Jose Hernán Alfonso

Work‐related skin diseases in Norway may be underreported: data from 2000 to 2013

Jose H. Alfonso1, Eva K. Lovseth2, Yogindra Samant3 and Jan-O. Holm4 1Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health (STAMI), N-0033 Oslo, Norway, 2Department of National Work Environment Surveillance, National Institute of Occupational Health, N-0033 Oslo, Norway, 3Norwegian Labour Inspectorate, 7468, Trondheim, Norway, and 4Department of Dermatology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 03180, Oslo, Norway

Self-reported Occupational Exposure to Chemical and Physical Factors and Risk of Skin Problems: A 3-year Follow-up Study of the General Working Population of Norway

Prospective studies on occupational dermatoses in the general working population are sparse. This study investigated prospectively the impact of self-reported occupational exposure to chemicals and physical factors on the risk of skin problems. The cohort comprised respondents drawn randomly from the general population in Norway, who were registered employed in 2006 and 2009 (n = 6,745). Indoor dry air (odds ratio (OR) 1.3; 95% confidence interval (95% CI) 1.1-1.6) was a significant baseline predictor of skin problems at follow-up, whereas exposure to cleaning products (OR 1.7; 95% CI 1.2-2.5), water (OR 1.4; 95% CI 1.1-1.9) and indoor dry air (OR 1.6; 95% CI 1.1-2.1) at both measurement time-points was significantly associated with skin problems. The population risk attributable to these factors was 16%. This study quantified the contribution of occupational exposure factors to skin problems in the general working population of Norway.

Preventive Measures for Occupationally Induced Immediate Contact Reactions

By definition, work-related and occupational immediate contact reactions can be prevented by measures that eliminate or reduce occupational exposures. Thus, effective prevention starts at the legislation level, which creates a framework for not only the elimination, substitution, and reduction of skin urticariogens and allergens at the workplace, but also for the recognition of occupational skin diseases. In addition, preventive measures must contribute to maintain the natural protective function of the skin and to restore a damaged skin barrier when it is disrupted by occupational exposures. This chapter provides evidence-based standards for the prevention of work-related and occupational immediate contact reactions from the legislation level to everyday medical practice.

Self-testing for contact allergy to hair dyes – a 5-year follow-up multicentre study

In 2011, a multicentre study was conducted in order to determine how hair dye manufacturers instructed consumers to perform a self‐test prior to dyeing their hair, in order to identify individuals who are likely to react upon subsequent hair dyeing. A number of concerns were raised concerning the variability in instructions between products and producers, and the safety and validity of this tool.

Self-reported occupational skin exposure and risk of physiciancertified long-term sick leave: A prospective study of the general working population of Norway

Little is known about the contribution of occupational skin exposure as a risk factor for physician-certified long-term sick leave in the general working population of Norway. This study drew a cohort (n = 12,255; response at baseline 69.9%) randomly from the general population of Norway. Occupational skin exposure (in 2009) was measured based on 5 items. The outcome of interest was physician-certified long-term sick leave ≥ 16 days during 2010. Statistical adjustment for psychosocial and mechanical occupational exposures was performed. Long-term sick leave was predicted by occupational skin exposure to cleaning products (odds ratio (OR) 1.7; 95% confidence interval (95% CI) 1.1-2.5) and waste (OR 2.1; 95% CI 1.1-3.7) among men, and occupational skin exposure to water (OR 1.3; 95% CI 1.0-1.6) among women. The estimated population attributable risk for occupational skin exposure was 14.5%, which emphasizes its contribution as an important risk factor for long-term sick leave.

1618e Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in europe – position paper of the cost action standerm (td 1206)

Introduction Skin diseases constitute up to 40% of all notified occupational diseases in most European countries, predominantly comprising contact dermatitis, contact urticaria, and skin cancer. While insufficient prevention of work-related skin diseases (WRSD) is a top-priority problem in Europe, common standards for prevention of these conditions are lacking. Objective To develop common European standards on prevention and management of WRSD and occupational skin diseases (OSD). Method Consensus amongst ca. 100 experts within occupational dermatology was achieved with regard to the definition of minimum evidence-based standards on prevention and management of WRSD/OSD (Delphi Technique). Results By definition, WRSDs/OSDs are (partially or fully) caused by occupational exposure. The definition of OSD sensu stricto additionally includes diverging national legal requirements, with an impact on registration, prevention, management, and compensation. With the implementation of the classification of WRSD/OSD in the International Classification of Diseases (ICD) 11th Revision in future, a valid surveillance and comparability across countries will be possible. Currently, WRDS and OSD are still under-reported. Depending on legislation and regulations, huge differences exist in notification procedures in Europe, although notification is crucial to prevent chronic and relapsing disease. Facilities for early diagnosis, essential for individual patient management, should be based on existing guidelines and include a multidisciplinary approach. Patch testing is essential if contact dermatitis persists or relapses. Workplace exposure assessment of WRSD/OSD requires full labelling of product ingredients on material safety data sheets helping to identify allergens, irritants and skin carcinogens. Comparable standards in primary, secondary and tertiary prevention must be established in Europe to reduce the burden of WRSD/OSD in Europe. Conclusion The adoption of common European standards on prevention of WRSD/OSD will contribute to reduce the incidence of OSD and their socio-economic burden. Reference 1. JEADV2017;31(Suppl 4):1–13.

844 Occupation and relative risk of cutaneous melanoma: a 45-year follow-up study of 15 million people in five nordic countries

Background The age-adjusted incidence of cutaneous melanoma (CM) in the Nordic countries has increased during the last 60 years. In Europe, the legislation of five out of 11 surveyed countries acknowledges CM as an occupational disease (Ulrich, et al, 2016). To our knowledge, population-based studies with a prospective design have not yet described the variation in the relative risk of CM among different occupational categories. Aim 1. To describe the variation in the relative risk of CM according to occupational categories with outdoor, mixed, and indoor work, as well as socioeconomic status (SES). 2. To evaluate trends across periods. Methods Historical prospective cohort study based on record linkages between census data for 15 million people and cancer registry data from 1961 to 2005 (Nordic Occupational Cancer Project, http://astra.cancer.fi/NOCCA). Standardised incidence ratios (SIR) were estimated for 53 occupational categories classified according to indoor, outdoor and mixed work and socioeconomic status. Results During follow-up of 385 million person-years, there were 83 898 incident cases of CM. Statistically significant SIRs of CM were found among occupational categories with indoor work for male workers (1.09) and the highest socio-economic status for men (1.36) and women (1.31). Occupational categories with outdoor work for both men (0.79) and women (0.92), and the lowest socio-economic status showed lowest SIRs for both sexes (men: 0.69, women: 0.97). The SIR pattern was similar in all periods for occupational categories with outdoor, mixed and indoor work. Findings were consistent between the different Nordic countries. Conclusion This historical prospective cohort study provides evidence of an increased relative risk of CM amongst occupational categories with indoor work for men, and highest SES for both sexes.

1200 Prevalence and risk factors for hand eczema among norwegian specialist nurses: a cross-sectional study

Background Hand eczema (HE), the most frequent work-related skin disease, is common among health workers, but knowledge about its occurrence in Norwegian specialist nurses is scarce. We aimed to investigate the prevalence of hand eczema and identify occupational and non-occupational risk factors among specialist nurses working at the Oslo University Hospital. Methods A cross-sectional survey of 115 specialist nurses (surgical and anestesics) was performed by using an adapted version of the Nordic Occupational Skin Questionnaire (NOSQ 2002-Norwegian), which includes standardised questions for HE, occupational and non-occupational exposures. Analyses comprised descriptive statistics and logistic regression (STATA 14). Results The participation frequency was 99.1%. Nearly three-quarters of the participants reported skin symptoms during the last 12 months. The lifetime prevalence, one-year prevalence and point prevalence of HE was 27.19%, 17.54%, and 11.40%; the prevalence of work-related HE was 14.9%. Although HE was more common in women, we did not find an association between sex and HE. Age, childhood eczema, and amount of years working as a specialist nurse were consistent predictors for work-related HE. Time spent using protective gloves did not predict work-related HE, but self-reported skin symptoms when using protective gloves was a consistent predictor. The most common aggravating factors at work comprised hand cleaning and disinfection, water and winter season. Domestic exposures (food preparation, cleaning/washing, care for children under 4 years, contact with animals) did not predict either HE or work-related HE. Conclusion The one-year prevalence for HE was almost twice, and for work-related HE was nearly thrice than in the general population. The occurrence of work-related HE was associated with older age, childhood eczema, amount of years working as specialist nurse, and skin symptoms when wearing protective gloves. A potential healthy worker survivor effect may underestimate the prevalence figures and associations reported here. Prevention strategies focusing on skin care and protection should be developed for specialist nurses.

Occupational Relevance of Contact Urticaria Syndrome

Immediate contact reactions, such as contact urticaria and protein contact dermatitis, may have many causes. Nevertheless, the contribution of occupational exposures as a causative or worsening factor is often overseen. What starts as a seemingly innocuous self-limiting pruritic wheal and flare skin reaction in relation to exposures at work can develop to a life-threating systemic reaction, with negative consequences on work, income, self-image, gastronomical enjoyment, hobbies, and life quality. Work-related and occupational skin immediate contact reactions may be greatly underdiagnosed, undertreated, and underreported. As these skin conditions are highly preventable by reduction or elimination of exposures at work, knowledge of risk factors, risk professions, and prognosis is essential for effective management from prevention, diagnosis, assessment of occupational relevance to treatment, and rehabilitation.

Basic Epidemiology Concepts Relevant in Contact Urticaria

Epidemiology is concerned with public health and prevention. Immediate-contact reactions such as contact urticaria are common in general medicine, dermatology, and occupational medicine. Although accurate epidemiological data on contact urticaria are scarce, the Global Burden of Disease Project 2016 shows that urticaria is among the ten leading skin and subcutaneous diseases with highest prevalence, incidence, and morbidity measured by terms of years lived with disability and disability-adjusted life-years.