Thomas Baumeister

Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year

Background  We recently found a very low adherence to a generally recommended skin protection regimen in a sample of 1355 metalworkers.

IL-4 supports the generation of a dendritic cell subset from murine bone marrow with altered endocytosis capacity

Dendritic cells (DC) of myeloid origin can be generated from mouse bone marrow (BM) using granulocyte macrophage‐colony stimulating factor (GM‐CSF). Immature major histocompatibility complex (MHC) IIlow DC are known to bear a high endocytosis capacity, in contrast to DC precursors and mature DC. Now we found that a subset of MHC IIlow DC in BM‐DC cultures is unable to exert mannose receptor‐mediated endocytosis of fluorescein isothiocyanate (FITC)‐dextran (DX) and resembles immature Langerhans cells (LC). The FITC‐DX endocytosis activity of LC‐like cells occurs at an earlier stage of development, where the surface MHC II expression is absent or very weak. This LC‐like subset expresses higher levels of E‐cadherin but lower amounts of the markers Gr‐1, scavenger receptor 2F8, and CD11b, when compared with the highly endocytic DC subset. The latter myeloid DC resemble monocyte‐derived DC (MoDC). The sorted LC‐like population develops completely and exclusively into mature MHC IIhigh DC, and the MoDC‐like cells remain immature MHC IIlow DC or develop into adherent MHC IIneg macrophages or mature into MHC IIhigh DC. The development of LC‐like cells is promoted by interleukin‐4. Thus, we show here that the simultaneous development of LC‐like and MoDC‐like DC subsets occurs in standard bulk cultures with GM‐CSF, suggesting the existence of two different precursors for LC and MoDC in BM.

Cutting Edge: Resistance to Apoptosis and Continuous Proliferation of Dendritic Cells Deficient for TNF Receptor-1

The individual roles of the two TNFRs on dendritic cells (DC) are poorly understood. Investigating bone marrow-derived DC from TNFR-deficient mice, we found that cultures from TNFR1−/− mice continue to form proliferating clusters for 6–9 mo. In contrast, DC derived from wild-type, TNFR2−/−, or TNFR1/2−/− mice survived for only 3–4 wk. DC obtained from these TNFR1−/− long term cultures (LTC) mice show an unusual mixed immature/mature phenotype. The continuous proliferation of the LTC is GM-CSF dependent and correlates with decreased protein levels of the cyclin-dependent kinase inhibitors p27KIP1 and p21CIP1. Prolonged survival of TNFR1−/− DC appears to be independent from NF-κB and Bcl-2 pathways and is rather enabled by the down-regulation of CD95, resulting in the resistance to CD95 ligand-induced apoptosis. These data point to proapoptotic signals mediated via TNFR1 and antiapoptotic signals mediated via TNFR2 in DC.

Current acceptance and implementation of preventive strategies for occupational hand eczema in 1355 metalworkers in Germany

Summary Background The effectiveness of a skin care programme is based mainly on the effectiveness of the products used and the frequency and diligence of the application of skin care products.

An overview of skin scores used for quantifying hand eczema: a critical update according to the criteria of evidence-based medicine

The present review gives an overview of the enormous variety of skin scores used for assessing severity in patients suffering from hand eczema. In order to evaluate the validity and practical relevance of different scoring systems according to the criteria of evidence‐based medicine, in May 2009 we performed a systematic search of the literature using PubMed and the Cochrane Library. A total of 69 articles reporting on 45 different methods for quantifying hand eczema were identified. The panel of methods varied from pure subjective categories to more or less quantitative scoring systems. Furthermore, by focusing on skin scores used in clinical trials in which the results led to the licensing of a systemic or topical drug for treatment of hand eczema, a panel of different scoring systems was identified. In addition to morphological pattern, some scoring systems included subjective complaints, which might cause an individual bias by overestimation of self‐reports. Inter‐ and intraobserver reliability was rarely reported except for three scores. Among these validated scores interobserver reliability was reported for three scores, but only one of the three included reliability within observers (repeatability). Advantages and disadvantages of the different scoring systems are critically discussed. Depending on different indications and particular settings (e.g. occupational screening vs. clinical examinations, evaluating progress of treatment in everyday clinical practice or for research purposes) scoring systems have to fulfil diverging demands. We draw the conclusion that a standardized diagnostic procedure for assessing the severity of hand eczema would facilitate the comparability of outcome of clinical trials. However, scoring systems used for occupational screening have to fulfil different demands compared with scoring systems used for licensing of drugs. This striking difference might be explained by the skin condition, which is generally supposed to be much better in subjects at medical check‐ups at the workplace.

How to quantify skin impairment in primary and secondary prevention? HEROS: a proposal of a hand eczema score for occupational screenings

Background  Skin scoring systems have to meet specific demands depending on their particular settings and indications, e.g. occupational screenings vs. clinical examinations, evaluating progress of treatment or supervision of preventive strategies. Until now, most scoring systems have been developed for severe cases of hand eczema. A validated quantitative scoring system for early hand eczema is still missing.

Non-invasive bioengineering methods in an intervention study in 1020 male metal workers: results and implications for occupational dermatology

Background: Measurements of transepidermal water loss (TEWL) as an indicator of skin barrier function and colorimetry for quantifying erythema have been recommended for monitoring persons at risk of occupational hand dermatitis.

Prevention of work-related skin diseases: teledermatology as an alternative approach in occupational screenings

Background: Prevention of occupational skin diseases is of high socio‐economic impact. Implementing teledermatology into preventive occupational screenings holds obvious advantages; nevertheless, studies concerning this subject are scarce.

Spoilt for choice – evaluation of two different scoring systems for early hand eczema in teledermatological examinations

Background: Besides improving working conditions and using personal protective equipment, early detection is most important in managing work‐related hand eczema. Implementing regular teledermatological skin screenings could be helpful, but none of the published hand eczema‐scores has hitherto been used in teledermatology.

Teledermatology-A Hitherto Underestimated Tool in Occupational Medicine-Indications and Limitations

Received Feb 27, 2007; Accepted Aug 22, 2007 Correspondence to: T. Baumeister, Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, University of Erlangen-Nuremberg, Schillerstr. 25 + 29, D91054 Erlangen, Germany (e-mail: Thomas.Baumeister@ipasum.imed.unierlangen.de) Teledermatology—A Hitherto Underestimated Tool in Occupational Medicine—Indications and Limitations