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PubMed2005

Incidence and prevalence rates for occupational contact dermatitis in an Australian suburban area.

Occupational contact dermatitis (OCD) regularly causes high levels of worker morbidity; however, this is often not reflected in available statistics. This study aimed to collect and verify OCD reports/referrals and generate disease estimates for a defined geographical area in Melbourne, Australia. Two methods of data collection were used. In the first method, 30 general practitioners (GPs), 2 dermatologists and 1 dermatology outpatient clinic within a defined area reported each worker with suspected OCD seen as part of routine practice. With the second method, workers living in the area who were referred to a tertiary referral OCD clinic were included in the study. An occupational dermatologist used a gold standard process that included diagnostic patch testing to verify suspected cases. The incidence rate for confirmed cases was 20.5 per 100,000 workers [95% confidence interval (CI): 13-32.1]. The 1-year-period prevalence rate was 34.5 per 100,000 (95% CI: 24.4-48.7). The positive predictive value (PPV) was highest for the occupational dermatology clinic referrals [63% (95% CI: 49-76%)] compared with reports from the dermatologists/dermatology outpatient clinic [55% (95% CI: 36-74%)] and from GPs [43% (95% CI: 29-59%)]. This study utilizes reports from GPs and dermatologists to provide OCD disease estimates and validation data for an OCD disease register.

Adult↗
PubMed1999

Pattern of occupational allergic dermatitis in the Dermatology Clinic, Hospital Kuala Lumpur.

A two years retrospective analysis of patients diagnosed as contact allergic dermatitis with positive patch test attending the Dermatology clinic was performed. Of the 346 patients with a positive patch test, 14% had occupational dermatitis. This condition affected mainly young and inexperienced workers. An inverse relationship was seen between age and prevalence of occupational allergic dermatitis. Allergic hand dermatitis was the commonest presentation in occupational allergic dermatitis. This was followed by dermatitis of the exposed skin (face, neck, hands and forearms). The common sensitising agents identified were rubber chemicals and nickel. The two main groups at risk were factory workers and medical personnel. The common allergens found in factory workers were epoxy resin, pewter, nickel and rubber chemicals. Exposure dermatitis occurred in patients working in the pewter industry. Two thirds of medical personnel with hand dermatitis were allergic to rubber gloves. One year follow up after patch testing showed that 19% of patients still suffered from chronic dermatitis. Dermatitis improved in 34% of patients. Forty-seven percent were cured and stopped attending the clinic after patch testing and adequate counselling.

Adult↗
PubMed1994

[Occupational contact dermatitis induced by allergens present in rubber. I. Allergy to rubber accelerators].

During the period between January 1989 and 15 April 1994 allergy to chemical compounds present in rubber was found in 51 (15%) out of 339 patients with occupational dermatitis. In this group (20 workers of the metallurgical industry, 15 health service workers, 6 workers of the building and 3 of the rubber industries, 2 farmers and 5 drivers) the frequency of allergy to 15 accelerators of the thiuram group, thiocarbamates, thiazoles as well as derivatives of diphenylguanidine and thiocarbamide was investigated. Thiurams caused over-sensitivity in 52.9% of patients, thiocarbamates in 41.2%, thiazoles in 35.3%, guanidine derivatives in 11.8% and thiocarbamide in 9.8%. In general, allergy to thiocarbamates was concomitant with allergy to thiurams (20 out of 21 patients allergic to carbamates) and over-sensitivity to thiazoles was very often parallel to allergy to thiurams (8 out of 18 patients allergic to thiazoles). Accelerators present in the rubber of protective gloves proved to be the most frequent source of allergy especially in health service workers.

Adult↗
PubMed1993

Prognosis of occupational contact dermatitis in New South Wales, Australia.

570 patients with occupational contact dermatitis (OCD) were seen between 1984 and 1990 at the Skin and Cancer Foundation in Sydney. 336 (59%) were followed up 1 to 5 years later. Roughly 1/3 were healed, 1/3 were improved without complete healing, 1/4 had no change and 1/12 of the patients had deteriorated. The overall improvement rate was in excess of 70%. Data derived from these patients demonstrated that changing the work duties of patients with OCD improved their outcome (p < 0.01), whilst leaving the industry altogether resulted in a greater overall healing rate (p < 0.01). No difference existed between the outcome of irritant contact dermatitis compared with allergic contact dermatitis. Atopics as expected had a worse prognosis. The outcome in the construction industry was significantly poorer than other industries. Patients suffering from allergic contact dermatitis from chromate also had a dismal prognosis.

Dermatitis, Contact↗
PubMed2007

Dermatologist and family practitioner practice patterns for occupational contact dermatitis.

Medical practitioners have a role in the recognition of occupational contact dermatitis. The longer the duration of symptoms before diagnosis, the poorer the outcome. Our objective was to understand practice patterns, barriers and needs for early diagnosis of occupational contact dermatitis. A survey to obtain information on practice patterns was developed based on the literature and interviews with dermatologists and family practitioners. The survey was sent to all dermatologists and a random sample of 600 family practitioners in Ontario. Fifty-seven per cent of dermatologists and 9% of family practitioners report seeing more than 20 patients per year with occupational contact dermatitis. The majority of practitioners report taking a workplace exposure history. Barriers to taking a workplace exposure history include time constraints and lack of knowledge. Reasons for referral to specialists include a lack of expertise, testing facilities and knowledge about workers' compensation, time constraints and inadequate reimbursement, whereas lack of access to specialists is a barrier for referral. Although most practitioners identify a need for further education, a low volume of patients and time constraints are key barriers to continuing education. Opportunities are identified to improve educational initiatives and health services delivery for occupational contact dermatitis, tailored to each practitioner group.

Dermatitis, Allergic Contact↗
PubMed1997

Occupational contact dermatitis.

The two commonest forms of occupational skin disease are irritant and allergic contact dermatitis. Morphology and history are used to establish the diagnosis and the relation of the disorder to work exposure, respectively. Diagnostic patch tests are used to define further the diagnosis and aetiology of the dermatitis.

Dermatitis, Atopic↗
PubMed2002

Prognosis and work absence due to occupational contact dermatitis.

The consequences of a diagnosis of occupational contact dermatitis (OCD) were investigated using cases available from the voluntary surveillance scheme, EPIDERM. Cases of OCD reported from November 1994 to September 1995 were identified and sampled to give at least 100 cases of allergic, irritant and mixed OCD reported by consultant dermatologists (344 cases) and occupational physicians (377 cases). A questionnaire was sent to the reporting physician to elicit further information. 512 completed questionnaires were returned, of which 510 were eligible for analysis. Among cases reported by dermatologists (n = 286) and occupational physicians (n = 224), 7% (6.3%) had been unemployed and 16.8% (20.1%) had taken sick leave. 3 factors independently predicted time off work in a logistic regression analysis: age OR = 1.25 (95% CI, 1.05-1.49), allergic dermatitis OR = 1.77 (95% CI, 1.13-2.79) and medicolegal assessment OR = 4.42 (95% CI, 2.20-8.89). Overall, 15.7% did not improve clinically between the first and last visit. Those who did not improve had been exposed to the agent for longer (mean 7.6 years) than those who did (5.3 years) (p = 0.09). In patients <or= 45 years, those reported to be atopic failed to improve (25.4%) more often than those not atopic (13.4%) (p = 0.04). The substantial numbers (21%) with time off work and with persistent dermatitis suggest that OCD continues to have a significant impact on workers and their employers.

Absenteeism↗
PubMed2006

Skin care in occupational contact dermatitis of the hands.

A survey of patients attending an occupational dermatology clinic with suspected occupational contact dermatitis affecting the hands was undertaken to determine if optimal skin care treatment had been instituted prior to referral for patch testing. Appropriate treatment for contact dermatitis of the hands was defined as concurrent use of a soap substitute, use of a lipid-rich moisturizer, and if appropriate, use of a topical corticosteroid in an ointment vehicle. Patients were asked about the use of a particular soap substitute, the name and type of any moisturizer used and the name and type of topical corticosteroids currently used. The products were examined where possible. Only one-third of all patients were using the complete package at the time of their clinic appointment. Nearly all of these patients had seen a dermatologist prior to this appointment. Of the group of patients with work-related diseases who reported having seen a dermatologist prior to the clinic appointment, only 38% were using the complete skin care routine.

Administration, Cutaneous↗
PubMed1995

The epidemiology of occupational contact dermatitis.

The dermatologist who is aware of the epidemiology of occupational contact dermatitis (OCD) can find this information helpful in making a diagnosis, determining etiology, and recommending preventive efforts. This article reviews some of the available epidemiologic data sources and their limitations. These data sources provide important information on the prevalence and incidence, the public health importance, the risk factors, the common etiologic agents, the prognosis, and the preventive measures for OCD.

Dermatitis, Occupational↗
PubMed1992

Occupational contact dermatitis in New South Wales.

Five hundred and seventy patients with occupational contact dermatitis (OCD) were seen between 1984 and 1990 at the Skin and Cancer Foundation in Sydney. Data derived from these patients demonstrated that hairdressing, food, construction and the medical industries were the most at risk of OCD. The hairdressing and food industries had a high percentage of apprentices suffering OCD whilst the 35 to 44 year age bracket was most at risk in the construction industry. Allergic contact dermatitis was responsible for 38.2% of cases. The main allergens were chromate, thiuram, epoxy resin, nickel and cobalt. A third (33.9%) of patients were atopic. The average time lost from work was 16 days each year and the calculated yearly cost of OCD in New South Wales was approximately $12 million.

Adolescent↗
PubMed1990

[Protective creams for prophylaxis of allergic contact dermatitis].

Occupational medicine is interested in effective prophylaxis of skin occupational diseases. Use of protective ointments and creams makes one of prophylaxis methods of professional dermatitis. The purpose of the investigation was to evaluate both the primarily irritant and the allergic action of the two creams devised by us for protection of skin exposed to aqueous solution of electrolytes. One of these creams was composed of hydrocarbons components, the other had in addition silicone oil and cetaceum. Protective properties of these creams in patients with allergic contact dermatitis were also examined. The experiments were carried out on 10 rabbits, 75 guinea pigs, and 491 patients mainly suffering from metal (Cr, Co, Ni) and formaldehyde allergy. It was found that investigated creams do not exert primarily irritant and sensitizing effects both in animals and humans. These creams demonstrate pronounced protective action in allergy due to water soluble allergens.

Adult↗
PubMed2003

Occupational contact dermatitis II: risk assessment and prognosis.

Contact dermatitis is a common and important condition in the occupational setting. In a companion paper, I describe changes in the incidence of recorded occupational skin disease from 1972 to 1999. Despite substantial improvements in workplace hygiene, the incidence of occupational skin disease remains half of that recorded in 1972. In the companion paper, it is argued that a more sophisticated approach to prevention and management may be required to substantially reduce the burden of occupational skin disease further. In this paper, I address the present state of risk assessment (including components of hazard identification, measuring or estimating dermal exposure, percutaneous absorption, dose-response relationships, and risk characterization) and the poor prognosis of serious occupational contact dermatitis, with a view to potential improvements in practice and outcomes.

Dermatitis, Allergic Contact↗
PubMed1980

Occupational contact dermatitis due to spiramycin and/or tylosin among farmers.

Nine farmers suspected of having occupational contact dermatitis had positive patch tests to spiramycin and/or tylosin. After diagnosis the dermatitis cleared or improved markedly in seven patients; five of these stopped using the antibiotics in question, and two began to wear gloves while handling the drugs. The two patients who continued use of the drugs and took no precautionary measures had little change in the activity of the dermatitis.

Adult↗
PubMed2001

Occupational contact dermatitis has an appreciable impact on quality of life.

In this study, we examined the impact of occupational contact dermatitis on quality of life. 181 patients, diagnosed with occupational contact dermatitis over a period of 3 years (1996-1999 inclusive), were sent a questionnaire based on the Dermatology Life Quality Index (DLQI) and the Short Form-36 (SF-36). 60 (32%) patients were in industrial occupations and 27 (14%) in health care. An overall response rate of 39% (n=70) was obtained. The median DLQI score was 5, with a mean score 6.6 (SD 6.4), which is similar to that seen in Behçet's syndrome and urticaria. There was no statistically-significant difference between male and female median scores (p=0.98) and no significant correlation between age and DLQI score nor between DLQI score and time from diagnosis. The most problematic quality of life areas were symptoms and feelings. Males scored highest in problems associated with work, relationships and treatment, whereas females scored highest in problems associated with symptoms and feelings, daily activities and leisure. The SF-36 scores showed an association between physical problems and emotional problems affecting work. From this study, it can be seen that occupational contact dermatitis has an appreciable impact on quality of life.

Adolescent↗
PubMed1991

Occupational contact dermatitis from rhodium and cobalt.

We report a case of occupational allergic contact dermatitis from rhodium sulphate and cobalt chloride in a 29-year-old woman working in a goldsmith's workshop. The relevance and source of sensitization to these metals in our patient is described, and the literature on the subject reviewed.

Adult↗
PubMed2004

Occupational contact dermatitis.

The dermatologist should be aware of the many facets of occupational skin diseases, which can be caused by physical, chemical, and biological insults. The most common manifestation of occupational skin diseases is contact dermatitis (both irritant and allergic). Three factors point out the importance of occupational skin diseases as diseases that have a public health impact: 1) occupational skin diseases are common; 2) they often have a poor prognosis; and 3) they result in a noteworthy economic impact for society and for an individual. They are also diseases amenable to public health interventions. Specific industries and exposures may put a worker at risk of occupational contact dermatitis. The accuracy of the diagnosis of occupational contact dermatitis is related to the skill level, experience, and knowledge of the medical professional who makes the diagnosis and confirms the relationship with a workplace exposure. Prevention of occupational contact dermatitis is important, and a variety of prevention strategies are available.

Allergens↗