Scope and Efficacy of Preventive Measures in Contact Dermatitis
- 80 Downloads
Purpose of review
To describe the scope and review the efficacy of interventions to prevent contact dermatitis.
Universal measures to prevent contact dermatitis start at the population level with legislation regulating exposure to skin irritants and sensitizers. Primary measures include health education on skin care and protection, use of moisturisers and proper use of protective gloves. The overall epidemiological evidence regarding the efficacy of such preventive measures varies from low to moderate. Secondary prevention comprises the application of specific diagnostic procedures and early intervention. Tertiary prevention measures focus on medical, psychosocial, and occupational rehabilitation of patients with a chronic form. Education on risk factors and skin protection is an essential element at all the levels of prevention.
Evidence-based recommendations and international standards for prevention, diagnosis and management of contact dermatitis are available. The low evidence on the efficacy of several primary measures can be due to limitations in study designs and low comparability of the studies.
Stakeholders should address shortcomings of the current legislation. Randomised control trials studies including a homogenous assessment of the outcome measure, a longer follow-up and better adjustment for potential bias can enhance the current level of evidence for the efficacy of preventive measures.
KeywordsPrimary prevention Secondary prevention Tertiary prevention Occupational Legislation Moisturisers Gloves Legislation
The author is grateful to Benedicte Mohr, librarian at the National Institute of Occupational Health, Norway (STAMI) for the assistance with the systematic review of the literature.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• GBD 2016. Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–59 Present worldwide measures of occurrence and burden of disease.CrossRefGoogle Scholar
- 2.• Diepgen TL, Ofenloch RH, Bruze M, Bertuccio P, Cazzaniga S, Coenraads PJ, et al. Prevalence of contact allergy in the general population- prevalence and main findings. Br J Dermatol. 2016;174:312–29 First population-based study to show prevalence figures of contact allergy among several European countries.CrossRefGoogle Scholar
- 3.• European Agency for Safety and Health at Work. Occupational skin diseases and dermal exposure in the European Union (EU-25): policy and practice review. 2008.Google Scholar
- 5.•• Nicholson PJ, Llewellyn D, English JS, on behalf of the Guidelines Development Group. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis. 2010;63:177–86 Evidence-based recommendations for the management of occupational contact dermatitis and urticaria.CrossRefGoogle Scholar
- 6.•• Alfonso JH, Bauer A, Bensefa-Colas L, Boman A, Bubas M, Constandt L, et al. Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe. Position paper of the COST Action StanDerm (TD 1206). J Eur Acad Dermatol Venereol. 2017;31:31–43 Consensus-based standards on prevention focusing on the primary, secondary and tertiary prevention of work-related and occupational hand dermatitis. It defines unmet needs for prevention.CrossRefGoogle Scholar
- 8.•• Julander A, Boman A, Johanson G, Lidén Carola. Occupational skin exposure to chemicals. Arbete och Hälsa (Work and Health) Scientific Serial. 2018; 52(3). http://hdl.handle.net/2077/56215. Accessed on 10.07.2018.Gives an overview of the current legislation to reduce occupational skin exposure to chemicals, its shortcomings, methods to assess skin exposure, and recommendations for future research.
- 9.ECHA. Guidance on the application of the CLP criteria. Guidance to Regulation (EC) No 1272/2008 on classification, labelling and packaging (CLP) of substances and mixtures. Version 5.0 July 2017. Helsinki, Finland: European Chemicals Agency, 2017.Google Scholar
- 10.European Parliament and Council of the European Union. Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures, amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/2006. 2008R1272 — EN — 01.06.2015 — 005.001 — 1. http://eur-lex.europa.eu/legalcontent/ EN/TXT/PDF/?uri = CELEX:02008R1272–20,150,601&from = E (accessed August 2018). Brussels, Belgium: European Parliament and Council of the European Union, 2015.
- 11.NIOSH. Current intelligence bulletin 61: a strategy for assigning new NIOSH skin notations. 80 pp. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 2009.Google Scholar
- 12.European Parliament and the Council of the European Union. Regulation (EC) No 1907/2006 of the European Parliament and of the Council of 18 December 2006 concerning the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH), establishing a European Chemicals Agency, amending Directive 1999/45/EC and repealing Council Regulation (EEC) No 793/93 and Commission Regulation (EC) No 1488/94 as well as Council Directive 76/769/EEC and Commission Directives 91/155/EEC, 93/67/EEC, 93/105/EC and 2000/21/EC. 2006R1907 — EN — 01.06.2015 — 023.001 — 1 http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2007:136:0003:0280:EN:PDF/ (accessed August 2018). Brussels, Belgium: European Parliament and the Council of the European Union, 2015.
- 13.• Schwensen JF, Bregnbak D, Johansen JD. Recent trends in epidemiology, sensitization and legal requirements of selected relevant contact allergens. Expert Rev Clin Immunol. 2016;12:289–300. https://doi.org/10.1586/1744666X.2016.1120159 Summarise the impact of legislation on the occurrence of sensitization and contact allergy of the most common allergens.CrossRefPubMedGoogle Scholar
- 15.European Commission. Commission Regulation (EU) No 301/2014 of 25 March 2014 amending Annex XVII to Regulation (EC) No 1907/2006 of the European Parliament and of the Council on the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) as regards chromium VI compounds (Text with EEA relevance). Official Journal of the European Union L 90/1, 26.3.2014.Google Scholar
- 19.EUR-Lex - 32017R1224 - EN - EUR-Lex [Internet]. http://eur-lex.europa.eu/legal-content/PT/TXT/?amp;toc = OJ%3AL%3A2017%3A174%3ATOC&uri = uriserv%3AOJ.L_.2017.174.01.0016.01.ENG. Accessed August 23, 2018.
- 25.European Commission. Commission decision of 17 March 2009 requiring Member States to ensure that products containing the biocide dimethylfumarate are not placed or made available on the market (notified under document number C(2009) 1723) (Text with EEA relevance) (2009/251/EC). Official Journal of the European Communities L 74/32, 20.3.2009.Google Scholar
- 29.European Parliament and the Council of the European Union Regulation (EC) No 648/2004 of the European Parliament and of the Council of 31 March 2004 on detergents. 2004R0648 — EN — 19.04.2012 — 006.001 — 1. http://eur-lex.europa.eu/legalcontent/ EN/TXT/PDF/?uri = CELEX:02004R0648–20,120,419&from = EN (accessed August 2018). Brussels, Belgium: European Parliament and the Council of the European Union, 2012.
- 30.European Parliament and the Council of the European Union. Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 on cosmetic products (recast). 2009R1223 — EN — 16.04.2015 — 006.001. http://eur-lex.europa.eu/legalcontent/ EN/TXT/HTML/?uri = CELEX:02009R1223–20,150,416&from = EN (accessed October 2017). Brussels, Belgium: European Parliament and the Council of the European Union, 2015.
- 33.BAuA. Risks resulting from skin contact - identification, assessment, measures. TRGS 401.Technical rules for hazardous substances. https://www.baua.de/EN/Service/Legislative-textsand-technical-rules/Rules/TRGS/TRGS-401.html (accessed May 2018). Dortmund, Germany: Committee on Hazardous Substances (AGS), Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (Federal Institute for Occupational Safety and Health), 2011.
- 36.•• Bauer A, Rönsch H, Elsner P, Dittmar D, Bennett C, Schuttelaar MLA, et al. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD004414. DOI: https://doi.org/10.1002/14651858.CD004414.pub3. Latest systematic review on the efficacy of primary interventions to prevent occupational irritant hand dermatitis.
- 37.Alfonso JH. Preventive measures for occupationally induced immediate contact reactions. In: Giménez-Arnau A, Maibach H, editors. Contact urticaria syndrome. Updates in Clinical Dermatology. Cham: Springer; 2018.Google Scholar
- 42.•• Jacobsen G, Carstensen O, Rasmussen K, Bregnhøj A. Review of causes of irritant (toxic) contact eczema after occupational skin exposure. The Danish Working Environmental Research Fund 2018 Available: https://www.aes.dk/-/media/A9A3BE8A7DCF40CDBBE5638A5013E98D.ashx. Last access: 11.09.2018. A systematic review on causative agents of irritant contact dermatitis due to skin exposures at work.
- 44.Suleiman AM. Assessment of suitability of disposable gloves for handling of cleaning chemicals with extreme pH values. Saf Sci. 2018; In press.Google Scholar
- 45.• Lachapelle JM, Gimenez-Arnau A, Metz M, Peters J, Proksch E. Best practices, new perspectives and the perfect emollient: optimising the management of contact dermatitis. J Dermatolog Treat. 2018;29:241–51. https://doi.org/10.1080/09546634.2017.1370074 Review the importance of emollients in both primary and secondary prevention of contact dermatitis. Gives perspectives for future research for the “ideal” emollient.CrossRefPubMedGoogle Scholar
- 47.Arbogast JW, Fendler EJ, Hammond BS, Cartner TJ, Dolan MD, Ali Y, Maibach HI. Effectiveness of a hand care regimen with moisturiser in manufacturing facilities where workers are prone to occupational irritant dermatitis. Dermatitis 2004:15:10–17.Google Scholar
- 48.• Hines J, Wilkinson SM, John SM, Diepgen T, English J, Rustemeyer T, et al. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol. 2017;31:53–64 Suggest a practical model for use of moisturisers in the workplace based on current evidence of mechanisms and prevention.CrossRefGoogle Scholar
- 58.•• Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, et al. Guidelines for diagnosis, prevention and treatment of hand eczema–short version. J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG 2015: 13:77–85. An essential guideline for the medical treatment of hand dermatitis.Google Scholar
- 60.•• van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen APM, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews 2017: Issue 2. Art. No.: CD012119. DOI: https://doi.org/10.1002/14651858.CD012119.pub2.
- 61.Mason JM, Carr J, Buckley C, Hewitt S, Berry P, Taylor J, et al. Improved emollient use reduces atopic eczema symptoms and is cost neutral in infants: before-and-after evaluation of a multifaceted educational support programme. BMC Dermatol. 2013;7:13.Google Scholar
- 62.Oakley R, Lawton S. Views on unwanted effects of leave-on emollients and experiences surrounding their incidence. Dermatol Nurs. 2016;15:38–43.Google Scholar
- 65.• Skudlik C, Wulfhorst B, Gediga G, Bock M, Allmers H, John SM. Tertiary individual prevention of occupational skin diseases: a decade’s experience with recalcitrant occupational dermatitis. Int Arch Occup Environ Health 2008: 81: 1059–1064. A clinical model with interventions for medical, psychosocial and occupational rehabilitation of occupational chronic dermatitis.CrossRefGoogle Scholar
- 66.Mahler V, Aalto-Korte K, Alfonso JH, Bakker JG, Bauer A, Bensefa-Colas L, et al. Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries. J Eur Acad Dermatol Venereol. 2017;31(Suppl. 4):12–30. https://doi.org/10.1111/jdv.14316.CrossRefPubMedGoogle Scholar