Britta Wulfhorst

Multicentre study ‘rehabilitation of occupational skin diseases –optimization and quality assurance of inpatient management (ROQ)’–results from 12‐month follow‐up

Background. Occupational skin disease (OSD) is common, and imposes a considerable personal and public burden. To tackle OSD, the German stepwise procedure of handling OSD was set up. It contains an interdisciplinary, integrated inpatient rehabilitation measure [tertiary individual prevention (TIP)] [dermatological treatment and diagnostic procedures, and patient education (health and psychological)]. The primary aims of the TIP are reduction of the severity of OSD, reduction in the use of corticosteroids, facilitation of return to work, decreased absence from work, and enhanced quality of life (QoL). It was positively evaluated for a period of 4 weeks after return to work.

First results from the multicentre study rehabilitation of occupational skin diseases--optimization and quality assurance of inpatient management (ROQ).

Background and objectives. The German stepwise procedure of handling occupational skin diseases (OSDs) offers interdisciplinary integrated (inpatient/outpatient) rehabilitation measures [tertiary individual prevention (TIP)] for severe OSD. In 2005, a prospective cohort multicentre study was started in order to evaluate TIP.

Prevention of Hand Eczema: Gloves, Barrier Creams and Workers’ Education

To date, there is fair-quality evidence from a large number of countries, where preventive initiatives for occupational contact dermatitis (OCD) in selected settings and professions have proven significantly effective and successful; in this context, early dermatological intervention as well as specific teaching of affected individuals has been demonstrated as pivotal. Undoubtedly, awareness to OCD, its pathogenesis and prevention by those at risk have, as yet, to be improved in all countries. Thus, it is an imminent future task to improve on workers’ education, multi-disciplinary approaches being advisable. Prevention may increasingly become a stronghold for dermatology: by their specific knowledge and competence – in close cooperation with other disciplines – dermatologists can save their patients’ health and jobs, and thus also save expenses for tax-payers and insurance systems. Of course, preventive intervention needs to be accompanied by common regulatory efforts including evidence-based standards for adequate manufacturing and use of gloves, protective creams and after-work skin care to limit exposure to hazardous substances.

Sustainability of interdisciplinary secondary prevention in patients with occupational hand eczema: a 5-year follow-up survey.

Background. Occupational hand eczema (OHE) is common in ‘wet work’ occupations. Thus, effective and sustainable prevention strategies are needed.

Association between tobacco smoking and prognosis of occupational hand eczema: a prospective cohort study

Hand eczema (HE) is a common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not yet been studied.

Long‐term effectiveness of secondary prevention in geriatric nurses with occupational hand eczema: the challenge of a controlled study design

Background. The high prevalence of occupational dermatoses indicates the need for effective and sustainable prevention strategies.

Semipermeable glove membranes–effects on skin barrier repair following SLS irritation

Background: Transepidermal water flux is the regulatory signal for barrier regeneration.

Site variations in susceptibility to SLS.

According to the European Society of Contact Dermatitis (ESCD) guidelines on the sodium lauryl sulfate (SLS) exposure test ‘the flexor side of forearm skin with cubital fossa and wrist excluded is the preferred study site’. In this study we analysed the exact anatomic region within the suggested test area in respect to the outcome of the SLS exposure test. 3 test areas at the volar forearm were chosen: ‘distal’ with a 5‐cm distance to the wrist, exact ‘midvolar’ and ‘proximal’ with a 5‐cm distance to the cubital fossa. 25 healthy volunteers were irritated for 24 hr with 1% SLS. Transepidermal water loss (TEWL) measurements were taken before and 1 and 24 hr after removal of Finn Chambers®. Median baseline TEWL showed no significant differences in the 3 test sites. However, postexposure TEWL proximal was significantly (P < 0.01) higher than midvolar and distal. The distal volar forearm showed the lowest TEWL 24 h after the irritation. The differences were in comparison to midvolar (P < 0.01) and proximal (P < 0.001) significant. The results show that it is essential to point out the exact position of the test area at the volar forearm in study reports and to randomize the irritation areas at the volar forearm if different treatments are to be compared.

Multicentre cohort study ‘Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assurance of Inpatient Management (ROQ)’: results from a 3-year follow-up: THREE-YEAR FOLLOW-UP OF ROQ STUDY

A tertiary individual prevention programme (TIP) is offered to patients with severe occupational skin disease (OSD) in Germany. Previously, it was shown that the burden of OSDs is considerably reduced in patients up to 1 year after the TIP.

Worker’s Protection: Gloves and Creams

A hierarchy of risk management aims to protect workers against hand eczema (elimination or substitution of harmful substances, technical measures/no touch techniques, organizational measures). Workers’ personal skin protection as the final step in the hierarchy of protective measures should be optimized by adequate choice of gloves, barrier creams, emollients, and skin cleaning products and by workers education to improve their motivation to practice skin protection and to avoid application errors (Wulfhorst 2011). All skin protective measures should be summarized in a skin protection plan that includes handwashing, skin protection (gloves and barrier creams), and skin care. For the selection of protective gloves, barrier creams, skin cleansing products, and skin care products, standardized requirements or regulations for skin protection (e.g., EU Directive or US Occupational Safety and Health Standard) must be considered.