Birgitta Meding

Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure

Occupational skin diseases are among the most frequent work‐related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool – Nordic Occupational Skin Questionnaire (NOSQ‐2002) – for surveys on work‐related skin disease and exposures to environmental factors. The 2 NOSQ‐2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ‐2002/SHORT is a ready‐to‐use 4‐page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ‐2002/SHORT) are included in the long version, NOSQ‐2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ‐2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ‐2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ‐2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.

Fifteen-year follow-up of hand eczema: persistence and consequences

Background  Hand eczema is a skin disease often with a long‐lasting and relapsing course. The long‐term prognosis in the general population is unknown.

Asthma, rhinitis, and dermatitis in workers exposed to reactive dyes.

A survey was conducted at 15 textile plants with dyehouses in western Sweden. Employees with a history of work related rhinitis, asthma, or skin symptoms were offered a clinical and immunological investigation including skin prick tests, skin patch tests, and radioallergosorbent tests (RASTs) to detect specific allergy to reactive dyes. Among the 1142 employees, 162 were exposed to reactive dyes and 10 of these (6%) reported work related respiratory or nasal symptoms. An allergy to reactive dyes could be confirmed in five (3%, 95% confidence interval 1-7%). All but one had been exposed to reactive dyes for one year or less before the onset of symptoms. Positive RASTs could be detected in four of the five patients. All of the RAST positive patients were positive to remazol black B, but six out of eight additional remazol dyes also elicited positive results. RAST and RAST inhibition showed a cross reactivity between some of the dyes. Seven persons with work related dermatitis and three with urticaria or Quincke oedema were found. In one patient contact dermatitis to a monoazo dye was shown, but no positive patch test reactions to reactive dyes. IgE-mediated allergy to reactive dyes seems to be an important cause of respiratory and nasal symptoms among dyehouse employees exposed to dust from reactive dyes.

Consequences of having hand eczema

Consequences of hand eczema were studied in 1238 patients who had the diagnosis confirmed in a prevalence study of hand eczema in I he population of Gothenburg. It was found that 2/3 of the patients had consulted a doctor on some occasion and 1/5 had been on sick leave for their hand eczema. The mean total time on sick leave was 18.9 weeks, the median 8 weeks. Patients in service occupations reported more periods of sick leave than other occupational groups. Local steroid preparation; were used by 1/2 the patients, emollients by 85%. Change of work was reported by 8% and was most common in service occupations. Hairdressers, had the highest rate of change. 80% of the patients experienced some kind of disturbance to their social and emotional lives, considered to be caused by the hand eczema. Frequent itching was reported by 1/2 the patients, occasional itching by another 1/3. Comparing different types of hand eczema, allergic contact dermatitis seemed throughout to cause more serious consequences. It is concluded that good care of a hand eczema patient includes attention to the impact of the disease on the patients total situation.

Predictive factors for hand eczema

Factors related to hand eczema were studied. Their relative importance as predictors was ranked by multiple logistic regression analysis. Questionnaires were sent to 20,000 individuals aged 20–65 years, randomly selected from the population register. Those subjects (1385) considering themselves to have had hand eczema within the previous 12 months were invited to a dermatological examination. It was found that it history of childhood eczema was the most important predictive factor for hand eczema. Second was female sex, followed by occupational exposure, a history or asthma and or hay fever, and service occupation. A small decrease in risk with advancing age was also found. The difference in the probability of having hand eczema In a l‐year period, between individuals having the most important risk factors studied and those having none of them proved to be for females 48% compared to 8%, and for males 34% compared to 4%. A history of childhood eczema was found to be more common among voting persons, indicating an increase in the prevalence of atopic dermatitis. Of those individuals who reported childhood eczema, 27% reported hand eczema on some occasion during the last 12 months.

Differences between the sexes with regard to work-related skin disease.

Work‐related skin disease is common and usually presents as hand eczema. From the Occupational Injury Information System in Sweden, as well as from registers of industrial injuries in other countries, it is evident that females report skin disease more often than males. Epidemiological studies of hand eczema also show that women are more often affected than men, in particular young women. The most common type of hand eczema is irritant contact dermatitis, which is often caused by wet work. Many female‐dominated occupations involve extensive wet work, e.g., hairdressing, catering, cleaning and health‐care work. These occupations are also high‐risk occupations for hand eczema. Experimental studies of skin irritation have not confirmed differences between the sexes; thus, the higher prevalence of irritant contact dermatitis among females is most likely due to exposure, occupational and non‐occupational. Nickel allergy is the most common contact allergy, which is most frequent in young females, and in 30–40% results over time in hand eczema. Hand eczema has an impact on quality of life and females seem to report a higher degree of discomfort than males. To achieve the optimal effect of preventive efforts regarding occupational skin disease, the focus for prevention should aim at reducing wet exposure.

Validity of self-reports of hand eczema.

The validity of questionnaire answers with respect to hand eczema was investigated. Car mechanics, dentists and office workers answered a questionnaire on the occurrence of hand eczema on any occasion during the past 12 months. “Yes”‐responders and a random sample of “no”‐responders were subsequently interviewed and examined by a dermatologist. 10.0% of the car mechanics, 12.0% of the dentists and 12.5% of the office workers were found to have hand eczema despite previous “no”‐answers. In the same populations, 81%, 94% and 80% of the “yes”‐answers were confirmed at the clinical examination. Considering false‐negative and false‐positive answers, the sensitivity was 53–59% and the specificity 96–99% in the 3 groups. The 1‐year prevalence changed from self‐reported 15% to estimated 21% in the car mechanics, from 15% to 24% in the dentists and from 15% to 23% in the office workers. It is concluded that self‐reported 1‐year prevalence of hand eczema considerably underestimates the true prevalence.

Hand eczema and quality of life: a population-based study.

Background  Hand eczema is a common disease in the population and is of interest from a public health perspective. Health‐related quality of life (HRQoL) is increasingly being measured in dermatology.

Occupational skin disease in Sweden : a 12-year follow-up

The aim of this project was to study the long‐term prognosis of occupational skin diseases in Sweden. In 1999, a questionnaire was sent to 623/655 individuals who in 1987 reported occupational skin disease to the Social Insurance Office. 394 answered the questionnaire, and 123 non‐responders were interwiewed by telephone, giving 517 participants (83%), 323 females and 194 males. 85% reported skin symptoms after 1987, 70% during the previous year. 28% considered themselves recovered, of those with nickel allergy only 12%. In a logistic regression model, skin atopy was the strongest unfavourable factor for the prognosis followed by contact allergy and female sex. 66% had consulted a doctor after 1987 and the majority, 82%, had performed occupational changes – most common was change of jobs, 44%. Those who had changed jobs reported less sick leave. The conclusion is that occupational skin diseases have a clear tendency to end up as chronic conditions with a majority reporting symptoms at a 12‐year follow‐up. The skin disease had influenced the occupational situation for the majority (82%) and for 15% resulted in exclusion from the labour market through unemployment or disability pension.

Occupational hand eczema in an industrial city

Hand eczema in relation to occupation was studied in an industrial city. Questionnaires were sent to 20,000 individuals aged 20–65 years, randomly selected from the population register of the city. Those subjects (1385) considering themselves to have had hand eczema within the previous 12 months were invited to a dermatological examination including patch testing. It was found that the reported 1‐year period prevalence of hand eczema in the total sample was 11.8%. The only occupational group reporting a statistically significant higher 1‐year period prevalence was service work, 15.4%. Among all occupations, cleaners turned out to have the highest period prevalence, 21.3%. Hand eczema was more common among people reporting some kind of occupational exposure. The most harmful exposure turned out to be to unspecified chemicals, water and detergents and dust and dry dirt. The use of protective gloves is reported and analyzed. The most common contact allergy was nickel, followed by cobalt, fragrance‐mix, balsam of Peru and colophony A statistically significant increase in contact allergy to colophony for women in administrative work was found. It is concluded that the type of hand eczema that is mostly dependent on occupation is irritant contact dermatitis.