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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. [ABSTRACT FROM AUTHOR]

Purpose: Uveal melanoma (UM) is an orphan cancer of high unmet medical need. Current patterns of care and surveillance remain unclear as they are situated in an interdisciplinary setting., Methods: A questionnaire addressing the patterns of care and surveillance in the management of patients with uveal melanoma was distributed to 70 skin cancer centers in Austria, Germany and Switzerland. Frequency distributions of responses for each item of the questionnaire were calculated., Results: 44 of 70 (62.9%) skin cancer centers completed the questionnaire. Thirty-nine hospitals were located in Germany (88.6%), three in Switzerland (6.8%) and two in Austria (4.5%). The majority (68.2%) represented university hospitals. Most patients with metastatic disease were treated in certified skin cancer centers (70.7%, 29/41). Besides, the majority of patients with UM were referred to the respective skin cancer center by ophthalmologists (87.2%, 34/39). Treatment and organization of follow-up of patients varied across the different centers. 35.1% (14/37) of the centers stated to not perform any screening measures., Conclusion: Treatment patterns of patients with uveal melanoma in Germany, Austria and Switzerland remain extremely heterogeneous. A guideline for the treatment and surveillance is urgently needed.

Background: Hand eczema has a high incidence and prevalence and has a negative impact on both physical and psychological well-being, with the risk of persistence as a chronic condition. Epidemiological studies on hand eczema provided mainly descriptive and risk analyses, but pattern analyses of variables associated with hand eczema, in particular chronic hand eczema, have not been explored to date., Objectives: To investigate and display the semantics of associations between variables of hand eczema obtained from the Swiss and German registries of chronic hand eczema (CARPE) to dissect patterns and novel links., Methods: This was a cross-sectional study on selected variables from the CARPE registries. Associations between variables were analysed by means of an autoassociative system. A semantic connectivity map was generated by using a maximum spanning tree algorithm., Results: Baseline datasets of 1466 patients with chronic hand eczema (Switzerland: 199; Germany: 1267) were analysed. Occupational exposure had the highest impact in the total and country cohorts. We identified two areas of exposure linked to corresponding occupations that clearly demarcated the sexes., Conclusions: This study, using semantic connectivity as a novel method of data analysis, reveals the complexity of features characterizing chronic hand eczema as well as novel association patterns that deserve further investigation., (© 2017 British Association of Dermatologists.)

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.

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.

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.

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.

Patients with allergic contact dermatitis due to dichromate are reputed to have a bad prognosis. Based on the Swiss Law on Accidents Insurance, the Swiss National Accidents Insurance Organization (SNAIO) may issue a declaration of medical inability (DMI) in cases of severe occupational dichromate dermatitis. With such a DMI, an employee is not allowed to perform any further work in contact with dichromate or cement. In this study, we reviewed medical records from 88 construction workers with DMI due to occupational dichromate dermatitis, between 1986 and 1989. Follow-up was performed by standardized questionnaire. 63 patients (72%) healed in the first few years after DMI. These patients mostly changed industry and strictly avoided all contact with cement or chromium salts. A few retired early. The outcome of our study is favorable in comparison to studies from other countries without the DMI mechanism. We conclude that strict allergen avoidance enforced by authorities, and financial support in the case of job change, are important factors in improving the prognosis in occupational dichromate dermatitis.

Background: For planning and evaluation of preventive activities against contact dermatitis, it is important to detect trends in contact sensitization., Objective and Methods: We performed a computer-aided analysis of the patch test results of 5,565 patients tested with the European standard allergens consecutively from 1990 to 1994 in our patch test clinic., Results: The male/female ratio was 42.4/ 57.6%. Sixty-one percent of the patients were < 45 years. Hands, face and lower legs were the major localizations of eczema. The largest occupational groups were office workers (21%), houseworkers and cleaning personnel (18%) and pensioners (10%). The highest sensitization rates were found for nickel (18.5%) and fragrance mix (9.6%). An increase of sensitizations to fragrance mix and balsam of Peru in both sexes and a decrease in nickel and cobalt sensitizations for females and potassium dichromate reactions for males were observed., Conclusion: Our data show considerable changes in the frequency of contact sensitizations that warrant further analytic studies.

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.

Background: Contact hypersensitivity to corticosteroids is increasingly reported and has been identified as a problem of considerable clinical relevance. The prevalence of positive patch tests to corticosteroids ranges from 0.2 up to 5%., Objective: The prevalence of positive patch tests to corticosteroids in Switzerland was determined in a multi-centre study of patients undergoing routine patch tests., Methods: As representatives of corticosteroid groups, the following substances were used for screening: tixocortol pivalate and hydrocortisone for group A (hydrocortisone type), hydrocortisone butyrate for group D (hydrocortisone butyrate type) and budesonide for both groups B (triamcinolone type) and D. Patients positive for at least one corticosteroid were retested with the screening series and 12 corticosteroids commonly used in Switzerland., Results: Among 3,016 consecutive patients, 65 individuals (2.2%) with a total of 106 positive reactions were found. Retesting showed a concordance of 70-98%, depending on the corticosteroid and the score of the positive reaction. In the subsequently tested corticosteroid series including 12 substances, 19 out of 56 screening-positive patients had a positive result to one or several corticosteroids. There were only few evident cross-reactive patterns in between the corticosteroids tested., Conclusions: Corticosteroids should be included in routine patch testing, because contact sensitization to a corticosteroid is of considerable practical importance. We confirm that as markers of corticosteroid sensitization tixocortol pivalate, budesonide and hydrocortisone butyrate may be suited, because there is no single corticosteroid which is a marker for all four corticosteroid groups. Patch test reactions of 2+ or higher have a better reproducibility than 1+ reactions.

Irritant contact dermatitis is the most frequent occupational skin disease resulting in considerable morbidity and economic losses to workers, employers, and insurers. This article reviews pathogenesis, epidemiology, diagnosis, and treatment of irritant dermatitis at the workplace and stresses the importance of integrated preventive measures that must be implemented by companies and employees to achieve optimal efficacy.