Prevention of Occupational Contact Dermatitis

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Eczema Free Forever by Rachel Anderson

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The severe impact of the disease on quality of life, the high costs of retraining and the poor employment prospects once workers lose their job highlight the need for effective primary and secondary preventive measures in occupational contact dermatitis.

Successful prevention programs focus not on one aspect, but they employ a combination of measures (table 4).

The first step in a prevention program should always be a thorough risk assessment of the workplace. Ideally, the skin exposure to irritants and allergens can be reduced or even removed by technical means. By organizational means, the exposure to damaging substances can be controlled. For instance, if shampooing in hairdressers' salons is not only limited to one employee (usually the apprentice) but is spread evenly over the whole workforce, the individual exposure time may be limited to acceptable levels. Personal skin protection measures are of great importance when skin contact with irritant or sensitizing substances cannot be avoided. The correct use of personal skin protection measures requires educational efforts; at the same time, the awareness of skin hazards at the workplace should be increased, and the motivation to take responsibility for one's own skin health should be fostered.

The hairdressers' trade is a paradigm for successful preventive interventions in occupational dermatology. During the 1990s, two legislative regulations concerning hairdressers came into effect in Germany [Technical Rules for Hazardous Substances 530 'Hairdressing trade' and 531 'Endangerment of the skin by work in the wet environment (wet work)']. At the same time, glyceryl


Fig. 2. Annual incidence (95% confidence interval) of hairdressers with a stated occupational skin disease (from Dickel et al. [24]).


Fig. 2. Annual incidence (95% confidence interval) of hairdressers with a stated occupational skin disease (from Dickel et al. [24]).

Fig. 3. Skin disease prevention program in the baking, hotel and catering industries [25]. OD = Occupational disease; OSD = occupational skin disease.
Fig. 4, 5. Examples of occupational hand dermatitis. 4 Irritant and secondarily allergic contact eczema due to cutting oils; identified allergen: monoethanolamine. 5 Eczema of the fingertips due to atopy and irritation.

monothioglycolate as an important occupational allergen was removed from the market. The German occupational insurance for the hairdressers' trade (BGW) supported dermatological and educational secondary intervention programs to prevent cases with minor hand dermatitis to progress leading to loss of job and need of retraining. As a result, the annual incidence of cases of hand dermatitis in hairdressers fell significantly from 194 to 18 cases per 10,000 workers between 1990 and 1999 (fig. 2) [24]. Similar positive results were reported from interventions in other trades, such as in the food industry (fig. 3) [25]. Considering these experiences of the last decade, skin protection and skin care measures can be introduced successfully in the daily routine of a skin risk occupation (fig. 4, 5), and high uptake and maintenance rates can be achieved.

As the efficacy of preventive intervention programs in occupational dermatology has been proven in an evidence-based approach, it is only consequent that evidence-based proof of efficacy and safety is also demanded for skin protection agents to be used in these programs. The guideline of the German Working Group for Occupational and Environmental Dermatology

(ABD) for occupational skin protection therefore explicitly demands the testing of these products in practice-oriented controlled clinical studies in humans [26].

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