Hand eczema and contact allergy in healthcare work

Abstract: Hand eczema is common in healthcare workers. Besides wet work, healthcare work also implies exposure to contact allergens. Occupational hand exposures have changed in recent years owing to implementation of hand hygiene procedures including an increased use of medical gloves. An increase of hand eczema caused by contact allergy to surgical gloves, in most cases owing to contact allergy to the rubber additive diphenylguanidine (DPG), was found in surgical theatre personnel (paper I). Most patients had worked with surgical gloves for decades, but their hand eczema was of recent onset. Contact allergy to DPG in medical gloves has previously been disputed, but in this study the presence of DPG in the patients' gloves was confirmed by chemical analysis. In a questionnaire study distributed to healthcare workers in Southern Sweden (paper II) a 1-year prevalence of hand eczema of 21% was found. After adjustment for confounding factors a dose-dependent association with hand eczema was found for daily number of hand washes with soap at work, and for time working with medical gloves. No association was found between hand eczema and use of alcoholic hand disinfectant.In a cross-sectional study healthcare workers with hand eczema were investigated (paper III). Occupational hand eczema was found in 62%. Of these 11% had occupational allergic contact dermatitis, in most cases caused by contact allergy to rubber glove additives. Occupational contact allergy to rubber additives was associated with sick-leave related to hand eczemaIn an experimental study factors influencing DPG release from a polyisoprene rubber glove was investigated (paper IV). Alcoholic hand disinfectant prior to glove donning increased the amount of DPG recovered from the hands. Within 10 minutes more than 80% of available DPG was released from the glove into artificial sweat. Compared to a nitrile glove, proportionally more DPG was released into artificial sweat from the polyisoprene glove