Heinrich Dickel

Importance of Irritant Contact Dermatitis in Occupational Skin Disease

AbstractBackground: Irritant contact dermatitis (ICD), provoked by work materials or workflows, is believed to be a frequent cause of occupational skin disease (OSD). Data of incidence rates of ICD within different occupations are inadequate. Objective: We conducted a population-based study to identify occupational groups at risk for irritant and allergic contact dermatitis (ACD). Methods: The data are based on all workers’ compensation claims reported to our register of OSDs in Northern Bavaria [Berufskrankheitenregister Haut-Nordbayern (BKH-N)], Germany. Results: From 1990 to 1999, 5285 patients had their cases completely assessed and recorded by government-employed physicians. We calculated the incidence rates of ICD and ACD in various occupations, divided into 24 occupational groups, in co-operation with the German State Institute of Labor and Occupation; there were a known total number of employees in each of the occupations.In these groups 3097 (59%) patients with OSD were observed, with an overall annual incidence rate of 4.5 patients per 10 000 workers for ICD, compared with 4.1 patients per 10 000 workers for ACD. The highest ICD annual incidence rates were found in hairdressers (46.9 per 10 000 workers per year), bakers (23.5 per 10 000 workers per year), and pastry cooks (16.9 per 10 000 workers per year); at the same time ICD was the main diagnosis of OSD in pastry cooks (76%), cooks (69%), food processing industry workers and butchers (63%), mechanics (60%), and locksmiths and automobile mechanics (59%). The results of a questionnaire showed frequent skin contact with detergents (52%), disinfectants (24%), and acidic and alkaline chemicals (24%) in the workplace. Conclusion: Based on the incidence data of the BKH-N, this study identified occupational groups with a high risk of ICD. Different frequencies of ICD and ACD within a single group are demonstrated. The frequent usage of detergents is being addressed because of the introduction of German legislation of recent date (the Approved Code of Practice 531 on ‘wet work’).

Occupational skin diseases in Northern Bavaria between 1990 and 1999: a population-based study

Background  Occupational skin diseases (OSDs) account for a large portion of occupational diseases in Europe, but population‐based epidemiological studies are missing.

Patch test results with the metalworking fluid series of the German Contact Dermatitis Research Group (DKG)

Based on the information of the interdisciplinary task force on allergy diagnostics in the metal branch, in 2001, the German Contact Dermatitis Research Group (DKG) compiled two metalworking fluid (MWF) test series with currently and previously used components, respectively. After 2 years of patch testing, we present results obtained with these series, based on data of the Information Network of Departments of Dermatology (IVDK). 251 metalworkers who were patch tested because of suspected MWF dermatitis in 2002 and 2003 were included in this retrospective data analysis. Of these, 206 were tested with the current MWF series and 155 with the historical MWF series. Among the current MWF allergens, monoethanolamine ranked 1st with 11.6% positive reactions. Diethanolamine (3.0%), triethanolamine (1.1%), and diglycolamine (1.9%) elicited positive reactions far less frequently. Allergic reactions to p‐aminoazobenzene were frequently observed (6.0%), but the relevance of these reactions is still obscure. Positive reactions to biocides ranged from 4.5% for Bioban® CS 1135 to 0.5% for iodopropynyl butylcarbamate and 2‐phenoxyethanol. Concomitant reactions to formaldehyde, which caused positive reactions in 3.3%, and formaldehyde releasers occurred to varying extents without conclusive pattern. No positive reactions were seen to dibutyl phthalate, di‐2‐ethylhexyl phthalate, tricresyl phosphate, isopropyl myristate or benzotriazole. With the historical MWF test series, positive reactions to methyldibromo glutaronitrile (MDBGN) were observed most frequently. However, sensitization via allergen sources other than MWF seems likely, as MDBGN, during the study period, has been one of the most frequent preservative allergens in cosmetics and body care products. Other historical MWF allergens comprised morpholinyl mercaptobenzothiazole (3.3%), benzisothiazolinone (BIT; 2.0%) and Bioban® P 1487(1.3%). BIT is currently used in MWF again, so it was shifted to the current MWF test series. As decreasing reaction frequencies to former MWF allergens that are no longer used can be expected, the historical series should be re‐evaluated after some years. The test series with current MWF allergens has to be kept up‐to‐date based on information from industry and to be kept concise by eliminating test substances which never cause positive reactions.

Standardized tape stripping prior to patch testing induces upregulation of Hsp90, Hsp70, IL-33, TNF-α and IL-8/CXCL8 mRNA: new insights into the involvement of 'alarmins'.

Background: The strip patch test is recommended if patch test results are presumed to be false‐negative. It is under discussion whether the cutaneous inflammation induced by tape stripping is a pivotal element in enhancing the allergic contact dermatitis response.

An attempt to improve diagnostics of contact allergy due to epoxy resin systems. First results of the multicentre study EPOX 2002

Epoxy resin systems (ERSs) are a frequent cause of occupational allergic contact dermatitis. Sensitization occurs not only to the resins, but also to hardeners and reactive diluents. However, only a fraction of the ERS components currently in use are available for patch testing. With the multicentre study EPOX 2002, we attempted to improve diagnostics in this field by patch testing with components currently used in ERSs. During the first study period (October 2002 to July 2003), in addition to commercially available ERS patch test substances, 16 study substances (1 resin, 9 hardeners and 6 reactive diluents) were patch tested in 70 patients with suspected contact allergy due to ERSs and 22 patients with a prior positive patch test reaction to epoxy resin (ER) in the standard series. Most frequently, allergic reactions to ER based on diglycidyl ether of bisphenol A and F were observed (55.2% and 43.7%, respectively). Agreement between positive reactions to both resins, which can be explained by immunological cross‐sensitization and/or coexposure, was substantial [Cohens kappa 0.65 (95% CI: 0.49–0.80)]. Among the reactive diluents, 1,6‐hexanediol diglycidyl ether (1,6‐HDDGE) and 1,4‐butanediol diglycidyl ether (1,4‐BDDGE) were the most frequent allergens, with 19.5% and 18.4% positive reactions, respectively. Although agreement between positive reactions to 1,6‐HDDGE and 1,4‐BDDGE was even better than with the 2 resins, the sample size is considered too small to decide reliably whether 1,6‐HDDGE alone could serve as a marker allergen for both. Allergic reactions to p‐tert‐butylphenyl glycidyl ether and to phenyl glycidyl ether (PGE) occurred in 11.5% of the patients tested, with only moderate agreement. All patients positive to cresyl glycidyl ether (6.8%) also reacted to PGE. Of the hardeners tested, m‐xylylene diamine was the most frequent allergen (13.8%), followed by isophorone diamine (5.7%). No reactions were observed to several substances, the test concentration of which may have been too low and will be increased in the future.

Guideline for the diagnosis of drug hypersensitivity reactions

Drug hypersensitivity reactions are unpredictable adverse drug reactions. They manifest either within 1–6 h following drug intake (immediate reactions) with mild to life-threatening symptoms of anaphylaxis, or several hours to days later (delayed reactions), primarily as exanthematous eruptions. It is not always possible to detect involvement of the immune system (allergy). Waiving diagnostic tests can result in severe reactions on renewed exposure on the one hand, and to unjustified treatment restrictions on the other. With this guideline, experts from various specialist societies and institutions have formulated recommendations and an algorithm for the diagnosis of allergies. The key principles of diagnosing allergic/hypersensitivity drug reactions are presented. Where possible, the objective is to perform allergy diagnostics within 4 weeks–6 months following the reaction. A clinical classification of symptoms based on the morphology and time course of the reaction is required in order to plan a diagnostic work-up. In the case of typical symptoms of a drug hypersensitivity reaction and unequivocal findings from validated skin and/or laboratory tests, a reaction can be attributed to a trigger with sufficient confidence. However, skin and laboratory tests are often negative or insufficiently reliable. In such cases, controlled provocation testing is required to clarify drug reactions. This method is reliable and safe when attention is paid to indications and contraindications and performed under appropriate medical supervision. The results of the overall assessment are discussed with the patient and documented in an „allergy passport“ in order to ensure targeted avoidance in the future and allow the use of alternative drugs where possible.

Characteristics of self-estimated enhanced skin susceptibility

A considerable number of people complain about enhanced skin sensitivity. The aim of this study was to investigate the characteristics of subjective statements and objective measurable parameters in subjects with self-estimated enhanced skin susceptibility. Four-hundred-and-twenty volunteers completed a questionnaire form with a self-estimation of skin susceptibility, possible triggering factors and other skin problems. In addition, basal values of transepidermal water loss, cutaneous blood flow and skin hydration were measured. One-hundred and fifty-two volunteers were also patch-tested with sodium lauryl sulphate 0.5% on the forearm and evaluated by bioengineering methods. We found no correlation between self-estimated skin susceptibility and bioengineering values, neither basal nor after sodium lauryl sulphate testing. These findings, along with interpretation of the questionnaire form, suggest that self-estimated enhanced skin susceptibility is a subjective problem mostly reported by women and of all ages.

Quantitative patch and repeated open application testing in hydroxyisohexyl 3‐cyclohexene carboxaldehyde sensitive‐patients

Objective: To identify the concentration of the fragrance compound hydroxyisohexyl 3‐cyclohexene carboxaldehyde (INCI) (HICC) that is sufficiently low not to cause an allergic reaction in patients with proven sensitization.

Standardized tape stripping: a practical and reproducible protocol to uniformly reduce the stratum corneum.

The basic idea of the strip patch test (SPT), a modification of the conventional patch test (PT), is to increase the bioavailability of a test substance in the deeper epidermal cell layers by defined tape stripping of the test area on the back prior to a PT. In a prospective, investigator-blinded clinical study, we evaluated the variability and the interrater agreement of our proposed SPT protocol. The relative stratum corneum (SC) reduction after tape stripping was measured on 75 subjects for variability and in a subgroup of 18 subjects for interrater agreement, by performing in vivo confocal laser scanning microscopy. We found good reproducibility with an SC reduction of 31%, with 95% of the values lying between 22 and 40%, and good interrater agreement. As a result, our SPT protocol yields a clinically adequate standardization of the SC reduction and the SPT may therefore be recommended for performance in daily clinical routine.

Association between TNFA-308 G/A polymorphism and sensitization to para-phenylenediamine: a case–control study

Background:  Para‐phenylenediamine (PPD) and related chemicals are common contact sensitizers, frequently causing allergic contact dermatitis (ACD). The cytokine tumor necrosis factor‐alpha (TNF‐α) plays a key role in contact sensitization.