职业性接触性皮炎二级预防方案的有效性。

Effectiveness of a secondary prevention protocol for occupational contact dermatitis.

作者信息

Mauro M, De Giusti V, Bovenzi M, Larese Filon F

机构信息

Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste, Italy.

出版信息

J Eur Acad Dermatol Venereol. 2017 Apr;31(4):656-663. doi: 10.1111/jdv.13947. Epub 2016 Sep 12.

DOI:10.1111/jdv.13947

PMID:27558199

Abstract

BACKGROUND

Occupational skin diseases are often responsible for sick leave or job changes, affect mostly young subjects, are costly to society and have been reported as significant predictor of unemployment.

OBJECTIVES

To assess, over time, the course of occupational hand dermatitis (OHD) after a specific training, by means of follow-up visits and TEWL measurement, to evaluate skin barrier integrity and if preventive measures for hand skin care provided may influence the course of the disease.

METHODS

Workers with a diagnosis of OHD from January 2011 to December 2013 were contacted by telephone, filled in a questionnaire (NOSQ-2002) and were invited to a training course on prevention of skin dermatitis, and to a new clinical evaluation with TEWL measurement. Workers who joined the training programme were asked to undergo a new evaluation after 3 months. A total of 65 subjects without contact dermatitis were recruited as control group.

RESULTS

One hundred and one subjects from 143 workers, who were contacted, filled in the questionnaire. Sixty-five of them followed the training course and underwent a new clinical evaluation withTEWL measurements. Ongoing symptoms of subjects decreased from 60.0% to 42.3% 3 months after the training, and the subgroup which strictly adhered to the recommendations given achieved better results (61.9% of symptoms improvement when compared to 29.0% obtained in subjects with partial adhesion to the protocol). TEWL values changed from 21.3 ± 9.6 to 18.6 ± 7.2 g/m²/h (P = 0.001) on the hands and from 16.6 ± 9.0 to 10.5 ± 4.6 g/m²/h (P = 0.001) on the forearm, confirming the skin barrier improvement.

CONCLUSIONS

Our secondary prevention intervention was effective, leading to a reduction in clinical signs of dermatitis. TEWL measurement is a useful tool to evaluate skin integrity, mostly in apparently healthy skin, which may have a compromised barrier function, resulting in an exacerbation of the dermatitis.

摘要

背景

职业性皮肤病常常导致病假或工作变动，主要影响年轻人群，对社会造成高昂成本，并且已被报道为失业的重要预测因素。

目的

通过随访和经皮水分流失（TEWL）测量，评估经过特定培训后职业性手部皮炎（OHD）随时间的病程，以评估皮肤屏障完整性，以及所提供的手部皮肤护理预防措施是否可能影响疾病病程。

方法

通过电话联系2011年1月至2013年12月期间被诊断为OHD的工人，让他们填写一份问卷（NOSQ - 2002），并邀请他们参加皮肤皮炎预防培训课程以及进行一次新的伴有TEWL测量的临床评估。参加培训项目的工人被要求在3个月后接受一次新的评估。总共招募了65名无接触性皮炎的受试者作为对照组。

结果

143名被联系的工人中有101名受试者填写了问卷。其中65人参加了培训课程并接受了伴有TEWL测量的新的临床评估。培训3个月后，受试者的持续症状从60.0%降至42.3%，严格遵守所给建议的亚组取得了更好的结果（症状改善率为61.9%，而部分遵守方案的受试者为29.0%）。手部的TEWL值从21.3±9.6变为18.6±7.2g/m²/h（P = 0.001），前臂的TEWL值从16.6±9.0变为10.5±4.6g/m²/h（P = 0.001），证实了皮肤屏障得到改善。