Hand eczema in metalworker trainees--an analysis of risk factors.

The present study, as part of PROMETES (Swiss Prospective Metal Worker Eczema Study), was performed to examine risk factors for the development of occupational hand dermatitis in metal-worker trainees. Since this disease is very common, a high standard of preventive measures is necessary, especially for persons with an endogenous disposition for the development of eczema, e.g., atopics. Within the cohort of 201 healthy young men, 47 (23%) showed at least mild signs of hand eczema at 1 point of the 2.5 year observation period. Various occupational and domestic exposures, skin protection behaviour, regeneration time, and smoking habits, as well as atopic disposition, were studied with regard to their influence on the skin condition of the metalworker trainees. By multivariate analysis, we determined 3 important risk factors for the development of hand eczema in the cohort. (i) We showed once more the important influence of an atopic disposition as a major risk factor for occupational contact dermatitis. (ii) Furthermore, the results suggest that, apart from chemical irritants, mechanical factors should not be underestimated in their role as irritants to the epidermal barrier. (iii) Additionally, an insufficient amount of skin recovery time seems to support a cumulative sub-irritant effect on the skin, which may lead to irritant contact dermatitis.

Is occupational irritant contact dermatitis predictable by cutaneous bioengineering methods? Results of the Swiss Metalworkers' Eczema Study (PROMETES).

BACKGROUND: Since identification of subjects with high eczema risk by screening tests is desirable, different skin bioengineering methods were studied for their validity as predictive measures for the development of hand eczema. METHODS: 205 metalworker trainees were followed up over 2.5 years from the beginning of their apprenticeship to observe the occurrence of hand eczema. Within the first weeks of their training they underwent a number of noninvasive biophysical tests. Transepidermal water loss, skin moisture and skin roughness were measured, and irritation tests with dimethyl sulfoxide (DMSO), sodium hydroxide (NaOH) and sodium lauryl sulfate were conducted. Sensitivity, specificity and predictive values of the performed tests and test combinations were calculated. RESULTS: None of the observed single biophysical methods can be considered a valid screening test. CONCLUSION: A combination of short irritation tests (DMSO and NaOH tests) and the measurement of skin moisture, however, allows to identify individuals at high risk for hand dermatitis with a high sensitivity, though low specificity.

Role of the atopy score and of single atopic features as risk factors for the development of hand eczema in trainee metal workers.

This study was performed as part of PROMETES (Swiss Prospective Metal Worker Eczema Study) to examine the role of atopy as a possible risk factor for the development of hand eczema in trainee metal workers. In a cohort of 201 young men without any skin problems at the start of their apprenticeship, 9.5% developed signs of dermatitis on their hands within a period of 6 months. The 2. 5-year incidence was 23%. We did not find a significantly increased risk for hand eczema in those participants with an atopic skin diathesis according to the atopy score of Diepgen et al. (Dermatosen 1991; 39: 79-83) Analysis of individual atopic signs and symptoms showed reported metal reactivity to have a significant influence on the onset of early skin damage within 6 months, whereas a history of flexural eczema appeared to be significantly related to the overall incidence over 2.5 years.

Skin roughness is negatively correlated to irritation with DMSO, but not with NaOH and SLS.

While many endogenous and exogenous factors have been found to influence skin irritant reactivity, the role of skin roughness in irritation has not yet been studied. In this study we measured skin roughness by visiometry and performed irritation tests on the flexural side of the forearm with sodium hydroxide (NaOH), sodium lauryl sulphate (SLS) and dimethyl sulfoxide (DMSO) in two different concentrations in a population of 151 volunteers between 15 and 25 years of age. The results showed a significant negative correlation between most roughness parameters and DMSO irritation. The correlation between roughness parameters and irritation tests with SLS and NaOH was not significant. We conclude that smoother skin is more prone to DMSO irritation than rougher skin and that this may be due to differences in percutaneous penetration of the compound.

An evaluation of the relationship between 'atopic skin' and skin irritability in metalworker trainees.

Skin hyperirritability to irritants as well as atopy are considered to be predisposing factors for contact dermatitis. The aim of the study was to evaluate whether these predictive factors are independent or whether they are so closely related that one could possibly replace the other 205 metalworker trainees underwent skin examination for skin atopy, including standardized questionnaire, clinical examination of the skin and a series of skin irritability tests. These tests included measurements of transepidermal water loss (TEWL) before and after irritation with 3 different irritants: sodium lauryl sulfate (SLS), dimethylsulfoxide (DMSO) and sodium hydroxide (NaOH). The results of the linear regression analysis demonstrate that skin atopy is not associated with increased skin irritability, as assessed by the irritability testing methods presented.

Reproducibility of a non-invasive skin irritancy test in a cohort of metalworker trainees.

The identification of subjects with increased susceptibility to irritants may play an important rôle in the prevention of irritant contact dermatitis. A short and quick method of non-invasive testing for assessing irritant sensitivity was developed by Wilhelm and coworkers in 1990, based on the alkali resistance test of Burckhardt. In order to determine the reproducibility of this screening method, 204 healthy metalworker trainees were tested 2 x according to Wilhelm within an interval of 6 months. No statistically-significant correlation could be shown, indicating that the reproducibility of this screening method is low. Therefore, we propose applying not just a single test for the assessment of skin irritability, but a series of tests, in order to improve the reliability of this kind of testing.

Predictive testing of metalworking fluids: a comparison of 2 cumulative human irritation models and correlation with epidemiological data.

Metalworking fluids (MWF) have been reported as being an important cause of irritant contact dermatitis in metal workers. Our purpose was to determine whether the irritancy of different MWF assessed by 2 different types of predictive human in vivo tests could be compared with epidemiological data. 3 water-based MWF were tested in the same panel of subjects. Reactions were assessed by a visual score (VS), evaporimetry to evaluate the transepidermal water loss (TEWL) and chromametry to quantify erythema. Test 1: MWF were applied with Finn Chambers on the volunteers' mid-back, removed after 1 day of exposure, and reapplied for a further 2 days. Test 2: Cumulative irritant contact dermatitis was induced using a repetitive irritation test for 2 weeks (omitting weekends) for 6 h per day. We observed an increase in VS, TEWL, and erythema for all MWF, with the same irritancy ranking in both test models. Differentiation of the substances was better in the D1/D3 test. The experimental results partially correlated with the epidemiological data. Considering the shorter application time and the better discrimination of irritancy, we prefer the D1/D3 model as a predictive test of MWF irritancy. Our results might aid development of a standardized test to reduce cumulative skin irritation in metal workers.

'Patient's delay'--analysis of the preclinical phase of occupational dermatoses.

BACKGROUND: In order to cure diseases effectively it is important that they are detected in their early stages so that medical precautions can be taken. With job-related disorders it is conceivable that anxiety concerning the workplace, as well as other factors of a demanding nature, may lead to a further delay of diagnosis and treatment. OBJECTIVE: The study was carried out for the purpose of gathering information about the patients' reactions in the preclinical phase of job-related eczema. METHODS: 79 patients suffering from a job-related skin disease were questioned. The patients were divided up into groups according to their respective delay and the results evaluated in line with the method of logistic regression. RESULTS: The average delay was 8.6 months. Fear of losing their job was mentioned by most participants as the reason for the postponement of seeking medical care. People with a long delay were mainly men, senior and Swiss citizens, those with a higher education and those with a longer professional training. CONCLUSION: Patient delay in occupational dermatology highly depends on the support of employers and on the counseling of workers on job-related skin disease and their insurance protection.

Foreign body granuloma of the penis caused by occupational glass fibre exposure.

We report a patient who presented with the suspected diagnosis of syphilis. Clinical findings included a penile ulcer, positive history of syphilis more than 20 years ago, and positive syphilis serology (TPHA, FTA-Abs). A biopsy showed a plasma-cell rich inflammation with granuloma formation. Since a birefractory structure was observed in the biopsy possibly corresponding to a foreign body, the patient's occupational exposure was investigated. Working in the fiber reinforced plastics industry, he was heavily exposed to glass fibre that was even detected on the inside of his underwear. Taking the serological pattern into account that was not consistent with active syphilis, a penile ulcer following a foreign body reaction was diagnosed. This case report demonstrates the difficulties of differentiating foreign body granuloma of the genital region from venereal diseases with granuloma formation.

Irritancy testing in occupational dermatology: comparison between two quick tests and the acute irritation induced by sodium lauryl sulphate.

To reduce the incidence of irritant contact dermatitis, the development of screening methods to identify subjects with increased susceptibility to irritants is essential. In a pilot study on the comparison between two quick, non-invasive irritancy tests (dimethyl sulfoxide (DMSO) and sodium hydroxide (NaOH) with the time-consuming patch testing with sodium lauryl sulphate (SLS), no correlation between the "quick tests" and SLS patch testing was observed. In the present paper the results of irritancy testing in 181 metal worker trainees are presented. Experimental irritant contact dermatitis reactions were induced on the medial third of the volar forearm using SLS 0.5%, applied for 23 h and as "quick tests" DMSO 90% and 95% and a solution of 0.2% mol/l NaOH applied for 5 min. Assessment of skin irritability was made by visual scoring and measurement of transepidermal water loss. Except for a statistically significant relationship between the irritations by DMSO 90% and 95%, correlations between the different techniques were weak or non-existent. This is most probably due to different pathophysiological pathways for the irritant reactions. We therefore propose to use a spectrum of different tests in occupational dermatology for predicting the individual's risk of irritant contact dermatitis.

Skin risk assessment of metalworking fluids: a survey among Swiss suppliers.

BACKGROUND: Metalworking fluids (MWF) are the most important cause of hand dermatitis in the metal industry. The substitution of noxious products by less aggressive MWFs is therefore an important measure to reduce the incidence of hand eczema in this type of industry. In order to do so, producers and suppliers have to evaluate the skin risk of such products by predictive allergenicity and irritancy testing. OBJECTIVE: The aim of the study is to evaluate if predictive testing is performed in MWF products that are currently offered in the Swiss market and what kind of tests are applied. METHODS: A questionnaire was sent to 11 Swiss MWF suppliers in order to collect information on the actual practice of skin risk testing. RESULTS: Nine of 11 suppliers returned the questionnaire. Five suppliers report some kind of allergenicity testing in some of the products. Seven companies test for irritancy by a single application method, but only two perform cumulative irritancy testing in some products. The methods of testing (animal, human, field studies) vary greatly among the different companies. CONCLUSION: It is concluded that the practice of predictive testing for sensitization and irritancy of MWF is unsatisfactory and does not allow the user to compare products based on their skin risk. Occupational dermatologists should strive for standardization of MWF testing including so far scarcely performed repeated insult tests.

Prevention of hand eczema in the metal-working industry: risk awareness and behaviour of metal worker apprentices.

BACKGROUND: In the metal-working industry, occupational hand eczema is very common and often due to contact with cutting fluids. Since it can be avoided by adequate protective measures, prevention plays an important role. However, the effectiveness of prevention depends heavily on the employees' awareness of this health risk. OBJECTIVE: The study aimed to collect information on the attitude of metal worker apprentices towards the risk of occupational skin disorders and skin protection since it is believed that their attitude at the beginning of the education will guide their future risk behaviour. METHODS: By means of a questionnaire, 79 metal worker apprentices were interviewed about their awareness of dermal risk factors and their risk behaviour at work. RESULTS: The apprentices are very badly informed about skin diseases and skin care. Most of them are not concerned about developing occupational skin problems, and they declared having obtained very little information about this subject. CONCLUSION: Considering this finding, it seems urgent to intensify health and safety education already at the beginning of the apprenticeship.

[Exposure to solvents in scleroderma: disseminated circumscribed scleroderma (morphea) in a painter exposed to perchloroethylene]. / Lösungsmittelexposition bei Sklerodermie: disseminierte zirkumskripte Sklerodermie (Morphea) bei einem Perchlorethylen-exponierten Lackierer.

We report on a 45-year-old painter who developed morphea-like scleroderma. He had been exposed to perchlorethylene for one year while operating a metal degreaser; the perchlorethylene concentration in the workplace ranged between 10 and 25 ppm. Whereas systemic scleroderma has frequently been attributed to solvent exposure in the past, this is only the third description of a morphea-like scleroderma suspected to be related to occupational contact with organic solvents.

Assessment of skin irritancy by 2 short tests compared to acute irritation induced by sodium lauryl sulfate.

Irritant contact dermatitis is a very common disease that is preventable by protective measures. The development of screening methods to identify subjects with increased susceptibility to irritants is essential to reduce the incidence of this disorder in the workplace. On the outlook for such methods, 2 quick non-invasive tests for irritability of the skin were compared to reliable, but time-consuming, patch testing with sodium lauryl sulfate (SLS). In 20 healthy volunteers, 0.5% SLS was applied on the medial 1.3 of the forearm for 23 h in order to induce experimental irritant contact dermatitis. On the same part of the forearm, 3 concentrations of dimethylsulfoxide (DMSO) and a solution of 0.2 mol/l NaOH were applied for 5 min. Assessment of skin irritability was made by visual scoring and measurement of transepidermal water loss. No correlation between the "quick tests" and SLS patch testing was found, indicating that these tests assess different mechanisms of irritation.