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Contact Dermatitis 12/2012; 67(6):386-387. · 3.51 Impact Factor
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Uwe Hillen,
Heinrich Dickel, Harald Löffler,
Wolfgang Pfützner,
Vera Mahler,
Detlef Becker,
Jochen Brasch,
Margitta Worm,
Thomas Fuchs,
Sven M John,
Johannes Geier
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ABSTRACT: p-Phenylenediamine (PPD) 1% in petrolatum has been shown in a prospective study to elicit late reactions in 1.5% of routine patch tests, which may be indicative of patch test sensitization.
To assess the frequency of late reactions to reduced PPD patch test concentrations.
In 1838 patients, PPD was tested at three concentrations (0.5% pet., group I; 0.4% pet., group II; and 0.35% pet., group III). Patch tests were read on D1 (D2) to D3 (D4); additional late readings were performed on D7, D14, and D21. Patients who were not able to return for all scheduled late readings were telephoned on D7, D14, and D21, and questioned about a reaction at the patch test sites.
Data of 1666 patients (1069 women and 597 men) were eligible. Late reactions were observed in 9 patients, 3 in group I (0.49%) and 5 in group II (0.63%). In 7 of 8 of the patients with late reactions, patch tests were applied for 48 hr. On retesting, 4 of 5 patients became positive at D2 or D3.
The occurrence of late reactions to PPD may be influenced by patch test concentration and duration. PPD 0.4-0.5% pet. may cause late reactions indicative of active sensitization.
Contact Dermatitis 04/2011; 64(4):196-202. · 3.51 Impact Factor
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ABSTRACT: Dermatitis of hands is a problem among nurses. The aim of this prospective questionnaire based survey was to analyze practice and knowledge of skin care of medical and surgical nurses. 250 questionnaires were distributed. 49% of respondent stated that they perform skin care at least 1-2 times/day. After hand-wash 15% of participants perform skin protection, after hand-disinfection only 2%. 40% give skin care products less than 3 minutes to be applied. It was shown that this knowledge is lacking in many individuals, leading to wrong behavior at work and insufficient use of skin protection and skin care products.
GMS Krankenhaushygiene interdisziplinär. 01/2011; 6(1):Doc08.
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ABSTRACT: The WHO regards hand hygiene as an essential tool for the prevention of noso-comial infections. The hygienic hand disinfection has a superior antimicrobial efficacy compared to hand washing and should be performed as the treatment of choice before and after a variety of activities at the point of patient care. Washing hands should be preferred when the hands are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap and long lasting occlusion. Compliance with hand disinfection in clinical practice is often low. Measures to improve compliance include training, provision of hand rubs where they are needed, and the responsibility of doctors to set a good example. Improved compliance in hand hygiene and targeted use of alcohol-based hand rubs can reduce the nosocomial infection rate by up to 40 %. The benefit of hand disinfection is therefore much larger than possible risks.
Journal der Deutschen Dermatologischen Gesellschaft 12/2010; 8(12):978-83. · 1.47 Impact Factor
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ABSTRACT: Congenital hemidysplasia with ichthyosiform nevus and limb defects (MIM 308050, CHILD) syndrome is an X-linked dominant, male-lethal, multisystem birth defect. Patients suffer from an inflammatory nevus that covers large areas, predominantly of one side of the body, with a sharp midline demarcation. Treatment of CHILD nevus is notoriously difficult.
The aim of this study was to develop a novel surgical approach for this disorder.
In 2 patients, the CHILD nevus was dermabraded, and the area was covered with split skin grafts obtained from a contralateral unaffected donor region. In a third patient, papillomatous, strawberry-like lesions on fingers and toes were excised, and the defects were covered with full-thickness grafts obtained from the unaffected left, gluteal area.
Highly satisfying functional and cosmetic results were documented during a follow-up period ranging from 3 to 8 years.
The favorable outcome, superior to that obtained by simple dermabrasion or extensive plastic surgery, can best be explained by the donor dominance of the grafted skin samples that carried, in all or most cells, the mutant X chromosome in an inactivated form.
Dermatology 04/2010; 220(4):340-5. · 2.05 Impact Factor
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ABSTRACT: Correction of an imbalance between allergen-specific T cell subsets is considered a critical event in establishing allergen tolerance by specific immunotherapy (SIT). In a comprehensive, longitudinal study, distinct T cell populations and Ig subtypes were analyzed in subjects allergic to birch pollen during decisive time points of SIT (i.e., induction and maintenance phase), as well as in and out of birch pollen season. An increase in Bet v 1-specific, IL-10-secreting T cells, fulfilling the criteria of inducible type 1 regulatory T (Tr1) cells, was observed by the end of the induction phase; this resulted in a decreased ratio of allergen-specific IL-5(+) Th2/Tr1 cells. In contrast, CD4(+)CD25(+)CD127(low) regulatory T cell numbers did not change. Furthermore, enhanced concentrations of allergen-specific IgG Abs were observed, whereas allergen-specific IgE and IgA levels remained unchanged. After 1 y of SIT, a reduced ratio of allergen-specific Th2/IFN-gamma(+) Th1 cells was apparent. Although untreated and SIT-treated allergic subjects developed enhanced Th2 cell responses during birch pollen season, only SIT-treated patients experienced elevated numbers of allergen-specific Tr1 cells, which were associated with reduced skin prick test reactivity and diminished clinical symptoms. In coculture assays, allergen-specific Tr1 cells showed an IL-10- and dose-dependent inhibition of CD4(+)CD25(-) T effector cells. Thus, SIT has differential effects on regulatory T cell subsets, resulting in an early induction of allergen-specific Tr1 cells associated with an increase in allergen-specific IgG, and it leads to a delayed shift from an allergen-specific Th2- to a Th1-dominated immune response.
The Journal of Immunology 02/2010; 184(4):2194-203. · 5.79 Impact Factor
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ABSTRACT: The WHO regards hand hygiene as an essential tool for the prevention of nosocomial infection, but compliance in clinical practice is often low.
The relevant scientific literature and national and international evidence-based recommendations (Robert Koch Institute [Germany], WHO) were evaluated.
Hygienic hand disinfection has better antimicrobial efficacy than hand-washing and is the procedure of choice to be performed before and after manual contact with patients. The hands should be washed, rather than disinfected, only when they are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap, and prolonged wearing of gloves. Compliance can be improved by training, by placing hand-rub dispensers at the sites where they are needed, and by physicians setting a good example for others.
Improved compliance in hand hygiene, with proper use of alcohol-based hand rubs, can reduce the nosocomial infection rate by as much as 40%.
10/2009; 106(40):649-55. · 2.92 Impact Factor
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Axel Schnuch,
Wolfgang Uter,
Heinrich Dickel,
Christiane Szliska,
Sibylle Schliemann,
Ricarda Eben,
Franziska Ruëff,
Ana Gimenez-Arnau, Harald Löffler,
Werner Aberer,
Yvonne Frambach,
Margitta Worm,
Margarete Niebuhr,
Uwe Hillen,
Vera Martin,
Uta Jappe,
Peter J. Frosch,
Vera Mahler
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ABSTRACT: Objective: To identify the concentration of the fragrance compound hydroxyisohexyl 3-cyclohexene carboxaldehyde (INCI) (HICC) that is sufficiently low not to cause an allergic reaction in patients with proven sensitization.Methods: Repeated open application testing (ROAT) in 64 subjects with 2 preparations (perfume and cream) in different concentration (0.005–2.5%). Confirmatory patch testing with four preparations in two different concentrations (2.5% and 5%).Results: The concentrations of HICC being tolerated by 90% of those sensitized to HICC are estimated as <88.2 ppm (cream) and <270 ppm (perfume) equivalent to 1.2 μg/cm2 (perfume) and 4.9 μg/cm2 (cream). Patch test preparations differed with regard to sensitivity (88.5–98.1%) and specificity (37.5–87.5%) against the ROAT result as external criterion. ROAT concentrations and the reaction strength in patch testing were inversely correlated (Kendall's tau-b: 0.69), both indicating the existence of different degrees of susceptibility.Conclusion: To protect 90% (50%) of people sensitized, the use concentration should be in the range of 0.009–0.027% (0.18–0.34%), depending on the product type. Taking into account these results, excessive concentrations should be avoided, as this would continue to sensitize people. Close monitoring is indispensable to prove the efficacy of any recommendations aiming to prevent induction.
Contact Dermatitis 09/2009; 61(3):152 - 162. · 3.51 Impact Factor
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Axel Schnuch,
Wolfgang Uter,
Heinrich Dickel,
Christiane Szliska,
Sibylle Schliemann,
Ricarda Eben,
Franziska Ruëff,
Ana Gimenez-Arnau, Harald Löffler,
Werner Aberer,
Yvonne Frambach,
Margitta Worm,
Margarete Niebuhr,
Uwe Hillen,
Vera Martin,
Uta Jappe,
Peter J Frosch,
Vera Mahler
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ABSTRACT: To identify the concentration of the fragrance compound hydroxyisohexyl 3-cyclohexene carboxaldehyde (INCI) (HICC) that is sufficiently low not to cause an allergic reaction in patients with proven sensitization.
Repeated open application testing (ROAT) in 64 subjects with 2 preparations (perfume and cream) in different concentration (0.005-2.5%). Confirmatory patch testing with four preparations in two different concentrations (2.5% and 5%).
The concentrations of HICC being tolerated by 90% of those sensitized to HICC are estimated as <88.2 ppm (cream) and <270 ppm (perfume) equivalent to 1.2 microg/cm(2) (perfume) and 4.9 microg/cm(2) (cream). Patch test preparations differed with regard to sensitivity (88.5-98.1%) and specificity (37.5-87.5%) against the ROAT result as external criterion. ROAT concentrations and the reaction strength in patch testing were inversely correlated (Kendall's tau-b: 0.69), both indicating the existence of different degrees of susceptibility.
To protect 90% (50%) of people sensitized, the use concentration should be in the range of 0.009-0.027% (0.18-0.34%), depending on the product type. Taking into account these results, excessive concentrations should be avoided, as this would continue to sensitize people. Close monitoring is indispensable to prove the efficacy of any recommendations aiming to prevent induction.
Contact Dermatitis 09/2009; 61(3):152-62. · 3.51 Impact Factor
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Johannes Geier,
Holger Lessmann,
Brigitte Hellweg,
Uta Jappe,
Petra Spornraft-Ragaller,
Thomas Fuchs,
Werner Aberer,
Peter J Frosch,
Elke Weisshaar,
Vera Mahler, [......],
Christoph Skudlik,
Christiane Szliska,
Patrick Koch,
Claudia Pföhler,
Martina Lilie,
Detlef Becker,
Jiri Trcka,
Jochen Meyer,
Jens-Uwe Hahn,
Monika Adam
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ABSTRACT: Hidden allergen exposure may contribute to persistence and relapse of chromate dermatitis. According to case reports, chromated metal products, such as screws, fittings, etc., may be relevant allergen sources for patients sensitized to chromate.
To examine concomitant patch test reactivity to potassium dichromate 0.5% petrolatum (pet.) and three different types of chromated metal rings.
Patients with proven or suspected chromate allergy were patch tested with potassium dichromate 0.5% pet. and three different types of chromated metal rings (yellow, olive, and black). Hexavalent chromium Cr(VI) release from the patch tested rings was chemically analysed.
Ninety-five patients were tested: 49/95 (52%) reacted to potassium dichromate and 25/95 (26%) reacted to black chromated rings. Reactions to chromated rings exclusively occurred in patients reacting to potassium dichromate. Of 20 patients with a strong reaction to potassium dichromate, 14 reacted to black chromated rings. These were shown to have a high Cr(VI) release. Only two patients reacted to the other chromated rings, which had a very low Cr(VI) release.
Handling chromated metal products must be regarded a hazard to chromate-sensitive patients, in particular those with a strong sensitization.
Contact Dermatitis 05/2009; 60(4):199-202. · 3.51 Impact Factor
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Axel Schnuch,
Werner Aberer,
Monika Agathos,
Detlef Becker,
Jochen Brasch,
Peter Elsner,
Peter J. Frosch,
Thomas Fuchs,
Johannes Geier,
Uwe Hillen, Harald Löffler,
Vera Mahler,
Gerhard Richter
Journal der Deutschen Dermatologischen Gesellschaft 02/2009; 6(9). · 1.47 Impact Factor
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Axel Schnuch,
Werner Aberer,
Monika Agathos,
Detlef Becker,
Jochen Brasch,
Peter Elsner,
Peter J Frosch,
Thomas Fuchs,
Johannes Geier,
Uwe Hillen, Harald Löffler,
Vera Mahler,
Gerhard Richter,
Christiane Szliska
Journal der Deutschen Dermatologischen Gesellschaft 10/2008; 6(9):770-5. · 1.47 Impact Factor
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ABSTRACT: Irritant contact dermatitis is commonly found on hands of healthcare employees and is often explained by contact to water and detergents. Studies on the dermal tolerance clearly show that the degree of skin irritation is significantly lower after application of alcohol in comparison to detergents. It has also been shown in standardised wash tests using a foam roller that the application of alcohol or water immediately after a detergent-based wash can significantly decrease the degree of skin irritation, probably due to a wash-off of residual detergent. If evidence-based hand hygiene is taught early during nurses training it can substantially reduce irritant contact dermatitis supporting initiatives of primary prevention among healthcare employees. The irritant potential of commonly used alcohols in hand antiseptics is very low. If the skin is pre-irritated, e.g. by detergents or water, alcohols can cause a burning sensation which is, however, not an allergic reaction and does not further harm the skin. True allergic reactions to alcohols have so far not been confirmed. From the dermatological point of view the use of alcohols for hand hygiene has clear advantages over washing with water and detergents.
Journal of Hospital Infection 10/2008; 70 Suppl 1:44-8. · 3.39 Impact Factor
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ABSTRACT: Mycosis fungoides may rarely simulate facial erysipelas. In a patient with that clinical presentation, a biopsy specimen revealed a diffuse dermal infiltrate with numerous neutrophils that also mimicked erysipelas histopathologically. The diagnosis of mycosis fungoides was made on the basis of atypical lymphocytes with focal epidermo- and folliculotropism. It was confirmed by typical findings of mycosis fungoides in a second biopsy from a clinically inconspicuous patch. An identical T-cell receptor gamma-gene rearrangement was detected in lymphocytes of both biopsy specimens.
Journal der Deutschen Dermatologischen Gesellschaft 05/2008; 6(4):298-301. · 1.47 Impact Factor
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ABSTRACT: Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.
Industrial Health 11/2007; 45(5):645-52. · 0.94 Impact Factor
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ABSTRACT: We investigated the biological response of regular human skin to alcohol-based disinfectants and detergents in a repetitive test design. Using non-invasive diagnostic tools such as transepidermal water loss, laser-Doppler flowmetry and corneometry, we quantified the irritative effects of a propanol-based hand disinfectant (Sterillium), its propanol mixture (2-propanol 45% w/w and 1-propanol 30% w/w), sodium lauryl sulfate (SLS) 0.5% and distilled water. The substances were applied in a 2-D patch test in a repetitive occlusive test design to the back. Additionally, we performed a wash test on the forearms that was supposed to mimic the skin affection in the normal daily routine of health care workers. In this controlled half-side test design, we included the single application of the hand rub, SLS 0.5% and water as well as a tandem application of the same substances. Patch test and wash test showed similar results. The alcohol-based test preparations showed minimal irritation rather comparable to the application of water. However, the detergent SLS produced stronger barrier disruption, erythema and dryness than the alcohol-based preparations. There was no additional irritation at the combined use of SLS and disinfectants. By contrary, there was even a decrease in barrier disruption and erythema induced by the tandem application of SLS followed by alcohol-based disinfection compared with the use of SLS alone. These findings show a less irritant effect of alcohol-based disinfectants on the skin than detergents. Our study shows that there is no summation of irritating effects of a common detergent and propanol and that the combination of washing and disinfection has a rather protective aspect compared with washing alone.
Contact Dermatitis 11/2007; 57(4):235-41. · 3.51 Impact Factor
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ABSTRACT: In most surgical theatres, a 1 min or even longer hand wash is routine as part of the pre-operative hand disinfection. But its benefit has recently been seen critically.
We have therefore investigated the effect of a 1 min hand wash on skin hydration and on the efficacy of consecutive surgical hand rubbing with three standard alcohols (60% propan-1-ol, 60% propan-2-ol, 80% ethanol; all v/v) on the resident hand flora. Three types of treatment were performed: (i) a 1 min pre-wash before surgical hand disinfection, (ii) no pre-wash before surgical hand disinfection and (iii) no pre-wash but use of a brush for 1 min during disinfection procedure. The efficacy of the alcohols was determined according to prEN 12791 with the same 20 volunteers in paired groups. To assess the effect of the hand wash on skin hydration, 10 volunteers washed their hands with sapo kalinus for 1 min and dried hands with a paper towel. Skin hydration was measured with a corneometer before the hand wash and subsequently up to 10 min thereafter both on the palm and dorsum of hands. We also tested the reduction of bacterial spores by a 15 s hand wash according to EN 1499 after artificial contamination of hands of 14 volunteers with spores of B. stearothermophilus.
Propan-1-ol (60%) was most effective with a mean log10 reduction of 2.11, followed by ethanol (80%) with a mean log10 reduction of 1.76 and propan-2-ol (60%) with a mean log10 reduction of 0.57 (all immediate effect without hand wash). The efficacy of the alcohols was neither significantly improved nor impaired by a preceding 1 min hand wash, but there is a trend towards better efficacy on dry hands. Using a brush for 1 min during disinfection resulted in a better efficacy with all alcohols. An anaylsis of variance revealed that the immediate effect of ethanol (p = 0.013) and propan-2-ol (p = 0.001) is significantly influenced by the variation of treatments which is mainly explained by the effect of brushing during disinfection. But no significant difference between treatment variations was found in the sustained effect with any of the alcohols. Skin hydration increased significantly by a 1 min hand wash for up to 10 min despite drying hands with a paper towel. A 15 s hand wash reduced the number of bacterial spores significantly from log10 3.84 to log10 1.99 (p = 0.001).
There is no benefit of a hand wash as part of surgical hand disinfection except that a short hand wash of 15 s can effectively reduce spores. The best time for this short hand wash is at the beginning of work in hospital, but at the latest in the sluice of the operating theatre about 10 min before applying an alcohol-based hand rub to give the skin enough time to dry.
International Journal of Hygiene and Environmental Health 06/2006; 209(3):285-91. · 3.81 Impact Factor
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ABSTRACT: Irritant contact dermatitis is a mayor problem in health care employees. Because educational programs have shown convincing success in certain occupations (e.g. in hairdressers), this study investigates the effect of a special training program in health care trainees. 521 trainees from 14 nursing schools in Central Germany were randomly divided in 2 groups, (i) an intervention group with a regular teaching protocol regarding all aspects of primary prevention and (ii) a control group without any further teaching. Morphological changes of the hands, use of hand care creams and knowledge regarding skin care were evaluated regularly during their 3 years lasting training period (1999-2002). In the intervention group, we found at the end of the 3-year training period a significant better skin condition of the hands than in the control group: a 3-year prevalence of morphological skin changes of 66.7% versus 89.3%. The unteached trainees (control group) had an odds ratio (OR) of 4.8 [95% confidential interval (CI): 2.9-7.8] for developing any skin changes on the hands after 3 years. Besides the effect of the teaching, the history of hand dermatitis before the study start was an independent risk factor for development of further hand dermatitis [OR 1.9, 95% CI: 1.0-3.6). Age and sex showed no influence on the skin condition. Atopic constitution had an influence on the development of skin changes only at the evaluation after 18 month. The observed effect in the intervention group may best be explained by different behaviour of the trainees, e.g. the amount of hand washing was reduced, while procedure of hand disinfection remained unchanged compared with the control group. However, the amount of used skin care cream did not differ between the both groups. This study shows that primary prevention of skin disease by regularly teaching during the training period of medical employees can effectively reduce the risk of development of irritant skin changes of the hands. Therefore, teaching and continuous motivation regarding preventive individual and collective measures during the training of medical staff should be an obliged part of the curriculum.
Contact Dermatitis 05/2006; 54(4):202-9. · 3.51 Impact Factor
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ABSTRACT: It is tacitly assumed that a positive patch test reaction is not affected by adjacent negative tests. However, despite its fundamental importance for the interpretation of test reactions this assumption has not been proven. To test this assumption, special TRUE-test strips were prepared containing placebo, nickel sulphate and fragrance mix as the only allergens, separated by distances of 1 cm and 7 cm and blinded to the investigators. Patients were synchronously tested with two strips. Out of 493 patients tested in 6 centres, the 93 with positive reactions to nickel sulphate only were evaluated. No relevant difference was found between positive nickel reactions in the two different distances to a negative fragrance patch test. We conclude that a positive patch test reaction is not affected by adjacent negative patch tests, which therefore can be neglected for the interpretation of positive reactions.
Acta Dermato Venereologica 02/2006; 86(4):345-7. · 3.18 Impact Factor
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Contact Dermatitis 10/2005; 53(3):186-7. · 3.51 Impact Factor
