Undesirable effects from latex gloves in hospital health-care personnel

The high incidence of occupational hand dermatitis in hospital employees and the increased number of reports on cutaneous, mucosal and systemic reactions connected with a widespread USE: OF GLOVES induced us to investigate the prevalence of undesirable effects caused by latex gloves and the possible risk factors. We distributed a self-administered questionnaire, elaborated by us. to 1030 Perugia Monteluce Hospital employees who usually used latex gloves at work. The questionnaire was returned by 922 (476 females and 446 males; mean age. 38.7 years). The subjects who reported atopy and/or undesirable glove reactions were interviewed and clinically examined. Of these, 128 (13.9%) had presented or still had glove problems and therefore were submitted to skin tests (patch and prick tests) and when negative, to use test. Our results showed that the large majority of skin complaints from gloves was caused by irritation rather than by allergy. Predisposing factors of irritant contact dermatitis (CD), which was present in 13.1% of the subjects investigated, were female sex. age under 31 years, cleaning activity mainly when carried out in the Held of internal medicine, and atopie constitution. The most common causative factors, investigated with two substitute latex gloves in 64 of the 120 patients affected by irritant CD, were cornstarch powder and perhaps latex proteins. Even if allergic skin disorders from latex gloves were rare in our unselected group (allergic CD: 0.5%-, contact urticaria: 0.3%), more attention should be given to IgE-mediated disorders since they may be a life threatening problem.     

Referral pattern of skin diseases in an acute outpatient dermatological clinic in Copenhagen

The referral pattern of acute dermatologic conditions is not well described in either outpatients or hospitalized patients. The aim of this study is to describe in more detail the skin diseases that were referred for evaluation in an acute outpatient clinic at Bispebjerg Hospital, Copenhagen. In a 3-month period in 2003 a total of 428 consecutive new patients were referred for various skin diseases that needed subacute and acute dermatological evaluation in a university hospital setting. Referral pattern, age ratio and sex ratio were examined retrospectively. Two hundred and twenty-five (53%) of the 428 patients were referred from other hospital clinics in the local area. Sixty-six (15%) were referred from private practising dermatologists and 64 (15%) from general practitioners in the City of Copenhagen. Referral information was not noted in 35 (8%) of the 428 patients. The most prevalent diagnoses were: unspecified eczema (10.7%), drug eruptions (6.3 %), psoriasis (6.3%), atopic dermatitis (5.6%), bacterial skin infections (4.0%), inflammatory skin disorders (3.7%), seborrhoeic dermatitis (3.5%), urticaria (3.0%), seborrhoeic keratosis (3.0%), toxic contact dermatitis (2.8%), ulcus cruris (2.8%), autoimmune diseases (2.8%), malignant skin tumours (2.5%), candidiasis (2.5%), pruritus/prurigo (2.5%) and viral skin infections (2.5%). The fact that drug eruptions are one of the leading causes of acute referral conditions probably reflects the proximity to other hospital settings, where a large number of patients receive several systemic medicaments for various conditions.     

The spectrum of skin disorders in abdominal stoma patients

BACKGROUND: Skin integrity is essential for the normal usage of a stoma appliance. However, there is little published on the prevalence, nature or management of stoma-related skin disorders. Objectives To document stoma-related skin disorders in a large cohort of patients. METHODS: We sent a postal questionnaire to all surviving patients who had had abdominal stoma surgery at Hope Hospital, Salford, U.K. in the 10 years from 1 January 1989. Those reporting skin disease were invited to attend a clinic run by a dermatologist and a stoma-care specialist nurse. All lesions were categorized and swabs taken for microbiological examination. RESULTS: Of 525 surviving patients, 325 (62%) replied to the questionnaire. Of these, 73% reported a skin problem that had affected normal stoma bag use. Dermatoses included irritant reactions, particularly from leakage of urine or faeces (42%); pre-existing skin diseases, principally psoriasis, seborrhoeic dermatitis and eczema (20%); infections (6%); allergic contact dermatitis (0.7%) and pyoderma gangrenosum (0.6% annual incidence). A further 15% of patients with skin problems had persistent or recurrent dermatitis not explained by allergy, frank infection or faecal irritation. This responded to short-term treatment with topical corticosteroids. Further investigation is under way into its pathogenesis. CONCLUSIONS: Skin disorders are common in stoma patients, and various patterns can be recognized and effectively treated.     

Change in pattern of skin disease in Kaduna, north-central Nigeria

BACKGROUND: We report our experience on the pattern of skin disease in Kaduna, north-central Nigeria over a 6-year period, and compare it with a similar survey conducted in the same area 30 years ago and with surveys from Nigeria and from other parts of Africa. METHODS: The medical records of new patients attending the dermatology outpatient clinics of Barau Dikko Specialist Hospital and Habbat Medical Center from March 2000 to December 2005 were retrieved. Demographic data (age and sex) and the diagnoses of skin disease were extracted and analyzed. RESULTS: A total of 5982 cases was seen. Forty-nine per cent were males and 51% were females. One-third of the patients were aged under 20 years, and three quarters were aged below 40 years. Eczematous dermatitis was the most common skin disorder seen, making up 35% of cases, and had replaced dermatophyte infections and scabies, which were the most dominant skin diseases 30 years previously (now constituting 6% and 1.4% of cases, respectively). Atopic dermatitis had more than doubled in frequency (13.8% vs. 5.2%), and contact dermatitis had tripled in frequency (5.8% vs. 1.8%). Acne vulgaris (6.7%), pigmentary disorders (3.9%), urticaria (3.6%), papular urticaria (3.6%), hair disorders (3.3%), lichen simplex chronicus (3%), viral warts (2.9%), and drug eruptions (2.7%) had also increased. Human immunodeficiency virus-related skin disease constituted 4.3% of cases, with pruritic papular eruption being the most common condition. CONCLUSION: These changes in skin disease can be attributed mainly to an increase in urbanization and improved socio-economic conditions.     

Skin problems in lower limb amputees: an overview by case reports

The stump in lower limb amputees is prone to skin problems because it is exposed to several unnatural conditions (shear and stress forces and increased humidity) when a prosthesis is used. This study reviews the literature on case reports of lower limb amputees with skin problems on the stump. In total, 56 reports comprising 76 cases were identified in the literature. The main disorders are acroangiodermatitis, allergic contact dermatitis, bullous diseases, epidermal hyperplasia, hyperhidrosis, infections, malignancies and ulcerations.     

Pattern of skin diseases among migrant construction workers in Mangalore

BACKGROUND: With increasing industrialization, the construction industry provides employment to a large number of skilled and nonskilled workers, many of them migrant workers. AIM: This study was undertaken to provide epidemiological data regarding various dermatoses among migrant construction workers in India as currently there is a paucity of the same. METHODS: One thousand construction workers, including 467 migrant laborers, were examined for various dermatoses. RESULTS: Most (88%) workers were males and 51.17% were in their third decade. Infective and noninfective dermatoses were seen in 89.72% and 53.74% of laborers respectively. Among infective dermatoses, fungal infections were the most common (46.25%) ones, followed by bacterial infections (24.83%), scabies (8.56%) and viral infections (6.42%). Contact dermatitis to cement was seen in 12.48% of the laborers. Masons had a significantly higher incidence of contact dermatitis to cement, viral infections and scabies than helpers. CONCLUSIONS: The pattern of dermatoses is an expression of poverty, overcrowding and the occupational hazards of the construction industry.     

The relevance of patch testing in peristomal dermatitis

Summary Background Skin disorders are a common problem for ostomates, resulting in more than a third of visits to a stoma nurse. Irritant reactions, particularly irritant contact dermatitis, are the most frequently seen, accounting for > 50% of problems in some studies. Objectives To report our experience in patch testing for peristomal dermatitis. Methods All patients were identified from our database of the skin‐stoma clinic. Patch testing to various chemicals was performed and results analysed. Results From a total of 850 stoma patients in the combined clinic, 149 patients were patch tested. Only seven patients (4·7%) had positive reactions of current, proven relevance, none of which was related to constituents of the stoma appliances themselves. Most of the relevant allergens were preservatives and fragrances. Conclusions The symptoms and clinical appearances of allergic contact dermatitis and irritant contact dermatitis are similar in the occluded peristomal environment and are therefore difficult to distinguish on clinical grounds alone. Allergy is a relatively infrequent cause of peristomal dermatitis despite the continual exposure of skin to the components of cleansers, medicaments, other accessories and the stoma bag systems themselves.     

Skin disorders in chronic psychiatric illness

Background Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. Objective To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. Methods Ninety‐one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin. Results Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40–49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38–39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67–24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34–10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation. Conclusions Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.     

Skin conditions in instrumental musicians: a self-reported survey

Background:  Instrumental musicians are a risk group for a variety of skin conditions.
Objectives:  To determine the frequency and risk factors of instrument-related skin disorders in musicians.
Method:  We mailed an 11-item survey to 19 German universities of music and performing arts.
Results:  412 musicians returned the completed questionnaire, of whom 21.6% (89/412) had an instrument-related skin disorder including callosities (52/89; 58.4%), contact dermatitis (CD; 17/89; 19.1%), fiddler's neck (17/89; 19.1%), and erosion (3/89; 3.4%). Allergic CD (13/17; 76.5%) was most frequently reported in violinists and violists. Of 116 violinists and violists, 17 (14.7%) suffered from fiddler's neck. String and plucking instrumentalists most frequently reported callosities (61/89; 68.5%) and skin problems (32/37; 86.5%). Instrument-related skin disorders were significantly associated with high practice frequencies ( P  = 0.022) and a professional status ( P  = 0.001).
Conclusions:  Callosities and CD were the most commonly reported skin changes in the respondents. Both callosities and skin problems such as CD and fiddler's neck are significantly associated with high practice frequencies and professional status. Our data indicate that among those returning the questionnaires, string players and plucking instrumentalists seem to be at highest risk of developing skin problems when compared with players of other musical instruments.     

Skin diseases in rural Nyala,Sudan (in a rural hospital,in 12 orphanages,and in two refugee camps)

Skin diseases are considered to be common in Nyala, Sudan. This study was carried out to verify the prevalence of skin diseases in Nyala. This prospective observational study included skin examination of a total of 1802 people: 620 patients who were evaluated in the outpatient clinics (OC) and 1182 people from orphanages and refugee camps (ORC) in Nyala, Sudan. χ² test was used. The total prevalence of skin disorders in the sample was 92.6% (1670/1802). One thousand and fifty of 1182 (88.8%) people from ORC had a skin disorder. The most common skin diseases in this community were: fungal infections (32.6%), dermatitis/eczema (10.5%), bacterial skin infections (10.3%), disorders of skin appendages (8.7%), parasitic infestations (7.7%), atrophic skin disorders (7.4%), disorders of pigmentation (7.4%), hypertrophic skin disorders (6.4%), viral infections (5.8), benign neoplasm (1.9%), dermatoses due to animal injury (0.4%), bullous dermatoses (0.1%), and malignant neoplasm (0.1%). Hypertrophic and atrophic disorders of the skin were mainly lesions of scarification (mostly atrophic) (5.7%) and keloids (5.6%). Fungal infection, bacterial infection, and parasitic infestation were more common in the ORC group, while dermatitis and eczema, disorders of skin appendages, hypertrophic and atrophic disorders of the skin, disorders of pigmentation, and benign neoplasm were more common in the OC group. The prevalence of skin diseases in the rural Nyala was more than our expectation and was dominated by infectious skin diseases. In addition, infectious skin diseases were more common in ORC rather than OC.     

Epidemiology of skin disorders in Ethiopian children and adolescents: an analysis of records from the Italian Dermatological Centre, Mekelle, Tigray, Ethiopia, 2005 to 2009

Skin disorders are an important problem in children living in developing countries, but only a few epidemiologic investigations on pediatric dermatoses are available in the literature. Our study is an analysis of the range and frequency of skin diseases presenting to the Italian Dermatological Center in a pediatric Ethiopian population. A retrospective analysis was performed on 17,967 medical records of children aged 0 to 18 years attending the Italian Dermatological Centre in Mekele (Ethiopia) from January 2005 to December 2009. Infections and infestations accounted for 47% of the disorders seen; fungal infections were the most common (44.1%), followed by bacterial and parasitic diseases. Dermatitis constituted the second most common diagnostic category (24.7%) of the disorders seen, and contact dermatitis was the most common diagnosis (48.8%). Pigmentary disorders and disorders of skin appendages were more common in girls, whereas fungal and parasitic infections were more common in boys. Bacterial and parasitic infections were more common in children younger than 1 year old, fungal infections in those aged 1 to 5.9, and disorders of skin appendages and pigmentary disorders in those aged 15 to 18. These findings demonstrate that most of the disorders seen could be easily managed in clinical practice with appropriate skill development. It is crucial to ensure that training of medical students and pediatricians focuses on accurate recognition, diagnosis, and management of these common skin diseases and that families, teachers, health workers, and nurses be educated about the most common signs of prevalent skin diseases to help facilitate appropriate care.     

Occupational skin problems in construction workers

Background

Construction workers handle cement which has constituents to produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients, such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients, such as chromium).

Aim:

The present study has been carried out among unorganized construction workers to find the prevalence of skin problems.

Materials and Methods:

The present cross-sectional study was conducted in 92 construction workers of Ahmedabad and Vadodara.

Results and Discussion:

All the workers were subjected to clinical examination after collection of information regarding demographic characteristics, occupational characteristics and clinical history on a predesigned proforma. Of them, 47.8% had morbid skin conditions. Frictional callosities in palm were observed in 18 (19.6%) subjects while 4 (4.3%) subjects had contact dermatitis. Other conditions included dry, fissured and scaly skin, infectious skin lesion, tinea cruris, lesion and ulcers on hands and/or soles.

Conclusion

The skin conditions were common in the age group of 20–25 years, males, those having ≥1 year exposure and those working for longer hours. Half of the workers not using personal protective equipment had reported skin-related symptoms.     

PATTERN OF SKIN DISEASES AT THE NATIONAL SKIN CENTRE (SINGAPORE) FROM 1989–1990

At the National Skin Centre, 74,589 new attendances were seen from 1989 to 1990. The M:F ratio was 1:1. The majority of the patients belonged to the 20-39 year age groups (40%). Frequencies of psoriasis (20.4%) and alopecia (17.2%) were higher among Indians; exfoliative dermatitis was higher among Malays (19.72%); and insect bites were higher among Chinese (87%) [P less than 0.05] compared with ethnic distribution (9.9%, 7.6%, and 77.2% respectively) of NSC patient population. Dermatitis (34.2%) and acne (10.9%) were the most common skin disorders seen. The more common dermatoses seen in 1989/90 differ slightly from those reported in 1950s and 1980s; however, the frequencies of contact dermatitis, fungal infection, and insect bite reactions of 5.8%, 10.9%, and 7.6%, respectively, in 1980 have decreased to 4.7%, 5.4%, and 2.3%, respectively, in 1989/90. There was no seasonal variation in the frequency of various dermatoses except for psoriasis, which was more prevalent during the first quarters of 1989 and 1990. Our results showed that the pattern of skin diseases in Singapore is slowly approximating that of developed countries. The changes in the pattern of skin diseases are probably due to improved economic status, better education and hygiene, ready availability of dermatology services, as well as changes in occupational and environmental contactants over the last decade.     

Spectrum of skin diseases in Yemen (Hajjah and adjacent region)

BACKGROUND: Epidemiological study of skin diseases from Yemen is not available, although some data has been published from nearby Arab countries. OBJECTIVE: To determine the pattern of skin diseases in Yemen and particularly in Hajjah and nearby regions. METHODS: This is a prospective study and analysis of the consecutive new patients attending the Dermatology Clinic of Saudi Hospital at Hajjah, Yemen, from January 1997 to December 1999. The majority of the patients were from Hajjah and nearby regions but a substantial number of patients came from different distant regions of Yemen. The diagnosis was mainly based on clinical features but supported by laboratory investigations, diagnostic procedures and histopathology when needed. RESULTS: The total number of new patients was 13,840 with 14,259 diseases, with a male to female ratio of 1:0.81. Ninety-nine percent of the patients were Yemeni nationals. The leading group of diseases was dermatitis and eczematous disorders, followed by infections and infestations (including cutaneous leishmaniasis and mycetoma), followed by acne and acneiform disorders. CONCLUSION: The spectrum of skin diseases in this analysis revealed that more than 50% of the diseases belonged to dermatitis and eczematous disorders and infectious diseases groups. Socioeconomic and environmental factors of the region are responsible for this. Implementation of public health programs, a proper health education, and inclusion of a suitable training program of dermatology in the undergraduate medical studies of this country may help to prevent and manage these problems rationally.     

Occupational allergic contact dermatitis is more prevalent than irritant contact dermatitis: a 5-year study

BACKGROUND: Irritant contact dermatitis is thought to be the leading cause of occupational skin disease in the United States. Recent reports suggest otherwise. OBJECTIVES: The purposes of this study were to determine the prevalence of allergic and irritant forms of occupational contact dermatitis in the population seen at a Midwestern dermatologic referral clinic, report professions commonly affected by occupational skin disease, and indicate which substances are frequent allergens. METHODS: A retrospective analysis of patch test data collected at the University of Kansas between 1994 and 1999 was performed. RESULTS: Of 537 patients who underwent patch testing, 135 (25%) had occupational skin disease. Allergic contact dermatitis affected 81 (60%) patients, and irritant contact dermatitis was found in 46 (34%). Health care professionals, machinists, and construction workers accounted for nearly half of all patients with occupational skin disease. Nickel sulfate, glutaraldehyde, and thiuram mix were the most common allergens. CONCLUSION: Patch tests with a wider array of allergens than those currently available in the United States are needed to prevent misdiagnosis of occupational contact dermatitis.     

Environmental and occupational skin diseases in Taiwan.

This presentation focuses on the four most important skin diseases in Taiwan thought to be of environmental and/or occupational origin. The majority of work-related dermatoses are contact dermatitis patients. Among occupational contact dermatitis patients, 58.5% involved irritant and 41.5%, allergic dermatitis. Electronics, hairdressing, medical practice, and construction were the most important occupations causing contact dermatitis. An endemic occurrence of chronic arsenism causing hyperpigmentation, keratosis, and cancer has been reported in Taiwan. Arsenical skin cancers present as multiple lesions at different disease stages. The skin cancers are usually found in non-sun-exposed areas. UVB exerts an inhibitory effect on the proliferation of arsenical cancers; this may explain its non-sun-exposed nature. An outbreak of premalignant and malignant skin lesions was reported among paraquat manufacturers in 1985. The skin lesions were mainly distributed over the sun-exposed areas. Photodamage and photocarcinogenesis revealed a strong association with exposure to bipyridines among paraquat manufacturers. In 1979, a mass poisoning occurred in Taiwan from cooking oil contaminated by polychlorinated biphenyls (PCBs). Over 60% of patients were in grades O-II by the Japanese classification. The blood PCB levels of the Taiwanese patients were found to be higher than those of the Yusho subjects.     

Skin diseases in south-east Nigeria: a current perspective

BACKGROUND AND OBJECTIVE: The incidence of skin diseases in south-east Nigeria during the present decade was analyzed and compared with results from other parts of Nigeria, particularly those in the same zone, obtained more than 30 years ago. This study was carried out to update the recent clinical picture of skin diseases in our environment in view of the rapid development, urbanization and advances in the region. PATIENTS AND METHODS: Consecutive new patients seen at the dermatology clinic of the University of Nigeria, Teaching Hospital, Enugu, Nigeria, from February 1999 to March 2001 were included in this prospective study. Only cases seen and examined by the author were included in this study to ensure uniformity of diagnosis. RESULTS: A total of 2871 patients were observed within the study period. Adults accounted for 69.7% and were aged between 18 and 73 years, while the male:female ratio was 1.3:1. Allergic skin diseases (24.9%) were the commonest skin disorders identified, as opposed to infestations which accounted for an extremely high result of 33.7% (for the same region between 1968 and 1971). In second place was infections/infestations (19.1%). A reversal of picture was thus observed. Within the allergic disorders; eczemas/dermatitis were found to be the most prevalent followed by follicular (13.7%) and pigmentary disorders (11.1%). Sexually transmitted diseases and HIV/AIDs have increased significantly and accounted for 5.4%. Blistering diseases (1.1%) and malignancies (0.5%) occurred less frequently, similar to results found in recent decades for the same region. CONCLUSION: The current picture of skin diseases in south-east Nigeria has changed significantly from mere infections to allergic skin, follicular and pigmentary disorders. Cutaneous lesions secondary to STDs and HIV/AIDs have also increased. Skin lesions related to malnutrition, kwashiorkor and starvation were not observed nor were cutaneous tuberculosis, yaws or pediculosis, while blistering disorders and malignancies remained almost the same. The current picture is similar to that in other developing and Afro-Caribbean countries. Primary-care physicians and health-care providers in Nigeria/Africa need to be aware of the globally changing pattern of skin diseases in the region to enable the allocation of necessary resources (financial, material and human) to manage these skin diseases.     

The Spectrum of Skin Disease Among Indian Children

Abstract:   Skin diseases in children are encountered frequently and their characterization is essential for the preparation of academic, research and health plans. A retrospective study was designed to evaluate the epidemiologic features of pediatric dermatoses in India. The setting was a tertiary care referral center in India (Kalawati Saran Children's Hospital, New Delhi) during January 1997 to December 2003. A total of 30,078 children less than 12 years of age with 32,341 new dermatoses were recorded, with a male to female ratio of 1.07:1. Most of the disease was seen in the 1- to 5-year age group (44.94%). The most common skin diseases were infections and infestations (47.15%) consisting of bacterial infections (58.09%) and scabies (21.54%), followed by eczemas (26.95%), infantile seborrheic dermatitis, scabies, and pityriasis alba. Other unique dermatoses in our settings were papular uticaria (3.59%), miliaria (5.46%), postinflammatory pigmentary abnormalities (1.68%), and nutritional deficiency dermatoses (0.45%). A majority of patients were diagnosed clinically and special diagnostic tests were conducted in 2.6% of patients. The most common diagnostic test used was KOH mount (59.2%), followed by skin biopsy (39%). Nearly 90% of patients were seen without any referral and in the remaining, a majority were referred by pediatricians (75%). A majority of patients were diagnosed to have infection followed by dermatitis in our setting.