Acceptance of skin products in healthcare workers: an empirical investigation.

BACKGROUND: Healthcare workers (HCWs) are at high risk of developing hand eczema (HE). This can be exacerbated by hygiene measures related to the coronavirus disease (COVID-19). Using mild skin cleansers and emollients or moisturizers is central in the prevention of HE-especially with increased COVID-19 hygiene regimes. AIMS: This study aimed to assess parameters important for the acceptance of a skincare concept in HCWs. METHODS: In this proof-of-concept user trial, HCWs were provided ad libitum with hand wash oil and hand cream during the 6-month period, when occupationally acquired COVID-19 infections among HCWs were peaking in Germany and then surveyed about acceptance of the products using questionnaires. RESULTS: Of 135 HCWs, 115 (85%) responded. Skin tolerance of the hand wash oil and the hand cream was rated very good by 63% and 52% of the 115 participants, respectively. Of the 115 participants, 58% and 57% were very satisfied with the hand wash oil and the hand cream, respectively. CONCLUSIONS: Acceptance of skin cleansing and skincare products in HCWs seems influenced by parameters such as self-assessed skin tolerance and self-reported overall satisfaction. It must be assumed that products are only used as recommended if they are well-accepted. Employers might survey employees about acceptance of products using the parameters identified to adjust concepts if necessary to sustainably contribute to the prevention of HE.

[Medical notification of occupational skin diseases by dermatologists]. / Ärztliche Meldung von Berufskrankheiten der Haut in der dermatologischen Praxis.

In accordance with § 202 SGB VII, physicians in Germany have a legal obligation to report to the statutory accident insurance institution any justified suspicion of an occupational disease. With regard to skin diseases, various occupational disease numbers (Berufskrankheitennummer = BK No.) can be considered, depending on the type of disease and the type of exposure, e.g. BK No. 3101, 3102, 3104, BK No. 5102 and others in addition to the most common BK No. 5101 and BK No. 5103. The prerequisite for a well-founded suspicion is that occupational effects exist or existed which can be brought into a causal relationship with the skin disease. Form F6000 "Medical notification of a suspected occupational disease" is used for reporting. In the case of the numerically most significant BK No. 5101, there is the special feature that even if the skin disease is classified as occupationally caused, but not as severe or repeatedly relapsing, according to § 41 (1) of the contract between physicians and the accident insurance institutions, every physician is obliged to immediately present the insured person to a dermatologist so that the so-called dermatologist procedure can be initiated to enable the rapid initiation of prevention. Since 1 January 2021, it has been stipulated that the dermatologist's report must be submitted in every case-i.e. both when there is merely the possibility and when there is a well-founded suspicion of the existence of a BK No. 5101. This ensures that preventive measures can be quickly and effectively implemented.

Experimental evaluation of nickel and cobalt release from tools and self-reported prevalence of nickel and cobalt allergy in the German hairdressing trade.

BACKGROUND: Nickel release from some metal tools in the hairdressing trade has been sporadically evidenced, whereas data about cobalt release from metal tools in the hairdressing trade are lacking. OBJECTIVES: To screen metal tools for nickel and cobalt release and to estimate the prevalence of nickel allergy and cobalt allergy in the German hairdressing trade. METHODS: Four hundred seventy-five metal tools in the hairdressing trade were tested in three North German states with a nickel spot test for nickel release and with a cobalt spot test for cobalt release. Seventy hairdressers were surveyed with a standardized questionnaire to collect data about the tested metal tools as well as the prevalence of nickel allergy and cobalt allergy. RESULTS: One hundred thirty-one of 475 metal tools (27.6%) - 60 of 60 hair clips (100%), five of five crochet hooks (100%), 24 of 40 tweezers (60.0%), 33 of 75 sectioning clips (44.0%), five of 32 straight razors (15.6%), and four of 45 tail combs (8.9%) - released nickel and 10 of 475 metal tools (2.1%) - three of 40 tweezers (7.5%), four of 60 hair clips (6.7%), one of 32 straight razors (3.1%), and two of 75 sectioning clips (2.7%) - released cobalt. Eight of 63 female hairdressers (12.7%) suffered from nickel allergy and two of 63 female hairdressers (3.2%) suffered from cobalt allergy. CONCLUSIONS: Metal tools in the German hairdressing trade - with which a prolonged skin contact is intended - release nickel and cobalt in allergologically relevant amounts and thus should be taken into account as occupational sources of exposure to nickel and cobalt.

[Occupational aspects of palmoplantar pustulosis : Discussion based on the evaluation of retrospective data]. / Berufsdermatologische Aspekte der Pustulosis palmoplantaris : Diskussionsbeitrag anhand einer retrospektiven Datenauswertung.

BACKGROUND: Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease. Its classification as a variant of psoriasis is controversial. Exogenous factors may affect PPP. OBJECTIVES: Occupational aspects of PPP based on a retrospective evaluation of patient data are discussed. METHODS: Data from 1518 patients who took part in a tertiary prevention program (TIP) for occupational skin diseases in our department between January 2015 and June 2019 were evaluated. RESULTS: PPP was diagnosed in 30 patients (1.98%). The hands were affected in all of them, while concomitant feet involvement was found in 83.3%. The majority was female (70.0%) and reported tobacco smoking (83.3%). Systemic treatment was continued or initiated in one third of patients. In only 8 patients (26.7%) was PPP considered to be work-related. CONCLUSIONS: PPP is an endogenous disease which is influenced by nonoccupational factors (e.g., tobacco smoking). Therefore, a thorough investigation is mandatory when assessing whether occupational factors are legally essential and exceed aggravation by everyday life. For this purpose, a well-documented course of the disease and a critical appraisal of occupational and nonoccupational factors are crucial. Only if occupational causality is probable can preventive measures be provided by the statutory accident insurance and PPP can be legally recognized as an occupational disease.

Assessment of occupational exposure and spectrum of contact sensitization in metalworkers with occupational dermatitis: results of a cohort study within the OCCUDERM project.

BACKGROUND: Metalworkers occupationally exposed to metals, tools, metalworking fluids (MWFs), technical oils, gloves, skin care products etc. frequently suffer from occupational dermatitis (OD). OBJECTIVES: To investigate occupational exposure and to identify relevant occupational sensitizers in metalworkers with OD, and to evaluate suitability of current German patch test recommendations for this occupational group. PATIENTS AND METHODS: As part of the OCCUDERM project, occupational exposure of 230 metalworkers with suspected OD patch tested in the departments of dermatology in Göttingen and Osnabrück (both Lower Saxony, Germany) in 2012-2017 was recorded by questionnaire. These data, as well as results, of patch testing with standardized allergens and with workplace material were analysed. RESULTS: Metalworking fluids and skin care products were the most important exposures. Among MWF allergens, most frequently sensitizations to formaldehyde and formaldehyde releasers, colophony/abietic acid and monoethanolamine were observed. Sensitization to methylisothiazolinone (MI) was frequent, probably as part of the general European epidemic of contact allergy to MI in leave-on cosmetics. Sensitization to glove ingredients only played a minor role. CONCLUSIONS: The known occupational allergen spectrum could largely be confirmed. In order not to miss relevant sensitizations, patch testing with material from the patients' workplaces in parallel to baseline and MWF series is recommended. Sensitizations diagnosed could not always be linked to particular occupational exposures.

[Prevention of hand eczema]. / Prävention des Handekzems.

Apart from endogenous factors, hand eczema is often caused by irritant or allergic contact dermatitis related to occupational or non-occupational exposure to skin hazards. This enables several complementary approaches on the level of primary, secondary and tertiary prevention. A high priority is set on identification and subsequent reduction or elimination of causative exposures. Important preventive approaches include legal regulations, technical and organizational measures as well as correct use of adequate personal protective equipment (e.g. protective gloves). Interventions based on health education are conducted to improve individual protective behaviour. Even though evidence-based proof of effectiveness is limited, preventive measures are considered of particular importance for avoidance of occupational hand eczema and its adverse sequelae. Therefore, a complex, step-wise approach to occupational skin diseases has been established in Germany. In recent years, the positive impact of secondary and tertiary preventive measures of this approach has been demonstrated.

[Individual prevention of occupational contact dermatitis: protective gloves and skin protection recommendations as part of the patient management scheme by the public statutory employers' liability insurance]. / Individualprävention beruflicher Kontaktekzeme: Schutzhandschuhe und Hautschutzempfehlungen im berufsgenossenschaftlichen Heilverfahren.

The dermatologist's procedure is a pivotal tool for early recognition of occupational contact dermatitis (OCD), for reporting OCD cases to the statutory accident insurance and for treating the diseases. The employer is in charge of implementing skin protection measures at the workplace. However, in terms of an individual prevention approach it may be necessary to propose targeted skin protection recommendations in specific patient cases. The patient's own skin protection behavior significantly contributes to regenerating and maintaining healthy skin. This behavior includes the use of occupational skin products, and in particular the correct use of appropriately selected protective gloves. Protective gloves are the most important personal protective measure in the prevention of OCD. Prevention services, occupational health and safety specialists, occupational physicians and centers specialized in occupational dermatology can support the identification of suitable protective measures. Nowadays, suitable protective gloves exist for (almost) every occupational activity and exposure. However, improper use in practice can become a risk factor by itself for the skin (e. g., incorrectly used gloves). Therefore, it is of utmost importance to identify application errors, to educate patients in terms of skin protection and to motivate them to perform an appropriate skin protection behavior. With particular focus on protective gloves, this article gives an overview of various types, materials and potentially glove-related allergens, presents strategies for reducing occlusion effects and discusses some typical application errors and solutions.

[Occupational skin cancer : Prevention and recommendations for UV protection as part of the treatment approved by the public statutory employers' liability insurance]. / Beruflicher Hautkrebs : Prävention und UV-Schutzempfehlungen im berufsgenossenschaftlichen Heilverfahren.

In Germany, approximately 2 to 3 million employees work in outdoor professions. They are exceptionally exposed to solar ultraviolet (UV) radiation for a large part of their daily working time. Cumulative UV exposure is associated with a significantly increased risk of skin cancer for outdoor workers from various occupational groups (e. g. landscape and horticulture, agriculture and forestry, fisheries and seafaring, construction and trade, as well as sports teachers, lifeguards and mountain guides). Since 1 January 2015, squamous cell carcinoma and multiple actinic keratosis due to natural UV radiation can be recognised as occupational disease No. 5103 by the German statutory social accident insurance. Reducing cumulative UV exposure is the main prevention aspect of this type of skin damage. Therefore, technical, organisational and personal UV protection measures should be implemented in the professional and private environment. Moreover, they have to be regularly used in an appropriate way. In addition to guideline-oriented therapy, training and counselling of patients with already existing actinic skin damage or a recognised occupational disease No. 5103 is therefore of particular importance. The focus should be on improving the individual UV protection behaviour. This article gives an overview of current recommendations for UV protection in the professional environment. It outlines possible solutions for patient counselling in terms of UV protection in everyday practice.

Ethylene oxide as an occupational contact allergen - an underestimated problem?

BACKGROUND: Ethylene oxide (EtO) is a volatile epoxy compound which is used to sterilize medical devices. EtO may cause irritant contact dermatitis, but only few cases of allergic contact dermatitis have been reported yet. OBJECTIVES: About 20 employees of a department for surgery developed eczematous skin reactions at the contact areas to wrist bands of surgical gowns which had been sterilized with EtO. Patch tests were performed to exclude contact allergy. METHODS: Due to the volatility of EtO, patch tests were done with epichlorohydrin (0.1% pet., 1% pet.) which is an epoxy compound chemically related to EtO. RESULTS: 7/8 patients and 4 healthy control persons showed non-allergic irritant reactions to 1.0% epichlorohydrin. 1.0% epichlorohydrin may have induced an iatrogenic sensitization in one of the control persons. None of the control persons reacted to 0.1% epichlorohydrin. Allergic contact dermatitis to EtO and a cross sensitization to epichlorohydrin was diagnosed in a nurse who showed an allergic crescendo patch test reaction to 0.1% epichlorohydrin. CONCLUSIONS: EtO can act as an occupational contact allergen in health personnel, a problem that may have been underestimated in the past due to methodological difficulties in patch testing. When allergic contact dermatitis to EtO is suspected, a patch test to 0.1% epichlorohydrin should be performed.

Occupational contact allergy in bricklayers, tile setters etc. - Current spectrum of sensitization and recent time trends.

BACKGROUND: Occupational exposure of bricklayers, construction workers, tile setters etc. has changed during the last years. For some years now, all manually handled cement in the European Union and in Switzerland is chromate-reduced. Epoxy resin systems are being used in more and more fields of application. Improved worker's protection, especially wearing protective gloves, is promoted. These changes influence the spectrum of occupational contact sensitization. OBJECTIVE: Description of the current allergen spectrum in patients working in the building trade who suffer from occupational contact dermatitis. MATERIAL AND METHODS: Retrospective analysis of data of the Information Network of Departments of Dermatology (IVDK), 2009 - 2011. RESULTS: During the study period, 245 bricklayers, construction workers, tile setters etc. with occupational dermatitis have been patch tested. Potassium dichromate was the most frequent allergen, yielding 15.1% positive reactions, followed by epoxy resin with 13.7% positive reactions. Beyond that, there were 8 additional components of epoxy resin systems (5 reactive diluents and 3 amine hardeners), as well as 9 rubber ingredients, mainly thiurams, among the 30 most frequent allergens. In the course of time, a decline of chromate sensitization could be noted, paralleled by a decline of cobalt sensitization. In contrast, sensitization to epoxy resin has increased. CONCLUSION: Thanks to the usage of chromate-reduced cement, chromate sensitization continues to decline in the building trade. The increase of epoxy resin sensitization must prompt intensified prevention efforts. When recommending protective gloves, thiuram-free products should be preferred. The most important allergens are covered by the following test series recommended by the German Contact Dermatitis Research Group (DKG): DKG baseline series, DKG test series "building trade", DKG rubber series.

Occupational contact sensitization in female geriatric nurses: Data of the Information Network of Departments of Dermatology (IVDK) 2005-2014.

BACKGROUND: Geriatric nurses (GN) have a high risk of occupational contact dermatitis (OCD), with chronic irritant contact dermatitis predominating. However, allergic contact dermatitis is an important issue as well. Little is known whether the relevant occupational allergen spectrum reported in the 1990s, including fragrances, preservatives, rubber chemicals and ingredients of surface disinfectants to be the most common sensitizers in GN, is still valid. OBJECTIVES: To monitor the current allergen spectrum in GN with OCD and verify the validity of the patch test recommendations (baseline-, preservative-, ointment base-, rubber-, disinfectant, series and fragrances) in GN with suspected OCD given by the German Contact Dermatitis Research Group (DKG). METHODS: Retrospective analysis of IVDK data (2005-2014) of 743 female GN with OCD, in comparison to 695 GN without OCD. RESULTS: GN with OCD reacted significantly more frequently to both fragrance mixes, hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC), thiuram mix, zinc diethyldithiocarbamate and mercaptobenzothiazole than GN without OCD. Reactions to MDBGN, methylchloroisothiazolinone/methylisothiazolinone and oil of turpentine occurred substantially, but not significantly more frequently among GN with OCD. The latter may be due to former use of a special alcoholic liniment in geriatric care. Among material from the patients' workplaces, tetrazepam was a frequent allergen, due to dust exposure from pill crushing. Furthermore, occupationally used protective gloves, body care products as well as surface disinfectants were often tested positively. CONCLUSIONS: The general allergen spectrum in GN with OCD is unchanged, so the DKG patch test recommendations are still valid. Prevention of occupational sensitization should focus on fragrance-free hygiene and body care products, usage of accelerator-free protective gloves and avoidance of drug dust exposure.

Tertiary individual prevention improves mental health in patients with severe occupational hand eczema.

BACKGROUND: Occupational hand eczema (OHE) is associated with impaired health-related quality of life (QoL) and mental distress. Interdisciplinary inpatient rehabilitation measures in the framework of tertiary individual prevention (TIP) offered by the German employers' liability insurance associations include dermatological treatment, education and psychological interventions. OBJECTIVE: To investigate the effects of interdisciplinary inpatient rehabilitation in the framework of TIP on mental health in patients with severe OHE and the relationships between recovery of OHE and improvement of mental health and QoL. METHODS: A total of 122 patients participated in the study. A test battery consisting of the German versions of the Hospital Anxiety and Depression Scale (HADS-D), the Dermatology Life Quality Index (DLQI), the Short Form Health Survey-36 (SF-36) and the Trier Inventory for the Assessment of Chronic Stress (TICS) was applied at the time of admission (T1) and 3 weeks after dismissal (T2). Severity of hand eczema was assessed with the Osnabrueck Hand Eczema Severity Index (OHSI). RESULTS: All parameters improved significantly from T1 to T2. A relationship was established between the improvement of QoL and recovery of OHE, while there was no such relationship between the improvement of mental distress and improvement of OHE. Nonresponders had significantly more cumulative days of sickness at T1. CONCLUSIONS: Our data underscore the importance of psychological interventions in addition to dermatological treatment in the framework of prevention measures for OHE. These measures should be applied at an early stage of OHE prior to the occurrence of sick leave.

[Individual in-patient and out-patient prevention in occupational skin diseases]. / Individuell ambulante und stationäre Prävention bei Berufsdermatosen.

Concerning all occupation-related diseases, one-third of those reported in Germany are skin diseases. Among them, contact dermatitis is the most frequent skin disease. It usually presents as hand eczema leading to a loss of function and ability to work as well as reduced quality of life. Due to the high demand a number of prevention programmes were introduced. They comprise measures of secondary (out-patient) and tertiary (in-patient) prevention. Out-patient prevention measures include dermatologist's report and occupation-tailored teaching and prevention programmes. If the occupational skin disease is severe, therapy is not successful or the diagnosis is not clear measures of tertiary prevention can be offered as an in-patient treatment and prevention programme. All this aims to prevent the job loss of the patient. Preventive measures in occupational dermatology have proven to be very effective in recent years, especially measures of individual in-patient and out-patient prevention as components of a complex hierarchical prevention concept. This integrated concept of an in-patient/out-patient disease management reveals remarkable pertinent effectivity for patients with severe occupational dermatoses in risk professions.

Association between tobacco smoking and prognosis of occupational hand eczema: a prospective cohort study.

BACKGROUND: Hand eczema (HE) is a common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not yet been studied. OBJECTIVES: To evaluate relations between smoking status, severity and prognosis of occupational HE in patients taking part in an interdisciplinary tertiary individual prevention programme (TIP). METHODS: In a prospective, multicentre, cohort study 1608 patients with occupational HE taking part in a TIP were recruited and followed up for 3 years. The clinical and self-reported outcome data of smokers and nonsmokers were compared. RESULTS: Nonsmokers and smokers were equally distributed. During the TIP, the average self-reported daily cigarette consumption and the severity of HE decreased significantly (P < 0·01). However, at all time points HE was significantly more severe in smokers than in nonsmokers. This association was not dependent on the self-reported number of cigarettes smoked daily. Smokers had significantly more days of absence from work due to occupational HE than nonsmokers in the year before the TIP (P < 0·01) and in the following year (P = 0·02). After the TIP, smokers reported significantly more often that they had to give up their occupation (P = 0·02) than nonsmokers. CONCLUSIONS: The severity of occupational HE is increased in smokers. Tobacco smoking is associated with a higher number of days of absence from work and with not staying in the workforce owing to occupational HE. Thus, smoking confers a worse prognosis and interferes with the outcome of prevention programmes.

["With all suitable means". Off-label-use and public statutory employers' liability insurance]. / "Mit allen geeigneten Mitteln". Off-label-Use und Berufsgenossenschaften.

In Germany, responsibility for treatment of occupational diseases lies with the public statutory employers' liability insurances (SELI). According to their legal obligation SELI have to ascertain cure--wherever possible--"with all suitable means". Thus, dermatologists treating patients with occupational dermatoses are required to deliver the best possible therapy, which, according to the current scientific knowledge, may in some cases be off-label. For example, in occupational contact dermatitis a number of scientifically promising topical and systemic drugs are not yet licensed for this indication. Off-label prescribing is not prohibited and there are no laws limiting physician flexibility in such prescribing. SELI also allows the use of off-label drugs. The goals of optimal treatment or effective prevention of occupational disease determine the measures which can be employed. Off-label use is approved for occupational skin diseases when the medication is required for cure or prevention and its use meets generally accepted medical standards. In these cases, SELI will cover off-label drug prescriptions. However, detailed patient counseling and informed consent are mandatory.