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BACKGROUND: Phenol-formaldehyde resin 2 (PFR2) has been shown to be a useful marker of contact allergy (CA) to various phenol-formaldehyde resins. These compounds are used in various industries as solids, powders or semisolid resins and are known to be sensitising agents. OBJECTIVES: The aims were to investigate the contact allergy to PFR2 in a single tertiary dermatology centre, to investigate associated simultaneous allergic reactions, and to identify cases of allergic contact dermatitis (ACD) to PFR2. METHODS: A retrospective study was performed of patients patch tested to PFR2 between January 1, 2003 and June 17, 2020. RESULTS: Some 337 of 7922 patients were tested to PFR2 and 16 (4.7%) reacted. Of those 16 individuals, 6 (37.5%) had a relevant reaction (1.8% of total). Simultaneous allergic reactions were noted to colophonium in 8 (50.0%), Myroxylon pereirae in 5 (31.3%), and fragrance mix 1 in 4 cases (25.0%). CONCLUSION: Contact allergy to PFR2, even in a selected population of patients, is uncommon. However, patients exposed to plastic and glues, or who work with wood products should be routinely patch tested to a plastics and glues series containing PFR2. We recommend that all centres include PFR2 in their plastics and glues series. This article is protected by copyright. All rights reserved.

BACKGROUND Hairdressers have a high risk of occupational contact dermatitis caused by exposure to wet work and allergens in hairdressing chemicals. OBJECTIVES To examine the distribution of diagnoses of occupational skin diseases (OSDs) and their main causes in hairdressers based on a national register data on occupational diseases. METHODS We retrieved cases of recognized OSDs in hairdressers from the Finnish Register of Occupational Diseases (FROD) in years 2005-2018. RESULTS During the 14-year period, a total of 290 cases of recognized OSD in hairdressers were registered in the FROD. Allergic contact dermatitis (ACD) was diagnosed in 54%, irritant contact dermatitis in 44%, and contact urticaria (CU) in 5% of them. ACD was most commonly caused by hair dye products and their ingredients (N = 57), persulfates (N = 35), and preservatives (N = 35; mainly isothiazolinones). Acrylates emerged as hairdressers' occupational contact allergens (N = 8) probably due to introduction of structure nails into hair salons. Persulfates was the most common cause of CU. CONCLUSIONS ACD was the most common OSD in hairdressers. Our analysis confirms that preservatives are important causes of ACD in hairdressers in addition to hair dye products and persulfates. Acrylates emerged as hairdressers' occupational contact allergens, but contact allergy to perming agents remained rare.

Background Construction workers are a known risk group for occupational skin disease (OSD). Objectives To study diagnoses and causes of OSD in construction workers in the Finnish Register of Occupational Diseases (FROD) 2005-2016. Materials and methods We searched the FROD for dermatological cases in (a) construction-related occupations defined by the International Standard Classification of Occupations (ISCO-08) and (b) in the industrial branch of construction defined by the Statistical Classification of Economic Activities in the European Community (NACE Rev. 2). Results The two searches yielded the same number of cases, 329, although they were not identical subgroups. The number of allergic contact dermatitis (ACD) cases was 235 (71%) in construction-related occupations and 228 (69%) in the industrial branch of construction. In the latter analysis, synthetic resin systems caused 66% of ACD cases and 46% of all OSDs, epoxy compounds being the leading cause (122 cases; 54% of ACD cases; 37% of all OSDs). Metals were the second most common group of causes of ACD with 31 cases (chrome 22 cases; cobalt 8 cases). Isothiazolinones caused ACD in 21 cases, many of whom were painters. Conclusions ACD dominated the OSDs of construction workers and epoxy products were by far the leading cause comprising 37% of all OSDs. Chrome and isothiazolinones were also prominent causes of ACD.

BACKGROUND Professional musicians have prolonged and intense physical contact with their instruments. This can lead to occupational skin diseases, particularly irritant and allergic contact dermatitis. OBJECTIVES To assess the skin diseases and sensitization patterns common among professional musicians. METHODS A retrospective analysis of the data of the Information Network of Departments of Dermatology (IVDK) was performed, including data from 1997 to 2017. RESULTS We identified 236 professional musicians. In this group, male sex (58.6%) and younger age (60.6% aged < 40 years) were common. The musicians suffered more frequently from facial dermatitis (23.7% vs 15.7%) and less often from leg dermatitis (5.1% vs 10.7%) than the control group (the non-musicians in the IVDK database). The most frequent diagnoses were allergic contact dermatitis, atopic dermatitis, and irritant contact dermatitis. The sensitization profile of the professional musicians was similar to that of the control group. In 8.9% of cases, an occupational background of skin disease was confirmed. CONCLUSIONS Severe occupational skin diseases among professional musicians are not as common as in classic "skin-damaging" professions. However, as these skin conditions can mostly be controlled with simple preventive measures, we recommend that this group should be patch tested and treated by a specialist.

Background Assessment of the clinical relevance of patch test reactions is an essential part of the diagnostic work-up of patients with (occupational) contact dermatitis. However, final diagnostic information, particularly the clinical relevance of allergic patch test reactions, has hitherto been ill-represented in clinical documentation systems (patch test software) and surveillance registries based on these. Objectives To develop, implement as a pilot study, and analyse concerning feasibility and contents a new concept of representing the full scope of diagnostic information utilized in the diagnosis of patients with (occupational) contact dermatitis. Methods On the basis of a European working group discussion on items to document and catalogue lists to use for this purpose, an online documentation system to collect data was set up, followed by pilot use involving 9 dermatology departments across Europe. Results Data on 176 patients with suspected occupational hand dermatitis were included; among these, work-relatedness was confirmed in 150, and in 53 non-occupational aetiology was the sole or a contributory cause. Data were further analysed with regard to occupations, product categories, substances (haptens), source of information on which the evaluation was based, and various combinations of these factors, to illustrate the usefulness of the proposed data representation. Conclusions An improved method of data collection is presented that more accurately links allergen to exposure and to clinical disease and patient history, and thus better represents clinical relevance. This enables more precise analysis of the causation of contact dermatitis, occupational or non-occupational, and thereby better targeting of prevention. The development of future databases should incorporate the above considerations to record the results of investigation.

SummaryBackground Fragrances are well known to cause allergic contact dermatitis (ACD). Occupationally related cases occur, with certain groups being at higher risk. Objective To investigate the incidence of occupationally related cases of cutaneous fragrance allergy and to evaluate trends. Method Data on incident cases of occupational ACD caused by fragrances between 1996 and 2015 (inclusive) reported to the EPIDERM surveillance scheme were analysed. Results Of the cases reported to EPIDERM during the study period, 5.2% had ACD attributed to fragrances. The highest annual incidence rates were observed in women. Hairdressers, beauticians and people working in related occupations had a 47-fold higher incidence rate ratio than the reference category (the average of all other occupations combined). Trends analysis suggested a non-significant increase in fragrance allergy over the study period among all occupations, and beauty and food workers, and a slight decrease in healthcare workers. Conclusions Fragrance allergy is a significant problem in an occupational setting. Although there was no significant change in the incidence of fragrance-related allergic occupational contact dermatitis (OCD) during the 20-year study period, this does not mirror the trend in OCD, which is falling. Fragrance allergy continues to be a major contributor to OCD, and contributes to a greater proportion of cases.

SummaryBackground The high risk of occupational skin disease among hairdressers, caused by skin exposure to irritants and sensitizers, such as hair dye substances, is of great concern. Objectives The aim of the present study was to assess how the various tasks involved in hair dyeing contribute to hairdressers' exposure to hair dye, in order to enable the formulation of well-founded recommendations on working routines that will reduce exposure and prevent occupational disease. Methods Skin exposure to hair dye was measured for 20 hairdressers applying highlights and all-over hair colour with the hand rinsing technique. Resorcinol was used as a proxy for hair dye exposure. Results Applying hair dye and cutting the newly dyed hair were the tasks that contributed most to exposure in treatments for highlights. After cutting all-over-coloured hair, all hairdressers had measurable amounts of hair dyes on both hands. Conclusions Hairdressers are exposed to hair dye ingredients during all steps of the hair dyeing procedure. Cutting newly dyed hair contributes significantly to exposure. As initial steps for the prevention of occupational disease resulting from hair dye exposure, we suggest cutting hair before dyeing it, and wearing gloves during all other work tasks.

Background Personal protective equipment (PPE) is defined as equipment that protects the wearer's body against health/safety risks at work. Gloves cause many dermatoses. Non-glove PPE constitutes a wide array of garments. Dermatoses resulting from these have hitherto not been documented. Objectives To determine the incidence and types of non-glove PPE-related dermatoses. Patients/methods We analysed incident case reports from dermatologists of non-glove PPE-related dermatoses to a UK-wide surveillance scheme (EPIDERM) between 1993 and 2013. Results The dermatoses associated with non-glove PPE accounted for 0.84% of all occupational skin disease. Of all PPE-related cases, 194 (9.2%) were attributable to non-glove PPE. Of these, 132 (68.0%) occurred in men, and the median age (both male and female) was 42 years (range 18-82 years). The non-glove PPE-related dermatoses were diagnosed as: allergic contact dermatitis (47.4%), irritant contact dermatitis (16.0%), friction (11.3%), occlusion (11.3%), unspecified dermatitis (8.8%), acne (3.1%), infections (1.5), and contact urticaria (0.52%). The industries most associated with non-glove PPE-related dermatoses were manufacturing (18.6%), public administration and defence (17.0%), health and social work (15.5%), and transport, storage, and communication (9.8%). Conclusions Clothing, footwear, facemasks and headgear need to be recognized as causes of dermatoses occurring at body sites less commonly associated with occupational skin disease.

Summary Background Natural and synthetic rubbers containing rubber accelerators are well-known causes of allergic contact dermatitis (ACD). Latex contact urticaria (CU) has been widely reported, especially when powdered latex glove use was commonplace. Consequently, interventions to reduce latex exposure by altering glove manufacture were introduced. Objective This study aimed to analyse trends in UK-reported incidence of occupational skin disease associated with rubber accelerators. Method We analysed cases reported to EPIDERM (part of The Health and Occupation Research network) of occupational ACD caused by natural and synthetic rubber products, between 1996 and 2012. Results For the studied period, a decreasing incidence of ACD associated with rubber products was found, with an average annual change of −1.2% [95% confidence interval (CI) −3.1 to 0.7]. The number of cases of latex CU (n = 580) significantly declined. The number of cases of ACD caused by mercapto mix and mercaptobenzothiazole (n = 177) and thiuram mix (n = 603) also declined. Reports of ACD associated with carba mix and its constituents (n = 219) increased significantly, by an average annual percentage of 10.1% (95%CI: 6.1–14.2). Twenty-six cases of ACD caused by rarer rubber compounds were identified, highlighting skin disease attributable to less widely recognized chemicals. Conclusions These data show a falling reported incidence of occupational ACD attributed to rubber chemicals, but within this a significant rise attributable to the constituents of the carba mix. Clinicians should recognize the changing diversity of chemicals used in rubber manufacturing, and consider including carba mix in their baseline series and testing beyond this in suspect cases to avoid false-negative results.

Nickel is used in coins because the metal has beneficial properties, including price, colour, weight, and corrosion resistance, and also because it is easy to stamp. It has often been claimed that the duration of skin contact with coins is too short to cause nickel release and dermatitis. However, it is well known by dermatologists specialized in occupational skin diseases, and by their nickel-allergic patients, that hand eczema in cashiers and other professionals who handle coins may be caused or aggravated by nickel release from coins. In this review, we present evidence from past studies showing that nickel-containing coins can indeed pose a risk for those who handle them. For protection of the health of consumers, cashiers, and other workers who handle coins, it is suggested that coins without nickel release should be used as a substitute for the high nickel-releasing coins currently in widespread use. The key risk factor in this situation is the ability of metal alloys in coins to release nickel and contaminate the skin after repeated contact from coin handling.

Background. Epoxy resin systems (ERSs) are frequent causes of occupational allergic contact dermatitis. Epoxy pipe relining has become a widely used alternative to replacing old and worn drain pipes in housing, and involves a high risk of skin exposure to ERSs. Objectives. To map out work methods, protective measures and skin and surface contamination among workers involved in epoxy pipe relining, as a basis for prevention of occupational skin disease. Methods. Twenty-one employees in eight relining companies in Stockholm County were observed. Contact and contamination with ERSs and the use of personal protective equipment during relining work were noted. Results. Contamination by uncured ERSs on gloves, personal and shared tools and work areas was identified during mixing, wetting, installation, and cleaning. The gloves used were often inadequate for handling ERSs. Conclusions. Relining pipes poses an extensive risk of uncured ERS exposure, and contamination was identified during the whole work process. Shared and personal tools and work areas were extensively contaminated. Changes in work routines and logistics for handling ERSs are essential, and knowledge among both employers and employees regarding the risks caused by ERS exposure is vital to create a safe work environment and prevent contact allergies.

Background: Prevention of occupational skin diseases is of high socio-economic impact. Implementing teledermatology into preventive occupational screenings holds obvious advantages; nevertheless, studies concerning this subject are scarce. Objectives: The present cross-sectional study was aimed at determining if results of a teledermatological examination are equally sensitive and specific at detecting minimal skin lesions as the conventional face-to-face examination. Methods: The skin condition of the hands of 100 male wet workers was assessed in a face-to-face examination and a tele-examination by means of a score for minimal skin lesions. Results: The comparison of the total score values that each participant received in face-to-face examination with those obtained in tele-examination proved the skin condition to be estimated significantly worse when seen in tele-examination (P < 0.0001). The median values of the sum totals and the median values for secondary lesions were higher in the tele-examination than in the face-to-face examination. Conclusions: Our findings show a tendency in tele-examination to assess the skin condition more critically in comparison with face-to-face examination. The teledermatological examination is sufficiently sensitive in detecting early signs of hand eczema, whereas signs for chronicity may get overestimated.

The purpose of this study was to implement an evidence-based prevention programme to reduce occupational skin diseases in a wet work occupation by educational activities and elements from an occupational health-management system. The effects were studied by telephone interviews using a standardized questionnaire (NOSQ-2002) with trade-modified questions on work and exposure. The study population consisted of all employees at 5 cheese dairies. At baseline, October 2002, a total of 557 answered (83.8%). At follow up 1 year later, a total of 650 current and former employees answered (81.8%). At 4 of the 5 dairies, the eczema frequency at baseline was relatively low (11.8% and 5.9% at intervention dairies; 7.0%, 10.4% and 33.3% at comparison dairies). On all the studied dairies, about one-third of the workers reported having 2 or more skin symptoms at baseline. At follow up, skin symptoms were reduced significantly on all dairies. Effects restricted to the intervention dairies included significant increases in the use of gloves and moisturizers. The comparison dairy with high eczema frequency at baseline introduced skin-care products, changed hand soap and mowed employees with skin problems, away from adverse working areas during the intervention period, and the frequency of eczema was significantly reduced at follow up.

Hair dye allergies are a frequent cause of occupational skin disease among hairdressers. Conventional hair dyes contain 4-phenylenediamine (PPD), 2, 5-diaminotoluene sulfate (DTS) and 2-nitro-4-phenylenediamine (ONPPD) as allergens. In new generation hair dyes, FD & C and D & C dyes are used in the hair dye formulations. This study investigated the cross-reaction pattern of new generation hair dyes among hairdressers (n = 40) with a known allergy to PPD and/or DTS and/or ONPPD. In the 40 hairdressers no positive reactions were observed to the single FD & C and D & C dyes. In two hairdressers, doubtful reactions were observed to one or more of the hair dye formulations. The data from this study suggest that for hairdressers sensitized to PPD and/or DTS and/or ONPPD this new generation of hair dyes is a safe alternative for use in their salons.

Summary Background Hairdressers are at risk for occupational skin diseases. Since 2008, an educational programme has been conducted in Danish hairdressing schools to prevent occupational skin diseases. Its effect is unknown. Objective To examine the current frequency of self-reported hand eczema and contact urticaria in Danish hairdressing apprentices as compared with controls, and to determine the occurrence of hand eczema and contact urticaria in hairdressing apprentices with different durations of exposure to the trade. Methods This was a cross-sectional, web-based questionnaire study conducted among 504 hairdressing apprentices and a control group of 1400 adolescents from the general population. Results Hand eczema was significantly more prevalent in the hairdressing apprentices than in controls (34.5% versus 18.8%, p

Occupational skin disease is highly prevalent among agricultural workers. Tobacco cultivation and harvest are particularly hazardous for farmworkers. We report 5 migrant Latino farmworkers in North Carolina with contact dermatitis related to tobacco work. These cases show a characteristic distribution of contact dermatitis; the flexural and medial surfaces of the upper extremities were affected in each case, whereas most cases showed some involvement of the torso and axilla. This pattern most likely reflects a common occupational practice of holding the tobacco leaves under the arm and pressed against the body during harvesting.

Occupational skin diseases among dental health personnel, particularly involving the hands, have been an issue in recent years. Dental personnel come into contact with (meth)acrylate, which can cause skin irritation as well as contact allergy. In addition, they frequently wash their hands and use natural rubber latex (NRL) gloves, increasing their susceptibility to hand dermatitis. We surveyed the staff members of a university dental college and hospital.

We have examined 6 construction workers who developed chronic skin diseases on their hands over a period of 15 years (1970-1985). 4 developed a Trichophyton rubrum infection, and the other 2 an irritant contact dermatitis. All of them carried out jobs which caused traumatization of the skin, due to the presence of ethylene glycol and mineral oils during operation of pneumatic hammers in winter. They also suffered other types of skin trauma during their work. Construction workers may be at risk of developing an occupational skin disease involving fungal infection.

From a total of 993 previously reported cases of occupational skin disease (OSD), 954 (96%) were contacted and 711 (75%) examined, The review time (i.e., period from original diagnosis of OSD until review] varied from u minimum of 6 months to a maximum of over 8 years. Over 60% of cases were reviewed more than 2 years after the original diagnosis was made. More than 50% were still suffering from OSD or consequences related thereto. Clearance was less likely in those who remained in their original, or similar, occupational environment. However, of those who changed their job due to OSD. Many suffered aggravation of the dermatitis from factors in the new work environment. Over 10% of cases had evolved into a persistent post occupational dermatitis without obvious cause. This condition is responsible for considerable impairment and is of medicolegal importance due lo confusion as to its relationship to the original occupational factors.

Objectives: To analyse the yearly incidence rates and causes of occupational skin diseases (OSD) in different metal-working industries. Methods: Between 1990 and 1999, all new cases of OSD and their causes were prospectively recorded in all metal-working enterprises of Northern Bavaria. We calculated the incidence rates according to the average employed population. Furthermore, we analysed the different allergens, irritants and constitutional factors (e.g. atopy) in the affected metal workers. Results: In metal workers, a total of 700 OSDs were registered which comprise 18.8% of all OSDs in our register. They were classified into metal-surface processors (260 OSDs, yearly incidence per 10,000 employees = 10.4), metal processors (129 OSDs, 5.9), locksmiths and automobile mechanics (119 OSDs, 2.5), electrical industry (69 OSDs, 1.4), machinists (47 OSDs, 11.6), mechanics (40 OSDs, 6.6), electroplaters (22 OSDs, 20.6) and solderers (14 OSDs, 13.4). The proportion between allergic (ACD) and irritant contact dermatitis (ICD) varies conspicuously. While electroplaters and solderers predominantly suffer from ACD (82% resp. 71%), in other occupational groups ICD is more common: mechanics (60%), locksmiths and automobile mechanics (59%) or metal-surface processors (53%). The type IV allergens differ widely depending on the occupational exposure. The most important allergen in solderers is colophony, in electroplaters nickel sulphate and potassium dichromate. There is a wide range of allergens in metal working fluids and it is mandatory to patch test patient‘s own working materials due to the fact that important allergens are not yet included in the screening series.

In order to know the actual risk of contact dermatitis in hairdressers, we studied, from 1994 to 2003, 300 hairdressers of a total of 7510 patients seen in our Department of occupational skin diseases. Most of them were women (93%) with a mean age of 23.7 years. A positive patch test response to one or more of the allergens tested was presented by 215 patients (71.7%). Occupational allergic contact dermatitis was diagnosed in 174 cases (58%). The most frequent sensitizations showed by positive patch test response were to: PPD (54.3%), 4-aminobenzene (40.7%), nickel (36.7%), disperse orange (17%), p-toluene-diamine (15.3%), ammonium persulfate (14.3%), aminophenoles (14.0%), acid thioglycolic (12.7%) and kathon (10.3%). Irritant contact dermatitis (20%), no occupational allergic contact dermatitis (5.3%), atopic dermatitis (6.7%) were some of the other diagnoses between the hairdressers. We compare these results with those of a previous study of 379 hairdressers who attended our department from 1980 to 1993, in order to evaluate the effects of the changes in the substances and techniques used in hairdressing and the occupational education in the risk of sensitization in this trade.

This is a study of occupational skin disease among military personnel and conscripts in Singapore. All military personnel and conscripts diagnosed with occupational dermatoses in the National Skin Centre, Singapore, between 1989-1999 were studied retrospectively. Conscripts and regulars comprised 7.3% of all occupational skin disease patients seen. All were male, with a mean age of 23 years. Irritant contact dermatitis was more common than allergic contact dermatitis, by 4.4:1. The most common vocations associated with occupational skin diseases are those involving vehicle repairs and maintenance (48%) and food handling (19%). The most common irritants were oil/ grease (66%), wet work (23%) and solvents (18%). The most common allergens were food (40%) and chromates (20%). Military personnel and conscripts make up a significant proportion of occupational skin disease patients seen in Singapore.

993 cases of occupational skin disease (OSD) were diagnosed in a private dermatology practice over an 8-year period. Dermatologists were the major source of referral. The sex ratio was 2.4 males to 1 female. Patch tests were conducted in 79% of cases. Wet work industries predominated in females; in males the causative industries were more varied. Apprentices were affected in a high proportion of hairdressers and food handlers. Atopics accounted for 75% of the apprentice hairdressers. Atopics also were more prevalent in females with OSD than males. 29% of all cases had suffered from OSD for over 2 years before diagnosis. 75% of patients with OSD were less than 40 years of age at onset of OSD. Irritant contact dermatitis predominated over allergic contact dermatitis in all age groups except those over 60 years of age. Nickel was the predominant occupational allergen in females, whereas chromate was the predominant occupational allergen in males. 46% had been in the causative occupation for over 2 years before developing irritant contact dermatitis. Some new occupational allergens have emerged in recent years. OSD in Western Australia does not appear to differ in any major way from that reported from other countries.

Skin disorders were reported in 33% of catering staff and 35% of women cleaners who returned a questionnaire, and were employed in a large hospital. Hand dermatitis occurred in 15% of the caterers and 12% of the cleaners. In the majority, the dermatitis was irritant in origin and related to their wet work occupations. Cleaners had a high prevalence of jewellery dermatitis. Limited patch testing revealed a majority positive to nickel, but a third were negative, indicating that jewellery reactions often but not invariably predict nickel sensitivity. Few subjects were atopic, but some psoriatic patients with hand problems were encountered. Most workers were able to carry on in their occupations despite having hand dermatitis.