Secondary individual prevention of hand dermatitis in geriatric nurses.

BACKGROUND: The incidence of occupational skin disease (OSD) in geriatric nurses (GNs) is increasing in Germany. OBJECTIVES: A prospective controlled study of secondary individual prevention (SIP) of OSD in GNs was conducted. METHODS: Two hundred and nine participants completed questionnaires prior to the start of the program and 3 months after its conclusion. One hundred and two GNs participated in an interventional program (intervention group, IG). Severity of OSD was classified upon each visit. Delta-TEWL values were measured at regular intervals. Findings were compared with those for 107 control group (CG) participants consulting a dermatologist on demand. SIP was not offered to CG participants. RESULTS: Upon entry, 89% of IG and 90% CG complained of OSD (NS). Dermatologic examination revealed skin changes in 90% of IG at first consultation. Upon study completion, 59% of IG was free of OSD. Questionnaires 3 months after study completion revealed skin lesions in 53% of IG and 82% of CG (p<0.01). Delta-TEWL measurements reflected significant improvement of the epidermal barrier during SIP in IG (median 6.9-3.0 g/m(2)/h, p<0.001). Three months after study completion, 96% of IG and 86% of CG were still employed. CONCLUSIONS: Objective dermatologic and skin physiologic data reveal that SIP in GNs is effective in the secondary prevention of OSD. Further, IG was superior to CG in terms of health maintenance and employment.

The "strip" patch test: results of a multicentre study towards a standardization.

BACKGROUND: The "strip" patch test (SPT) is a variant of patch testing which is used for substances with a poor percutaneous penetration. Penetration of the substances is enhanced by repeated applications of adhesive tape prior to their application to the skin. However, no guidelines exist for standardized performance of the SPT. OBJECTIVES: The aim of this multicentre study was to obtain a first practical approach towards a standardized SPT procedure. METHODS: Intact noninflamed skin of the upper back of 83 healthy volunteers was tape-stripped. For sequential strips, a 25-mm diameter 3M Blenderm surgical tape was vertically applied and gently pressed downward using the fingertips for about 2 s. The tape was removed in one quick movement at an angle of 45 degrees in the direction of adherence. Each strip was performed with a new piece of tape on exactly the same skin area. RESULTS. In each subject, we first determined the number of strips (A) until the skin surface started to glisten and calculated the median number of strips (A) in the sample (A=26 strips). We then ascertained the median number of strips (a) in the sample that was necessary to achieve a statistically significant and twofold increase in TEWL (a=11 strips), revealing a "critical" stratum corneum strip depth. The unknown number of strips (a) for each subject was finally calculated from the formula a/A=a/A, i.e. the individual number of strips (A) until the skin surface started to glisten was multiplied by a derived tape-specific correction factor (cf=a/A=11/26=0.4). The increase in percutaneous penetration in strip patch testing by performing "a" strips versus conventional patch testing was shown by scoring of clinical and subjective SLS irritant reactions. CONCLUSIONS: The present multicentre study outlines an experimentally derived approach for a uniform SPT procedure, which does not require the use of complex technical equipment. This first approach now requires validation by a study involving the application of allergens to obtain evidence of enhancement in the sensitivity of patch testing.

[Prevention and regeneration of barrier disturbances in occupational dermatology]. / Prävention und Regeneration epidermaler Barrierestörungen bei Berufsdermatosen.

Over the past 10 years primary, secondary and tertiary prevention of occupational skin disorders has been shown to be successful, documented with appropriate statistical methods. Interventional strategies are the main features of secondary and tertiary prevention, now well-established in occupational dermatology. Primary prevention is best accomplished by health education measures, both in the form on individual counseling and seminars. This overview reviews the scientific background of hand eczema with respect to barrier damage and repair and then considers the options for individualized and focused prevention. Special anatomical features of the interdigital space and palms, as well as functional disorders, such as palmar hyperhidrosis, are discussed. The importance of barrier regeneration is considered in light of the role of an acid pH, the epidermal calcium gradient and aspects of percutaneous absorption. The effects of anti-oxidants are considered, and new bioengineering methods which rely on physiologic measuring techniques are reviewed.