Richard Brans

Universität Osnabrück | UOS · Department of Dermatology

Occupational skin diseases (OSD) belong to the most common occupational diseases worldwide. However, there are clear indications for underdiagnosing and underreporting and thus, the magnitude of the problem is underestimated. The two most frequent OSD are occupational contact dermatitis (OCD) due to exposure to irritants and/or allergens and non-me...

Background: Benzisothiazolinone (BIT; CAS No. 2634-33-5) is used as a biocide in various products, including water-based paints, metalworking fluids, and household products. In recent years, increasing sensitization rates have been observed in Europe. Objective: To describe a time trend of sensitization to BIT, analyse concomitant reactions, and...

Indications for epicutaneous patch testing include the detection or exclusion of allergic contact dermatitis of the skin, transitional mucosa or oral mucosa, suspected delayed-type immune reactions to ingredients of implants, and certain drug reactions (maculopapular exanthema, symmetrical drug-related intertriginous and flexural exanthema [SDRIFE]...

Background: Occupational skin diseases have led the occupational disease statistics in Europe for many years. Especially occupational allergic contact dermatitis is associated with a poor prognosis and low healing rates leading to an enormous burden for the affected individual and for society. Objectives: To present the sensitization frequencies...

Introduction Healthcare workers (HCWs) constitute a high-risk group for developing occupational hand eczema (HE). The present systematic review and meta-analysis will compile and appraise evidence regarding prevalence and incidence of HE in HCWs. Methods and analysis Systematic searches will be performed in three electronic literature databases (P...

Linked Article: Christiansen et al. Br J Dermatol 2022; 187:988–996.

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...

Background: Occupational hand eczema (HE) is common among healthcare workers (HCWs) and has - in some regions of the world - increased during the COVID-19 pandemic due to related hygiene measures. Objectives: To evaluate the efficacy of an intervention for HE prevention in HCWs during the pandemic. Methods: A prospective, controlled, unblinded...

Background: Continual analyses of patch test results with the European baseline series (EBS) serve both contact allergy surveillance and auditing the value of included allergens. Objectives: To present results of current EBS patch testing, obtained in 53 departments in 13 European countries during 2019 and 2020. Methods: Anonymised or pseudony...

Background: Semipermeable gloves might be an alternative to cotton gloves in management of hand dermatoses. Objectives: To compare acceptance and tolerability of gloves made of cotton or a semipermeable Sympatex membrane in patients with hand dermatoses and their effect on skin lesions when worn overnight. Methods: 199 patients with work-relat...

Background: In Germany, a stepwise multidisciplinary approach has been established to prevent occupational skin diseases (OSDs), primarily occupational contact dermatitis. Objectives: To perform a systematic evaluation of the short- and long-term effects of the German secondary and tertiary individual prevention programmes (SIP and TIP) for OSD....

Background: Increased hand hygiene measures during the COVID-19 pandemic have led to an increased quantum of hand eczema (HE). Objectives: To examine the effects of varying washing frequencies using current mild cleansing agents - alongside with the effect of a rehydrating cream - on the epidermal barrier function and inflammatory processes of t...

Limonene and linalool are among the most common fragrance terpenes used in products of everyday life. They are pre‐haptens forming hydroperoxides (Lim‐OOHs, Lin‐OOHs) upon oxidation inducing frequent positive patch test reactions in patients with dermatitis. Still, they are not yet routinely tested in Europe. This review evaluates the patch testing...

Background: Hand eczema is a common inflammatory skin disorder. Health care providers need continuously updated information about the management of hand eczema to ensure best treatment for their patients. Objectives: To update the European Society of Contact Dermatitis guideline on the diagnosis, prevention, and treatment on of hand eczema. Met...

Protective gloves are an elementary component of personal protective equipment in many occupations and are intended to protect the hands from various hazards (e.g., wetness, chemicals, mechanical forces, or thermal stress). This is particularly important when other occupational safety measures (e.g., technical-organizational measures) cannot be imp...

Background There is a need for non-invasive biomarkers to assess in vivo efficacy of protective measures aiming at reducing ultraviolet radiation (UVR) exposure. Stratum corneum (SC) biomarkers showed to be promising markers for internal UVR dose and immune response. Purpose To establish a dose-response relationship for SC biomarkers and explore t...

Background: Glove liners (GLs) made of cotton (COT) are worn under impermeable gloves to prevent occlusion effects. Semipermeable GLs made of Sympatex (SYM) might be an alternative. Objectives: To evaluate the acceptance of GLs (COT/SYM) in health care workers (HCWs) with work-related skin diseases (WRSDs). Methods: 161 HCWs with WRSDs were as...

Introduction Painters and varnishers (“painters”) are exposed to various contact allergens and skin irritants, and therefore, at risk to develop occupational dermatitis (OD). Objective To describe the spectrum of occupational sensitizations in painters and revise corresponding current patch test recommendations. Patients and Methods Retrospective...

Background Patients taking part in a tertiary individual prevention programme (TIP) for work‐related skin diseases frequently suffer from chronic hand eczema (HE) for which alitretinoin is a treatment option. Objective To investigate treatment with alitretinoin before and during the TIP and related factors. Methods Data of 1614 patients taking pa...

Irritant contact dermatitis (ICD) is more common than allergic contact dermatitis (ACD). It ranges from acute irritant reactions to chronic forms, often morphologically indistinguishable from ACD. Numerous exogenous and endogenous factors are involved in the pathogenesis of ICD. Major irritants are water, detergents, and acidic and alkaline substan...

Background Patch test (PT) reactions to thiuram mix (TM) and fragrance mix (FM) I or II without concomitant reactions to their single constituents are potentially caused by the irritant properties of the mixes. Objective Comparing inflammatory profiles of PT reactions to TM, FM I, FM II, and their constituents and assessing their potential in disc...

Background It is recommended that patch‐test readings include a day (D)7 reading. Substitution of the D7 reading with a photo may be a valid option. Objectives To compare the sensitivity of digital photos at D7 to clinical readings, to assess the number of positive reactions appearing at D7 only (late reactions), and after D7 only (delayed reactio...

Occupational contact dermatitis (OCD) is common in hairdressers due to a great amount of wet work and substantial exposure to multiple irritants and allergens included in hairdressing products, such as shampoos, hair dyes, permanent wave, and bleaching agents. This results in a high prevalence of irritant and allergic contact dermatitis in hairdres...

Background: Clinical surveillance of the prevalence of contact allergy in consecutively patch tested patients is a proven instrument to continually assess the importance of contact allergens (haptens) assembled in a baseline series. Objectives: To present current results from the European Surveillance System on Contact Allergies (ESSCA), includi...

Background: A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates. Objectives: To evaluate the influence o...

Background Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials etc. Most large‐scale reports on contact allergy due to MWFs are more than 10 years old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to...

Background In Germany, a multi‐step approach has been established to prevent work‐related skin diseases (WRSD). Objectives To evaluate the effect of a secondary individual prevention program (SIP) in metalworkers with WRSD and to compare their characteristics with participants of a tertiary individual prevention program (TIP). Patients and Method...

Background Studies on patch testing with workplace materials and evaluation of current occupational relevance of positive patch test (PT) reactions are scarce in patients with occupational dermatitis (OD). Objectives To identify frequent sensitizations with occupational relevance and to determine the value of patch testing with workplace materials...

Background Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease. Its classification as a variant of psoriasis is controversial. Exogenous factors may affect PPP.Objectives Occupational aspects of PPP based on a retrospective evaluation of patient data are discussed.Methods Data from 1518 patients who took part in a tertiary preventi...

Background Clinical hand eczema trials measure a variety of outcome domains to determine the success of interventions. This considerably limits the comparability and overall confidence in the study results, and thereby the strength of recommendations for clinical practice. Objectives HECOS aims to develop a core outcome set (COS) for the standardi...

Kontaktekzeme der Hände zählen zu den häufigsten berufsbedingten Erkrankungen. Das persönliche Hautschutzverhalten, zum Beispiel die richtige Anwendung geeigneter Hautmittel und Schutzhandschuhe, trägt maßgeblich zur Wiederherstellung und Aufrechterhaltung der Hautgesundheit bei. Maßnahmen der gesetzlichen Unfallversicherungsträger zur sekundären I...

Linked Article: Madan et al. Br J Dermatol 2020; 183:462–470.

Background: Occupational skin diseases (OSD) are the most common work-related diseases in Germany and responsible for large individual and financial burdens. Therefore, a tertiary individual prevention programme (TIP) is offered to patients with severe OSD who are at increased risk of abandoning their profession. Objectives: To define cost-of-il...

Background: Metal work apprentices (MWA) frequently develop work-related hand eczema (HE). Objectives: To evaluate the effect of health education on incidence of work-related HE in MWA and and to assess confounding factors. Materials/methods: In a prospective controlled intervention study, 131 MWA received educational training on prevention of...

Background Fragrances are regarded as the most common contact allergens after nickel. In this context, the frequency of positive patch test reactions to fragrance mix is often presented as proof. According to EU regulation No. 1223/2009, 26 fragrances that are regarded as significant allergens have to be declared on cosmetic products.Objectives The...

Background: Metalworkers occupationally exposed to metals, tools, metalworking fluids (MWFs), technical oils, gloves, skin care products etc. frequently suffer from occupational dermatitis (OD). Objectives: To investigate occupational exposure and to identify relevant occupational sensitizers in metalworkers with OD, and to evaluate suitability...

Occupational exposure to solar UV radiation (SUVR), a Group 1 carcinogen according to the IARC classification is at high exposure levels in outdoor construction workers, usually above the suggested occupational limits. Furthermore, there are no regulations related to this exposure in the EU, except for the artificial UVR. Also, the use of the ICNIR...

Background: Methylisothiazolinone (MI) has caused an unprecedented epidemic of contact allergy in Europe and elsewhere. Subsequently, regulatory action has been taken, at least in Europe, aiming at reducing risk of MI sensitisation. Objective: To follow-up on the prevalence of contact allergy to MI in consecutively patch tested patients and asse...

Handekzeme können neben anlagebedingtem Ursprung auch Ausdruck eines beruflich oder außerberuflich bedingten irritativen oder allergischen Kontaktekzems sein. Dies bietet Ansatzpunkte für sich ergänzende Maßnahmen auf der Ebene der primären, sekundären und tertiären Prävention. Im Vordergrund steht dabei die Identifikation des/der Auslöser(s) mit n...

The considerable heterogeneity of outcomes and measurement instruments in hand eczema trials substantially limits the evidence synthesis concerning therapeutic and preventive interventions. Therefore, the Hand Eczema Core Outcome Set (HECOS) initiative is developing a core outcome set for future trials. The first objective was to identify outcomes...

Background Allergic contact dermatitis (ACD) is one of the most common occupational skin diseases (OSDs). Its prevalence and the causative allergens differ between occupations. Objectives To evaluate the prevalence of ACD and the pattern of patch test results of patients taking part in a tertiary individual prevention programme (TIP) for OSD in Ge...

Background Assessment of the clinical relevance of patch test reactions is an essential part of the diagnostic work‐up of patients with (occupational) contact dermatitis. However, final diagnostic information, particularly the clinical relevance of allergic patch test reactions, has hitherto been ill‐represented in clinical documentation systems (p...

Bei einem 30-jährigen Koch mit rezidivierenden verzögerten Angioödemen konnte anamnestisch und laborexperimentell als Ursache die Sensibilisierung gegen das Kohlenhydratepitop Galactose-alpha-(1,3)-Galactose (alpha-Gal) aufgedeckt werden. Mit der Diagnose einer verzögerten Anaphylaxie bei Sensibilisierung gegen alpha-Gal erfolgte aufgrund des beruf...

Background Occupational skin diseases (OSDs) are frequent in professions with exposure to skin hazards. Thus, a health educational intervention for apprentices of high-risk professions was conducted. It was the aim of this study to gain insight into possible effects of this intervention. Methods A one-time skin protection seminar was conducted in...

Background Irritant exposure may be a contributory cause or the sole cause of (occupational) hand dermatitis. However, the documentation of irritant exposures in clinical practice is not standardized. Objectives To examine the feasibility and usefulness of a form with different items addressing both occupational and non‐occupational irritant expos...

Hand eczema can be caused or aggravated by metals, especially in occupational settings. In particular, metal-induced allergic contact dermatitis of the hands should be considered in individuals with metal allergy. The most important metal allergens are nickel, cobalt and chromium. The level and type of exposure to these metals have substantially ch...

Introduction Occupational contact dermatitis (OCD) is one of the most frequent occupational diseases worldwide and very common among metal workers. The burden of disease is high due to its often chronic course and a high risk of work absenteeism and unemployment. The prerequisite for the development of OCD is work-related exposure to irritants and/...

Tobacco smoking is a major health risk factor which may influence the development and course of occupational skin diseases. So far, the results of studies investigating associations between tobacco smoking and the prevalence of hand eczema have been inconsistent, also in occupational settings. However, some studies indicate that hand eczema related...

Background: Squamous cell carcinoma (SCC) is among the most frequent types of cancer constituting a significant public health burden. Prevention strategies focus on limiting UV-exposure during leisure time. However, the relative impact of occupational and non-occupational UV-exposure for SCC occurrence is unclear. Objectives: To investigate the...

Contact sensitization is common and affects up to 20% of the general population. The clinical manifestation of contact sensitization is allergic contact dermatitis. This is a clinical expression that is sometimes difficult to distinguish from other types of dermatitis, for example irritant and atopic dermatitis. Several studies have examined the pa...

Background: Recent studies have demonstrated allergen-specific differences in the gene expression of inflammatory mediators in patch tested skin. Objectives: To determine levels of various inflammatory mediators in the stratum corneum (SC) after patch testing with common contact allergens and the skin irritant sodium lauryl sulfate (SLS). Metho...

Objective: The aim of this study was to explore the tape strip sampling technique in the assessment of stratum corneum levels of inflammatory mediators in a clinical trial setting. Methods: Thirty-eight inflammatory mediators were analyzed by a multiplex-assay in the stratum corneum, collected by adhesive tapes before and after 6 weeks of therap...

Objectives To evaluate the prevalence of colonisation with methicillin-resistant Staphylococcus aureus (MRSA), associated factors and the effectiveness of decolonisation procedures among nurses with occupational skin diseases (OSD). Methods In a retrospective cohort study, the medical records of 319 nurses from Germany who were screened consecutive...

Background: Hereditary factors may influence individual susceptibility to contact allergy (CA). Objectives: To investigate genetic variants with impacts on early inflammatory reactions and T cell functions that possibly increase the risk of CA. Patients and methods: Three hundred and seventy two patients undergoing patch testing were recruited...

Background/purpose: Urocanic acid (UCA) absorbs ultraviolet (UV)B radiation in the epidermis which may interfere with phototherapy. Therefore, the influence of individual levels of UCA on immune reactivity and vitamin D synthesis induced by narrowband UVB radiation was assessed. Methods: 28 subjects with irritant contact dermatitis of the hands...

Background: A tertiary individual prevention programme (TIP) is offered to patients with severe occupational skin disease (OSD) in Germany. Previously, it was shown that the burden of OSDs is considerably reduced in patients up to 1 year after the TIP. Objectives: To evaluate the long-term effects of the TIP. Patients and methods: In a prospec...

Background: The risk of developing occupational skin diseases (OSDs) is high in hairdressers, but may differ between countries. Objective: To evaluate safety at work measures, and the prevalence and severity of skin symptoms and their impact on quality of life (QoL), among Croatian hairdressing apprentices. Methods: Data on self-reported skin...

Background: Skin cancer is the most common malignancy in Caucasian populations worldwide and ultraviolet radiation (UVR) is known for being the number one carcinogen. As, especially in outdoor workers, UVR is an inevitable carcinogen, the prevention and management of UVR-related skin cancers in these at-risk populations represent a collective chal...

Background: Hand eczema (HE) is the most common skin disease acquired at work. It presents in different clinical patterns. Objective: To classify different types of HE according to their clinical pattern and associated factors in patients taking part in a tertiary individual prevention programme (TIP) for occupational skin diseases. Methods: I...

Murine contact hypersensitivity (CHS) is a dendritic cell (DC)-dependent T cell mediated inflammation with CD8(+) T cells as effectors and CD4(+) T cells as regulators (Treg cells) that models human allergic contact dermatitis. The integrin αE(CD103) is expressed by some T cell and DC subsets and has been implicated in epithelial lymphocyte localiz...

Foot eczema often occurs in combination with hand eczema. However, in contrast to the situation with hand eczema, knowledge about foot eczema is scarce, especially in occupational settings. To evaluate the prevalence of foot eczema and associated factors in patients with hand eczema taking part in a tertiary individual prevention programme for occu...

Beim beruflich bedingten Handekzem handelt es sich um ein multifaktorielles Geschehen, an dem nicht nur exogene, sondern auch individuelle Faktoren beteiligt sind. Hierzu zahlen u. a. die atopische Disposition, genetische Polymorphismen und der Zigarettenkonsum. Die Identifikation von Personen mit erhohter Suszeptibilitat konnte dazu dienen, moglic...

Health care of patients with occupational dermatitis (OD) in the sense of suspected "BK 5101" is carried out in Germany within the optimized dermatologist's procedure and the "dermal intervention" (formerly: hierarchical multistep intervention approach) of the statutory accident insurance (UVT), respectively. Dermatologists and UVT administrators a...

Background: Hand eczema (HE) is a common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not yet been studied. Objectives: To evaluate relations between smoking status, severity and prognosis of occupational HE in patients taking p...

Hand eczema is a common, noninfectious skin inflammation restricted to the hands. The cause, localization, and morphology of hand eczema are heterogeneous. Endogenous factors impairing the skin barrier may be involved. Several studies have investigated associations between loss-of-function mutations in the gene encoding filaggrin (FLG) and hand ecz...

Hand eczema (HE) is often associated with a poor prognosis. A chronic course over years is frequently seen, particularly in occupational HE. The prognosis is influenced by internal and external factors, of which the most important are atopic dermatitis or atopy, contact sensitization, certain morphological features, the extent of the disease, socio...

Occupational contact dermatitis affects primarily the hands (90–95 %) and results from a complex interaction of exogenous factors (irritant or allergic) and predisposing endogenous factors like atopy or “sensitive skin.” Irritant factors play a causative role in up to 80 % of occupational skin diseases, primarily determined by “wet work” but also b...