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Background: Occupational contact dermatitis (OCD) is frequent in the workplace. Objectives: To provide recent data on the epidemiology of OCD in Italy. Methods: This multicenter retrospective study, conducted from 1996 to 2016, included patients with suspected allergic contact dermatitis (ACD) patch tested in the departments comprising the North-East Italy Contact Dermatitis Group. Results: We studied 18 859 workers with a diagnosis of contact dermatitis (CD), of which 10.4% were recognized as being of professional origin. OCD declined from 1996 to 2011–2013 and increased in 2014–2016. The overall prevalence of both CD and OCD was higher in women compared to men, but the share of OCD of the total CD was greater for men compared to women. A history of atopic dermatitis was less frequent in workers with OCD than in non-OCD patients (5.8% vs 8.6%). Hairdressers were the youngest profession (27.1 ± 11.7 years). Hands were the primary site of involvement in patients with OCD (76.6%). The five highest risk occupations for OCD were hairdressers, cooks, metalworkers, chemical industry workers, and construction workers. Conclusions: OCDs have a relevant impact in our region, mainly for five job categories, and the increase in the last 3 years suggests the need to improve preventive measures.

Objective To evaluate the incidence of COVID-19 infection in health care workers from the start of COVID-19 pandemic in NE of Italy, to the vaccination with BNT162b2. Materials and methods This was a retrospective cohort study. Health care workers were routinely tested for SARS-CoV-2 infections using real-time polymerase chain reaction tests in nasopharyngeal swabs. Logistic regression was used to calculate incident rate ratios (IRRs) of factors associated to COVID-19. Results A total of 4251 workers were followed-up and an annual incidence of COVID-19 of 13.6% was found. In March 2021 the incidence of infection was 4.88 and 103.55 cases for 100.000 person-days in vaccinated and non-vaccinated workers, respectively, with an adjusted IRRs of 0.05 (95% CI 0.02–0.08). Conclusions Our study evaluated the monthly incidence in health care workers in Trieste hospitals before and after the vaccination finding the protective effect of BNT162B2 vaccine in 95% of health care workers routinely tested.

Airport activity causes the emission of particulate matter and noise, two environmental contaminants and potential health hazards, particularly for the personnel operating nearby taxiways. We explored the association between exposure to fine/ultrafine particles (UFPs) and noise with heart rate variability (HRV), an early indicator of cardiovascular autonomic response, among a sample of airport ground staff. Between May and June 2018, thirty-four male operators (mean age = 43 years and SD = 6.7) underwent personal monitoring of exposure to nanoparticles and noise, and HRV during their work activity. We conducted univariate and multivariate analysis to test the effect of UFP and noise exposure HRV. Total Lung Deposition Surface Area (LDSA) was significantly associated with a decrease in HRV Total Power and Triangular index (β = −0.038 p = 0.016 and β = −7.8*10−5, p = 0.042, respectively). Noise peak level showed an opposite effect, which was significant for Total Power (β = 153.03, p = 0.027), and for Triangular index (β = 0.362, p = 0.035). Further investigation is warranted to clarify the effect of the concurrent exposure to UFPs and noise on early changes of cardiac autonomic regulation.

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COVID-19 became a pandemic in a few months, leading to adverse health outcomes, reducing the quality of life, affecting the sleep/wake cycle, and altering coping strategies, especially among hospital personnel. Life quality, insomnia, and coping strategies were thus assessed among hospital personnel during the first wave of the COVID-19 pandemic in Italy. This cross-sectional study was conducted from May to November 2020 through an online survey. There were 558 participants (28.5% males and 71.5% females) enrolled in two different metropolitan areas (in North and South of Italy, respectively). Three standardized questionnaires were administered: European Quality of life–5 Dimensions (EQ-5D), Athens Insomnia Scale (AIS), and Brief COPE. Differences in sociodemographic characteristics and work-related factors were also investigated in order to identify possible predictors through a generalized linear model and logistic regression analysis. Results showed good perceived life quality and high insomnia prevalence. After sample stratification, the statistical analysis highlighted that personal (gender, age, educational level) and work-related factors (employment in COVID wards, remote working) played different roles in predicting quality of life, insomnia, and coping attitude. Active, Planning, and Acceptance were the most frequently adopted coping strategies. Despite women confirming their attitude in reacting to the difficulties, adopting emotion-focused coping strategies, they showed a higher probability to develop insomnia, so a gender perspective should be considered in the health protection of this working category. An integrated approach should be implemented at individual, interpersonal and organizational levels aiming to monitor psychological distress, favor regular sharing and communication between peers, and also allow conciliation of work with family life. At the organizational level, preventive and protective measures adequate to work-related risk to COVID-19 should be adopted.

Contact dermatitis in construction workers (CWs) is frequent due to the widespread exposure to sensitizing substances and irritating agents and the wet and cold working conditions.Background: Contact dermatitis in construction workers (CWs) is frequent due to the widespread exposure to sensitizing substances and irritating agents and the wet and cold working conditions. Objective: Our objectives were to evaluate contact dermatitis characteristics among CWs who underwent patch test in northeastern Italy and to identify related allergens. Methods: Seven hundred ninety-five CWs were studied and their data were compared to 2.099 male white-collar workers. The associations between patch test results and occupations were assessed by multivariate logistic regression analysis. Incidence data were calculated from 1996 to 2016. Results: CWs with confirmed occupational dermatitis presented an increased risk to be sensitized to potassium dichromate [OR 3.1 (95%IC 2.0-4.8)], to thiurams [OR 8 .6 (95%IC 4.0-18.4)], and to epoxy resins [OR 12.7 (95%IC 6.1-26.4)]. Sensitization to chromate decreased significantly after 2004, following EU regulation of chromate content in concrete, while sensitization to epoxy resins and thiurams increased. The overall incidence of occupational contact dermatitis in CWs decreased significantly. Conclusion: Our study demonstrated the effectiveness of EU regulations in reducing chromate sensitization in CWs and the overall incidence of occupational contact dermatitis. However, sensitization to other haptens is increasing, though improvement of protective measures is compulsory.

"Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM", Background: Clinical surveillance of the prevalence of contact allergy in consecutively patch tested patients is a proven instrument to continually assess the importance of contact allergens (haptens) assembled in a baseline series. Objectives: To present current results from the European Surveillance System on Contact Allergies, including 13 countries represented by 1 to 11 departments. Methods: Anonymized or pseudonymized patch test and clinical data from various data capture systems used locally or nationally as transferred to the Erlangen data centre were pooled and descriptively analysed after quality control. Results: In the 4 years (2015-2018), data from 51 914 patients patch tested with the European baseline series (EBS) of contact allergens were analysed. Contact allergy to nickel was most frequent (17.6% positive), followed by contact allergy to fragrance mix I (6.9%), methylisothiazolinone (MI; 6.2%), and Myroxylon pereirae resin (balsam of Peru; 5.8%). Conclusions: While the prevalence of MI contact allergy decreased substantially following regulatory intervention, the persistently high levels of allergy to metals, fragrances, other preservatives, and rubber chemicals point to problems needing further research and, potentially, preventive efforts. Results with national additions to the baseline series provide important information on substances possibly to be considered for inclusion in the EBS., Partial funding by EADV Grant PPRC-2018-8

Background: Hairdressers are at high risk of contact dermatitis (CD) due to skin exposure to numerous irritants and haptens in hair products in combination with frequent wet work. Objectives: To investigate the characteristics and incidence of CD among hairdressers in north-eastern Italy. Methods: A total of 324 hairdressers who had been examined and patch tested in north-eastern Italy from 1996 to 2016 were retrospectively identified, and compared with 9669 matched controls. Sensitization to allergens of the hairdressing series was analysed among hairdressers attending an occupational medicine clinic in Trieste, Italy. Incidence data were calculated from 1999 to 2016. Results: Sensitization to p-phenylenediamine, thiuram mix, and N-isopropyl-N'-phenyl-p-phenylenediamine was significantly associated with hairdressing and with hand/forearms dermatitis. Frequent sensitizers from hairdressing series were ammonium persulfate, toluene-2,5-diamine, and p-aminobenzene. The overall incidence of CD declined from 2003 (31.7 cases/10 000 workers) to 2016 (20.8 cases/10 000 workers). Conclusions: Sensitization to several haptens was significantly associated with hairdressing. The incidence of CD among hairdressers in north-eastern Italy has declined in recent years, but is still high. Preventive efforts are needed to reduce the burden of CD in this professional group.

Environmental nanoparticles or ultrafine particles (UFPs) are defined by their aerodynamic size

Occupational solar ultraviolet radiation (UVR) exposure is a relevant heath risk in dock workers, potentially exposed to both direct and reflected radiation, but apparently was scantly studied up now and few studies on measurements of solar UVR levels are currently available for these workers. Our aim was to provide an evaluation of UVR exposure in 10 longshoremen and 4 port traffic coordinators/goods acceptors of a dock in North-East Italy. During a Summer day, workers' exposure was measured with personal UV dosimeters, and the environmental UV effective radiant exposure with a spectroradiometer. Personal solar UV dose ranged between 257–1975 J/m2 in longshoremen, and between 44–139 J/m2 for port traffic coordinators/goods acceptors. The percentage of personal compared to ambient exposure resulted between 16 and 59% for longshoremen, while were much lower, between 2 and 7%, in port traffic coordinators/goods acceptors. Eye exposure was also estimated using an ocular UV dosimeter placed on a stem of the sunglasses in a subject spending the day close to the longshoremen, resulting in a non-weighted solar UV-A ocular dose between 133.9 and 401.8 J/m2. Our results show an occupational solar UVR exposure of uncovered skin exceeding the suggested occupational limit of 1—1.3 standard erythemal dose per day, in all longshoremen. In one case this value was exceeded also in one of the port traffic coordinators /good acceptors, despite the overall lower UVR doses received. In conclusion, our UV measurement campaign in a group of Italian dock-workers support the existence of a significantly high occupational UVR risk at least for longshoremen, possibly inducing long-term UV-related adverse skin effects. Accordingly, an effort for the development of adequate interventions to protect these workers from solar UV risk is highly recommended in Italy.

MnFe2O4 nanoparticles (NPs) are commonly produced in some occupational settings and may reach high concentration in activities such as arc-welding or ferroalloy metallurgy. Manganese is an essential cofactor in enzyme activities but it has been demonstrated that long-term exposure to excessive levels can lead to “manganism”, a neurodegenerative disease resembling Parkinson features. Inhaled NPs deposit partially in pharynx and nasopharynx and may reach the central nervous system through the olfactory nerve, which is completely enveloped by the meningeal membranes throughout its course from the nasal cavity to the olfactory bulb or through the trigeminal nerves. This study investigated in vitro the transmeningeal absorption of 50 nm MnFe2O4NPs, using excised porcine meninges mounted on Franz diffusion cells. We tested two donor solutions: the first containing MnFe2O4NPs (2.0 g/L) and the second obtained by the ultrafiltration of the first one, in order to test only the NPs water soluble fraction. Each experiment was carried separately for 4 h. Results showed that no Mn flux permeation through the meninges occurred, since only trace of the metal was found in receivers solutions of cells exposed to MnFeNPs (5.5 ± 2.2 ng/cm2), ultrafiltered solution (3.5 ± 1.5 ng/cm2) and blank cells. (2.1 ± 0.6 ng/cm2) (mean and SE). Differences did not reach the statistical significance. Our study shows – for the first time - that MnFe2O4NPs penetrate the meningeal membrane in a negligible amount, thus making unlikely the hypothesis of a transcellular and paracellular absorption through the olfactory nerve but not excluding the hypothesis of an active intraneuronal absorption.

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.

Exposure to laboratory animals (LA) can cause allergic sensitization and symptoms as rhinitis, conjunctivitis, asthma, anaphylaxis and dermatitis. In 2000, a program was instituted at Trieste Universities to decrease LA allergy among scientists and technicians working with animals. The aim of our study was to investigate LA allergy in workers exposed to LA from 2001 to 2016, and to verify the effects of a preventive program. Four hundred sixty seven people underwent pre-employment screening for a job with laboratory animals at Universities of Trieste consisting in a medical examination, a full respiratory and allergy anamnesis, using a standardized questionnaire, skin prick test with common and occupational allergens, and spirometry. Every year, each worker repeated the medical examination and underwent again tests and questionnaire. Each worker can ask for a medical examination and skin prick test, in case of unset of symptoms. Logistic multivariate analysis and generalized equation estimation were use, to verify factors associated to LA allergy. Sensitization to LA decreased in years, going from 25.6% in 2001-2004 to 8.2% in 2013-2016 (p 0.001). Multivariate logistic regression analysis confirmed the role of atopy by prick test (OR = 6; IC95% 2.2-16.6), of common allergic symptoms (OR = 2.9; IC95% 1.4-6.39) and of calendar periods. No association was found between LA allergy, years, and hours of exposure. Our study demonstrated a significant reduction of LA allergy after the application of a preventive program.

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Highlights After the introduction of the EU regulatory interventions, nickel sensitization decreased significantly in the group of females aged ≤25 years. Women born between 1966 and 1975 presented the higheest prevalence of sensitization to nickel, then prevalence of sensitization gradually decreased with a minimum in more recent years. Nickel sensitization is higher in Italian patients compared to people living in other EU coutries. Additional interventions are needed to address nickel sensitization.

(1) Background: Fragrance sensitization is common in Italy and their constituents are used in many cosmetics and detergents. The objective of the study was to analyze the temporal trend of sensitivity to fragrance mix-1 in northeastern Italy and to evaluate gender differences, (2) Methods: From 1996 to 2016, 27,381 consecutive patients with suspected allergic contact dermatitis were patch tested. Individual characteristics were collected through a standardized questionnaire in six departments of dermatology or occupational medicine, (3) Results: The overall prevalence of sensitization to fragrance mix-1 was 7.3%, the prevalence was significantly higher in women (7.7%) than in men (6.3%). From 1996 to 2016, we observed an increase of this sensitization, ranging from 6.2% to 7.7% in males and from 7.2% to 9.1% in females, (4) Conclusions: Our study showed that contact allergy to fragrance mix-1 is important in both sexes and prevalence is increasing over time, despite the introduction of new fragrances with lower sensitization potential. There is the need to reduce the use of fragrances mix-1 to stop the increase of sensitization in exposed subjects.

BACKGROUND: During work, hairdressers are exposed to several hazardous agents that can cause skin and respiratory symptoms. Because few data are available for long-term follow-up, and none are from Italy, the aim of our study was to investigate occupational symptoms in hairdressers after a 10-year follow-up. METHODS: Work-related skin and respiratory symptoms were investigated in 2006 and 2016 by means of a standardized questionnaire and medical examination. RESULTS: Eighty-two workers completed the 10-year follow-up with a response rate of 86.3%. At follow-up, skin- and respiratory work-related symptoms had increased significantly, involving 40.7% of workers. Skin symptoms increased to 12.5%, throat irritation to 15.6%, and cough to 12.5%. The occurrence of the symptom of skin irritation was significantly related to dryness of the skin at the baseline. CONCLUSIONS: Our long-term follow-up on hairdressers demonstrated an increase in work-related irritant skin and upper respiratory symptoms that involved more than one-third of the population studied. More efforts are needed in prevention activities to promote better ventilation of workplaces, use of less irritating and less sensitizing hair products, and use of moisturizers to prevent dry skin.

BACKGROUND: Mechanics are at higher risk to develop occupational skin diseases from exposure to irritants, oils, greases, preservatives, and metals. AIMS: The aim of the study was to investigate contact dermatitis in mechanics who underwent patch test in Northeastern Italy and compare them with white-collar workers (WCW). SUBJECTS AND METHODS: From 1996 to 2016, 27,381 patients with suspected allergic contact dermatitis were patch tested in Northeastern Italy; in this group, 1270 mechanics were studied. Odds ratios (ORs) and 95% confidence interval (CI), adjusted by age and sex, were calculated assuming WCW as the reference category (n = 6933). RESULTS: Mechanics represented 4.6% of the population tested. Their mean ± SD age was 36.1 ± 11.2 years. Compared with WCW, they were found to have an increased risk of occupational dermatitis (OR = 14.4; 95% CI = 11.6-18) and hand/forearm dermatitis (OR = 2.5; 95% CI = 2.3-2.9). They presented an increased risk of sensitization to epoxy resin (OR = 2.7; 95% CI = 1.5-4.8), to thiurams (OR = 2.4; 95% CI = 1.5-3.8), to 2-mercaptobenzothiazole (OR = 1.9; 95% CI = 1.1-3.4), and to diaminodiphenylmethane (OR = 1.7; 95% CI = 1.1-2.5). CONCLUSIONS: Compared to WCW, mechanics were found to be at higher risk to develop occupational contact dermatitis, associated mainly to sensitization to epoxy resin and rubber accelerators.

The great antimicrobial action of copper oxide nanoparticles (CuO NPs) and their consequent use in many applications in the biomedical field have caused concern about the potentially negative effects of human skin exposure to CuO NPs. However, so far, very few studies have investigated the toxic action of CuO NPs toward humans, with a special focus on the skin penetration route of entry. This study considers for the first time the absorption of topically applied CuO NPs through the human skin, using a Franz static diffusion cell model. We characterised the colloidal behaviour and static dissolution of commercial bare CuO NPs, evaluating both intact and damaged skins. We tested physiological solutions as the receiving phase; as the donor phase, CuO NPs were dispersed in synthetic sweat and exposed to the outer surface of the skin (0.11 mg cm(-2)) for 24 hours. The Cu elemental analysis in the receptor fluid and in the exposed skin allowed us to quantify the copper translocation within the epidermis and dermis. The experimental data showed that the CuO NPs absorption through intact skin was negligible. However, in damaged skin, we observed an increasing permeation of copper. The latter would justify the capacity of CuO NPs to pass the first skin layers and release Cu2+ ions into the stratum corneum, reaching the receptor fluid in the in vitro diffusion cell system.

Background UV exposure is strongly associated with the incidence of non melanoma skin cancers (NMSCs), both basal and squamous cell carcinomas. The aim of our study was to analyze risk perception, UV exposure, preventive habits, and occupation in 126 subjects affected by NMSC and 187 controls. Methods Consecutive cases with incident NMSC were recruited in Dermatologic Unit at University of Trieste; controls were recruited in Unit of Occupational Medicine. All had a medical examination to define Fitzpatrick skin type and skin lesions, and filled a standardized questionnaire on sun exposure habits, sun protection, occupational exposures, and sunburns in adulthood and childhood. Results In multivariate regression analysis, NMSC resulted significantly associated with age (OR: 1.03; 95% CI 1.01-1.05), with a positive feeling for tan (OR: 1.10; 95% CI 1.01-1.20), and sunbath numbers per year (OR: 1.02; 95% CI: 1.001-1.03). A protective effect was demonstrated for Fitzpatrick phototypes III-IV compared to I and II (OR: 0.31; 95% CI: 0.18-0.55), sunscreen use (OR: 0.35; 95% CI: 0.22-0.58), and risk perception (OR: 0.98; 95% CI: 0.97-0.99). In univariate analysis, we demonstrated an increased risk for fishermen, sailors, and lifeguards (OR: 4.3; 95% CI: 1.1-16.4); foundry and metallurgy workers (OR: 5.58; 95% CI: 1.14-27.3); and mechanics, fixers, and welders (OR: 8.2; 95% CI: 1.76-37.9). Conclusions Our study demonstrated that protective behavior must be implemented in people living in Trieste. Workers must avoid direct UV exposure and must use protective equipment. More efforts are needed to increase knowledge on this risk and to raise awareness among at-risk people.

Nickel nanoparticles (NiNPs) represent a new type of occupational exposure because, due to the small size/high surface, they can release more Ni ions compared to bulk material. It has been reported a case of a worker who developed sensitization while handling nickel nanopowder without precautions. Therefore there is the need to assess whether the skin absorption of NiNPs is higher compared to bulk nickel. Two independent in vitro experiments were performed using Franz diffusion cells. Eight cells for each experiment were fitted using intact and needle-abraded human skin. The donor phase was a suspension of NiNPs with mean size of 77.7 ± 24.1 nm in synthetic sweat. Ni permeated both types of skin, reaching higher levels up to two orders of magnitude in the damaged skin compared to intact skin (5.2 ± 2.0 vs 0.032 ± 0.010 μg cm(-2), p = 0.006) at 24 h. Total Ni amount into the skin was 29.2 ± 11.2 μg cm(-2) in damaged skin and 9.67 ± 2.70 μg cm(-2) in intact skin (mean and SD, p = 0.006). Skin abrasions lead to doubling the Ni amount in the epidermis and to an increase of ten times in the dermis. This study demonstrated that NiNPs applied on skin surface cause an increase of nickel content into the skin and a significant permeation flux through the skin, higher when a damaged skin protocol was used. Preventive measures are needed when NiNPs are produced and used due to their higher potential to enter in our body compared to bulk nickel.

Introduction Primary and secondary prevention for occupational contact dermatitis is a challenge for the occupational physician: educational training and the avoidance of contact with irritant and allergic substances permits a reduction of incidence cases and days of work lost for a disease that is the third in frequency among workers in industrialized countries. Methods Workers with a diagnosis of occupational hand dermatitis were invited to a training course on prevention of skin dermatitis, their skin condition were evaluated by a dermatologist/allergologist and by TEWL (trans-epidermal water loss) measurements. Information on skin disease, occupational and non-occupational exposure were recorded using a standardized questionnaire. Workers participated to a second control after 3 months, to verify the effectiveness of the training. Results 80 workers with an occupational hand dermatitis accepted to participate to a training course and 62 (77.5%) completed the 3 months follow-up. Symptoms improved after the training for the 73% of subjects that adhered to suggestions and followed recommendations and for the 38% of workers that partially followed recommendations (p Discussion Our intervention was effective, leading to a reduction in clinical signs of dermatitis in people that strictly adhere to recommendations, mainly on cleaning habits and skin cream use. The educational intervention permitted to improve skin condition in a short-term follow-up. More efforts are needed to train workers on skin protection procedures.

Metals can penetrate the skin barrier and reach the viable epidermis and dermis, inducing allergic sensitization that can cause allergic contact dermatitis through a delayed-type hypersensitivity reaction. Moreover, metals can permeate the skin, reaching the general circulation with a potential for systemic intoxication that has been demonstrated only for extremely toxic metals, such as dimethylmercury. Penetration is related to many factors, such as applied dose, area involved, duration of contact, body site, thickness and integrity of the skin layers, sweating, temperature, humidity, physical activity, gender, race, age, characteristic of the substance, vehicles used, etc.

BackgroundIrritant exposure may be a contributory cause or the sole cause of (occupational) hand dermatitis. However, the documentation of irritant exposures in clinical practice is not standardized.ObjectivesTo examine the feasibility and usefulness of a form with different items addressing both occupational and non-occupational irritant exposures in a semiquantitative way.MethodsBetween May 2016 and May 2017, successive patients with work-related hand dermatitis, irrespective of aetiology, were examined in 9 specialized European departments. Department-specific investigation was supplemented with the above proforma. The results were recorded by use of an anonymized secured online documentation system in a pilot study.ResultsAltogether, 193 patients were included; 114 females and 79 males, with a mean age of 40years (range 18-68years). The most common occupational group comprised healthcare workers (n =35); occupational exposure of the hands to gloves, dusts and water without detergents of >2hours/day was seen in 54.5%, 24.4% and 24.3% of patients, respectively. Non-occupational exposures rarely exceeded 2hours/day.ConclusionsIt is hoped that the set of descriptors will offer a basis for (clinical) epidemiological studies assessing the role of irritant exposures in occupational hand dermatitis, and to support a high level of quality and consistency in daily patient care.

Background Colophonium is a natural substance derived from Pineaceae trees. It is used in a wide range of consumer and occupational products because of its tackiness, and is a known sensitizer. Objectives To analyse the temporal trend of contact allergy to colophonium in north-eastern Italy, and to evaluate the associations with occupations in our geographical area. Methodology From 1996 to 2016, 27 381 patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were documented by use of a standardized questionnaire in 6 departments of dermatology or occupational medicine. Results The overall prevalence of colophonium sensitization was 1.67%; the prevalence was significantly higher in women (1.75%) than in men (1.49%). No significant differences among departments were observed. We found significant associations between colophonium sensitization and being a student (odds ratio [OR] 4.64; 95% confidence interval [CI]: 1.04-20.6), being a farmer or fishermen (OR 3.63; 95%CI: 1.21-10.84), being a housekeeper (OR 2.02; 95%CI: 1.08-3.77), and being retired (OR 2.06; 95%CI: 1.08-3.92). Conclusion Our study showed that contact allergy to colophonium is still relevant in north-eastern Italy. The frequency of sensitization has dropped significantly over a period of 10 years, but students and farmers/fishermen still have sensitization prevalences above 3.5%. Our results are in line with European data.

Summary Background Allergic contact dermatitis caused by rubber allergens is common, and causes significant patient morbidity. Contemporary data are important to allow appropriate preventive measures and identification of contact allergy trends. Objectives To describe the pattern of patch test reactivity to rubber allergens, including those in the European baseline series. Methods Data collected by the European Surveillance System on Contact Allergies (ESSCA) network between 2009 and 2012 from 12 European countries were analysed. Results Contact allergy to thiuram mix declined over the studied time period, with an overall prevalence of 1.87%. The prevalence of allergy to carba mix was 2.29%, and was significantly increasing. Prevalence rates of sensitization to other rubber allergens were largely unchanged. Statistical analysis with the MOAHLFA index confirmed the strong links between rubber allergy and occupational hand dermatitis. Conclusions Changing patterns of allergy to rubber additives have been identified. Inclusion of carba mix in the European baseline series may be appropriate.

Silver nanoparticles (AgNPs) can come in contact with human oral mucosa due to their wide use in food industry and hygiene devices. We evaluate transmucosal absorption of 19 nm AgNPs using excised porcine buccal mucosa applied on Franz diffusion cells. Two donor solutions were used: one containing AgNPs (0.5 g/L) and one derived from the ultrafiltration of the former and containing only Ag in its soluble form. Experiments were carried out separately for 4 h. Silver flux permeation was demonstrated through oral mucosa, showing similar values for AgNPs (6.8±4.5 ng cm(-2) h(-1)) and Ag ions (5.2±4.3 ng cm(-2) h(-1)). Our study demonstrates that silver can permeate the oromucosal barrier and that absorption is substantially due to Ag ions, since no permeation difference was found using the two solutions. Mucosal absorption has to be considered in further risk assessment studies.

Titanium dioxide nanoparticles (TiO2NPs) suspensions (concentration 1.0 g/L) in synthetic sweat solution were applied on Franz cells for 24 h using intact and needle-abraded human skin. Titanium content into skin and receiving phases was determined. Cytotoxicity (MTT, AlamarBlue® and propidium iodide, PI, uptake assays) was evaluated on HaCat keratinocytes after 24 h, 48 h, and seven days of exposure. After 24 h of exposure, no titanium was detectable in receiving solutions for both intact and damaged skin. Titanium was found in the epidermal layer after 24 h of exposure (0.47 ± 0.33 ?g/cm2) while in the dermal layer, the concentration was below the limit of detection. Damaged skin, in its whole, has shown a similar concentration (0.53 ± 0.26 ?g/cm2). Cytotoxicity studies on HaCaT cells demonstrated that TiO2NPs induced cytotoxic effects only at very high concentrations, reducing cell viability after seven days of exposure with EC50s of 8.8 × 10-4 M (MTT assay), 3.8 × 10-5 M (AlamarBlue® assay), and 7.6 × 10-4 M (PI uptake, index of a necrotic cell death). Our study demonstrated that TiO2NPs cannot permeate intact and damaged skin and can be found only in the stratum corneum and epidermis. Moreover, the low cytotoxic effect observed on human HaCaT keratinocytes suggests that these nano-compounds have a potential toxic effect at the skin level only after long-term exposure. © 2015 by the authors; licensee MDPI, Basel, Switzerland.

Skin absorption and toxicity on keratinocytes of cobalt oxide nanoparticles (Co3O4NPs) have been investigated. Co3O4NPs are commonly used in industrial products and biomedicine. There is evidence that these nanoparticles can cause membrane damage and genotoxicity in vitro, but no data are available on their skin absorption and cytotoxicity on keratinocytes. Two independent 24 h in vitro experiments were performed using Franz diffusion cells, using intact (experiment 1) and needle-abraded human skin (experiment 2). Co3O4NPs at a concentration of 1000 mg/L in physiological solution were used as donor phase. Cobalt content was evaluated by Inductively Coupled–Mass Spectroscopy. Co permeation through the skin was demonstrated after 24 h only when damaged skin protocol was used (57 ± 38 ng·cm−2), while no significant differences were shown between blank cells (0.92 ± 0.03 ng cm−2) and those with intact skin (1.08 ± 0.20 ng·cm−2). To further investigate Co3O4NPs toxicity, human-derived HaCaT keratinocytes were exposed to Co3O4NPs and cytotoxicity evaluated by MTT, Alamarblue® and propidium iodide (PI) uptake assays. The results indicate that a long exposure time (i.e., seven days) was necessary to induce a concentration-dependent cell viability reduction (EC50 values: 1.3 × 10−4 M, 95% CL = 0.8–1.9 × 10−4 M, MTT essay, 3.7 × 10−5 M, 95% CI = 2.2–6.1 × 10−5 M, AlamarBlue® assay) that seems to be associated to necrotic events (EC50 value: 1.3 × 10−4 M, 95% CL = 0.9–1.9 × 10−4 M, PI assay). This study demonstrated that Co3O4NPs can penetrate only damaged skin and is cytotoxic for HaCat cells after long term exposure.

BackgroundPatch test results often vary between departments, and also between countries. Such variation may be partly attributable to systematic effects introduced by patient characteristics, differing exposures, patient selection, or methodological differences. ObjectiveTo examine the amount of variation of patient characteristics in terms of the MOAHLFA index and of the proportion of patients with at least one positive reaction to the (European) baseline series (P' measure), and to examine potential reasons for the variation. MethodsA retrospective analysis was performed of patch test data from 63530 consultations collected by 53 departments from 12 countries participating in the European Surveillance System on Contact Allergies (ESSCA) ( ) between 2009 and 2012. ResultsConsiderable variation in the prevalence of the MOAHLFA factors between departments was found, caused, for example, by differing specializations (e.g. occupational dermatology) or patient characteristics. Notable variation concerning the P' measure was observed; however, larger national networks (contributing to the ESSCA) tend to have quite similar ranges of this measure. ConclusionsData from one department per country give valuable insights into the spectrum of contact allergy prevalence rates in that country, but are not as representative as national data pooled from several departments.

Summary Background Primin is the main contact allergen found in the ornamental plant Primula obconica Hance. Objective To analyse the temporal trend of sensitivity to primin in north-eastern Italy and to evaluate the associations with occupations in our geographical area. Methodology From 1996 to 2012, 24 052 consecutive patients with suspected allergic contact dermatitis were patch tested in north-eastern Italy. Individual characteristics were collected through a standardized questionnaire in eight departments of dermatology or occupational medicine. Results The overall prevalence of primin sensitization was 1.9%; the prevalence was significantly higher in women (2.6%) than in men (0.5%). The Pordenone area had the higher prevalence of sensitization, which reached 6% in 1999–2001. We found a significant association between primin sensitization and household workers [odds ratio (OR) 2.3; 95% confidence interval (CI): 1.61–3.35], retired people (OR 1.8; 95%CI: 1.22–2.81), woodworkers (OR 2.1; 95%CI: 1.10–6.18), and chemical industry workers (OR 2.9; 95%CI: 1.05–8.29). Conclusion Our study showed that contact allergy to primin is still relevant in north-eastern Italy. The frequency of sensitization is decreasing, but for retired and household workers it is still >4%. Our results suggest the need to promote the use of primin-free P. obconica in Italy.

SummaryBackground Occupational contact dermatitis is one of the most common occupational diseases in Europe. In order to develop effective preventive measures, detailed and up-to-date data on the incidence, main causes and professions at risk of occupational contact dermatitis are needed. Objectives To describe the pattern of patch test reactivity to allergens in the European baseline series of patients with occupational contact dermatitis in different occupations. Methods We analysed data collected by the European Surveillance System on Contact Allergy (ESSCA) network from 2002 to 2010, from 11 European countries. Results Allergens in the European baseline series associated with an at least doubled risk of occupational contact dermatitis include: thiuram rubber chemical accelerators, epoxy resin, and the antimicrobials methylchloroisothiazolinone/methylisothiazolinone, methyldibromo glutaronitrile, and formaldehyde. The highest risk of occupational contact dermatitis was found in occupations classified as ‘other personal services workers’, which includes hairdressers, nursing and other healthcare professionals, precision workers in metal and related materials, and blacksmiths, tool-makers and related trades workers. Conclusions In the planning and implementation of measures aimed at preventing occupational contact dermatitis, the focus should be on the identified high-risk occupational groups and the most common occupational allergies.

The role of the skin as a potential route of exposure to nanomaterials is described in the present chapter. We survey the existing literature on various types of nanomaterials with respect to their penetration through the skin and toxicological responses. Most studies suggest minimal skin penetration and little to no systemic exposure. However, studies have also shown that nanoparticle size, shape, charge, surface properties, and vehicle/solvent as well as the choice of animal species are important determinants as to whether or not nanoparticles traverse through the rate-limiting lipid barrier of the stratum corneum. Long-term in vivo studies in animals or humans are needed because in vitro systems and differences in animal species provide limitations for a complete understanding of nanoparticle penetration through the skin.

Growing warnings on health effects related to electronic cigarettes have met inconclusive findings at present. This study analyzed the in vitro percutaneous absorption of nicotine resulting by skin contamination with two e-liquids (refill 1 and 2) containing nicotine at 1.8%. Donor chambers of 6 Franz cells for each refill liquid were filled with 1 mL of nicotine e-liquid for 24 h; at selected intervals, 1.5 mL of the receptor solutions were collected for nicotine concentration analysis by mean gas chromatography–mass spectrometry (LOD: 0.01 μg/mL). The experiment was repeated removing the nicotine donor solution after 10 min from the application and rinsing the skin surface three times with 3.0 mL of milliQ water. A total of 12 cells with 24 h exposure and 12 cells washed were studied. The mean concentration of nicotine in the receiving phase at the end of the experiment was 54.9 ± 29.5 and 30.2 ± 18.4 μg/cm2 for refill 1 and 2 respectively and significantly lower in washed cells (4.7 ± 2.4 and 3.5 ± 1.3 μg/cm2). The skin absorption of nicotine can lead to minor health illness in vapers, while caution must be paid to dermal contamination by e liquids in children. The skin cleaning significantly reduced the transdermal absorption kinetic and intradermal deposition of nicotine.

Visual fatigue and discomfort are very common complaints for video display operators (VDTs). The aim of our study was to study work-related visual symptoms in relation to refractive disorders and psychosocial factors in 3054 public employees by way of follow-ups for 10 years with periodic medical examinations with eye evaluation in the period 2000&ndash, 2009. Factors related to visual fatigue were evaluated in the follow-up using generalized equation estimation. Visual fatigue was very common in VDT operators (64.03%). During the follow-up, no relationship between visual fatigue and age, sex, seniority of work, visual acuity and refractory disorders was found. Visual fatigue was significantly associated with anxiety perception in a dose-related matter (odds ratio (OR) 7.40, confidence interval (CI) 95% 1.77&ndash, 31.3), psychosocial factors (OR 1.03, CI 95% 1.01&ndash, 1.07), use of lenses (OR 1.34, CI 95% 1.09&ndash, 1.64) and time of VDT usage (OR 1.27, CI 95% 1.04&ndash, 1.53). This study confirmed that visual fatigue is common in VDT users and is related to anxiety perception, time of VDT usage, use of lenses and stress. No relationship was found between visual fatigue and refractory disorders or visual acuity.

Background Atopic diseases have increased since the second half of the previous century. Atopic workers are at higher risk to be sensitized to latex, and the first years of exposure are supposed to be especially risky. Objective To assess atopic status and rate of latex sensitization in health care students starting their exposure to latex gloves. Methods We analyzed medical surveillance data from 1,628 health care students from 2010 to 2016. Students completed a questionnaire focused on their previous and current latex exposure and personal and family histories of allergic diseases; underwent skin prick testing with common allergens and latex extract (and/or total and latex-specific immunoglobulin E in serum); and underwent a medical examination. Results Skin prick test results for common inhalant allergens showed that 807 of 1,628 students (49.6%) had atopy. Atopy by skin prick testing was associated with male sex (odds ratio 1.49, 95% confidence interval 1.18–1.86), a personal history of oculorhinitis or asthma (odds ratio 10.22, 95% confidence interval 7.4–14.13), and atopic eczema (odds ratio 1.87, 95% confidence interval 1.05–3.36) at multivariate regression analysis. Eleven students (0.7% of total population) were found to be sensitized to latex and all had atopy. Conclusion Despite the high prevalence of atopy in health care students of Trieste, the latex sensitization rate is very low and comparable to general population. This is reasonably due to the low exposure to latex gloves at the time of the evaluation and to low latex release from the gloves currently used in our hospital.

Due to the increased production and use of nanoparticles (NPs), there are workers and consumers that can be exposed to NPs. There is a debate among scientists to define possible effects related to this exposure and there are more open questions. The review evaluates the recent knowledge on this topic trying to classify NPs in relation to their hazard for skin exposure, both for workers and consumers. While the same kind of NPs can be safe for skin contact (such as titanium dioxide and zinc oxide), others can exert a sensitization effect such as NPs that can release sensitizing metals (i.e., Ni, Pd, Co), as well as a toxic effects for NPs that can release toxic metals such as Cd or As.

Silver is increasingly being used in garments to exploit its antibacterial properties. Information on the presence of silver nanoparticles (AgNPs) in garments and their in vivo penetration across healthy and impaired skin from use is limited. We investigated the presence of AgNPs in a silver containing garment and in the stratum corneum (SC) of healthy subjects (CTRLs) and individuals with atopic dermatitis (AD). Seven CTRLs and seven AD patients wore a silver sleeve (13% Ag w/w) 8 h/day for five days on a forearm and a placebo sleeve on the other forearm. After five days, the layers of the SC were collected by adhesive tapes. The silver particles in the garment and SC were characterized by scanning electron microscopy with energy dispersive X-ray analysis (SEM-EDX) and atomic force microscopy (AFM). AFM and SEM revealed the presence of sub-micrometre particles having a broad range of sizes (30–500 nm) on the surface of the garment that were identified as silver. On the SC tapes collected from different depths, aggregates with a wide range of sizes (150 nm–2 μm) and morphologies were found. Most aggregates contained primarily silver, although some also contained chlorine and sulfur. There was no clear difference in the number or size of the aggregates observed in SC between healthy and AD subjects. After use, AgNPs and their aggregates were present in the SC at different depths of both healthy subjects and AD patients. Their micrometre size suggests that aggregation likely occurred in the SC.

Over the past decade, the primary focus of nanotoxicology and nanoenvironmental health and safety efforts has been largely on inhalation exposure to engineered nanomaterials, at the production stage, and much less on considering risks along the life cycle of nano-enabled products. Dermal exposure to nanomaterials and its health impact has been studied to a much lesser extent, and mostly in the context of intentional exposure to nano-enabled products such as in nanomedicine, cosmetics and personal care products. How concerning is dermal exposure to such nanoparticles in the context of occupational exposures? When and how should we measure it? In the first of a series of two papers (Larese Filon et al., 2016), we focused our attention on identifying conditions or situations, i.e. a combination of nanoparticle physico-chemical properties, skin barrier integrity, and occupations with high prevalence of skin disease, which deserve further investigation. This second paper focuses on the broad question of dermal exposure assessment to nanoparticles and attempts to give an overview of the mechanisms of occupational dermal exposure to nanoparticles and nano-enabled products and explores feasibility and adequacy of various methods of quantifying dermal exposure to NOAA. We provide here a conceptual framework for screening, prioritization, and assessment of dermal exposure to NOAA in occupational settings, and integrate it into a proposed framework for risk assessment.