Doppelblinde, randomisierte repetitive In-vivo-Wirksamkeitsstudie zu kommerziellen Hautschutzprodukten gegen Natriumlaurylsulfat (SLS).

HINTERGRUND: In der Primär- und Sekundärprävention von Berufsdermatosen werden Hautschutzprodukte eingesetzt, die eine präexpositionelle Schutzwirkung aufweisen sollen. Insbesondere finden sich auf dem Markt zahlreiche Produkte, die zum Einsatz bei Feuchtarbeit ausgelobt werden. Eine objektive Qualitätsbeurteilung dieser Produkte für Anwender ist auf Grund fehlender vergleichender Wirksamkeitsstudien oft nicht möglich. MATERIAL UND METHODIK: In einer doppelblinden, randomisierten und kontrollierten In-vivo-Studie wurden sechs kommerzielle Hautschutzexterna in einem repetitiven Irritationsmodell untersucht. Sie wurden hinsichtlich ihrer präexpositionellen Schutzwirkung vor dem durch Natriumlaurylsulfat (SLS) induzierten irritativen Kontaktekzem mittels hautphysiologischer Methoden getestet. Es wurde ein Wirkindex anhand des transepidermalen Wasserverlustes (TEWL) gemäß des Protokolls der multizentrischen Studie des Forschungsprojektes FP 275 der Deutschen Gesetzlichen Unfallversicherung DGUV berechnet. ERGEBNISSE: Die untersuchten Externa zeigten eine Schutzwirkung gegen SLS im Vergleich zum unbehandelten Kontrollfeld, wiesen allerdings signifikante Wirkunterschiede auf. Die Auswertung der Nebenparameter Corneometrie und visueller Score erbrachte ebenfalls Unterschiede zwischen den Externa. SCHLUSSFOLGERUNGEN: Die zwischen den untersuchten Externa festgestellten Unterschiede hinsichtlich der Wirkgüte ermöglichten eine Einteilung der Produkte, welche als Grundlage für die Auswahl geeigneter Schutzpräparate dienen kann.

Double blind randomized repetitive efficacy test of various occupational skin protection preparations against sodium lauryl sulphate.

BACKGROUND: Skin protection products, formerly named as barrier creams, are being used as primary and secondary prevention measures against occupational dermatoses. Many of these cosmetic products are claimed by manufacturers to be efficacious against wet work-induced skin barrier impairment if applied prior to exposure. However, results of validated and standardized in vivo efficacy tests allowing the comparison of different products are lacking. MATERIAL AND METHODS: Efficacy of six skin protection products against sodium lauryl sulphate-induced irritant contact dermatitis was investigated in a double blind, randomized and controlled repetitive irritation study in healthy volunteers using skin physiological methods. Transepidermal water loss (TEWL) results were used to calculate an efficacy index of protection by mathematical/statistical means according to a protocol developed in a German Statutory Accident Insurance (DGUV) multicenter study (research project FP 275). RESULTS: All tested products had a demonstrable, protective effect against SLS compared to controls, but their relative efficacy varied significantly. Differences were also seen upon evaluation of other parameters such as corneometry and clinical irritation score (visual score). CONCLUSIONS: Product ranking as a result of the established differences allows improved selection of appropriate skin protection products based on objective parameters, as compared to heterogenous product claims.

Work and diet-related risk factors of cardiovascular diseases: comparison of two occupational groups.

BACKGROUND: Although work related risk factors associated with Cardiovascular Diseases (CD) have been well researched, there is no detailed knowledge regarding disparate occupational groups each with a different risk exposition. Therefore, two occupational groups (chefs and office workers) were compared with a focus on nutritional and psychosocial factors. METHODS: Two groups of subjects were tested for work and diet-related risks of CD (45 chefs and 48 office workers). The groups matched both for gender (male) and age (30 to 45 years). The study included a medical check-up, bioelectrical impedance analysis as well as an evaluation of questionnaires on health, nutritional behaviour and coping capacity. In addition, volunteers were required to compile a 7-day-dietary-record and collect their urine 24 h prior to their check-up. Blood samples drawn were analysed for glucose and lipid metabolism, homocysteine, vitamin B12, folic acid; C-reactive protein, uric acid, red blood cell fatty acids, plant sterols, antioxidative capacity and oxidative stress. RESULTS: On average, the chefs showed one risk factor more compared to the office workers. The most frequent risk factors in both groups included overweight/obesity (chef group [CG]: 62.2%; office group [OG]: 58.3%) and elevated TC (CG: 62.2%; OG: 43.8%]. Moreover, although the chefs often had higher CRP-concentrations (40.0%), more office workers suffered from hypertension (37.5%).Chefs showed significant higher concentrations of saturated fatty acids and oleic acid, whereas docosahexaenoic acid, Omega-6- and trans fatty acids were found more frequently in the red blood cell membranes of office workers. While there were no significant differences in analysed plant sterols between the two occupational groups, 7,8-dihydro-8-oxo-2'-deoxyguanosine was significantly increased in office workers.Concerning the work-related psychosocial factors, the chefs were characterised by a stronger subjective importance of work, a greater degree of professional aspiration and enhanced efforts at perfectionism at their workplace. CONCLUSIONS: The chefs in the study bear a higher risk of CD compared to the office-workers. Although, CD is not exclusively a result of workplace-conditions, study results show that work-related influences can not be ignored. Thus, prevention of CD may be an important task attributable to occupational physicians.

Recruitment strategies for a hand dermatitis prevention programme in the food industry.

BACKGROUND: An interdisciplinary 'Skin Disease Prevention Programme (SDPP) in the baking, hotel, and catering industries' was established. However, only 30% of the eligible employees suffering from occupational hand dermatitis (OHD) participated in the programme. OBJECTIVES: The aim of the present study was to increase the participation rate in the SDPP from 30% to 50% by specific recruitment strategies. PATIENTS/METHODS: Two hundred and twenty five baker and catering trade employees suffering from OHD were included in a prospective controlled intervention study. The employees were invited to take part in the SDPP using (i) a standard invitation letter (n = 40), (ii) a newly developed, personalized, and targeted invitation letter (n = 52), (iii) the new invitation letter and a case report (n = 75), and (iv) the new invitation letter, the case report, and the additional information (n = 58). RESULTS: The commitment of the employees to join the SDPP increased significantly from 30% to 54% (P < 0.02) in the group receiving the new personalized targeted invitation letter. Neither the additional case report nor the supplementation with additional information concerning the SDPP did further increase the recruitment. CONCLUSIONS: The strategy to personalize and target the new invitation letter was successful to influence the employees' commitment to participate in the SDPP.

Prevention of hand dermatitis in bakers' apprentices: different efficacy of skin protection measures and UVB hardening.

OBJECTIVE: The objective of this controlled intervention study was to quantify the efficacy of skin protection (SP) measures and ultraviolet B (UVB) hardening in the prevention of hand dermatitis in bakers' apprentices. METHOD: SP measures were compared against UVB hardening in a controlled clinical trial of 94 apprentices. The apprentices were assigned to the intervention arms class-wise. Bakers' apprentices involved in a previous follow-up study served as additional controls representing no intervention. The apprentices were interviewed and examined in a standardised way at the beginning of the training and at 4 monthly follow-ups. Transepidermal water loss (TEWL) was measured at the back of the hands. RESULTS: Demographic profile and atopy criteria were equally distributed in the two intervention arms and the control group. Point prevalence of hand dermatitis after 6 months was highest in the controls (29.1%) followed by the UVB (19.4%) and the SP group (13.3%). UVB hardening and SP measures reduced hand dermatitis prevalence by 9.7% (95%CI: -8.5 to 28.1) and 15.7% (95%CI: -2.4 to 33.9), respectively. Application of SP measures reduced the odds ratios (ORs) for hand dermatitis 0.8-fold (95%CI: 0.17-3.70) and 0.33-fold (95%CI: 0.09-1.23) compared with the UVB group and the controls, respectively. These clinical trends were confirmed by statistically significant differences in TEWL values. TEWL values were consistently higher in the UVB group than in the SP group ( P=0.002). CONCLUSIONS: This study provided evidence, based on significant differences in TEWL levels, that general SP measures may be more effective than UV light hardening of the skin, which in turn was more effective than no intervention. This trend was supported by the frequency of development of clinical hand dermatitis, although differences did not reach statistical significance. A multi-centre trial is recommended to confirm the efficacy of SP measures in a larger randomised study.

Skin protection in bakers' apprentices.

Skin protection measures - barrier creams, protective gloves - and skin care are widely recommended for the prevention of occupational hand dermatitis (HD) in skin risk professions, but there is hardly anything known about uptake levels of the measures. The objective of this controlled intervention study was to quantify the uptake and maintenance of skin protection and skin care measures in first-year bakers' apprentices. A total of 94 first-year bakers' apprentices were included in the study in September 2000. The apprentices were assigned to the skin protection and control group class-wise to reduce contamination. The skin protection group comprised 39 apprentices who were trained in skin protection measures at the beginning and after 4 weeks of training. 55 apprentices were assigned to the control group representing no skin protection intervention. Standardized interviews took place at the beginning of the training and at 4 monthly follow-ups (FU). The uptake of skin protection measures differed significantly between the groups (barrier cream p < 0.0001, protective gloves p = 0.046, skin care p = 0.025). Barrier cream use in the skin protection group was incorporated in the daily routine very well from the start and reached 100% at the end of the examination period (4th FU). At this time, only 3.2% of the controls used barrier creams. The level of acceptance of protective gloves (4th FU: skin protection group 43.3%; controls 32.3%) was considerably lower than that of barrier creams. The initial level of regular skin care was high in both groups (skin protection group 67.6%, controls 61.7%). After the intervention the acceptance of skin care rose to 88.9% in the skin protection group compared to 68.1% in the controls (4th FU). The present study has shown that skin protection and skin care measures can be introduced successfully in the daily routine of a skin risk occupation and high uptake and maintenance rates can be achieved.