Atopic dermatitis Langan, Sinéad M; Irvine, Alan D; Weidinger, Stephan
The Lancet (British edition),
08/2020, Letnik:
396, Številka:
10247
Journal Article
Recenzirano
Atopic dermatitis is a common inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. The disorder affects people of all ages and ethnicities, has a substantial ...psychosocial impact on patients and relatives, and is the leading cause of the global burden from skin disease. Atopic dermatitis is associated with increased risk of multiple comorbidities, including food allergy, asthma, allergic rhinitis, and mental health disorders. The pathophysiology is complex and involves a strong genetic predisposition, epidermal dysfunction, and T-cell driven inflammation. Although type-2 mechanisms are dominant, there is increasing evidence that the disorder involves multiple immune pathways. Currently, there is no cure, but increasing numbers of innovative and targeted therapies hold promise for achieving disease control, including in patients with recalcitrant disease. We summarise and discuss advances in our understanding of the disease and their implications for prevention, management, and future research.
Background
Massage therapists are particularly exposed to constituents of massage preparations, wet work and mechanical strain and therefore, at high risk to develop occupational dermatitis (OD).
...Objectives
To describe the sensitization spectrum of massage therapists with OD.
Patients and Methods
In a retrospective study, patch test data of patients with OD (128 massage therapists and 24 374 patients working in other professions) collected by the Network of Departments of Dermatology (IVDK, 2008–2020) were analysed.
Results
Hand dermatitis (91.4%) and allergic contact dermatitis (34.4%) were common in massage therapists with OD. Most frequent were sensitizations to fragrances/essential oils which were found in 54 (42.2%) massage therapists and thus, more often than in other patients with OD. Concomitant positivity to several fragrances/essential oils was frequent. In 8 (14.8%) of the 54 massage therapists, sensitizations to fragrances/essential oils were not detected with the baseline series, but only with special fragrance series.
Conclusions
Allergic contact dermatitis is common in massage therapists with OD and is mainly caused by fragrances and essential oils. Hence, massage therapists should be aware of this risk. When OD is suspected, not only the baseline series, but also special fragrance series should be patch tested in this occupational group.
Hand dermatitis (91.4%) and allergic contact dermatitis (34.4%) were common in massage therapists with occupational dermatitis. Most frequent were sensitizations to fragrances/essential oils which were found in 54 (42.2%) of massage therapists and thus, more often than in other patients with occupational dermatitis.
In eight (14.8%) of the massage therapists, sensitizations to fragrances/essential oils were not detected with the baseline series, but only with special fragrance series.
Massage therapists should be made aware of the sensitization risk of fragranced massage preparations. When OD is suspected, a broad spectrum of fragrances/essential oils beyond the baseline series and patients' own products should be tested.
Allergic contact dermatitis is a common diagnosis resulting from exposure to a chemical or chemicals in a patient's personal care products, home, or work environment. Once patch testing has been ...performed, the education and management process begins. After the causative allergens have been identified, patient education is critical to the proper treatment and management of the patient. This must occur if the dermatitis is to resolve. Detailed education is imperative, and several resources are highlighted. Photoallergic contact dermatitis and occupational contact dermatitis are other considerations a clinician must keep in mind.
Background
Skin diseases are among the most common occupational diseases, but detailed analyses on their epidemiology, diagnoses, and causes are relatively scarce.
Objectives
To analyze data on skin ...disease in the Finnish Register of Occupational Diseases (FROD) for (1) different diagnoses and (2) main causes of allergic contact dermatitis (ACD).
Methods
We retrieved data on recognized cases with occupational skin disease (OSD) in the FROD from a 12‐year‐period 2005–2016 and used national official labor force data of the year 2012.
Results
We analyzed a total of 5265 cases, of which 42% had irritant contact dermatitis (ICD), 35% ACD, 11% contact urticaria/protein contact dermatitis (CU/PCD), and 9% skin infections. The incidence rate of OSD in the total labor force was 18.8 cases/100 000 person years. Skin infections concerned mainly scabies in health care personnel. Twenty‐nine per cent of the ACD cases were caused by plastics/resins‐related allergens, mainly epoxy chemicals. Other important causes for ACD were rubber, preservatives, metals, acrylates, and hairdressing chemicals. Cases of occupational ACD due to isothiazolinones reached a peak in 2014.
Conclusion
Our analysis confirms that epoxy products are gaining importance as causes of OSD and the isothiazolinone contact allergy epidemic has started to wane.
In the Finnish Register of Occupational Diseases (FROD), there were 5265 recognized cases of occupational skin disease (OSD) in 2005–2016. Incidence rate was 18.8 cases/100 000 person years.
Forty‐two per cent had irritant contact dermatitis (ICD), 35% had allergic contact dermatitis (ACD), 11% had contact urticaria/protein contact dermatitis (CU/PCD), and 9% had skin infections.
ACD cases were caused mainly by plastics/resins‐related allergens, rubber, preservatives, metals, acrylates, and hairdressing chemicals. Epoxy products are gaining importance as causes of OSD.
Patients with atopic dermatitis (AD) have increased penetration of allergens, immune dysregulation (including shared cytokine pathways), and frequent use of emollients and topical medications, all of ...which may predispose toward developing allergic contact dermatitis (ACD). Recent systematic reviews have suggested that ACD is a significant clinical problem in both children and adults with AD. While this remains controversial, ACD remains an important comorbidity and potential exacerbant of AD in clinical practice. Common relevant allergens, include lanolin, neomycin, formaldehyde, sesquiterpene lactone mix, compositae mix, and fragrances that are commonly found in AD patients' personal care products. We herein review the clinical scenarios where patch testing is indicated in AD. In addition, we review the contraindications, preferred patch-testing series, pitfalls, and challenges determining the relevance of positive patch-test reactions in AD patients.
Pathophysiologie der atopischen Dermatitis Grobe, William; Bieber, Thomas; Novak, Natalija
Journal der Deutschen Dermatologischen Gesellschaft,
April 2019, 2019-04-00, 20190401, Letnik:
17, Številka:
4
Journal Article
Recenzirano
Zusammenfassung
Wenige Erkrankungen wurden in den letzten Jahren so intensiv und vielfältig auf verschiedenen Ebenen erforscht wie die atopische Dermatitis (AD). Das liegt zum einen daran, dass es ...sich um die häufigste chronisch‐entzündliche Hauterkrankung handelt, die bis zu 30 % der Kinder und 1–10 % der Erwachsenen betrifft. Zum anderen konnten zahlreiche komplexe Veränderungen auf genetischer Ebene sowie auf Ebene des angeborenen und erworbenen Immunsystems identifiziert werden, die für die Charakterisierung der Patienten und Entwicklung neuer diagnostischer und therapeutischer Ansätze wichtig sind. Trotz der komplexen Pathogenese und immunologischen Unterschiede in verschiedenen Krankheitsstadien, sowie der Heterogenität der Krankheitstrigger, war die Therapie der AD, vor allem der mittelschweren bis schweren Form, lange auf rein symptomatische bzw. unspezifische immunsuppressive Ansätze limitiert 1.
Mit Zulassung des ersten Biologikums zur Behandlung der mittelschweren und schweren AD bei Erwachsenen und dessen Verfügbarkeit auf dem deutschen Markt seit Ende 2017, ist nun Bewegung in das Feld gekommen. In dieser Arbeit werden die aktuellen pathophysiologischen Erkenntnisse zur AD zusammengefasst. Durch die Fortschritte bei der Erforschung der Erkrankung wird eine verbesserte Charakterisierung von Patientensubgruppen und verschiedenen Krankheitsausprägungen möglich, was die Grundlage zukünftig zunehmend individuellerer Behandlungsmöglichkeiten darstellen wird.
Background
Studies on the causes and consequences of occupational contact dermatitis (OCD) among young workers are non‐existent.
Objectives
Determine causes and consequences of OCD among workers ...younger than 35 years of age.
Methods
A questionnaire was sent to 6251 workers younger than 35 years at notification with recognized OCD (response rate 47%).
Results
The most prevalent occupations were health care workers, kitchen workers, nursery teachers, and hairdressers and beauticians. Seventy‐six percent still had eczema, and 77% of these had eczema half to all the time over the last 3 months, with 61% evaluating their eczema as moderate to very severe. Fifty‐three percent had changed their occupation since notification, and 42.5% had lost their job because of OCD. Allergic OCD increased the odds ratio (OR) for facial or foot eczema, job loss, change in work tasks, difficulties finding work, decrease in income, and sick leave. Age at notification of 25 years of age or younger increased the risk of job loss and feeling restricted in choice of job. Workers in the food industry had a higher OR for job loss, whereas hairdressers and beauticians had a higher risk of job loss and a decrease in income.
Conclusions
The severe, long‐term consequences of OCD notification signify the need for further preventive strategies among young workers.
In young persons who were 35 years of age or younger at notification of occupational hand eczema (OCD), most had current eczema problems a median of 6 years later.
Many had to change occupation or had lost their job because of the recognized OCD. If 25 years of age or younger, the consequences for their job situation were worse.
OCD caused moderate to severe negative effects on life quality: emotions, feelings, and symptoms.
Hand eczema in Danish adolescents—Beyond atopic dermatitis Simonsen, Anne Birgitte; Dietz, Jojo Biel‐Nielsen; Johansen, Jeanne Duus
Contact dermatitis,
January 2024, 2024-Jan, 2024-01-00, 20240101, Letnik:
90, Številka:
1
Journal Article
Recenzirano
Background
Hand eczema (HE) is a common inflammatory skin disease that may have serious consequences. The age of HE onset varies, but is estimated to be early‐ to mid‐20s. However, very little is ...known about HE in childhood and adolescence.
Objective
We aimed to explore the epidemiology, aetiology and severity of HE among a random sample of Danish adolescents drawn from the general population.
Methods
The study was designed as a self‐administered questionnaire study. An electronic questionnaire was sent to a random sample of 13 000 individuals aged 15–19 years.
Results
The point‐prevalence, 1‐year prevalence and life‐time prevalence of HE among Danish adolescents was 4.9%, 12.1% and 18.3%, respectively. Among patients with a history of HE, 64.6% of cases were not associated with atopic dermatitis. Of all respondents, 60.2% were either part‐time or full‐time employed. Among respondents with current HE, 38.2% believed that the occupational exposures either caused or exacerbated the HE.
Conclusion
We found a high prevalence of HE among Danish adolescents which raises concern. Knowing the potential consequences that HE may have, attention should be paid to the prevention of HE in adolescence, especially on occupational aspects and prevention of skin disease in young workers.
We found a high prevalence of hand eczema (HE) among Danish adolescents which raises concern as it reflects a significant clinical problem. Among patients with a history of HE, 64.6% of cases were not associated with atopic dermatitis. Occupational exposure may be an important factor.
Background
During the COVID‐19 pandemic, the use of face masks has increased among healthcare workers (HCWs). Questionnaire studies have shown a high frequency of self‐reported facial adverse skin ...reactions. Case reports have been published on face mask‐induced allergic contact dermatitis and urticaria.
Objectives
To describe the results of the contact allergy investigations in consecutive HCWs investigated for skin reactions to face masks during the COVID‐19 pandemic and the results of the chemical investigations of face masks supplied by the hospital.
Methods
Participants were patch tested with baseline series and chemicals previously reported in face masks not included in the baseline series. Face mask(s) brought by the HCW were tested as is and/or in acetone extract. Chemical analyses were performed on nine different face masks for potential allergens.
Results
Fifty‐eight HCWs were investigated. No contact allergies were found to the face mask(s) tested. Eczema was the most common type of skin reaction, followed by an acneiform reaction. Colophonium‐related substances were found in one respirator and 2,6‐di‐t‐butyl‐4‐methylphenol (BHT) were found in two respirators.
Conclusion
Based on this report, contact allergies to face masks is uncommon. Patch test with colophonium‐related substances and BHT should be considered when investigating adverse skin reactions to face masks.
Questionnaire studies have shown a high frequency of self‐reported facial adverse skin reactions among healthcare workers during the COVID‐pandemic. Case reports have been published on face mask‐induced allergic contact dermatitis.
In this retrospective study, we describe the data of 58 HCWs with skin reactions to face masks investigated at our department. We also performed chemical analyses on nine different face masks for potential allergens.
No contact allergies were found to the face mask(s) used. In the chemical analyses, colophonium‐related substances were found in one respirator and 2,6‐di‐t‐butyl‐4‐methylphenol were found in two respirators. These allergens have to our knowledge not previously been described in face masks.
PDF
