Rustemeyer T, Pilz B, Frosch P J
Hautklinik, Städtischen Kliniken, Dortmund.
Hautarzt. 1994 Dec;45(12):834-44. doi: 10.1007/s001050050182.
Based on reports in the literature, data from the information network of German dermatology centres (Informationsverbund Dermatologischer Kliniken) and the authors own findings, a review is presented on prevalence, clinical picture and causative agents of contact allergic dermatoses in health care professions. In 1991 the proportion of suspected occupational diseases in the health care professions (including hairdressers) represented by cases of dermatitis, as reported to the responsible insurance institution, reached 72% of the total for the year (7287 out of 10127). Every 20th to 40th case was recognized as an occupational dermatosis according to German law. Accurate figures on incidence are scarce; for dentists an incidence of 0.11% has been calculated. The risk of developing occupational hand eczema has been shown to be at least three times higher for nurses than for other so-called dry professions. For persons engaged in the personal care of the ill and the elderly, relevant occupational allergens were found to be benzalkonium chloride and aldehydes in disinfectants, as well as rubber accelerators such as thiuram mix. Latex contact urticaria has increasing significance for medical personnel, with prevalence rates of sensitization between 4.5% and 10.7%. Among physicians, contact allergies to thiuram mix were found to be dominant (12.9%). For surgeons and orthopaedic surgeons, methyl methacrylate as a constituent of bone cement is of great importance. Various esters of acrylic acid and methacrylic acid are important sensitizers in the dental professions, particularly in heavily exposed dental laboratory technicians. Only a few gloves protect against these types of sensitizers. Sensitizations by medicaments can be avoided in most cases by reducing direct skin contact, as practiced with penicillin or ispaghula powder. Strategies of prevention include information of atopics regarding the increase in occupational dermatitis, the regular use of barrier creams, intensive skin care after work and avoidance of irritants and allergens wherever possible.
基于文献报道、德国皮肤科中心信息网络（Informationsverbund Dermatologischer Kliniken）的数据以及作者自己的研究结果，本文对医疗行业中接触性过敏性皮肤病的患病率、临床表现和致病因素进行了综述。1991年，向负责的保险机构报告的医疗行业（包括美发师）中疑似职业病病例中，以皮炎病例所占比例达到当年总数的72%（10127例中的7287例）。根据德国法律，每20至40例病例中就有1例被认定为职业性皮肤病。关于发病率的准确数据很少；据计算，牙医的发病率为0.11%。研究表明，护士患职业性手部湿疹的风险至少是其他所谓“干性职业”的三倍。对于从事病人和老年人护理工作的人员，发现相关职业过敏原为消毒剂中的苯扎氯铵和醛类，以及秋兰姆混合物等橡胶促进剂。乳胶接触性荨麻疹对医务人员的重要性日益增加，致敏率在4.5%至10.7%之间。在医生中，对秋兰姆混合物的接触性过敏占主导地位（12.9%）。对于外科医生和骨科医生来说，作为骨水泥成分的甲基丙烯酸甲酯非常重要。丙烯酸和甲基丙烯酸的各种酯类是牙科行业中的重要致敏剂，尤其是在暴露程度高的牙科实验室技术人员中。只有少数手套能防止这些类型的致敏剂。在大多数情况下，通过减少直接皮肤接触，如使用青霉素或卵叶车前子粉时的做法，可以避免药物致敏。预防策略包括向特应性个体宣传职业性皮炎的增加情况、定期使用防护霜、下班后加强皮肤护理以及尽可能避免刺激物和过敏原。
