Exposure to skin irritants : Validation of questions and epidemiological aspects

Abstract: Hand eczema is common, and is the most frequent occupational skin disease. Exposure to skin irritants contributes to hand eczema. Common skin irritants are water, detergents, chemicals and foodstuffs. The aim of this thesis was to study exposure to skin irritants in the general population in relation to gender, age and occupation, and in individuals with and without hand eczema. A further aim was to validate questions regarding occupational exposure to skin irritants. In the first study, 182 individuals with hand eczema and 182 without hand eczema, matched for age and sex, participated in telephone interviews regarding exposure to skin irritants at work and during leisure time (Study I). In the second study a validation was performed of self-reported occupational exposure to water, chemicals, foodstuffs, gloves and hand washing, in five different occupations (Study II). Forty participants completed a questionnaire before the start of a working day and observers subsequently registered the exposure during the working day. In another study, a validation was performed as above, in 40 nurses/assistant nurses working in six different geriatric wards (Study III). The participants answered questions regarding exposure to water (frequency and total time of exposure), gloves, hand disinfection and moisturizers. Finally, in an epidemiological study, as part of a public health survey 18,267 gainfully employed individuals aged 18 64 years answered questions regarding occupational water exposure (Study IV). About 20 % of individuals in the general population reported occupational skin exposure to water (Study IV). Furthermore, 7 % reported exposure of more than 2 hours and 6 % of more than 20 times a day. Women reported more water exposure at work compared with men. The youngest group, aged 18 29 years, reported more water exposure than did the older groups. Eighty per cent of the population reported wet exposure during leisure time, for half an hour or more a day, and women were more exposed than men (Study I). Individuals who reported wet exposure at work also reported more wet exposure in their leisure time. No statistically significant differences were seen regarding exposure to water, hand washing or chemicals in individuals with and without hand eczema. The correlation between self-reports and observations regarding water, gloves and foodstuffs were strong, while they were moderate regarding hand washing. There was a tendency to overestimate all exposures (Study II). In nursing the correlations between self-reports and observations were strong for hand disinfection and moisturizers. They were moderate for frequency of water exposure and weak for total time of exposure to water (Study III). The nurses/nurse assistant nurses overestimated their exposures, to water in particular. In conclusion, one-fifth of the general population are occupationally exposed to water and half of the them are highly exposed. Wet exposure during leisure time is common and individuals with high water exposure at work also tend to have high wet exposure in their leisure time. Women have more wet exposure than men both at work and at leisure. Individuals with and without hand eczema seem to have similar exposure to skin irritants. Despite some tendency to overestimate the exposure in the validation studies, the questions are considered useful for surveying exposure to skin irritants.