Hand eczema in metalworker trainees – an analysis of risk factors

Abstract

The present study, as part of PROMETES (Swiss Prospective Metal Worker Eczema Study), was performed to examine risk factors for the development of occupational hand dermatitis in metal-worker trainees. Since this disease is very common, a high standard of preventive measures is necessary, especially for persons with an endogenous disposition for the development of eczema, e.g., atopics. Within the cohort of 201 healthy young men, 47 (23%) showed at least mild signs of hand eczema at 1 point of the 2.5 year observation period. Various occupational and domestic exposures, skin protection behaviour, regeneration time, and smoking habits, as well as atopic disposition, were studied with regard to their influence on the skin condition of the metalworker trainees. By multivariate analysis, we determined 3 important risk factors for the development of hand eczema in the cohort. (i) We showed once more the important influence of an atopic disposition as a major risk factor for occupational contact dermatitis. (ii) Furthermore, the results suggest that, apart from chemical irritants, mechanical factors should not be underestimated in their role as irritants to the epidermal barrier. (iii) Additionally, an insufficient amount of skin recovery time seems to support a cumulative sub-irritant effect on the skin, which may lead to irritant contact dermatitis.

Tobacco smoking and hand eczema – is there an association?

“…Three studies found a statistically significant positive association between tobacco smoking and HE with respect to prevalence (27)(28)(29), and one found no clear association, but a slightly increased risk of HE in heavy smokers in one subgroup, along with a potential protective association in another subgroup (30). Three studies found no association between tobacco smoking and HE prevalence (31)(32)(33), but, in one of these, smoking was linked to severe eczema (32), and in another non-smoking was linked to more severe eczema (33). For information regarding adjustment for risk factors in each of the articles, see Table 1.…”

“…Berndt et al (31) performed a prospective cohort study including 201 male metalworking trainees, followed for 2.5 years from the beginning of their apprenticeship. During the observation period, 47 (23%) of the young men developed at least an early stage of HE.…”

“…One study (30) showed conflicting data: no significant association was found between smoking and the 1-year prevalence of HE in the total group, but, in one subgroup (hairdressers), heavy smoking was a risk factor for HE, whereas analysis of another subgroup (bakers) showed a protective effect of smoking. Among the studies in which no association between HE and smoking was found, data on the relationship were not presented in one article (31). Four studies examined the relationship between HE severity and smoking (Table 3).…”

Individual Susceptibility to Occupational Contact Dermatitis

“…Higher risk (1.5-fold) for OCD associated with respiratory atopy was also found in nurses 85) . However, the majority of studies have failed to find such associations 55,57,68,86,87) . Patients with respiratory atopy were found to have a similar barrier function and response to SLS induced irritation compared to healthy control subjects 88) .…”

“…However, in practice several differing, more or less circumscribed definitions are used, which seriously hamper the comparison of the many studies in this field. For the development of OCD, atopic skin diathesis indicated by previous or present AD is considered as an important predisposing factor [56][57][58][59][60][61][62][63] . To assess atopic skin diathesis (ASD), a prognostically useful diagnostic score based on the accompanied signs and symptoms of AD has been proposed by Diepgen 64,65) .…”