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ABSTRACT: Background. Occupational contact dermatitis is frequent, and further understanding of the epidemiology will improve the basis of its prevention. Objectives. To identify occupations at risk for severe occupational contact dermatitis. Methods. The last 1000 cases of severe occupational contact dermatitis seen at our department were identified. Results. The study population comprised 618 females and 382 males. The mean age at onset of irritant contact dermatitis was significantly lower than the mean age at onset of allergic contact dermatitis for both sexes, irrespective of the presence of atopic dermatitis. Females at high riskwere cooks, butchers, beauticians, bakers, and hairdressers, ranging from 23.3 to 96.8 cases per 10 000 workers per year. Males at high risk were painters, cooks, mechanics, locksmiths, and bakers, ranging from 16.5 to 32.3 cases per 10000 workers per year. Conclusions. Occupational contact dermatitis remains frequent, even if only severe cases are considered. It is a concern that no effective, systematic interventions and prevention schemes have been launched in Europe, despite documentation of a significant problem overmany years, and knowledge of risk occupations and risk factors. This study suggests new approaches for general and specific prevention of occupational contact dermatitis.
Contact Dermatitis 05/2013; 68(5):259-68. · 3.51 Impact Factor
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Betina H Thuesen,
Charlotte Cerqueira,
Mette Aadahl,
Jeanette Frost Ebstrup,
Ulla Toft,
Jacob P Thyssen,
Runa Vavia Fenger,
Lars-Georg Hersoug,
Jesper Elberling,
Oluf Pedersen,
Torben Hansen, Jeanne Duus Johansen,
Torben Jørgensen,
Allan Linneberg
International Journal of Epidemiology 04/2013; · 6.41 Impact Factor
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Cecilia Svedman,
Klaus E Andersen,
F M Brandão,
Derk P Bruynzeel,
Thomas L Diepgen,
Peter J Frosch,
Thomas Rustemeyer,
Ana Giménez-Arnau,
Margarida Gonçalo,
An Goossens, Jeanne Duus Johansen,
Arto Lahti,
Torkil Menné,
Stefania Seidenari,
Antonella Tosti,
Jan E Wahlberg,
Ian R White,
John D Wilkinson,
Martin Mowitz,
Magnus Bruze
Contact Dermatitis 11/2012; 67(5):312-314. · 3.51 Impact Factor
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ABSTRACT: BACKGROUND: Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual's daily life, occupation and quality of life. However, no guidelines of selfmanagement recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named 'The Healthy Skin Clinic' or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. DISCUSSION: The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.
BMC Dermatology 06/2012; 12(1):6.
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ABSTRACT: Occupational hand eczema is common in hairdressers, owing to excessive exposure to wet work and hairdressing chemicals.
To quantify occupational skin exposure and the use of protective gloves among hairdressers in Denmark.
A register-based study was conducted comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self-administered postal questionnaire in May 2009, including questions on hairdressing tasks performed in the past week at work and the extent of glove use. A response rate of 67.9% (n = 5324) was obtained.
Of the respondents, 55.7% still worked as hairdressers, and they formed the basis of this study. Daily wet work was excessive; 86.6% had wet hands for ≥2 hr, and 54% for ≥ 4 hr. Glove use was fairly frequent for full head hair colouring and bleaching procedures (93-97.7%), but less frequent for highlighting/lowlighting procedures (49.7-60.5%) and permanent waving (28.3%). Gloves were rarely worn during hair washing (10%), although this was more frequently the case after hair colouring procedures (48.9%).
Occupational skin exposure was excessive among hairdressers; the extent of wet work and chemical treatments was high, and glove use was inconsistent, especially for certain hair colouring procedures and wet work tasks.
Contact Dermatitis 06/2012; 66(6):323-34. · 3.51 Impact Factor
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ABSTRACT: BACKGROUND. Protein contact dermatitis was originally defined in 1976 by Hjorth and Roed-Petersen as a distinct kind of dermatitis seen in patients with occupational food contact. Even though occupational skin diseases are frequent in Denmark, little attention has been paid to protein contact dermatitis, and the frequency is unknown.
To evaluate the frequency of occupational food-related hand dermatoses and test results in patients occupationally exposed to foods.
This was a retrospective study based on examinations, including skin prick testing and patch testing, performed at the Department of Dermato-Allergology, Gentofte University Hospital, Denmark between 2001 and 2010.
Of all patients (n = 372), 57.0% had irritant contact dermatitis, 22.0% had protein contact dermatitis, 2.4% had contact urticaria, and 1.8% had allergic contact dermatitis. A suggestion for diagnostic criteria is presented. Frequent risk occupations were cooking in restaurants, baking, and kitchen work. Substantially more patients reacted in skin prick testing with fresh foods than with food extracts. Conclusion. Protein contact dermatitis is a frequent disorder among patients who professionally handle foods, and should be considered to be a distinct clinical entity. When diagnosing protein contact dermatitis and in other food-related skin prick testing procedures, it is important to include fresh foods.
Contact Dermatitis 05/2012; 66(5):264-70. · 3.51 Impact Factor
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Nannie Bangsgaard,
Jacob Pontoppidan Thyssen,
Torkil Menné,
Klaus Ejner Andersen,
Charlotte G Mortz,
Evy Paulsen,
Mette Sommerlund,
Niels Kren Veien,
Grete Laurberg,
Knud Kaaber,
Jens Thormann,
Bo Lasthein Andersen,
Anne Danielsen,
Christian Avnstorp,
Berit Kristensen,
Ove Kristensen,
Susanne Vissing,
Niels Henrik Nielsen, Jeanne Duus Johansen
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ABSTRACT: Epoxy resin monomers are strong skin sensitizers that are widely used in industrial sectors. In Denmark, the law stipulates that workers must undergo a course on safe handling of epoxy resins prior to occupational exposure, but the effectiveness of this initiative is largely unknown.
To evaluate the prevalence of contact allergy to epoxy resin monomer (diglycidyl ether of bisphenol A; MW 340) among patients with suspected contact dermatitis and relate this to occupation and work-related consequences.
The dataset comprised 20 808 consecutive dermatitis patients patch tested during 2005-2009. All patients with an epoxy resin-positive patch test were sent a questionnaire.
A positive patch test reaction to epoxy resin was found in 275 patients (1.3%), with a higher proportion in men (1.9%) than in women (1.0%). The prevalence of sensitization to epoxy resin remained stable over the study period. Of the patients with an epoxy resin-positive patch test, 71% returned a questionnaire; 95 patients had worked with epoxy resin in the occupational setting, and, of these, one-third did not use protective gloves and only 50.5% (48) had participated in an educational programme.
The 1% prevalence of epoxy resin contact allergy is equivalent to reports from other countries. The high occurrence of epoxy resin exposure at work, and the limited use of protective measures, indicate that reinforcement of the law is required.
Contact Dermatitis 04/2012; 67(2):73-7. · 3.51 Impact Factor
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ABSTRACT: Background. Occupational hand eczema is common in hairdressers, owing to excessive exposure to wet work and hairdressing chemicals. Objectives. To quantify occupational skin exposure and the use of protective gloves among hairdressers in Denmark. Methods. A register-based study was conducted comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self-administered postal questionnaire in May 2009, including questions on hairdressing tasks performed in the past week at work and the extent of glove use. A response rate of 67.9% (n = 5324) was obtained. Results. Of the respondents, 55.7% still worked as hairdressers, and they formed the basis of this study. Daily wet work was excessive; 86.6% had wet hands for ≥2 hr, and 54% for ≥ 4 hr. Glove use was fairly frequent for full head hair colouring and bleaching procedures (93-97.7%), but less frequent for highlighting/lowlighting procedures (49.7-60.5%) and permanent waving (28.3%). Gloves were rarely worn during hair washing (10%), although this was more frequently the case after hair colouring procedures (48.9%). Conclusions. Occupational skin exposure was excessive among hairdressers; the extent of wet work and chemical treatments was high, and glove use was inconsistent, especially for certain hair colouring procedures and wet work tasks.
Contact Dermatitis 03/2012; · 3.51 Impact Factor
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ABSTRACT: According to EU legislation, 26 fragrance substance allergens must be labelled on cosmetic products. For 12 of them, the optimal patch test concentration/dose has not been evaluated.
To establish the optimal patch test doses in mg/cm2 for the 12 fragrance substances that are not included in fragrance mix I or II in the European baseline patch test series.
Patch testing with the 12 fragrance substances was performed in a stepwise manner encompassing up to five rounds in at least 100 dermatitis patients for each round. Before patch testing, an individual maximum concentration/dose was determined for each fragrance substance.
The predetermined maximum patch test concentrations/doses could be tested for all 12 fragrance substances, with no observable adverse reactions being noted.
For each fragrance substance investigated, it is recommended that half of the maximum patch test dose (mg/cm2) be used for aimed and screening patch testing.
Contact Dermatitis 03/2012; 66(3):131-6. · 3.51 Impact Factor
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ABSTRACT: To investigate whether an evidence-based intervention could reduce the incidence of hand eczema in a cohort of Danish hairdressing apprentices during their training, as hairdressing apprentices are known to have a high risk of developing hand eczema.
This study was a clinically controlled, prospective intervention study. Within 2 weeks of starting their training, 502 hairdressing apprentices were enrolled in the study on occupational hand eczema. Approximately half of the apprentices were assigned to an intervention group and received an evidence-based training program developed for this study and delivered by teachers specially trained in the prevention of hand eczema; the other half received normal training and served as a control group. All apprentices completed self-administered questionnaires including questions regarding hand eczema, use of gloves and degree of wet work, and were all clinically examined for hand eczema three times during the 18-month study period. The three examinations were scheduled as school visits and consisted of a baseline examination and two follow-up examinations approximately 8 and 18 months later.
More apprentices from the intervention group used gloves during wet work procedures and significantly fewer developed hand eczema compared with apprentices from the control group (p=0.04). A logistic regression model showed that atopic dermatitis had a significant influence on the development of hand eczema in the cohort irrespective of the intervention.
We were able to increase the use of gloves and reduce the incidence of hand eczema in hairdressing apprentices by implementing a training program in hairdressing schools.
Occupational and environmental medicine 01/2012; 69(5):310-6. · 3.64 Impact Factor
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BMJ (Clinical research ed.). 01/2012; 345:e8221.
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Nikolaj Drimer Berg,
Lise Lotte N Husemoen,
Betina Heinsbæk Thuesen,
Lars-Georg Hersoug,
Jesper Elberling,
Jacob Pontoppidan Thyssen,
Berit Christina Carlsen, Jeanne Duus Johansen,
Torkil Menné,
Klaus Bønnelykke,
Steen Stender,
Michael Meldgaard,
Pal Bela Szecsi,
Allan Linneberg
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ABSTRACT: The mechanisms underlying the association between filaggrin (FLG) deficiency and asthma are not known. It has been hypothesized that FLG deficiency leads to enhanced percutaneous exposure to environmental substances that might trigger immune responses. We hypothesized that interactions between FLG deficiency and environmental exposures play a role in asthma development.
We sought to investigate possible interactions between FLG null mutations and tobacco smoking in relation to asthma.
A total of 3471 adults from a general population sample participated in a health examination. Lung function and serum specific IgE levels to inhalant allergens were measured, and information on asthma and smoking was obtained by means of questionnaire. Participants were genotyped for the 2 most common FLG null mutations in white subjects: R501X and 2282del4. Another Danish population was used for replication.
The FLG null mutation genotype was significantly associated with a higher prevalence of asthma and decreased FEV(1)/forced vital capacity ratio. In logistic regression analyses with asthma as the outcome, a significant interaction was found between FLG null mutations and smoking status (P = .02). This interaction was confirmed, although it was not statistically significant, in another Danish population study. Interactions between FLG genotype and cumulated smoking exposure were found in relation to asthma (P = .03) and decreased FEV(1)/forced vital capacity ratio (P = .03). A 3-way interaction was found among FLG genotype, smoking, and asthma, suggesting that the FLG-smoking interaction mainly played a role in nonatopic subjects.
FLG null mutations modified the effects of smoking on the risk of asthma. This finding might have implications for risk stratification of the population.
The Journal of allergy and clinical immunology 11/2011; 129(2):374-80, 380.e1-2. · 9.17 Impact Factor
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ABSTRACT: We have previously epidemiologically shown that type 1 diabetes is inversely associated with contact allergy. This finding is intriguing as type 1 diabetes and contact allergy are two completely different diseases, although T cells are involved in both diseases. The objective of this study was therefore to experimentally study the effect of contact allergens on the development of diabetes in non-obese diabetic mice.
Non-obese diabetic mice 4 weeks of age were separated into seven groups. One group was exposed to tapped water every 14th day, whereas the remaining six groups were split into sensitizations groups or elicitation groups (exposure every 14th day). These groups were then treated with one of the selected contact allergens (PPD or DNCB) or vehicle (AOO). All groups received the sensitizing treatment regime, and hereafter only the elicitation groups were further treated. If the blood glucose reached 14 mM, the mice were considered diabetic and euthanized. Cardiac heart blood was drawn at euthanization, and a Luminex analysis was done on the serum.
We showed that repeated application of a low dose of PPD reduced the incidence of diabetes compared to application with water (47% versus 93%, p=0.004). The rest of the groups developed diabetes with a cumulative incidence rate above 80%. The Luminex cytokine analysis revealed no differences between the groups, and no elevated cytokine level suggested a systemic response. Dermatitis was not noticeable by visual inspection, a histological examination, however, revealed a slight infiltration in the ears in the elicitation groups exposed to contact allergens.
This study showed that repeated topical application on the ears with a contact allergen could prevent the development of diabetes in non-obese diabetic mice. The contact allergens gave a non-visible, subclinical dermatitis on the application site. Activation of NKT cells to the ear lymph nodes seems to be involved.
Diabetes/Metabolism Research and Reviews 11/2011; 27(8):954-8. · 3.37 Impact Factor
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Journal of the American Academy of Dermatology 09/2011; 65(3):659-60. · 3.99 Impact Factor
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ABSTRACT: Allergic contact dermatitis (ACD) in children was previously considered to be a rare occurrence. However, the growing number of case reports and cross-sectional studies through the past three decades indicate that ACD is, in fact, a highly relevant diagnosis in children. Furthermore, the frequency of ACD in children seems to be increasing. In 1999, a review of the literature reported prevalence rates of 14.5-70% in selected paediatric populations. The current paper reviews the studies on the prevalence of positive patch test reactions and ACD in the paediatric population during the past decade, and provides an overview of the main findings. We found reported sensitization rates of 26.6-95.6% in selected groups of children. The associated relevance was 51.7-100%. The most common allergens were nickel, cobalt, thimerosal, and fragrance. Tailored patch testing increases the rate of relevant patch test reactions. Children with atopic dermatitis are as frequently sensitized as children with no history of atopic dermatitis, and there are no differences associated with sex. Children and adults can be tested with equal concentrations of patch test allergens. Our findings may support the notion that the prevalence of ACD in children is increasing over time or indicate an increased awareness.
Contact Dermatitis 08/2011; 65(5):254-65. · 3.51 Impact Factor
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ABSTRACT: Perfumes are complex mixtures composed of many fragrance ingredients, many of which are known to be only weak allergens when tested individually. It is therefore surprising that fragrance contact allergy is one of the most common forms of contact allergy.
To investigate whether mixing different fragrance allergens leads to increased sensitization potency, and to examine the difference in the challenge response to one chemical in mice sensitized either with the mixture of allergens or with only the relevant allergen.
CBA mice were sensitized with three different concentrations of three fragrance allergens alone or as a mixture. The sensitization and elicitation responses were measured by ear thickness plus infiltration of B and T cells and T cell proliferation in the draining lymph nodes.
We found a dose-dependent sensitization response for each of the allergens. An increased response was seen when the allergens were mixed. A stronger challenge response to cinnamal was seen in mice sensitized with the allergen mixture than in mice sensitized with cinnamal alone.
Our findings suggest that mixtures of allergens increase the primary response that potentiates the generation of memory T cells in response to the specific allergen. Thus, allergen mixtures enhance both induction and elicitation of contact allergy.
Contact Dermatitis 07/2011; 65(6):336-42. · 3.51 Impact Factor
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Jeanne Duus Johansen,
Marianne Hald,
Bo Lasthein Andersen,
Grete Laurberg,
Anne Danielsen,
Christian Avnstorp,
Berit Kristensen,
Ove Kristensen,
Knud Kaaber,
Jens Thormann,
Torkil Menné,
Niels Veien
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ABSTRACT: No generally accepted classification scheme for hand eczema exists. The Danish Contact Dermatitis Group recently developed a guideline defining common clinical types and providing criteria for aetiological types.
To test the concepts of this guideline in a group of hand eczema patients.
Seven hundred and ten hand eczema patients were included from seven dermatology clinics in Denmark. The hand eczema was classified into one of five clinical types, with standard photographs as reference. The severity was scored by the physician, who also made a final aetiological diagnosis.
Irritant contact dermatitis was most frequent in chronic, dry fissured hand eczema (44.3%), pulpitis (41.7%), and nummular hand eczema (40.9%), whereas allergic contact dermatitis dominated in vesicular types of hand eczema, with recurrent (35%) and few (24.2%) eruptions. Hyperkeratotic palmar hand eczema was the only clinical type that constituted a distinct subgroup; it was found most frequently in older men and had the strongest relationship, although not significant, with non-specific dermatitis.
The relationship between clinical type of hand eczema and aetiological diagnosis fitted with general experience, but no simple relationship was found. This emphasizes that patch testing and exposure analysis are mandatory. Hyperkeratotic palmar hand eczema was identified as a distinct clinical subtype.
Contact Dermatitis 07/2011; 65(1):13-21. · 3.51 Impact Factor
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ABSTRACT: Occupational hand eczema is common in hairdressers, owing to wet work and hairdressing chemicals.
To estimate the prevalence of hand eczema and its career consequences among hairdressers in Denmark.
A register-based study was conducted, comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self-administered postal questionnaire including questions on hand eczema, atopic dermatitis, and career change. A response rate of 67.9% (n = 5324) was obtained.
Of the respondents, 44.3% no longer worked as hairdressers and had worked for an average of 8.4 years in the profession before leaving it. Hand eczema was more common among ex-hairdressers (48.4%) than among current hairdressers (37.6%) (p < 0.0001), and significantly more ex-hairdressers (26.8%) than current hairdressers (15.7%) had chronic hand eczema (p < 0.0001). Of the respondents with hand eczema, 75% were aged 15-24 years at onset, and 45.5% gave hand eczema as a reason for career change. In this group, logistic regression analysis showed that chronic hand eczema contributed the most to the decision to change career (odds ratio 50.12; 95% confidence interval 18.3-137).
Hairdressers work an average of 8.4 years in the profession before leaving it, and hand eczema contributes significantly to this career change.
Contact Dermatitis 06/2011; 65(3):151-8. · 3.51 Impact Factor
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ABSTRACT: Allergic contact dermatitis is triggered by chemicals in the environment. Primary prevention is aimed at minimizing the risk of induction, whereas secondary and tertiary prevention are aimed at reducing elicitation.
To identify the elicitation doses that will elicit an allergic reaction in 10% of allergic individuals under patch test conditions (ED(10) patch test) for different allergens, and to compare the results with those for different allergens and with animal data indicating sensitizing potency from the literature.
The literature was searched for patch test elicitation studies that fulfilled six selected criteria. The elicitation doses were calculated, and fitted dose-response curves were drawn.
Sixteen studies with eight different allergens-methylchloroisothiazolinone/ methylisothiazolinone, formaldehyde, nickel, cobalt, chromium, isoeugenol, hydroxyiso hexyl 3-cyclohexene carboxaldehyde, and methyldibromo glutaronitrile-were selected. The median ED(10) value was 0.835 µg/cm(2). The ED(10) patch test values were all within a factor of 7 from the lowest to the highest value, leaving out three outliers. No obvious patterns between the sensitization and elicitation doses for the allergens were found.
We found a rather small variation in the ED(10) patch test between the allergens, and no clear relationship between induction potency and elicitation threshold of a range of allergens. This knowledge may stimulate thoughts on introducing a generic approach for limitations in exposure to well-known allergens.
Contact Dermatitis 06/2011; 64(6):337-42. · 3.51 Impact Factor
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ABSTRACT: Hairdressing apprentices have a high incidence of hand eczema. Most studies use self-reported hand eczema as a cost-effective method to estimate the prevalence of hand eczema. No validation studies on self-reported hand eczema among hairdressing apprentices exist.
To evaluate the validity of self-reporting of hand eczema among Danish hairdressing apprentices.
During their first 2 weeks of training, 502 hairdressing apprentices were enrolled in this study. All apprentices completed a self-administered questionnaire including questions regarding, for example, current hand eczema, and they were all clinically examined for hand eczema three times during the first part of their education by use of the Hand Eczema Severity Index. The validity of self-reporting of hand eczema was measured with the clinical examination as the gold standard.
The sensitivity of self-reporting of hand eczema was 70.3%, and the specificity was 99.8%. The positive predictive value was 96.3%, and the negative predictive value was 98.5%.
We found good agreement between self-reporting of hand eczema and clinical examination. There was good sensitivity and high specificity. Self-reporting of hand eczema among hairdressing apprentices is considered to be a valid method for estimating the prevalence of hand eczema, although it might underestimate the true prevalence.
Contact Dermatitis 05/2011; 65(3):146-50. · 3.51 Impact Factor
