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Occupational Contact Dermatitis: Health Personnel

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Contact Dermatitis

Abstract

Healthcare personnel show high occupational risks suffering mainly from irritant and/or allergic contact dermatitis and less frequently contact urticaria. The spectrum of occupations involved is broad. The specialized nature of the tasks developed by some of these workers makes it difficult to relocate or substitute them. Although atopic condition and wet work increases the risk of hand eczema in healthcare workers, the hazard of sensitization is also very high. The agents capable to induce contact allergy show different chemical structures including proteins and low molecular weight molecules. This updated chapter reviews the causes of occupational contact dermatitis and urticaria in nurses, clinical assistants and cleaners, surgeons, laboratory personnel, other therapists, veterinarians, and laboratory animal handlers. Skin complains should be assessed habitually with both prick and patch testing. The identification of the responsible agents is always necessary being fundamental for developing effective preventive measures, some of which have been already demonstrated to be effective.

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References

  1. Stingeni L, Lapomarda V, Lisi P (1995) Occupational hand dermatitis in hospital environments. Contact Dermatitis 33:172–176

    Article  CAS  PubMed  Google Scholar 

  2. Mahler V (2007) Skin protection in health care setting. Curr Probl Dermatol 34:120–132

    Article  CAS  PubMed  Google Scholar 

  3. Camarasa JG, Conde Salazar L (1988) Occupational dermatoses in sanitary workers. In: Orfanos CE, Stadler R, Gollnick H (eds) Dermatology in five continents. Proceedings of the XVIIth world congress of dermatology, Berlin, 24–29 May 1987. Springer, Berlin/Heidelberg/New York, pp 1045–1048

    Google Scholar 

  4. Holness DL, Mace SR (2001) Results of evaluating health care workers with Prick and Patch testing. Am J Contact Dermatitis 12:88–92

    CAS  Google Scholar 

  5. Nettis E, Colanardi MC, Soccio AL, Ferrannini A, Tursi A (2002) Occupational irritant and allergic contact dermatitis among healthcare workers. Contact Dermatitis 46:101–107

    Article  CAS  PubMed  Google Scholar 

  6. Higgins CL, Palmer AM, Cahill JL, Nixon RL (2016) Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993–2014. Contact Dermatitis 75:213–222

    Article  CAS  PubMed  Google Scholar 

  7. Akan A, Toyran M, Erkoçohlu KA, Kocabas C (2012) The prevalence of allergic contact sensitization of practicing and student nurses. Int J Occup Environ Med 3:10–18

    CAS  PubMed  Google Scholar 

  8. Suneja T, Belsito DV (2008) Occupational dermatosis in health care workers evaluated for suspected allergic contact dermatitis. Contact Dermatitis 58:285–290

    Article  CAS  PubMed  Google Scholar 

  9. Kikuchi-Numagami K, Saishu T, Fukaya M, Kanazawa E, Tagami H (1999) Irritancy of scrubbing up for surgery with or without a brush. Acta Derm Venereol 79:230–232

    Article  CAS  PubMed  Google Scholar 

  10. Hachem JP, De Paepe K, Sterckx G, Kaufman L, Rogiers V, Roseeuw D (2002) Evaluation of biophysical and clinical parameters of skin barrier function among hospital workers. Contact Dermatitis 46:220–223

    Article  PubMed  Google Scholar 

  11. Callahan A, Baron E, Fekedulegn D, Kashon M, Yucesoy B, Johnson VJ, Domingo DS, Kirkland B, Luster MI, Nedorost S (2013) Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers. Dermatitis 24:170–175

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Weber DJ, Consoli SA, Rutala WA (2016) Occupational health risks associated with the use of germicides in health care. Am J Infect Control 44(5 Suppl):e85–e89

    Article  CAS  PubMed  Google Scholar 

  13. Pedersen LK, Held E, Johansen JD, Agner T (2005) Short-term effects of alcohol-based disinfectant and detergent on skin irritation. Contact Dermatitis 52:82–87

    Article  CAS  PubMed  Google Scholar 

  14. Slotosch CM, Kampf G, Löffler H (2007) Effects of disinfectants and detergents on skin irritation. Contact Dermatitis 57:235–241

    Article  CAS  PubMed  Google Scholar 

  15. Stutz N, Becker D, Jappe U, John SM, Ladwig A, Spornraft-Ragaller P, Uter W, Löffler H (2009) Nurses’ perceptions of the benefits and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group. Br J Dermatol 160:565–572

    Article  CAS  PubMed  Google Scholar 

  16. Valsecchi R, Leghissa P, Cortinovis R, Cologni L, Pomesano A (2000) Contact urticaria from latex in healthcare workers. Dermatology 201:127–131

    Article  CAS  PubMed  Google Scholar 

  17. Lammintausta K, Kalimo K (1981) Atopy and hand dermatitis in hospital wet work. Contact Dermatitis 7:301–308

    Article  CAS  PubMed  Google Scholar 

  18. Nilson E, Mikaelsson B, Andersson S (1985) Atopy, occupation and domestic work as risk factors for hand eczema in hospital workers. Contact Dermatitis 13:216–223

    Article  Google Scholar 

  19. Gupta SB, Gupta A, Shah B, Kothari P, Darall S, Boghara D, Sonkar S, Deo K (2018) Hand Eczema in nurses, nursing auxiliaries and cleaners- A cross-sectional study from tertiary hospital in western India. Contact Dermatitis 79:20–25

    Article  PubMed  Google Scholar 

  20. Visser MJ, Verberk MM, Campbell LE, McLean WH, Calkoen F, Bakker JG, van Dijk FJH, Bos JD, Kezic S (2013) Filaggrin loss-of-function mutations and atopic dermatitis as risk factors for hand eczema in apprentice nurses: part II of a prospective cohort study. Contact Dermatitis 70:139–150

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lammintausta K, Kalimo K, Havu VK (1982) Occurrence of contact allergy and hand eczemas in hospital wet work. Contact Dermatitis 8:84–90

    Article  CAS  PubMed  Google Scholar 

  22. Flyvholm MA, Bach B, Rose M, Jepsen KF (2007) Self-reported hand eczema in hospital population. Contact Dermatitis 57:110–115

    Article  PubMed  Google Scholar 

  23. Lan CC, Feng WW, Lu YW, Wu CS, Hung ST, Hsu HY, Yu HS, Ko YC, Lee CH, Yang YH, Chen GS (2008) Hand eczema among University Hospital nursing staff: identification of high-risk sector and impact in quality of life. Contact Dermatitis 59:301–306

    Article  PubMed  Google Scholar 

  24. Skudlik C, Dulon M, Wendeler D, John SM, Nienhaus A (2009) Hand Eczema in Geriatric Nurses in Germany. Prevalence and Risk Factors. Contact Derm 60:136–143

    Article  Google Scholar 

  25. Hansen KS (1983) Occupational dermatoses in hospital cleaning women. Contact Dermatitis 9:343–351

    Article  CAS  PubMed  Google Scholar 

  26. Singgih SI, Lantinga H, Nater JP, Woest TE, Kruyt-Gaspersz JA (1986) Occupational hand dermatoses in hospital cleaning personnel. Contact Dermatitis 14:14–19

    Article  CAS  PubMed  Google Scholar 

  27. Gawkrodger DJ, Lloyd MH, Hunter JAA (1986) Occupational skin disease in hospital cleaning and kitchen workers. Contact Dermatitis 15:132–135

    Article  CAS  PubMed  Google Scholar 

  28. Gibbon KL, McFadden JPM, Rycroft RJG, Ross JS, Chinn S, White IR (2001) Changing frequency of thiuram allergy in healthcare workers with hand dermatitis. Br J Dermatol 144:347–350

    Article  CAS  PubMed  Google Scholar 

  29. Aalto-Korte K, Jolanki R, Estlander T, Alanko K, Kanerva L (1996) Occupational allergic contact dermatitis caused by Euxyl K 400. Contact Dermatitis 35:193–194

    Article  CAS  PubMed  Google Scholar 

  30. Weisshaar E, Radulescu M, Bock M, Albrecht U, Diepgen TL (2006) Educational and dermatological aspects of secondary individual prevention in healthcare workers. Contact Dermatitis 54:254–260

    Article  PubMed  Google Scholar 

  31. Crippa M, Balbiani L, Baruffini A, Belleri L, Draicchio F, Feltrin G, Larese F, MAaggio GM, Marcer G, Micheloni GP, Montomoli L, Moscato G, Previdi M, Sartorelli P, Sossai D, Spatari G, Zanetti C (2008) Consensus document. Update on latex exposure and use of gloves in Italian health care settings. Med Lav 99:387–399

    CAS  PubMed  Google Scholar 

  32. Allmers H, Schmengler J, John SM (2004) Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol 114:347–351

    Article  PubMed  Google Scholar 

  33. Bensefa-Colas L, Telle-Lamberton M, Faye S, Bourrain JL, Crepy MN, Lasfargues G, Choudat D, Members RP, Momas I (2015) Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Br J Dermatol 173:1453–1461

    Article  CAS  PubMed  Google Scholar 

  34. Molin S, Bauer A, Schnuch A, Geier J (2014) Occupational contact allergy in nurses: results from the Information Network of Departments of Dermatology 2003–2012. Contact Dermatitis 72:164–171

    Article  PubMed  CAS  Google Scholar 

  35. Schubert S, Bauer A, Molin S, Skudlik C, Geier J (2017) Occupational contact sensitization in female geriatric nurses: data of the Information Network of Departments of Dermatology (IVDK) 2005–2014. JEADV 31:469–476

    CAS  PubMed  Google Scholar 

  36. Gielen K, Goossens A (2001) Occupational allergic contact dermatitis from drugs in healthcare workers. Contact Dermatitis 45:273–279

    Article  CAS  PubMed  Google Scholar 

  37. Pinheiro V, Pestana C, Pinho A, Antunes I, Gonçalo M (2018) Occupational allergic contact dermatitis caused by antibiotics in healthcare workers- relationship with non-immediate drug eruptions. Contact Dermatitis 78:281–286

    Article  CAS  PubMed  Google Scholar 

  38. Lyon TC (1971) Allergic contact dermatitis due to Cidex. Oral Surg 32:895

    Article  CAS  PubMed  Google Scholar 

  39. Schnuch A, Geier J, Uter W, Frosch PJ (1998) Patch testing with preservatives, antimicrobials and industrial biocides. Results from a multicenter study. Br J Dermatol 138:467–476

    Article  CAS  PubMed  Google Scholar 

  40. Shaffer MP, Belsito DV (2000) Allergic contact dermatitis from glutaraldehyde in health-care workers. Contact Dermatitis 43:150–156

    Article  CAS  PubMed  Google Scholar 

  41. Neering H, van Ketel WG (1974) Glutaraldehyde and formaldehyde allergy. Contact Dermatitis Newslett 16:518

    Google Scholar 

  42. Maibach HI (1975) Glutaraldehyde: cross reaction to formaldehyde. Contact Dermatitis 1:326

    Article  CAS  PubMed  Google Scholar 

  43. Nethercott JR, Holness DL, Page E (1988) Occupational contact dermatitis due to glutaraldehyde in health care workers. Contact Dermatitis 18:193–197

    Article  CAS  PubMed  Google Scholar 

  44. Hansen KS (1983) Glutaraldehyde occupational dermatitis. Contact Dermatitis 9:81–82

    Article  CAS  PubMed  Google Scholar 

  45. Hansen EM, Menné T (1990) Glutaraldehyde: patch test, vehicle and concentration. Contact Dermatitis 23:369–370

    Article  CAS  PubMed  Google Scholar 

  46. Waters A, Beach J, Abramson M (2003) Symptoms and lung function in health care personnel exposed to glutaraldehyde. Am J Ind Med 43:196–203

    Article  PubMed  Google Scholar 

  47. Lehman PA, Franz TJ, Guin JD (1994) Penetration of glutaraldehyde through glove material: tactylon versus natural rubber latex. Contact Dermatitis 30:176–177

    Article  CAS  PubMed  Google Scholar 

  48. Foussereau J, Samsoen M, Hecht MT (1983) Occupational dermatitis to Ampholyt G in hospital personnel. Contact Dermatitis 9:233–234

    Article  CAS  PubMed  Google Scholar 

  49. Suhonen R (1980) Contact allergy to dodecyl-di-(aminoethyl) glycine (Desimex i). Contact Dermatitis 6:290–291

    Article  CAS  PubMed  Google Scholar 

  50. Dejobert Y, Martin P, Piette F, Thomas P, Bergoend H (1997) Contact dermatitis from didecyldimethylammonium chloride and bis-(aminopropyl)-laurylamine in a detergent-disinfectant used in hospital. Contact Dermatitis 37:95–96

    Article  CAS  PubMed  Google Scholar 

  51. Dibo M, Brasch J (2001) Occupational allergic contact dermatitis from N,N-bis(3-aminopropyl)dodecylamine and dimethyldidecylammonium chloride in 2 hospital staff. Contact Dermatitis 45:40

    Article  CAS  PubMed  Google Scholar 

  52. Lombardi P, Gola M, Acciai MC, Sertoli A (1984) Unusual occupational allergic contact dermatitis in a nurse. Contact Dermatitis 20:302

    Article  Google Scholar 

  53. Cristersson S, Wrangsjö K (1991) Contact allergy to undecylenamide diethanolamide in a liquid soap. Contact Dermatitis 27:191–192

    Article  Google Scholar 

  54. Diba VC, Chowdhury MM, Adisesh A, Statham BN (2003) Occupational allergic contact dermatitis in hospital workers caused by methyldibromoglutaronitrile in a work soap. Contact Dermatitis 48:118–119

    Article  CAS  PubMed  Google Scholar 

  55. Larsen TH, Gregersen P, Jemec GB (2001) Skin irritation and exposure to diisocyanates in orthopedic nurses working with soft casts. Am J Contact Dermatitis 12:211–214

    CAS  Google Scholar 

  56. Kiec-Swierczynska M, Krecisz B, Swierczynska-Machura D (2003) Occupational allergic contact dermatitis due to thimerosal. Contact Dermatitis 48:337–338

    Article  PubMed  Google Scholar 

  57. Suzuki K, Matsunaga K, Umemura Y, Ueda H, Sasaki K (2000) 2 cases of occupational dermatitis due to mercury vapor from a broken sphygmomanometer. Contact Dermatitis 43:175–177

    CAS  PubMed  Google Scholar 

  58. Pegum J, Medhurst FA (1971) Contact dermatitis from penetration of rubber gloves by acrylic monomer. Br Med J 2:141

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Fries JB, Fisher AA, Salvati EA (1975) Contact dermatitis in surgeons from methylmethacrylate bone cement. J Bone Joint Surg Am 57:547

    Article  CAS  PubMed  Google Scholar 

  60. Fisher AA (1979) Paresthesia of the fingers accompanying dermatitis due to methylmethacrylate bone cement. Contact Dermatitis 5:56

    PubMed  Google Scholar 

  61. Bergh M, Menné T, Karlberg AT (1994) Colophony in paper-based surgical clothing. Contact Dermatitis 31:332–333

    Article  CAS  PubMed  Google Scholar 

  62. Knudsen BB, Avnstorp C (1991) Chlorhexidine gluconate and acetate in patch testing. Contact Dermatitis 24:45–49

    Article  CAS  PubMed  Google Scholar 

  63. Foti C, Vena GA, Angelini G (1992) Occupational contact allergy to benzydamine hydrochloride. Contact Dermatitis 27:328–329

    Article  CAS  PubMed  Google Scholar 

  64. Ophaswongse S, Maibach HI (1994) Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome, a review. Contact Dermatitis 30:1–6

    Article  CAS  PubMed  Google Scholar 

  65. Steinkraus V, Hansen BM (1994) Contact allergy to propylene oxide. Contact Dermatitis 31:120

    Article  CAS  PubMed  Google Scholar 

  66. Wakelin SH, McFadden JP, Leonard JN, Rycroft RJG (1998) Allergic contact dermatitis from d-limonene in a laboratory technician. Contact Dermatitis 38:164–165

    Article  CAS  PubMed  Google Scholar 

  67. Sommer S, Wilkinson SM, Wilson CL (1998) Airborne contact dermatitis caused by microscopy immersion fluid containing epoxy resin. Contact Dermatitis 39:141–142

    Article  CAS  PubMed  Google Scholar 

  68. Le Coz C, Goossens A (1998) Contact dermatitis from an immersion oil for microscopy. N Engl J Med 339:406–407

    PubMed  Google Scholar 

  69. Hughes R, Taylor JS (2002) Surveillance of allergic contact dermatitis: epoxy resin and microscopic immersion oil. J Am Acad Dermatol 47:965–966

    Article  PubMed  Google Scholar 

  70. Rademaker M (1994) Allergic contact dermatitis from lavender fragrance in Difflam® gel. Contact Dermatitis 31:58–59

    Article  CAS  PubMed  Google Scholar 

  71. Pazzaglia M, Vincenzi C, Gasparri F, Tosti A (1996) Occupational hypersensitivity to isothiazolinone derivatives in a radiology technician. Contact Dermatitis 34:143

    Article  CAS  PubMed  Google Scholar 

  72. Fung MA, Geisse JK, Maibach HI (1996) Airborne contact dermatitis from metaproterenol in a respiratory therapist. Contact Dermatitis 35:317–318

    Article  CAS  PubMed  Google Scholar 

  73. Forschner K, Zuberbier T, Worm M (2002) Benzoyl peroxide as a cause of airborne contact dermatitis in an orthopaedic technician. Contact Dermatitis 47:241

    Article  CAS  PubMed  Google Scholar 

  74. Camarasa JG (1986) Contact eczema from cow saliva. Contact Dermatitis 2:117

    Article  Google Scholar 

  75. Prahl P, Roed-Petersen J (1979) Type I allergy from cows in veterinary surgeons. Contact Dermatitis 5:33–36

    Article  CAS  PubMed  Google Scholar 

  76. Hjorth N (1967) Occupational dermatitis among veterinary surgeons caused by penethamate. Berufsdermatosen 15:163

    CAS  PubMed  Google Scholar 

  77. Melhorn HC, Beetz D (1971) Das Antioxydans Aethoxyquin als berufliches Ekzematogen bei einem Futtermitteldosierer. Berufsdermatosen 19:84

    Google Scholar 

  78. Burrows D (1975) Contact dermatitis in animal feed mill workers. Br J Dermatol 92:167

    Article  CAS  PubMed  Google Scholar 

  79. Caplan RM (1973) Contact dermatitis from animal feed additives (letter to editor). Arch Dermatol 107:918

    Article  CAS  PubMed  Google Scholar 

  80. Shauder S, Schröder W, Geier J (1996) Olaquindox-induced airborne photoallergic contact dermatitis followed by transient or persistent light reactors in 15 pig breeders. Contact Dermatitis 35:344–354

    Article  Google Scholar 

  81. Bleumink E, Nater JP (1973) Allergic contact dermatitis to dinitolmide (letter to editor). Arch Dermatol 108:423–424

    Article  CAS  PubMed  Google Scholar 

  82. Nelder KM (1972) Contact dermatitis from animal feed additives. Arch Dermatol 106:722–723

    Article  Google Scholar 

  83. Agrup G, Sjöstedt L (1985) Contact urticaria in laboratory technicians working with animals. Acta Derm Venereol 65:111–115

    CAS  PubMed  Google Scholar 

  84. Davies GE, McArdle LA (1981) Allergy to laboratory animals: a survey by questionnaire. Int Arch Allergy Appl Immunol 64:302–307

    Article  CAS  PubMed  Google Scholar 

  85. Aoyama K, Ueda A, Manda F, Matsushita T, Ueda T (1992) Allergy to laboratory animals: an epidemiological study. Br J Ind Med 49:41–47

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Alfonso JH, Bauer A, Bensefa-Colas L, Boman A, Bubas M, Constandt L, Crepy MN, Gonçalo M, Macan J, Mahler V, Mijakoski D, Ramada Rodilla JM, Rustemeyer T, Spring P, John SM, Uter W, Wilkinson M, Giménez-Arnau AM (2017) Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe- position paper of COST Action StanDerm (TD 1206). J Eur Acad Dermatol Venereol 31(Suppl 4):31–43

    Article  CAS  PubMed  Google Scholar 

  87. Papadatou Z, Williams H, Cooper K (2018) Effectiveness of interventions for preventing occupational irritant hand dermatitis: a quantitative systemic review. JBI Database System Rev Implement Rep 16:1398–1417

    Article  PubMed  Google Scholar 

  88. Madan I, Parsons V, Cookson B, English J, Lavender T, McCrone P, Murphy C, Ntani G, Rushton L, Smedley J, Williams H, Wright A, Coggon D (2016) A behavioural change package to prevent hand dermatitis in nurses working in national health service (the SCIN trial): study protocol for cluster randomised controlled trial. Trials 17:145

    Article  PubMed  PubMed Central  Google Scholar 

  89. Soltanipoor M, Kezic S, Sluiter JK, Rustemeyer T (2017) The effectiveness of a skin care program for prevention of contact dermatitis in health care workers (the Healthy Hands Project): study protocol for a cluster randomized controlled trial. Trials 18:92

    Article  PubMed  PubMed Central  Google Scholar 

  90. Ibler KSI, Jemec GB, Diepgen TL, Gluud C, Lindschou Hansen J, Winkel P, Thomsen SF, Agner T (2012) Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial. BMJ 345:e7822

    Article  PubMed  PubMed Central  Google Scholar 

  91. Wilke A, Gediga K, Weinhöppel U, John SM, Wulfhorst B (2012) Long-term effectiveness of secondary prevention in geriatric nurses with occupational hand eczema: the challenge of a controlled study design. Contact Dermatitis 66:79–86

    Article  PubMed  Google Scholar 

  92. Chen J, Gomez P, Kudla I, DeKoven J, Holness DL, Skotnicki S (2016) Return to work for nurses with hand dermatitis. Dermatitis 27:308–312

    Article  PubMed  Google Scholar 

  93. Brans R, Skudlik C, Weisshaar E, Scheidt R, Ofenloch R, Elsner P, Wulfhorst B, Schönfeld M, John SM, Diepgen TL, ROQ Study Group (2016 Oct) Multicentre cohort study ‘Rehabilitation of Occupational Skin Diseases – Optimization and Quality Assurance of Inpatient Management (ROQ)’: results from a 3-year follow-up. Contact Dermatitis 75(4):205–212

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Ana M. Giménez-Arnau .

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Giménez-Arnau, A.M., Skudlik, C. (2019). Occupational Contact Dermatitis: Health Personnel. In: Johansen, J., Mahler, V., Lepoittevin, JP., Frosch, P. (eds) Contact Dermatitis. Springer, Cham. https://doi.org/10.1007/978-3-319-72451-5_43-1

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