Review of causes of irritant (toxic) contact eczema after occupational skin exposure (Udredning af årsager til irritativt (toksisk) kontakteksem efter erhvervsmæssig udsættelse for irritative påvirkninger af huden) Afslutningsrapport Forfattere: Gitte Jacobsen, Ole Carstensen, Kurt Rasmussen (Arbejdsmedicin Herning) og Anne Bregnhøj (Dermatologisk afdeling Aarhus Universitetshospital) Arbejdsmedicin Herning Hospitalsenheden Vest "Review of causes of irritant (toxic) contact eczema after occupational exposure” Title: Review of causes of irritant (toxic) contact ec- zema after occupational skin exposure. Danish title: Udredning af årsager til irritativt (tok- sisk) kontakteksem efter erhvervsmæssig udsættelse for irritative påvirkninger af huden Project number: 20150018092/3 Prepared by: Gitte Jacobsen, Senior Consultant, PhD, Ole Carstensen, Senior Consulant, Head of Department, Kurt Rasmussen, Associate professor, PhD, (Depart- ment of Occupational Medicine, Herning) and Anne Bregnhøj, Senior Consultant PhD (Department of Dermatology, Aarhus University Hospital) Marianne Kyndi, MD, PhD and Rasmus Boe Mortensen, MD have contributed to the literature selection External reviewers: Marléne Isaksson, Head of Department, Professor, PhD (Department of Occu- pational and Environmental Dermatology, Skåne Uni- versity Hospital, Lund University), Thomas L. Diepgen, Medical Director, Professor, DMedSc (Department of Clinical Social Medicine, Occupational and Environmen- tal Medicine, University Hospital Heidelberg) Financed by: The Danish Working Environmental Re- search Fund Department of Occupational Medicine, University Clinic, Herning 2 "Review of causes of irritant (toxic) contact eczema after occupational exposure” Content Foreword ....................................................................................... 7 Dansk resumé ................................................................................ 9 Abstract ...................................................................................... 14 Abbreviations ............................................................................... 16 Background .................................................................................. 17 Introduction ................................................................................................... 17 Objectives ..................................................................................................... 17 The outcome of investigation ........................................................................... 18 Definition of ICD and irritant HE ............................................................ 18 The Exposures ............................................................................................... 21 Definition of wet work.......................................................................... 21 Descriptive epidemiology of OICD ..................................................................... 21 Individual competitive-, pre-existing diseases and risk factors ............................. 23 Atopy, filaggrin mutations and other genetic factors ................................ 23 Previous Hand Eczema ......................................................................... 24 Sex ................................................................................................... 24 Age ................................................................................................... 24 Smoking ............................................................................................ 25 Non-occupational exposures to irritants ................................................. 25 Background Tables ......................................................................................... 26 Table 1 .............................................................................................. 26 Table 2 .............................................................................................. 26 Table 3 .............................................................................................. 27 Table 4 .............................................................................................. 28 Table 5 .............................................................................................. 29 Material and methods .................................................................... 30 Literature search ............................................................................................ 30 Inclusion criteria ............................................................................................ 30 Data assessment: extraction, quality, bias and confounding ................................ 31 Department of Occupational Medicine, University Clinic, Herning 3 "Review of causes of irritant (toxic) contact eczema after occupational exposure” Results ........................................................................................ 33 Selection of papers ......................................................................................... 33 Fig. 1 Results from database search ...................................................... 33 Fig. 2 Inclusion and exclusion of articles found by the systematic database search ...................................................................................................... 34 Overall study characteristics ................................................................. 35 Wet work exposure ......................................................................................... 36 Design ............................................................................................... 36 Exposure source and measure .............................................................. 36 Outcome ............................................................................................ 37 Confounding ....................................................................................... 38 Quality of the studies .......................................................................... 38 Results .............................................................................................. 39 Conclusion ......................................................................................... 40 Exposure to disinfectants and detergents/soaps ................................................. 41 Design ............................................................................................... 41 Exposure source and measure .............................................................. 41 Outcome ............................................................................................ 41 Confounding ....................................................................................... 42 Quality of the studies .......................................................................... 42 Results .............................................................................................. 42 Supplementary evidence ...................................................................... 43 Conclusion ......................................................................................... 43 Exposure to gloves ......................................................................................... 44 Design ............................................................................................... 44 Exposure source and measure .............................................................. 44 Outcome ............................................................................................ 44 Confounding ....................................................................................... 44 Quality of the studies .......................................................................... 45 Results .............................................................................................. 45 Supplementary evidence ...................................................................... 46 Conclusion ......................................................................................... 47 Metals, metalworking fluids and grease ............................................................. 48 Design ............................................................................................... 48 Exposure, source and measure ............................................................. 48 Department of Occupational Medicine, University Clinic, Herning 4 "Review of causes of irritant (toxic) contact eczema after occupational exposure” Outcome: .......................................................................................... 49 Confounding ....................................................................................... 49 Quality of the studies .......................................................................... 49 Results .............................................................................................. 50 Conclusion ......................................................................................... 50 Mechanical exposures ..................................................................................... 51 Design ............................................................................................... 51 Exposure, source and measure: ............................................................ 51 Outcome ............................................................................................ 51 Confounding ......................................................................................