This thesis describes and discusses the results of a series of investigations into the occurence of skin diseases of the hands and forearms. The problem is approached from an occupational dermatological point ofview and focuses on contacteczema/dermatitis, which is the primary component of the spectrum of hand dermatoses and, except for trauma, also the most frequently reported work-related disease. ... Zie: Samenvattin

Coenraads, Pieter Jan

English

ARTS repository - University of Groningen

   University of GroningenPrevalence of hand eczemaCoenraads, Pieter JanIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:1983Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Coenraads, P. J. (1983). Prevalence of hand eczema. s.n.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 20-06-2022SummaryT h i s  t h e s i s  d e s c r i b e s  a n d  d i s c u s s e s  t h e  r e s u l t s  o f  a  s e r i e s  o f  i n v e s t i -ga t i ons  j n to  t he  occu r rence  o f  sk in  d j seases  o f  t he  hands  and  fo rea rms .The  p rob lem i s  app roached  f rom an  occupa t i ona l  de rma to log i ca l  po in to f  v i ew  and  focuses  on  con tac teczema/de rma t j t i s ,  wh i ch  i s  t he  p r imarycomponent  of  the spectrum of  hand dermatoses and,  except  for  t rauma'a l so  t he  mos t  f r equen t l y  repo r ted  work - re la ted  d i sease .The  f i r s t  chap te r  i nc ludes  a  d i scuss ion  o f  t he  two  ma io r  ca tego r i es  o fhand  de rma toses :  i r r j t an t  con tac t  de rma t i t i s  and  a l  l e rg i c  con tac t  eczema.A  number  o f  o the r  common  de rma toses ,  t he  c l i n i ca l  p i c tu re  o f  wh i chmay  m im ic  i r r i t an t  de rma t i t i s  o r  a l l e rg i c  eczema,  i s  cons ' i de red  fo rd i f f e ren t i a l  d i agnos t i c  pu rposes .  The  cou rse  and  p rognos i s  o f  eczemao f  t he  hands  i n  re la t i on  t o  occupa t i on  a re  d i scussed  by  us ing  da tao b t a i n e d  i n  e a r l i e r  i n v e s t i g a t i o n s  b y  t h e  a u t h o r .The  second  chap te r  p rov ides  some bas i c  i n fo rma t i on  on  the  ep idemio log i ca land  s ta t i s t i ca l  aspec ts  wh i ch  a re  o f  impo r tance  i n  t he  p lann ing  phaseo f  a  c ross -sec t i ona l  s tudy  o f  eczema in  se lec ted  popu la t i ons .  I npa r t i cu la r ,  p rob lems  conce rn ing  the  compar i son  o f  t he  p reva lence  o feczema in  t he  gene ra l  popu la t i ons  w i th  t ha t  i n  an  occupa t i ona l  g roup ,i . e . ,  c o n s t r u c t i o n  w o r k e r s ,  a r e  d j s c u s s e d .The types of  s tudies commonly used to determine the prevalence andinc idence  a re  b r i e f l y  rev iewed  and  the  l im i t a t i ons  o f  t he  p reva lence  asa  summary  measu re  i n  a  c ross -sec t i ona l  s tudy  des ign  a re  d i scussed .The  sens i t i v i t y  and  spec i f i c i t y  o f  t he  sc reen ing  me thods  fo r  t he  de tec -t i on  o f  hand  eczema re  i l l us t ra ted  w i th  examp les .  The  chap te r  a l sod e s c r i b e s  t h e  c a l c u l a t ' i o n  o f  t h e  d e s i r e d  s a m p l e  s i z e ,  i . e . ,  t h e  m i n i m u mnumber of  construct ion workers to be screened in order  to be able tode tec t  a  h ighe r  p reva lence  than  i n  t he  gene ra ï  popu la t i on .  The  ca l cu la -t ions are based on est imates of  the eczema prevalence in the generalpopu la t i on  ob ta ined  by  s tud ies  such  as  desc r i bed  i n  Chap te r  3 .  The  me thodo f  s a m p l i n g  i s  a l s o  o u t l i n e d .  I n  a d d i t i o n ,  i t  i s  p o i n t e d  o u t  t h a t  acase -con t ro l  s tudy  wou ld  i nc rease  the  e f f i c i ency  o f  t he  c ross -sec t i ona ls tudy  i n  a  popu la t i on  o f  cons t ruc t i on  wo rke rs .  Ma io r  sou rces  o f  b i asIt7t ha t  may  i n f l uence  the  s tudy  resu l t s  a re  rev iewed .C h a p t e r  3  c o n t a i n s  a n  a n a l y s j s  o f  t h e  r e s u l t s  o f  t w o  j n v e s t i g a t i o n sin to  t he  p reva lence  o f  sk in  d i so rde rs  o f  t he  hands  and  fo rea rms ;  t hea n a l y s i s  f o c u s e s  o n  e c z e m a ,  p a r t i c u l a r l y  a s  r e l a t e d  t o  o c c u p a t i o n  i nm a l e s .  T w o  s a m p l e s  e l e c t e d  f r o m  t h e  g e n e r a l  p o p u l a t i o n ' i n  a  r u r a land  an  u rban  a rea  cons i s t i ng  o f  a  t o ta l  o f  3140  adu l t s  we re  s tud ied .The  mos t  impor tan t  d iagnos t i c  ca tego ry  was  eczema:  t he  p reva lence  amongma les  was  4 .6% and  among  fema les  8%.  The re  was  a  d j f f e rence  i n  age -ad jus ted  p reva lence  be tween  the  two  a reas .A  fu r the r  ana l ys i s  \ ^ /as  made  o f  t he  p reva lence  among  ma les ,  who  cou ld  bec lass i f i ed  i n to  6  ma jo r  occupa t i ona l  g roups .  The  mean  ages  were  d i f f e ren t' i n  t h e  v a r i o u s  o c c u p a t i o n a l  g r o u p s .  A l s o  t h e  d i s t r i b u t i o n  o f  t h e  m a l e sove r  t he  occupa t i ona l  ca tego r i es  was  d j f f e ren t  i n  t he  two  a reas .  Toassess  the  re la t i ve  impor tance  o f  age ,  occupa t i on  and  a rea !  a  s tep -w iselog i s t i c  reg ress ion  o f  eczema p reva lence  was  pe r fo rmed  on  these  fac to rs .The  resu l t s  show a  s ign i f i can t  con t r i bu t i on  o f  t he  f ac to r  occupa t i on  t othe  p reva lence  o f  eczema in  t h i s  mode l .  The  fac to r  age  d id  no t  con t r i -b u t e  s j g n i f i c a n t l y  b e f o r e  a n d  a f t e r  c o r r e c t j o n  f o r  o c c u p a t i o n .  A l s o  t h econ t r i bu t i on  o f  t he  f ac to rs  a rea  o f  r es idence  and  the  i n te rac t ' i on  aqe -o c c u p a t i o n  w a s  n o t  s i g n i f i c a n t .Th ree  ma jo r  occupa t i ona l  g roups  i n  wh i ch  the  p reva lences  o f  hand  eczemal v a s  r e l a t i v e l y  h i g h  c o u l d  b e ' i d e n t i f i e d :  t h e  c h e m j c a l  i n d u s t r y  1 4 . 4 % ,the  me ta l  i ndus t r y  10 .7% and  the  cons t ruc t j on  i ndus t r y  7 .1%.  More' i r r i t a n t  t h a n  a l l e r g i c  e c z e m a  w a s  f o u n d  i n  a l l  o f  t h e s e  c a t e g o r i e s .The  append i x  t o  t h i s  chap te r  desc r i bes  the  resu l t s  o f  a  reexamina t j ono f  one  o f  t he  samp les  a f t e r  3  yea rs .  The  sens i t i v i t y  and  spec i f i c i t yo f  t he  me thods  used  du r i ng  the  f i r s t  examina t i on  we re  ca l cu la ted .  Pa tchtes t i ng  cou ld  be  a r ranged  fo r  a l1  pe rsons  w i th  eczema.  The  resu l t s  o f  t hepa tch  tes t s  emphas i zed  the  p rom inen t  p lace  o f  i r r j t an t  de rma t i t i s  w i t h i nthe  spec t rum o f  hand  eczema.A  rev iew  o f  t he  l i t e ra tu re  pub l i shed  up  to  now w i th  respec t  t o  de rma to lo -g i c a l  s t u d i e s  i n  t h e  c o n s t r u c t i o n  i n d u s t r y  i s  g i v e n  i n  C h a p t e r  4 .Th i s  rev iew  does  no t  dea l  spec i f i ca l l y  w i t h  cemen t  eczema in  assoc ia t i on1 1 8IÈF>w i t h  c h r o m a t e  a n d  c o b a l t  a l l e r g y ,  b u t  c o n s ' i d e r s  t h e  a v a i l a b l e  e p i d e m i o -l o g i c a l  d a t a  o n  s k i n  d i s e a s e s  o b t a i n e d  b y  e x a m i n i n g  p o p u l a t i o n s  o fcons t ruc t i on  wo rke rs .  Such  i n fo rma t i on  i s  l im i t ed ,  s i nce  mos t  o f  t heava i l ab le  da ta  a re  based  on  ou t -pa t i en t  r eco rds  and /o r  i nsu rance  f i l es .Fo r  t he  Ne the r l ands ,  da ta  a re  p rov ided  by  t he 'Economjc  I ns t j t u te  f o rt he  Cons t ruc t i on  I ndus t r y  Sec to r '  (E IB ) ,  wh i ch  a re  based  on  the i rpe rmanen t  samp le  o f  cons t ruc t i on  wo rke rs .  These  da ta  p robab i y  unde r -es t ima te  t he  t rue  morb id i t y  due  to  sk jn  d i seases  i n  t h i s  wo rk fo rce .The  da ta  revea l  t ha t  many  work ing  days  a re  l os t ,  w j t h  impor tan t  f i nanc ia lconsequences .  Howeve r ,  i t  has  a l so  been  no ted  tha t ,  desp i t e  ex tens i vede rma to log i ca l  p rob lems ,  wo rke rs  some t imes  t r y  t o  con t i nue  the i r  wo rkw ' i t h o u t  e v e n  c o n s u l t i n g  a  p h y s i c i a n .A  b r i e f  r ev iew  o f  t he  two  ava i l ab le  repo r t s  on  sys tema t i c  i nves t i ga t i onson  bu i l d i ng  s i t es  wh i ch  we re  pe r fo rmed  by  l ^ l ah lbe rg  (1969 )  and  by  Hdvd r ' ng( 1 9 7 0 )  i s  g i v e n .  I t  i s  c o n c l u d e d  t h a t  f u r t h e r  j n v e s t i g a t i o n s  b y  t r a i n e dde rma to log i s t s  and  expe r i enced  occupa t i ona l  phys i c i ans  w i l l  be  necessa ryto  de tec t  and  s tudy  ea r l y  cases  o f  occupa t i ona l l y  i nduced  de rma toses ,thus  p rov id ing  a  more  comp le te  p i c tu re  o f  t he  rea l  med jca l  and  soc ia limpor tance  o f  occupa t i ona l  de rma toses  i n  t h i s  b ranch  o f  i ndus t r y .The resul ts  of  the examinat ion of  the hands and fore,arms of  about  1700cons t ruc t i on  wo rke rs  a re  ana l yzed  i n  Chap te r  f i ve .  These  pe rsons  were  a l lemp loyees  o f  a  samp le  o f  cons t ruc t i on  compan ies  l oca ted  j n  t he  no r the rnpa r t  o f  t he  Ne the r l ands .  They  were  seen  a t  t he  wo rk  s i t es  i n  t he  sp r i ngand  ea r l y  summer  o f  1982 .  A  fo rm o f  eczema was  p resen t  j n  133  (7 .8%)worke rs ,  pso r i as i s  i n  22  ( I . 3%)  and  va r i ous  o the r  de rma toses  i n  30  (1 , . 8%) .I r r i t an t  de rma t i t i s  was  the  ma jo r  d iagnos t i c  ca tego ry  and  was  found  i n4%,  wh i l e  a l l e rg i c  con tac t  eczema was  p resen t  i n  1 .4%.  ï he  p reva lenceo f  eczema in  d i f f e ren t  j ob  ca tego r i es  va r i ed  be tween  5 ,9% in  t echn i c i ansa n d  1 2 , 6 %  i n  b r i c k l a y e r s  a n d  p l a s t e r e r s .From the persons wi thout  eczema, a controï  group of  about  300 workerswas  se lec ted  and  sub jec ted  to  pa tch  tes t i ng  and  h i s to ry  t ak ing  j n  t hesame manner as were the cases wi th eczema.A  h i s to ry  o f  a topy  was  more  p reva len t  i n  pe rsons  w i th  i r r i t an t  de rma t i t j s(24%)  as  compared  w i th  o the r  f o rms  o f  eczema (15%)  and  con t ro l s  (11%) .D1 1 9Patch  tes t i ng  v ías  pe r fo rmed  w i th  d i ch roma te ,  coba l t ,  t h i u rammjx  andepoxy - res in .  Pos j t i ve  pa tch  tes t s  we re  found  i n  15% o f  t he  wo rke rs  w j t he c z e m a  n d  i n  5 . 5 %  o f  t h o s e  w i t h o u t  t h e  d i s e a s e .  I n  c a r p e n t e r s ,  t h e r ew ^ q  v ê r v  l i f f l p  d i f f e r e n c p  i n  t h p  n r o n n r t i o n  o f  n o s i t i v ê  r ê a c t o r s  t OY t  v Y v t  u , v i l  v ,  y v Jp a t c h  t e s t s  b e t w e e n  c a s e s  w i t h  e c z e m a  ( 6 . I % )  a n d  c o n t r o l s  ( 4 . 3 % ) .In  b r i ck laye rs  and  p las te re rs ,  howeve r ,  a  d i f ï e rence  t ^ tas  f ound :  t hep ropo r t i on  o f  pos i t i ve  pa tch  tes t s  be ing  24% and  7 .6%,  respec t i ve l y ,  i ncases  and  con t ro l s .  I n  o rde r  t o  de te rm ine  the  impor tance  o f  a  h i s to ry  o fexposu re  t o  pa in t  &  t a r ,  91ues ,  syn the t i c  res ins !  wood  impregnan tg ,g reases  and  so l ven ts ,  t he  odds - ra t i os  o f  exposu re  i n  cases  vs .  con t ro l swere  ana l yzed .  No  s ign i f i can t  assoc ia t j on  be tween  eczema nd  suchexposu re  cou ld  be  de tec ted  when  a l1  occupa t i ons  \ ^ /e re  comb ined ,  bu t ,  i nt h e  s t r a t u m  c o n t a i n i n g  t h e  c a r p e n t e r s ,  a  s t a t i s t i c a l  a s s o c i a t i o n  w a sfound between eczema and a h is tory of  f requent  exposure to wood impreg-n a n t s  ( 0 R  =  2 . 4 3 )  a n d  s o l v e n t s  ( 0 R  =  1 . 8 6 ) .  T h e  i r r i t a n t  n a t u r e  o ft hese  subs tances  unde r l i nes  t he  impor tance  o f  t he  ro le  o f  i r r i t an tde rma t i t i s  i n  t he  spec t rum o f  hand  de rma toses ,  a t  l eas t  i n  ca rpen te rs .O the r  i ob  s t ra ta  we re  too  sma l l  f o r  a  p rope r  ana l ys i s .  The  assoc ia t i onbe tween  eczema nd  exposu re  t o  wood impreqnan ts  and  sO lven ts  cou ldbe  con f i rmed  by  pe r fo rm ing  a  l og i t  r eg ress ion  ana l ys i s  i n  wh i ch  o the rfac to rs  cou ld  be  s imu l taneous l y  examined .  Seve ra l  t ypes  o f  b i as  t ha tmay  have  d i s to r ted  the  da ta  a re  b r j e f l y  d i scussed  j n  t he  append i x  o ft h i s  c h a p t e r .C o n c l  u s iThe  ana  lt ha t  t hei  n  occupI  r r i  t an tdamage i' i  n  nonclI  n f l  uencaccoun t ;i  mpor ta rThe i  nvepl  ayed bworke rs .An  eva l  useve ra  Ih r r  f h a  lHowever ,a  s i g n i fof  woodpropert iCon tac tpopu l  a t  igene ra l  1Comb i  natA1  thoughi  t  o f fereczema hPenetratl a f o d  .Thi  s  woua1  I  e rgena1  thoughMoreoverr20

Prevalence of hand eczema:Association with occupational exposure, especially in construction workers

University of Groningen

   University of GroningenPrevalence of hand eczemaCoenraads, Pieter JanIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:1983Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Coenraads, P. J. (1983). Prevalence of hand eczema. Groningen: s.n.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 12-11-2019SummaryT h i s  t h e s i s  d e s c r i b e s  a n d  d i s c u s s e s  t h e  r e s u l t s  o f  a  s e r i e s  o f  i n v e s t i -ga t i ons  j n to  t he  occu r rence  o f  sk in  d j seases  o f  t he  hands  and  fo rea rms .The  p rob lem i s  app roached  f rom an  occupa t i ona l  de rma to log i ca l  po in to f  v i ew  and  focuses  on  con tac teczema/de rma t j t i s ,  wh i ch  i s  t he  p r imarycomponent  of  the spectrum of  hand dermatoses and,  except  for  t rauma'a l so  t he  mos t  f r equen t l y  repo r ted  work - re la ted  d i sease .The  f i r s t  chap te r  i nc ludes  a  d i scuss ion  o f  t he  two  ma io r  ca tego r i es  o fhand  de rma toses :  i r r j t an t  con tac t  de rma t i t i s  and  a l  l e rg i c  con tac t  eczema.A  number  o f  o the r  common  de rma toses ,  t he  c l i n i ca l  p i c tu re  o f  wh i chmay  m im ic  i r r i t an t  de rma t i t i s  o r  a l l e rg i c  eczema,  i s  cons ' i de red  fo rd i f f e ren t i a l  d i agnos t i c  pu rposes .  The  cou rse  and  p rognos i s  o f  eczemao f  t he  hands  i n  re la t i on  t o  occupa t i on  a re  d i scussed  by  us ing  da tao b t a i n e d  i n  e a r l i e r  i n v e s t i g a t i o n s  b y  t h e  a u t h o r .The  second  chap te r  p rov ides  some bas i c  i n fo rma t i on  on  the  ep idemio log i ca land  s ta t i s t i ca l  aspec ts  wh i ch  a re  o f  impo r tance  i n  t he  p lann ing  phaseo f  a  c ross -sec t i ona l  s tudy  o f  eczema in  se lec ted  popu la t i ons .  I npa r t i cu la r ,  p rob lems  conce rn ing  the  compar i son  o f  t he  p reva lence  o feczema in  t he  gene ra l  popu la t i ons  w i th  t ha t  i n  an  occupa t i ona l  g roup ,i . e . ,  c o n s t r u c t i o n  w o r k e r s ,  a r e  d j s c u s s e d .The types of  s tudies commonly used to determine the prevalence andinc idence  a re  b r i e f l y  rev iewed  and  the  l im i t a t i ons  o f  t he  p reva lence  asa  summary  measu re  i n  a  c ross -sec t i ona l  s tudy  des ign  a re  d i scussed .The  sens i t i v i t y  and  spec i f i c i t y  o f  t he  sc reen ing  me thods  fo r  t he  de tec -t i on  o f  hand  eczema re  i l l us t ra ted  w i th  examp les .  The  chap te r  a l sod e s c r i b e s  t h e  c a l c u l a t ' i o n  o f  t h e  d e s i r e d  s a m p l e  s i z e ,  i . e . ,  t h e  m i n i m u mnumber of  construct ion workers to be screened in order  to be able tode tec t  a  h ighe r  p reva lence  than  i n  t he  gene ra ï  popu la t i on .  The  ca l cu la -t ions are based on est imates of  the eczema prevalence in the generalpopu la t i on  ob ta ined  by  s tud ies  such  as  desc r i bed  i n  Chap te r  3 .  The  me thodo f  s a m p l i n g  i s  a l s o  o u t l i n e d .  I n  a d d i t i o n ,  i t  i s  p o i n t e d  o u t  t h a t  acase -con t ro l  s tudy  wou ld  i nc rease  the  e f f i c i ency  o f  t he  c ross -sec t i ona ls tudy  i n  a  popu la t i on  o f  cons t ruc t i on  wo rke rs .  Ma io r  sou rces  o f  b i asIt7t ha t  may  i n f l uence  the  s tudy  resu l t s  a re  rev iewed .C h a p t e r  3  c o n t a i n s  a n  a n a l y s j s  o f  t h e  r e s u l t s  o f  t w o  j n v e s t i g a t i o n sin to  t he  p reva lence  o f  sk in  d i so rde rs  o f  t he  hands  and  fo rea rms ;  t hea n a l y s i s  f o c u s e s  o n  e c z e m a ,  p a r t i c u l a r l y  a s  r e l a t e d  t o  o c c u p a t i o n  i nm a l e s .  T w o  s a m p l e s  e l e c t e d  f r o m  t h e  g e n e r a l  p o p u l a t i o n ' i n  a  r u r a land  an  u rban  a rea  cons i s t i ng  o f  a  t o ta l  o f  3140  adu l t s  we re  s tud ied .The  mos t  impor tan t  d iagnos t i c  ca tego ry  was  eczema:  t he  p reva lence  amongma les  was  4 .6% and  among  fema les  8%.  The re  was  a  d j f f e rence  i n  age -ad jus ted  p reva lence  be tween  the  two  a reas .A  fu r the r  ana l ys i s  \ ^ /as  made  o f  t he  p reva lence  among  ma les ,  who  cou ld  bec lass i f i ed  i n to  6  ma jo r  occupa t i ona l  g roups .  The  mean  ages  were  d i f f e ren t' i n  t h e  v a r i o u s  o c c u p a t i o n a l  g r o u p s .  A l s o  t h e  d i s t r i b u t i o n  o f  t h e  m a l e sove r  t he  occupa t i ona l  ca tego r i es  was  d j f f e ren t  i n  t he  two  a reas .  Toassess  the  re la t i ve  impor tance  o f  age ,  occupa t i on  and  a rea !  a  s tep -w iselog i s t i c  reg ress ion  o f  eczema p reva lence  was  pe r fo rmed  on  these  fac to rs .The  resu l t s  show a  s ign i f i can t  con t r i bu t i on  o f  t he  f ac to r  occupa t i on  t othe  p reva lence  o f  eczema in  t h i s  mode l .  The  fac to r  age  d id  no t  con t r i -b u t e  s j g n i f i c a n t l y  b e f o r e  a n d  a f t e r  c o r r e c t j o n  f o r  o c c u p a t i o n .  A l s o  t h econ t r i bu t i on  o f  t he  f ac to rs  a rea  o f  r es idence  and  the  i n te rac t ' i on  aqe -o c c u p a t i o n  w a s  n o t  s i g n i f i c a n t .Th ree  ma jo r  occupa t i ona l  g roups  i n  wh i ch  the  p reva lences  o f  hand  eczemal v a s  r e l a t i v e l y  h i g h  c o u l d  b e ' i d e n t i f i e d :  t h e  c h e m j c a l  i n d u s t r y  1 4 . 4 % ,the  me ta l  i ndus t r y  10 .7% and  the  cons t ruc t j on  i ndus t r y  7 .1%.  More' i r r i t a n t  t h a n  a l l e r g i c  e c z e m a  w a s  f o u n d  i n  a l l  o f  t h e s e  c a t e g o r i e s .The  append i x  t o  t h i s  chap te r  desc r i bes  the  resu l t s  o f  a  reexamina t j ono f  one  o f  t he  samp les  a f t e r  3  yea rs .  The  sens i t i v i t y  and  spec i f i c i t yo f  t he  me thods  used  du r i ng  the  f i r s t  examina t i on  we re  ca l cu la ted .  Pa tchtes t i ng  cou ld  be  a r ranged  fo r  a l1  pe rsons  w i th  eczema.  The  resu l t s  o f  t hepa tch  tes t s  emphas i zed  the  p rom inen t  p lace  o f  i r r j t an t  de rma t i t i s  w i t h i nthe  spec t rum o f  hand  eczema.A  rev iew  o f  t he  l i t e ra tu re  pub l i shed  up  to  now w i th  respec t  t o  de rma to lo -g i c a l  s t u d i e s  i n  t h e  c o n s t r u c t i o n  i n d u s t r y  i s  g i v e n  i n  C h a p t e r  4 .Th i s  rev iew  does  no t  dea l  spec i f i ca l l y  w i t h  cemen t  eczema in  assoc ia t i on1 1 8IÈF>w i t h  c h r o m a t e  a n d  c o b a l t  a l l e r g y ,  b u t  c o n s ' i d e r s  t h e  a v a i l a b l e  e p i d e m i o -l o g i c a l  d a t a  o n  s k i n  d i s e a s e s  o b t a i n e d  b y  e x a m i n i n g  p o p u l a t i o n s  o fcons t ruc t i on  wo rke rs .  Such  i n fo rma t i on  i s  l im i t ed ,  s i nce  mos t  o f  t heava i l ab le  da ta  a re  based  on  ou t -pa t i en t  r eco rds  and /o r  i nsu rance  f i l es .Fo r  t he  Ne the r l ands ,  da ta  a re  p rov ided  by  t he 'Economjc  I ns t j t u te  f o rt he  Cons t ruc t i on  I ndus t r y  Sec to r '  (E IB ) ,  wh i ch  a re  based  on  the i rpe rmanen t  samp le  o f  cons t ruc t i on  wo rke rs .  These  da ta  p robab i y  unde r -es t ima te  t he  t rue  morb id i t y  due  to  sk jn  d i seases  i n  t h i s  wo rk fo rce .The  da ta  revea l  t ha t  many  work ing  days  a re  l os t ,  w j t h  impor tan t  f i nanc ia lconsequences .  Howeve r ,  i t  has  a l so  been  no ted  tha t ,  desp i t e  ex tens i vede rma to log i ca l  p rob lems ,  wo rke rs  some t imes  t r y  t o  con t i nue  the i r  wo rkw ' i t h o u t  e v e n  c o n s u l t i n g  a  p h y s i c i a n .A  b r i e f  r ev iew  o f  t he  two  ava i l ab le  repo r t s  on  sys tema t i c  i nves t i ga t i onson  bu i l d i ng  s i t es  wh i ch  we re  pe r fo rmed  by  l ^ l ah lbe rg  (1969 )  and  by  Hdvd r ' ng( 1 9 7 0 )  i s  g i v e n .  I t  i s  c o n c l u d e d  t h a t  f u r t h e r  j n v e s t i g a t i o n s  b y  t r a i n e dde rma to log i s t s  and  expe r i enced  occupa t i ona l  phys i c i ans  w i l l  be  necessa ryto  de tec t  and  s tudy  ea r l y  cases  o f  occupa t i ona l l y  i nduced  de rma toses ,thus  p rov id ing  a  more  comp le te  p i c tu re  o f  t he  rea l  med jca l  and  soc ia limpor tance  o f  occupa t i ona l  de rma toses  i n  t h i s  b ranch  o f  i ndus t r y .The resul ts  of  the examinat ion of  the hands and fore,arms of  about  1700cons t ruc t i on  wo rke rs  a re  ana l yzed  i n  Chap te r  f i ve .  These  pe rsons  were  a l lemp loyees  o f  a  samp le  o f  cons t ruc t i on  compan ies  l oca ted  j n  t he  no r the rnpa r t  o f  t he  Ne the r l ands .  They  were  seen  a t  t he  wo rk  s i t es  i n  t he  sp r i ngand  ea r l y  summer  o f  1982 .  A  fo rm o f  eczema was  p resen t  j n  133  (7 .8%)worke rs ,  pso r i as i s  i n  22  ( I . 3%)  and  va r i ous  o the r  de rma toses  i n  30  (1 , . 8%) .I r r i t an t  de rma t i t i s  was  the  ma jo r  d iagnos t i c  ca tego ry  and  was  found  i n4%,  wh i l e  a l l e rg i c  con tac t  eczema was  p resen t  i n  1 .4%.  ï he  p reva lenceo f  eczema in  d i f f e ren t  j ob  ca tego r i es  va r i ed  be tween  5 ,9% in  t echn i c i ansa n d  1 2 , 6 %  i n  b r i c k l a y e r s  a n d  p l a s t e r e r s .From the persons wi thout  eczema, a controï  group of  about  300 workerswas  se lec ted  and  sub jec ted  to  pa tch  tes t i ng  and  h i s to ry  t ak ing  j n  t hesame manner as were the cases wi th eczema.A  h i s to ry  o f  a topy  was  more  p reva len t  i n  pe rsons  w i th  i r r i t an t  de rma t i t j s(24%)  as  compared  w i th  o the r  f o rms  o f  eczema (15%)  and  con t ro l s  (11%) .D1 1 9Patch  tes t i ng  v ías  pe r fo rmed  w i th  d i ch roma te ,  coba l t ,  t h i u rammjx  andepoxy - res in .  Pos j t i ve  pa tch  tes t s  we re  found  i n  15% o f  t he  wo rke rs  w j t he c z e m a  n d  i n  5 . 5 %  o f  t h o s e  w i t h o u t  t h e  d i s e a s e .  I n  c a r p e n t e r s ,  t h e r ew ^ q  v ê r v  l i f f l p  d i f f e r e n c p  i n  t h p  n r o n n r t i o n  o f  n o s i t i v ê  r ê a c t o r s  t OY t  v Y v t  u , v i l  v ,  y v Jp a t c h  t e s t s  b e t w e e n  c a s e s  w i t h  e c z e m a  ( 6 . I % )  a n d  c o n t r o l s  ( 4 . 3 % ) .In  b r i ck laye rs  and  p las te re rs ,  howeve r ,  a  d i f ï e rence  t ^ tas  f ound :  t hep ropo r t i on  o f  pos i t i ve  pa tch  tes t s  be ing  24% and  7 .6%,  respec t i ve l y ,  i ncases  and  con t ro l s .  I n  o rde r  t o  de te rm ine  the  impor tance  o f  a  h i s to ry  o fexposu re  t o  pa in t  &  t a r ,  91ues ,  syn the t i c  res ins !  wood  impregnan tg ,g reases  and  so l ven ts ,  t he  odds - ra t i os  o f  exposu re  i n  cases  vs .  con t ro l swere  ana l yzed .  No  s ign i f i can t  assoc ia t j on  be tween  eczema nd  suchexposu re  cou ld  be  de tec ted  when  a l1  occupa t i ons  \ ^ /e re  comb ined ,  bu t ,  i nt h e  s t r a t u m  c o n t a i n i n g  t h e  c a r p e n t e r s ,  a  s t a t i s t i c a l  a s s o c i a t i o n  w a sfound between eczema and a h is tory of  f requent  exposure to wood impreg-n a n t s  ( 0 R  =  2 . 4 3 )  a n d  s o l v e n t s  ( 0 R  =  1 . 8 6 ) .  T h e  i r r i t a n t  n a t u r e  o ft hese  subs tances  unde r l i nes  t he  impor tance  o f  t he  ro le  o f  i r r i t an tde rma t i t i s  i n  t he  spec t rum o f  hand  de rma toses ,  a t  l eas t  i n  ca rpen te rs .O the r  i ob  s t ra ta  we re  too  sma l l  f o r  a  p rope r  ana l ys i s .  The  assoc ia t i onbe tween  eczema nd  exposu re  t o  wood impreqnan ts  and  sO lven ts  cou ldbe  con f i rmed  by  pe r fo rm ing  a  l og i t  r eg ress ion  ana l ys i s  i n  wh i ch  o the rfac to rs  cou ld  be  s imu l taneous l y  examined .  Seve ra l  t ypes  o f  b i as  t ha tmay  have  d i s to r ted  the  da ta  a re  b r j e f l y  d i scussed  j n  t he  append i x  o ft h i s  c h a p t e r .C o n c l  u s iThe  ana  lt ha t  t hei  n  occupI  r r i  t an tdamage i' i  n  nonclI  n f l  uencaccoun t ;i  mpor ta rThe i  nvepl  ayed bworke rs .An  eva l  useve ra  Ih r r  f h a  lHowever ,a  s i g n i fof  woodpropert iCon tac tpopu l  a t  igene ra l  1Comb i  natA1  thoughi  t  o f fereczema hPenetratl a f o d  .Thi  s  woua1  I  e rgena1  thoughMoreoverr20

   University of GroningenPrevalence of hand eczemaCoenraads, Pieter JanIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:1983Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Coenraads, P. J. (1983). Prevalence of hand eczema: Association with occupational exposure, especiallyin construction workers. s.n.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 30-10-2023STELLINGEN ). Het relatief grote aandeel van publikaties over allergisch kontakt­eczeem t.o.v. orthoergische kontaktdermatitis is omgekeerd evenredig met de werkelijkheid. (Fregert,S. Contact Dermatitis 6,510,1980) 2. Bij expositie aan sterke allergenen is streven naar "allergen replacement" zinvol, t.a.v. de zwakke ubiquitaire allergenen dient de pre­ventie van eczeem allereerst gezocht te worden in het tegengaan van beschadiging van het stratum corneum. 3. De belangrijke plaats van huidaandoeningen in statistieken betreffende beroepsgebonden aandoeningen rechtvaardigt een intensieve op de praktijk gerichte arbeidsdermatologische scholing van tenminste een bedrijfsarts per BGD. 4. Aan de mogelijke lange termijn effekten van de expositie aan vrije zuurstof radicalen door de toepassing van benzoylperoxyde bij de a·cne­therapie wordt in de dermatologische literatuur onvoldoende aandacht geschonken. 5. Spoel- en bewaarvloeistoffen voor zachte contactlenzen dienen geen thiomersal te bevatten. 6. Het dyshidrotisch eczeem bestaat niet. 7. Ook na de introduktie van een vaccin tegen lepra zijn er op grond van de prevalentie en incidentie nog grote logistieke problemen te verwachten voordat het gestelde einddoel, n.l. eradicatie, binnen bereik ligt. 8. Het feit dat multipele contactallergieen waargenomen worden bij Mycosis Fungoides en M.Sezary berust op een epifenomeen. 9. Uit epidemiologisch onderzoek naar voetwratten bij schoolkinderen kan geconcludeerd worden dat ter preventie van deze aandoening bij het zwemmen gymschoenen gedragen moeten worden. J-0. Bij de medische faculteiten in Nederland is de tijd rijp voor een zinvolle samenwerking met de industrie. 

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Prevalence of hand eczema

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