudaram de área, 7 (10%) foram afastados e 3 (4%) se aposentaram. Conclusões: Na casuística estudada, a DAO prevaleceu no sexo masculino, em faixa etária condizente com faixa trabalhadora; com maior número de casos de rinite ocupacional. Metade dos pacientes continuou exercendo a mesma função mesmo após o diagnóstico.

Background: Occupational diseases involving the immune system are considered as occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. Objectives: To describe demographic and clinical characteristics of patients with OAD and their social outcomes. Methods: Descriptive and retrospective study of the medical records of patients diagnosed with OAD and cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil. Results: A total of 72 patients exhibited OAD, with age from 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) remained in their job, 19 (26%) changed function, 7 (10%) changed work area, 7 (10%) were fired and 3 (4%) retired. Conclusions: In the present study, OAD prevailed in males and the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same function even after diagnosis.

Pés de imersão em água morna entre trabalhadores de lavagem de automóveis / Warm-water immersion feet among car wash workers

Introdução: O quadro clínico de pés de imersão em água morna (PIAM) está relacionado ao contato prolongado com água em temperaturas elevadas. Uma categoria profissional com possibilidade de exposição frequente à umidade é a dos prestadores de serviço de lavagem de automóveis (lava a jato). Não foram encontrados estudos científicos sobre doenças que acometam os trabalhadores dessa área. Objetivo: Avaliar a frequência de quadros de PIAM entre trabalhadores de um lava a jato. Métodos: O estudo foi realizado em um lava a jato na cidade de Jundiaí (SP), em 2013. Um grupo de 30 trabalhadores foi submetido a anamnese e exame físico dermatológico. Foram realizados testes estatísticos para avaliar associação entre quadros de PIAM e variáveis independentes. Resultados: Todos os participantes eram do sexo masculino, com idade média de 23 anos, e a maioria (60%) trabalhava na empresa há mais de um ano. Sessenta por cento dos participantes apresentaram lesões compatíveis com PIAM. A faixa etária e o tempo de trabalho estiveram associados ao quadro. Havia exposição frequente e permanente à umidade durante o trabalho, sem uso de vestuário impermeável. Conclusão: A maioria dos trabalhadores que fizeram parte da pesquisa tinha diagnóstico de PIAM; os com idade superior a 30 anos e que trabalhavam há menos de 1 ano na função tiveram maior probabilidade de apresentar o quadro clínico por exposição ocupacional à umidade.

Introduction: The diagnosis of warm-water immersion foot (WWIF) is related to prolonged contact with water at high temperatures. Car wash workers are exposed to humidity, but there are not studies about diseases that affect workers in this area. Objective: To evaluate the frequency of WWIF among car wash workers and associated factors. Methods: The study was carried out in a car wash service in the city of Jundiaí, in the state of São Paulo, Brazil, in 2013. A group of 30 workers was submitted to an interview and skin medical examination. Statistical tests were performed to evaluate the association between WWIF and independent variables. Results: All participants were males, average 23 years old, and the majority (60%) have worked in the company for over a year. Sixty percent of the participants presented injuries similar to WWIF. Age and working time were associated with the outcome. There was frequent and permanent exposure to humidity in the working hours, without the use of impermeable clothes. Conclusion: Most of the participants had diagnosis of WWIF; those over 30 years old and who had been working less than 1 year were more likely to have the diagnosis due to occupational exposure to humidity.

Caracterización de la Dermatitis ocupacional en pacientes evaluados en consulta de Dermatología / Characterization of the occupational Dermatitis in patients evaluated in consultation of Dermatology

Introducción: La Dermatitis ocupacional es una inflamación de la piel provocada por el entorno laboral o contacto de una sustancia perjudicial, siendo considerada el problema de salud más frecuente en el ámbito laboral. Objetivo: Describir las características de los pacientes con Dermatitis ocupacional atendidos en una consulta de Dermatología durante 2015. Material y Métodos: Se realizó una investigación descriptiva transversal con una muestra de 56 personas diagnosticadas con esta enfermedad y que acudieron a consulta de Dermatología del Policlinico Pedro Fonseca durante todo 2015. Resultados: El 58,9 por ciento fue del sexo femenino, quienes llevaban más de 5 años de trabajo e iniciaron los síntomas más de 12 meses antes. El 100 por ciento de los pacientes tenían lesiones eritematosas y 94,6 por ciento presentaron liquenificación. La presentación de las lesiones costrosas fue de 69,6 por ciento más evidente en manos y muñecas. Conclusiones: Los pacientes con diagnóstico de Dermatitis ocupacional fueron los más frecuentes en la consulta de Dermatología de nuestra área de salud durante 2015. La Dermatitis ocupacional atópica superó en número de casos diagnosticados y en severidad de las lesiones a la Dermatitis ocupacional irritativa, siendo además la de mayor tiempo de evolución de los síntomas(AU)

Introduction: The occupational Dermatitis is an inflammation of the skin caused by the labor environment or contact of a harmful substance, being considered the more frequent health problem in the labor environment. Objective: To describe the characteristics of the patients with occupational Dermatitis assisted in a consultation of Dermatology during 2015. Material and Methods: He/she was carried out a traverse descriptive investigation with a sample of 56 people diagnosed with this illness and that they went to consultation of Dermatology of the Policlinic Pedro Fonseca during everything 2015. Results: 58,9 percent was of the feminine sex who had more than 5 years of work and they began the symptoms before more than 12 months. 100 percent of the patients had erythematous lesions and 94,6 percent of them presented lichenification. The presentation of the scabby lesions was of 69,6 more evident percent in hands and risks. Conclusions: The patients with diagnostic of occupational Dermatitis were the most frequent in the consultation of Dermatology of our health area during 2015. The atopic occupational Dermatitis overcame in number of diagnosed cases and in severity of the lesions to the occupational irritating Dermatitis, being also the one with the bigger time of evolution of the symptoms(AU)

Prevalência de agravos de pele e fatores associados em trabalhadores de uma empresa agropecuária do sul do Brasil / Prevalence of skin disease and associated factors in workers of an agricultural company in Southern Brazil

Contexto: Apesar da proteção conferida à saúde pela pele e anexos, há fatores que podem atingir esse órgão, provocando nele importantes agravos. Entre tais fatores estão os ocupacionais. Objetivo: Descrever a prevalência e analisar os fatores associados com problemas de pele, em geral autorrelatados, causados pelo trabalho. Métodos: O presente estudo, de corte transversal, entrevistou trabalhadores de uma empresa agropecuária do sul do Brasil. O instrumento da pesquisa foi um questionário semiestruturado com questões abertas e fechadas, aplicado por meio de entrevistas. Resultados: Dos 326 trabalhadores da empresa, foram entrevistados 273 (83,8%), e foi encontrada uma prevalência de agravos de pele de 15,2%. Houve maior ocorrência de problemas de pele em homens (16,8%), faixa etária dos 41 aos 50 anos (20,3%), associados com exposições ocupacionais, especialmente a poeiras. Conclusão: Conclui­se que é importante o gerenciamento dos riscos ambientais, uma vez que podem estar associados ao surgimento de problemas de pele relacionados ao trabalho.

Context: Despite the health protection provided by the skin and appendages, there are factors that can affect this organ, causing major skin injuries. Among such factors are the occupational ones. Objective: To describe the prevalence and to analyze the factors associated with generally self-reported skin problems caused by work. Methods: This cross-sectional study interviewed workers from an agricultural company in Southern Brazil. The research instrument was a semi-structured questionnaire containing opened and closed questions. Results: Out of the 326 employees in the company, 273 (83.8%) were interviewed. A prevalence of skin disorders of 15.2% was found. There was a greater occurrence of skin problems in men (16.8%), who were aged between 41 and 50 years (20.3%). These problems were associated with occupational exposures, especially to dust. Conclusion: It can be concluded that environmental risk management is important, as it may be associated with the occurrence of work-related skin problems.

Epidemiological analysis of occupational dermatitis notified in Brazil in the period 2007 to 2012

Abstract: BACKGROUND: Occupational dermatitis affects the quality of life and productivity of workers. Studies on the subject are scarce in Brazil. It is estimated that the disease is underreported and that many affected patients do not seek health care. OBJECTIVES: To conduct an epidemiological analysis of occupational dermatitis notified via SINAN in Brazil from January 2007 to December 2012; evaluate the profile of patients assisted; and check the main etiological agents involved. METHODS: We analyzed the compulsory notification forms of cases of occupational dermatitis filled nationwide during January 2007 to December 2012. RESULTS: During the study period 3027 cases of occupational dermatitis were notified in Brazil. In 61.4% of cases patients were men aged between 35-49 years (39.6%). The most described etiological agent was chromium (13.9%). The location of the body most affected was the hands, with 28.4% of cases. The construction sector is implicated in 28.7% of cases and domestic services by 18%. Allergic contact dermatitis is the most prevalent occupational dermatitis (20.6%) and the region with the highest number of notifications was the Midwest, with 376.4 cases per million inhabitants. CONCLUSIONS: The profile of patients most affected by occupational dermatitis in Brazil during the study period was: men with elementary school, aged between 20 and 49 years old and working in the construction industry. The most common occupational dermatitis were allergic contact dermatitis caused by chromium after years of exposure, being the hands and head the parts of the body most affected.

El problema médico legal de las dermatosis ocupacionales / The legal medical problem of occupational dermatoses

Resumen:La dermatosis profesional es aquella alteración dermatológica que se ve originada o empeorada por las condiciones de trabajo. Los estudios comparativos entre países se ven limitados por las diferencias existentes en la notificación de enfermedades profesionales, siendo muchas veces su incidencia subestimada a pesar de ser de gran impacto socioeconómico, pues éstas son una causa frecuente de incapacidad y/o discapacidad relacionada con el trabajo, pudiendo constituir un porcentaje importante de las indemnizaciones económicas en muchas naciones. Es difícil establecer la relación de causalidad entre las dermatosis y una profesión o actividad laboral específica sin disponer de parámetros objetivos, por lo que este artículo busca dar un amplio panorama de cómo abordar el problema médico legal de las dermatosis ocupacionales en las pericias diarias de un médico legista.

Abstract:The professional dermatosis is a dermatological alteration that is originated or worsened by conditions of work. The comparative studies among different countries are limited by the differences in the notification system of occupational diseases, in such a manner that is often underestimated even though they have a socioeconomic impact. In the case of the occupational dermatosis, in many countries they constitute an important percentage of the economic indemnifications, and also a frequent reason of disability related to the job itself. Being able to establish a relation of causality between the dermatosis and a profession or specific labor activity without having objective parameters is most of the time difficult, so that this article seeks to give a wide panorama of how to approach the medical legal problem of the occupational dermatosis in the daily expertise of a forensic doctor.

Chemical leukoderma induced by dimethyl sulfate

Abstract Chemical leukoderma occurs due to the toxic effect of a variety of chemical agents. Mechanisms include either destruction or inhibition of melanocytes. We report two male patients (36 and 51 years old) who presented with multiple hypopigmented macules and patches on the neck, wrist, and legs after exposure to dimethyl sulfate in a chemical industry. Physical examination revealed irregular depigmentation macules with sharp edges and clear hyperpigmentation around the lesions. History of repeated exposure to a chemical agent can help the clinical diagnosis of chemical leukoderma. This diagnosis is very important for prognosis and therapeutic management of the disease.

Ocorrência de espécies fúngicas isoladas a partir de mãos e unhas de trabalhadores / Occurrence fungal species isolated from hands and nails of workers

Contexto: A infecção fúngica que acomete as mãos, além de funcionar como porta de entrada para infecções, também pode causar dor, desconforto, limitação física e ocupacional. As pesquisas de microrganismos nas mãos de trabalhadores e as recomendações relacionadas à higiene adequada das mãos valorizam mais o risco de contaminação de alimentos e objetos e a transmissão de infecções a terceiros, desconsiderando muitas vezes a importância de manter a saúde das mãos dos profissionais. É importante conhecer a legislação e as orientações pertinentes que regulamentam as atividades profissionais e os aspectos relacionados ao desempenho profissional para promover medidas de proteção e prevenção de agravos à saúde do trabalhador e no estabelecimento de nexo que possa existir com dermatose ocupacional. Objetivo: Pesquisar sobre estudos de espécies fúngicas isoladas a partir das mãos de manipuladores de alimentos e profissionais da área de saúde, comparar com espécies isoladas em outras populações, destacar as dermatoses cutâneas por agentes biológicos e mais especificamente por fungos dermatófitos e Candida, abordar aspectos relacionados à segurança, saúde e medicina do trabalho. Métodos: Revisão de literatura de artigos publicados nos bancos de dados da CAPES, sítio da biblioteca virtual em saúde, SciELO e pesquisas em livros específicos. Conclusões: Evidenciou-se diferenças na detecção de fungos nas mãos de trabalhadores, em manipuladores de alimentos os percentuais variaram de 26,3 a 63,4% e em profissionais de saúde a variação foi desde 6,7 até 93%; predominaram espécies de Candida. Observou-se, em outras populações, menor percentual de positividade dos exames laboratoriais e predomínio de dermatófitos.

Context: The fungal infection that affects the hands, in addition to functioning as a gateway for infection, can also cause pain, discomfort, physical and occupational limitations. Research of microorganisms in the hands of workers and recommendations related to proper hand hygiene value the risk of contamination of food and objects and transmission to third parties infections, often disregarding the importance of maintaining the health of the hands of professionals. It is important to know the relevant legislation and guidelines governing their professional activities and aspects related to the performance to promote protection and prevention of harm to workers? health and the nexus of business that might exist with occupational dermatosis. Objective: To analyse studies of fungal species isolated from the hands of food handlers and health professionals, to compare them to species from other populations, highlighting the skin dermatoses by biological agents and more specifically by dermatophytes and Candida, and to address aspects related to safety, health and occupational medicine. Methods: Literature review of articles published in the CAPES, Biblioteca Virtual em Saúde website, and SciELO databases and also from specific books. Conclusions: Differences were identified in the detection of fungi in the hands of workers; in the food handlers the percentage ranged from 26.3 to 63.4%; and in health professionals the range was from 6.7% to 93%, with a prevalence of Candida species. It was observed, in other populations, lower percentage of positive laboratory tests and prevalence of dermatophytes.

Dermatitis de contacto ocupacional / Occupational contact dermatitis

La dermatitis de contacto ocupacional representa una de las patologías laborales de mayor frecuencia y sin embargo por el difícil diagnóstico y determinación de la relación de causalidad al trabajo existen subregistros de la misma en todo el mundo. Corresponde a una condición que se puede cronificar y que llega a incapacitar de forma recurrente a muchos trabajadores, lo cual se traduce en pérdidas económicas tanto para el empleado como para el empleador. El diagnóstico tardío o incorrecto lleva a un mal control de la enfermedad y a escasa instauración de medidas de prevención en el ámbito laboral por lo que debe ser identificada y tratada oportunamente.

Occupational contact dermatitis is one of the most frequent occupational diseases and yet the difficult diagnosis and determination of being work-related causes underreporting worldwide. This condition can turn into a chronic issue and recurrently incapacitate a worker, which results in economic losses for both the employee and the employer. Incorrect or late diagnosis leads to poor management of the disease and few preventive measures in the workplace which is why it should be identified and treated promptly.

Clinical Characteristics of Patients with Chromium Allergy in a Single University Hospital in Korea / 대한피부과학회지

BACKGROUND: Chromium is one of the most common metal allergens that cause allergic contact dermatitis. European regulation of chromium (VI) content in cement was first implemented in 2005, and regulation of chromium in leather in 2015. OBJECTIVE: This clinical study was performed to obtain basic data on subjects with allergic contact dermatitis due to chromium in Korea. We investigated the clinical characteristics of patients with chromium allergy among subjects with contact dermatitis who underwent patch tests. METHODS: Patch test data from June 1998 to January 2014 were retrospectively analyzed (n=975; men=290, women=685). Patients who showed positive reactions to potassium dichromate (chromium [+] group; n=58) and who showed positive reactions to other allergens except potassium dichromate (others [+] group; n=497) were identified and the characteristics of both groups were compared. Patients who only reacted to chromium (only chromium group; n=17) were identified, and their clinical characteristics were investigated. The prevalence of chromium allergy was analyzed in each 4-year period to study the changes over time. RESULTS: The sensitization rate of potassium dichromate was 5.9% (n=58) and women comprised 72.4% (n=42) of the chromium (+) group. Hands and feet were more frequently affected in the chromium (+) group (p=0.002 and 0.019, respectively). Occupational dermatitis was significantly less common in the chromium (+) group. Chromium allergy was the most prevalent in patients in their 50s (8.4%). The only chromium group had significantly more number of patients aged 40 years or older (p=0.004). The prevalence of chromium allergy was 13.5% during 1998~2002, but decreased to 5.4% during 2010~2014. CONCLUSION: The characteristics of patients with chromium allergy suggests that chromium exposure in daily activities, including leather exposure, is more relevant than occupational exposure for most patients. The prevalence of chromium allergy has been decreasing in Korea, which may be an effect of voluntary regulation of chromium content in cement by manufacturers.