Is skin exposure to water mainly occupational or nonoccupational? A population-based study.

BACKGROUND: Skin exposure to water is considered to contribute to hand eczema. Knowledge about total water exposure during a day is scanty. OBJECTIVES: To investigate self-reported water exposure at work as well as throughout the day. METHODS: Skin exposure to water was assessed from two questionnaire-based health surveys: the nationwide Environmental Health Survey 2007 (EHS), which enquired about water exposure throughout the day, and the Stockholm Public Health Survey 2006 (PHS), which probed water exposure at work. Answers from 19,667 individuals (EHS) and 18,318 individuals (PHS) were available for analysis. RESULTS: In total, 22% of respondents (women 30%, men 12%) reported skin exposure to water more than 20 times during an entire day (EHS) compared with 6% (women 8%, men 4%) at work (PHS). In a univariate analysis, using a merged file comprising data from the EHS and the PHS, water exposure more than 20 times a day was more common in the EHS (prevalence proportion ratio 3·570, 95% confidence interval 3·353-3·802). In multivariate models the variables studied did not fulfil the criteria for being confounders. Water exposure at work declined with increasing age in both women and men (P < 0·0001) as did water exposure during the entire day in men (P < 0·0001). However, women were equally exposed during the entire day across age groups (P = 0·205). CONCLUSIONS: High water exposure over the entire day was found to be considerably more frequent than exposure at work. Thus, a significant proportion of water exposure seems to occur outside work. This should be considered in prevention of hand eczema and when counselling patients with hand eczema in clinical practice.

Life-style factors and hand eczema.

BACKGROUND: Previous knowledge of the impact of certain life-style factors on hand eczema is scanty. OBJECTIVES: To investigate a possible association between hand eczema and life-style factors such as obesity, physical exercise, stress, smoking and alcohol consumption. METHODS: In a cross-sectional public health survey in Stockholm, Sweden, 27,994 (58%) randomly chosen individuals aged 18-64 years completed a postal questionnaire regarding physical and mental health, social relations, economic status and work. Of these, 27,793 individuals responded to the question regarding hand eczema and were included in the present study. The association between life-style factors and hand eczema was analysed by prevalence proportion ratios (PPR), using a generalized linear model. RESULTS: Hand eczema was more common among individuals who reported high stress levels, PPR 1·326 (95% CI 1·303-1·350). There was also a positive dose-response relationship between hand eczema and stress. Hand eczema was less common among individuals reporting high physical exercise, and most apparent in women, PPR 0·781 (95% CI 0·770-0·792). Men who reported high alcohol intake reported hand eczema less often, PPR 0·958 (95% CI 0·930-0·987). Obese individuals reported hand eczema more commonly, PPR 1·204 (95% CI 1·174-1·234). There was a slight increase of hand eczema among smokers, PPR 1·025 (95% CI 1·006-1·044). CONCLUSIONS: Hand eczema was more common in individuals who reported stress, obesity and smoking. In individuals who reported high physical exercise levels hand eczema was less common. As there appears to be an association between life-style factors and hand eczema it is important to consider life-style factors in clinical practice.

Occupational skin exposure to water: a population-based study.

BACKGROUND: Occupational exposure to skin irritants, in particular to water, is an important risk factor for hand eczema. OBJECTIVES: To assess occupational skin exposure to water in the general population. METHODS: As part of a public health survey in Stockholm, Sweden, 18,267 gainfully employed individuals aged 18-64 years completed a questionnaire with previously validated questions regarding occupational skin exposure to water. RESULTS: Altogether 16% reported exposure to water for (1/2) h or more a day, and 13% reported exposure to water more than 10 times a day. Furthermore, 7% reported water exposure of more than 2 h and 6% of more than 20 times a day. Women reported more water exposure than men and many female-dominated occupations were seen to comprise water exposure. Women were also more exposed than men within the same jobs. Young adults were more exposed than older. A total of 18% were employed in high-risk occupations for hand eczema. Fifty-nine per cent of individuals employed in high-risk occupations reported water exposure at work, compared with 11% in low-risk occupations. CONCLUSIONS: A total of 20% of the population of working age acknowledged occupational skin exposure to water, which was found to be more common in young adults and women. Using job title as a proxy for water exposure gives an underestimation due to misclassification. In assessing occupational skin exposure to water, both exposure time and frequency should be considered.