Search

Competing Interests: HOR ist Fachgutachter beim IMPP. BK ist Leiterin des Fachbereichs Medizin und Ständige Vertreterin der Direktorin am IMPP.

Background: The prognosis of occupational hand eczema is strongly associated with its duration, severity, and the onset of treatment., Objectives: The study was aimed at characterizing skin eruptions that might be potential precursors of occupational hand eczema, their pattern, and typical sites in a population at moderate risk of hand eczema., Patients/materials/methods: Eight hundred German male metal workers took part in a structured interview focused on their medical history combined with a dermatological examination of their hands, by use of the quantitative Hand Eczema Score for Occupational Screenings, with follow-up 1 year later., Results: The most frequent lesions were erythema (91.8%), lichenification (98.8%), crusting (70%), and scaling (35%); all other lesions were relatively rare (15%). The distribution of lesions remained stable between baseline and follow-up. The areas most affected were knuckles, palms, and finger shafts (excluding tips). Interdigital regions were uncommonly affected in this sample., Conclusions: Erythema, lichenification, and crusting, indicating constant skin 'strain', can be regarded as precursor lesions for slight hand eczema, and should be monitored quantitatively. As other occupations, for example hairdressing, have different predilection sites, it can be concluded that the pattern of occupational hand eczema is strongly influenced by the distinct strain profile of an occupation., (© 2011 John Wiley & Sons A/S.)

Purpose: The present review is aimed at providing an overview of skin cancer with particular focus on occupational concern and giving evidence-based recommendation for effective prevention at workplace., Methods: We performed a systematic search of literature using PubMed and the Cochrane Library., Results: Outcome of preventive strategies depends either on efficacy of the strategy itself but also on acceptance and implementation of protective means among the persons at possible risk for hazardous health effects. Epidemiological studies have reported significantly more non-melanoma skin cancer in men than in women. Life-style choices and difference in immunosuppression play a major role in this gender disparity. Tumor biology of skin cancer is diverging: severe blistering sunburns corresponding to intermittent intense UV exposures are associated with an increased risk for both melanoma and basal cell carcinoma (BCC); whereas the risk of squamous cell carcinoma (SCC) and actinic keratoses (AK) is strongly associated with chronic UV exposure. Several clinical trials give evidence that long-term use of sunscreen prevents the appearance of non-melanotic skin cancer such as AK and SCC, but not of BCC. All technical and organizing measures aimed at reducing UV exposure at workplace belong to first-line prevention; however, there is much room for improvement. The efficacy of personal protection means (second-line strategy) strongly depends on the workers' compliance which is quite low at workplace., Conclusion: Evidence-based data confirming the benefit of sun protective strategies are scarce, general recommendations are mainly based on the avoidance of UV radiation being identified as potential risk factor for non-melanoma skin cancer in epidemiological studies. Occupational screenings should include regular interventions aimed at enhancing a clear understanding of risk factors for individuals and finally improving the acceptance and maintenance for UV-protective means at workplace.

Purpose: Sinonasal adenocarcinoma is a rare cancer, frequently associated with occupational exposure to inhalable wood dust. Among the EU member States, Germany was reported to have the highest number of exposed workers. Location and long latency make early diagnosis difficult. This case-control study was aimed at assessing potential risk factors and at characterizing initial clinical symptoms, both serving as matrix to identify persons at increased risk and to improve management of this cancer., Methods: Of 58 patients, 31 diagnosed with sinonasal adenocarcinoma (cases) between 1973 and 2007 were identified and underwent standardized interview on clinical data. A total of 85 patients diagnosed over the same period with carcinoma of the oral cavity served as controls., Results: The ethmoid was confirmed as the predominant site of adenocarcinoma associated with wood dust exposure, whereas the nasal cavity was most commonly affected in patients denying any exposure to wood dust. Cases were significantly engaged in mainly woodworking occupations compared to controls. The main initial clinical symptoms were nasal obstruction 6 months (71%) and epistaxis 4 years (41.9%) prior to diagnosis. Hardwood dust from beech and oak proved to be the most common occupational exposure, with a mean exposure period of 32.3 years and a latency of 43.5 (34-58) years., Conclusions: Our investigation confirms the importance of regular screenings for persons exposed to wood dust even years after the end of occupational or private exposure. Banal clinical symptoms such as epistaxis and nasal obstruction might be predictive, requiring early and thorough investigation.

Background: Measurements of transepidermal water loss (TEWL) as an indicator of skin barrier function and colorimetry for quantifying erythema have been recommended for monitoring persons at risk of occupational hand dermatitis., Objective: This study examines the practicability and usefulness of biophysical measurements at the workplace. PATIENTS/MATERIAL/METHODS: A sample of 1020 male metal workers was enrolled; 800 participants were followed up for 1 year. TEWL results and colorimetry (a* value), respectively, were used as effectiveness outcomes, comparing the findings in the four study arms (skin care, skin protection, both combined, and control group)., Results: At 1 year follow-up, the TEWL was slightly but significantly lower in the group of participants randomized for application of barrier cream alone, indicating a protective effect. However, addressing both the individual absolute change of a* value and the differences of TEWL (delta-TEWL) of the dominant hand over the study period, no significant difference was found between the four groups., Conclusions: Dermatological examinations at the workplace cannot be replaced by bioengineering techniques. The supplementary benefit is apparently low, possibly because of difficulties in achieving standardized measurement conditions and other technical reasons.

Due to an increasing awareness of the potential hazardousness of air pollutants, new laws, rules and guidelines have recently been implemented globally. In this respect, numerous studies have addressed traffic-related exposure to particulate matter using stationary technology so far. By contrast, only few studies used the advanced technology of mobile exposure analysis. The Mobile Air Quality Study (MAQS) addresses the issue of air pollutant exposure by combining advanced high-granularity spatial-temporal analysis with vehicle-mounted, person-mounted and roadside sensors. The MAQS-platform will be used by international collaborators in order 1) to assess air pollutant exposure in relation to road structure, 2) to assess air pollutant exposure in relation to traffic density, 3) to assess air pollutant exposure in relation to weather conditions, 4) to compare exposure within vehicles between front and back seat (children) positions, and 5) to evaluate "traffic zone"-exposure in relation to non-"traffic zone"-exposure.Primarily, the MAQS-platform will focus on particulate matter. With the establishment of advanced mobile analysis tools, it is planed to extend the analysis to other pollutants including NO2, SO2, nanoparticles and ozone.

Background: Besides improving working conditions and using personal protective equipment, early detection is most important in managing work-related hand eczema. Implementing regular teledermatological skin screenings could be helpful, but none of the published hand eczema-scores has hitherto been used in teledermatology., Objective: Testing and comparing two validated scores [Osnabrück hand eczema severity index (OHSI); hand eczema severity index (HECSI)] for their suitability in an occupational telemedical screening., Patients/materials/methods: One hundred and twenty photographic records of the hands of 30 male wet workers were examined twice with each score. Results were tested for reproducibility, intra-observer reliability and inter-score-correlation., Results: Examination time, mean score values, and score ranges reached did not differ significantly. The inter-score-correlation was moderate (correlation coefficients: 0.651 for first examination; 0.642 for second examination). In the qualitative assessment, the HECSI showed a better overall agreement between results of first and second examinations., Conclusions: Both scores are suitable for assessing the skin condition in a teledermatological setting. The comparability is limited to qualitative assessment, as the strictly objective OHSI measures the extent of hand eczema and the finer graduated HECSI measures the intensity of hand eczema, adding a subjective component. For assessing minimal skin changes, a scoring system that reduces subjective elements while at the same time it offers a differentiated grading is advisable.

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.

Background: The validity of epidemiological studies assessing a lifetime cancer risk due to environmental factors, such as nutrition or smoking behavior strongly depends on the validity of the patient's history., Objectives: This study assesses whether a standardized questionnaire is a valid tool to identify exposure with acrylamide by relating the self-reported food and smoking history with a biomarker, namely hemoglobin-adduct levels of acrylamide., Methods: Objective parameters of previous exposure, such as hemoglobin-adduct levels of acrylamide and of the smoking-specific acrylonitrile, respectively, were related to self-reported data in 1,008 volunteers of the general population in bivariate analyses and a multiple linear regression analysis using the log-transformed biomarker levels as outcome., Results: Smoking was significantly associated with adduct levels of acrylamide (p < 0.0001) and had a main contribution to the internal burden with acrylamide. In cigarette smokers a strong correlation between the number of cigarettes smoked daily and the corresponding biomarkers was observed. Focusing on non-smokers (n = 828), a significant but weak correlation was found in bivariate analyses (Spearman rank correlation coefficient: 0.178 (95% CI: 0.089-0.268) in females and 0.168 (95% CI: 0.063-0.273) in males. A multiple linear regression analysis similarly yielded evidence of a significant association between the highest intake category and adduct levels; however, explained variability was very small (R(2) = 0.08)., Conclusion: Self-reported data concerning smoking behavior were highly valid, while self-reported food intake is apparently not as useful for estimating food-related acrylamide exposure.

For many years the three-step programme of skin protection, consisting of skin protection before work, cleaning and skin care after work, is one of the generally recommended measures to prevent occupational contact dermatitis. While protective creams are supposed to prevent skin damage caused by irritant contact, skin cleansing should mildly remove aggressive substances from the skin, whereas post-exposure skin care is intended to enhance epidermal barrier regeneration. This programme is strongly followed by most of the employees. But in spite of intensive preventive measurements the rate of reported occupational skin diseases according to BK 5101 is with a mean of 27.9% unchanged high since 1980. Occupational dermatologists even suggest that the reported cases mimic the top of an iceberg and that the incidence of occupational skin diseases might be much higher. These findings raise the question of how effective the actual recommended three-step programme really is in primary and secondary prevention of occupational contact dermatitis. This review is aimed to give an evaluation on the evidence of each single element of the three-step concept. Following results can be determined: In cases of impaired skin condition the therapeutic properties of skin protection (secondary prevention) is undoubted. The effectiveness of barrier creams in the primary prevention of hand eczema could not be proven. Beyond doubt is the fact that barrier creams facilitate the removal of sticky oils, greases, and resins from the skin, thus decreasing the need to wash with potentially irritating abrasives and waterless cleansers.

Introduction: Allergic reactions caused by animals are a common and significant occupational health concern. In a large population-based study on occupational asthma in Europe, farming has been among the occupations with the highest risk., Objectives: Characteristics of cattle-allergic farmers are described in a retrospective observational design., Methods: The study covers farmers from all regions of Germany which were reported to the Agricultural Institutions for Statutory Accident Insurance and Prevention (Landwirtschaftliche Berufsgenossenschaften, LBGs) between 1990 (January) and 2002 (December) with a suspected occupational cattle-allergic airways disease. For these farmers, the following parameters were considered: age, gender, onset of airways symptoms related to contact with cattle, begin of employment disability, total and specific Immunoglobulin E (IgE) against cattle allergens, and results of lung function measurements., Results: A total of 513 patients (age 14-74, mean 40.7 years; 45.6% women, 54.4% men) had been reported for a suspected occupational cattle-allergic airways disease. Of these patients 24.8% showed cattle-related symptoms of asthma, 11.7% of rhinitis, and 60% of both asthma and rhinitis, while only 34.5% of all reported patients showed an airways obstruction in the first documented lung function test. A total of 62.5% out of the group of patients with an officially recognized occupational disease (42.1%, n=216) have an initial employment disability with a rating of 20% or above., Conclusions: Our results underline the high public health relevance of cattle allergy in farmers, especially in the light of the large number of young patients. Considering the known difficulties in diagnosing cattle allergy due to the number of false negative test results, we are convinced that its relevance is even higher than the number of reported cases suggests. The high rate of initial employment disability among the affected patients underlines the need for improved preventive measures.