Effectiveness of secondary prevention in metalworkers with work‐related skin diseases and comparison with participants of a tertiary prevention program: A prospective cohort study

Abstract

Background: In Germany, a multistep approach has been established to prevent work-related skin diseases (WRSDs). Objectives: To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with those of participants of a tertiary individual prevention program (TIP). Patients and Methods: In a prospective cohort study, metalworkers with WRSD of the hands participating either in the SIP (n = 114) or in the TIP (n = 83) were recruited. At baseline and at the respective follow-up 8-12 weeks after the SIP or at dismissal from the TIP (3-4 weeks later), questionnaires were completed and the severity of WRSD was assessed. Saliva samples were collected for assessment of filaggrin (FLG) mutations and an explorative genome-wide association study (GWAS). Results: Ninety-three SIP patients (81.6%) attended the follow-up. Disease severity was significantly reduced, and knowledge and protective behavior were significantly improved compared to baseline. Significant differences between SIP and TIP patients were found regarding duration and severity of symptoms, work absenteeism, tobacco smoking, and presence of atopic dermatitis, but not regarding FLG mutations and by GWAS. Conclusions: The SIP was effective in metalworkers with WRSDs. Individual factors may influence the course of the disease and the need for the TIP.

Evaluation of the secondary and tertiary prevention strategies against occupational contact dermatitis in Germany: A systematic review

“…An overview of the prevalence and severity of hand dermatitis in the seven included studies is presented in Table 2. 8,14,[16][17][18][19]21 In three cohorts of cleaners, kitchen workers and healthcare personnel with OSDs or exclusively occupational hand dermatitis, there was a nonsignificant decrease in the prevalence of hand dermatitis 1 year after the SIP, compared with baseline. [17][18][19] In the cohort with occupational hand dermatitis who were still employed after 5 years, there was a significant reduction in the self-reported prevalence (83.7%-58.1%; P = .007) and severity (moderate/severe: 39.5%-16.3%; P = .002) of hand dermatitis.…”

“…Three SIP studies reported on disease-specific knowledge. 8,22,23 In 105 patients with mild to moderate OSDs, a considerable increase in disease-specific knowledge was noted immediately after the skin protection seminar (an increase in the mean Occupational Skin Diseases Knowledge Questionnaire [OSD-KQ] score from 38.5 to 55.6; P < .001), and this knowledge increase was still significant after 3 months. 22 Interestingly, preinterventional knowledge scores were greater in health-related occupations, compared with non-healthrelated occupations (eg, metal workers, electricians, carpenters, cleaners, and kitchen employees).…”

“…All five studies that presented data on hand washing frequencies reported short-or long-term reductions after the SIP. 8,[16][17][18][19] In a 1-year follow-up study of 206 healthcare workers with OSDs, the proportion of workers reporting daily hand washing frequencies of 11 to 20 or more than 20 times decreased significantly (P < .001). 18 After 6 years, the mean daily hand washing frequency among geriatric nurses was 5.5 vs. 10 (P = .0022) for those who had attended the SIP (IG) and those who only received treatment from a local dermatologist (CG), respectively.…”

“…An increase in attention to skin care after the SIP was observed by some studies, 17,18,20 but not by others. 8,19 After 1 year, 81.5% of 212 cleaning and kitchen personnel with OSDs and 35% of 253 healthcare workers with OSDs reported an increase in their attention to skin care. 17,18 Regarding the use of skin care products, no short-term changes were observed in 114 metal workers with OSDs, and no long-term changes were observed in 134 cleaners, kitchen, and healthcare workers with occupational hand dermatitis.…”

“…The SIP tries to improve disease management and individual skin protection strategies at an early phase, to encourage remission and prevent worsening and long-term persistence of the disease. 8 The SIP was initially established for hairdressers and healthcare workers, then extended for cleaning and kitchen employees, and in 2007 metal workers were also included. Today, the seminars may be occupation specific or may target participants from different occupational backgrounds.…”