contact dermatitis - american college of occupational and ... · occupational skin disease is a...

3/27/2015

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Occupational DermatologyPearls

Heather P. Lampel, MD, MPH, FAAD, FACOEM

Duke University

Assistant Professor of Dermatology and

Occupational and Environmental Medicine

May 3, 2015

Disclosures

I have no relevant financial relationships to disclose.

I will be discussing off-label use of patch testing and off-label treatment of contact dermatitis

I will mention companies

Objectives

Discuss the epidemiology of contact dermatitis in the occupational setting

Differentiate irritant from allergic contact dermatitis

Understand the role of patch testing in diagnosis

Highlight recently described allergens in the workplace

Review the trends in the occupational dermatitis literature 2014- present

Explore pitfalls and misconceptions in the workplace

Why should we care?

Occupational skin disease is a “hot” topic

Healthy People 2020

“Reduce occupational skin diseases or disorders among full-time workers”

ACOEM Core Competencies- Clinical Dermatology

OEM physicians can provide early recognition, diagnosis, and management …

Diagnose primary irritant-induced dermatoses

Differentiate occupational skin disorders…

Diagnose and determine the cause of allergic contact dermatitis …

Manage occupational and environmental skin injuries and dermatoses

Treat and prevent recurrence of contact dermatitis

Epidemiology of Occupational Contact Dermatitis

Contact Dermatitis

Contact dermatitis (CD) is reported to account for up to 30% of all occupational disease in industrialized nations

CD is the most common occupational skin disorder

About 90-95% of all cases of occupational skin diseases

Occupational CD Epidemiology United States

Incidence rate of 0.5-1.9 cases per 1000 full-time workers per year

US Bureau of Labor Statistics 2004 estimated 48,800 cases of Occupational CD

1 year prevalence estimate of 20%

21-22% in healthcare workers

Ibler et al., Contact Dermatitis 2012;67:200-207.

Luk et al., Contact Dermatitis 2011;65:329-335.

Occupational CD Epidemiology Denmark

Occupational CD

95% of all occupational skin cases

Irritant CD 70% of these Occupational CD

68% due to wet work

Caroe et al., Contact Dermatitis 70, 56-62.

Occupational Contact Dermatitis Epidemiology

True epidemiologic data are lacking

Likely underestimated due to underreporting

Mild cases specifically

Bureau of Labor Statistics has rigorous criteria for inclusion

May not be obviously work-related (delayed-onset)

Self-treated

Only requiring first aid excluded

Underestimated by 85-88%

Luckhaupt et al., Am J Ind Med 2012.


Survey of established cases of Occupational CD reported that over one year:

19.9% reported prolonged sick leave

23% reported job loss


1985 Mathias estimated annual costs of Occupational CD to be between $222 million and $1 billion

2004 NIOSH estimates $1.2 billion


Hands are usually involved

80-90% of cases

Great impact on quality of life

What percent of all contact dermatitis is allergic versus irritant?

Contact Dermatitis Overview

Irritant contact dermatitis accounts for 60-80% of all CD

Allergic contact dermatitis accounts for remaining 20-40%

Overlap common


ACD is a SPECIFIC immunologic reaction, requiring prior sensitization

Elliott G and Das PK. Using p-Phenylenediamine: A Gateway to Chemical Immunology. Journal of Investigative Dermatology (2010) 130, 641–643.

Immunology of Allergic Contact Dermatitis


90% of the population can be sensitized to certain antigens such as dinitrochlorobenzene


Irritant contact dermatitis is NONSPECIFIC

Requires no prior sensitization

Clinically can be difficult to distinguish ICD from ACD

Common Occupational Irritants

Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents


Frictional Dermatitis

Repetitive handling of objects or materials

Likely underappreciated

Examples

Fabric

Paper

Metal objects

Driving


Gloves

Prolonged contact with skin affects the epidermal barrier

May be irritant itself

May make epidermal barrier more susceptible to allergens or other irritants

Irritants- Recent Literature

Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)

Friis et al., Contact Dermatitis 71, 364-370.

Occupations

Occupations at High-Risk for Hand Dermatitis

Hairdressers

Musicians

Food Industry workers

Agricultural workers

Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders

Medical and Dental workers

Occupations at Risk for ICD

Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers


Occupations at Risk for CD- Denmark

Healthcare

Cleaning

Kitchen work


Epidemiology by Occupation

Shoe manufacturer

Indonesia

29% OCD point prevalence

Febriana et al., Int Arch Occup Environ Health 2014; 87.

Poultry processing and manual laborers

1 year prevalence 23% skin symptoms

Quandt et al., Am J Indust Medicine 2014; 57.

Construction Industry

25.4% point prevalence of hand skin symptoms

Timmerman et al., Am J Ind Med 2014; 57.

Healthcare workers

Dutch apprentice nurses followed prospectively

1 year period prevalence of hand eczema

23% in first year

25% in second year

31% in third year

Frequent hand washing at work, at home, and outside wet work job all risk factors

Visser et al., Contact Dermatitis 70, 44-55.

ACD vs ICD

Photo Quiz

Allergic or Irritant Contact Dermatitis?

Allergic or Irritant?

Irritant



Allergic


Irritant


Allergic


Allergic and Irritant

Debunking the myths…

CD Misconceptions

Allergy only develops to new exposures/products

CD Misconceptions


FALSE

Allergy can develop after years of using the same product

CD Misconceptions

If a change in chemical/product exposure does not clear the rash, that product is not etiologic

CD Misconceptions


FALSE

There are many cross-reactants in other products, it is best to have NO exposures to topicals/cross-reactors when clearing a rash

CD Misconceptions

If product exposure is bilateral, the eruption should be bilateral

CD Misconceptions


NOT NECESSARILY

Common misconception held by MDs

There are many aspects affecting end-product eruption

Can be patchy!

CD Misconceptions

Adult onset “eczema”

If no history of eczema or atopy, more likely ACD

Especially if on hands, face, neck

90% of eczema has onset by age 5

“The greatest abuse of patch testing is failure to use the test.”

Coleman, 1982

Epicutaneous Patch testing

Intended to detect allergens relevant to eruption

Is at least a week-long process

Detects Type IV allergic reaction (delayed-type hypersensitivity)

Requires at least 2-3 visits to clinic for complete testing

T.R.U.E. Test

Thin-layer Rapid Use Epicutaneous Test

Allerderm product

Only FDA-approved patch testing product

36 allergens

Comes pre-filled

May not detect all relevant allergens

Patch testing

Step 1: Take extensive exposure history

Include home exposures, work tasks and exposures, implants, intermittent exposures, MSDS if appropriate

Patch testing

Step 2: Determine allergen panel

Would be pre-determined if only TRUE Test is available

Patch testing

Step 3: Prepare allergen tray as appropriate

TRUE test is pre-prepared

Patch testing

Step 4: Apply patches to back

Back must be clear of rash

Patches are marked

Securing paper tape is used

Patch testing

Step 5: Patches removed in 48 hours

Variability in how this is done

Areas remarked

Reactions noted- Irritant

Patch testing

Step 6: Patches read at 3-7 days after application

Our clinic reads at 4 days

Consider delayed read for late reactors

Patch testing

Step 7: Determine clinical relevance

Consider the Mathias Criteria for Occupational cases

Excellent tool for ascertaining occupational causation

Keep in mind that irritant CD remains a diagnosis of exclusion, and dermatitis may be both ICD and ACD, multifactorial, etc.

Patch testing

Step 8: Instruct in avoidance of allergen(s) and cross-reactors

If in topical medicaments, cosmetics, etc. it is best to print out the CAMP “safe list”

On American Contact Dermatitis Society member webpage

Mayo Clinic also has a database

Also consider all objects that may contain allergen

Information (written) and verbal counseling of patient is KEY

May include modified work, increased or alternative PPE, modified environment-both home and work

Mathias Criteria

1. Is the clinical appearance consistent with contact dermatitis?

2. Are there workplace exposures to potential cutaneous irritants or allergens?

3. Is the anatomic distribution of the dermatitis consistent with cutaneous exposure in relation to work tasks?

4. Is there a temporal association between onset of dermatitis and exposure consistent with contact dermatitis?

Mathias Criteria

5. Are non-occupational exposures excluded as probable causes?

6. Does dermatitis improve away from work exposure to the suspected allergen or irritant?

7. Do patch or provocation tests identify a probable causal agent?

Mathias Criteria

Answer of “yes” to 4 or more of the 7 criteria yields a greater than 50% probability of occupational cause

Provides a “reasonable degree of medical certainty”

Allergens

Top 10 Allergens in North America

Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine

Top Allergens in the Workplace

Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Formaldehyde-Releasers

Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15

Imidazolidinyl urea (Germall 115)

Diazolidinyl urea (Germall II)

DMDM hydantoin (Glydant)

2-Bromo-2-nitropropane-1,3-diol (Bronopol)

Sodium hydroxymethyl glycinate


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Top Workplace Allergens- Canada

Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride

Potassium dichromate

Glyceryl thioglycolate

P-phenylenediamine

Formaldehyde

Glutaraldehyde

Arrandale et al Am J Ind Med 2012; 55:353-60.

Top Workplace Allergens-Denmark

Rubber allergens

Epoxy (windmill workers)


What’s new in Occupational Contact Allergens?

Coconut derivatives

Capryldiethanolamine in metalworking fluids

May not react to:

Monoethanolamine, diethanolamine, triethanolamine, methyldiethanolamine, and cocamide DEA

Not in MSDS

Suuronen et al., Contact Dermatitis 72, 120-121.

Coconut derivatives

Sodium cocoamphopropionate

Surfactant

Derivative of coconut fatty acids condensed with amino-ethyl ethanolamines

Soaps, shampoos, conditioners

Sweden, fast-food workers

Hagvall et al., Contact Dermatitis 71, 122-124.

Coconut derivatives

Cocamide MEA

AKA tall oil fatty acids monoethanolamide

In metal working fluid

Aalto-Korte et al. Contact Dermatitis, 69,316-7.

Coconut derivatives

Cocamide diethanolamine (cocamide DEA)

Surfactant

Industrial, household and cosmetic products

Finland 19/25 positives were occupational, most in metal industry

Soaps (hand, dish), metalworking fluids, barrier cream

Noted concomitant reactions

Monoethanolamine

Diethanolamine- impurity of cocamide DEA

Aalto-Korte et al., Contact Dermatitis 70, 169-174.

Airborne medications

Benzodiazepines

Airborne contact from crushing pills for patients

2 nurses, 1 pharmacy tech, one relative

Consider in facial dermatitis

Swinnen et al., Contact Dermatitis 70, 227-232.

Sevofluorane

Systemic allergic contact- airborne

Required ROAT (negative to routine patch testing)

Surgeon

Burches et al., Contact Dermatitis 72, 62-63.

Medications- Nonairborne

Omeprazole

Horse trainer

Handled paste for horse’s stomach ulcers

Al-Falah et al., Contact Dermatitis 71, 377-378.

“Head lad” caring for race horses

Dispensed omeprazole paste via syringe

Alwan et al., Contact Dermatitis 71, 376.

Fragrance

Citral

Hands and arms

9 beauticians in high-end spa

DeMozzi and Johnston, Contact Dermatitis 70, 377-378.

D- limonene

Machine cleaners, hand soaps, moisturizers, surface cleanser, dishwashing soaps

Pesonen et al., Contact Dermatitis 71, 273-279.

Isothiazolinones (Denmark)

Occupations

Painting

Welding (blacksmiths)

Machine operating

Cosmetology

Schwensen et al., Contact Dermatitis 71, 295-302.

Sources

Paints and varnishes

Cleaners

Polishing liquids

Some in high concentrations


Methylisothiazolinone

Ultrasound gel in ultrasonographer

Madsen et al., Contact Dermatitis 71, 312-313.

Water cooling tower technicians

Maor et al., Dermatitis 26, 62-64.

Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer

Also in sheer strips (Band Aids)

Crepy et al., Contact Dermatitis 70, 325-328.

Blue Collar Workers

Compared to controls patch-tested, BCW higher hand eczema, lower atopic dermatitis

Epoxy resins

Methyldibromo glutaronitrile

2-bromo-2-nitro-1,3-propanediol


Methylchloroisothiazolinone (MCI)/ methylisothiazolinone (MI)

Allergen: Occupation

Epoxy: construction

MCI/MI: Painting

Potassium dichromate: tile setting/terrazzo work


Blue Collar Workers

Case report of a cement worker with poor PPE

Sweden

Legislation in Europe to decrease hexavalent chromium in cement

Addition of ferrous sulfate

Chromium allergy persists

Hedberg et al, Contact dermatitis 70, 321-323.

Hairdressers- Denmark

Hairdressers 2002-2011

Compared to patch tested controls, hairdressers more significantly had Occupational CD and hand eczema, lower AD

Allergens significantly associated:

p-phenylenediamine, thiuram mix, benzocaine

Frequent sensitizers from the hairdressing series:

ammonium persulfate, toluene-2,5-diamine, 3-aminophenol, and 4-aminophenol

New sensitizers:

Cysteamine hydrochloride- substitute for glycerol monothioglycolate (restricted in Germany)

Chloroacetamide- preservative


Hairdressers- Germany

German contact allergy database 2007-2012

Compared hairdressers to clients

Allergens significantly associated with hairdressers > clients:

Ammonium persulfate

Glyceryl monothioglycolate

Demonstrated concern as young hairdressers still with some positive reaction, despite legislation

Uter et al, Contact Dermatitis 71, 13-20.

Food Industry

Cobalt in a baker

Bregnbak et al., Contact Dermatitis 72, 118-119.

Food Industry

Pizza makers

Diallyl disulfide and

Ammonium persulfate

Lembo et al., Dermatitis 25, 194-196.

Wine maker

Potassium metabisulfite

Ortiz et al., Dermatitis 25, 150-151.

Heathcare workers

Chlorhexidine

Australian study

2% relevant ACD in healthcare workers

Higher than other studies, keep on radar

Toholka et al., Australiasian J Derm 54, 303-306.

Preferred Approach to Occupational Exposure

1. Elimination

2. Substitution

3. Isolation

4. Engineering controls

5. Safe work practices

6. Personal protection

Material Safety Data Sheets

Mandated

Hazardous chemical name

Chemical properties

Physical hazards

Route of entry

Known exposure limits

Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary

Specific name often avoided (general category used)

Irritants and sensitizers if <1% concentration

Often do not address prevention of sensitization and irritancy

Diagnosis- MSDS

Diagnosis- MSDS

Treating Dermatitis- Step 1

AVOIDANCE!

Allergens

Irritants

Treatment/Prevention

Avoidance

Harder with omnipresent allergens (epoxy versus rubber allergens)

Contact urticaria more problematic than ACD

Clemmensen et al., Br J Dermatol 2014;170.

Personal protective equipment

Legislation


Recommended short-term high-potency topical steroids for hands:

Clobetasol propionate

Ointment

Halcinonide ointment

No propylene glycol, no sensitizers

For body:

Short-term hydrocortisone 2.5% bid for face, neck, axillae, groin, intertriginousareas

Short-term triamcinolone 0.1% bid for body


Avoid more than a few weeks of potent steroid use topically

Can thin the skin making hands more susceptible to allergen/irritant!

Consider calcineurin inhibitors topically

Consider IM steroids x 1

Oral steroids with SLOW taper

Doxycycline for anti-inflammatory effects

Treating Hand Dermatitis- Step 1

Barrier creams- Repair versus Protect

Repair creams with ceramides

Barrier creams with dimethicone

Studies are variable in demonstrating any benefit from barrier creams when compared to regular emollients

At least recommend moisturizing

Occupational Contact Dermatitis Prevention

Barrier creams

Prevention of irritant contact dermatitis

At high dose of application (2-20x actual application) can help prevent ICD

Schliemann et al., Contact dermatitis 70, 19-26.

Cotton liners under gloves

Adisesh et al., Br J Dermatol 2013.


Appropriate gloves

Match task with glove

“Quick Selection Guide to Chemical Protective Clothing” by Forsberg and Mansdorf

ACDS website lists glove manufacturers

Treating Dermatitis- Step 2 (Maintenance)

Calcineurin inhibitors

Tacrolimus 0.1%

Pimecrolimus 0.1%

Therapeutic moisturizers

Shea butter

Aquaphor

Petrolatum

Lower potency steroids for hands:

Triamcinolone 0.1%

Fluticasone cream or lotion

Hydrocortisone butyrate lipid cream

Clocortolone cream

Treating Dermatitis- Step 3 (Recalcitrant)

Hand psoralen- ultraviolet A therapy (PUVA)

Narrow-band UV B therapy (NBUVB)

Often used for recalcitrant body dermatitis

Excimer laser

308 nm

Treating Hand Dermatitis- Step 3 (Recalcitrant)

Methotrexate

Mycophenolate mofetil

2-3g/day recommended for control

Acitretin

Best for psoriasiform hand dermatitis

2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily

Biologics are not helpful overall (yet!)

Treatment

Multidisciplinary teams aid in successful return to work

German model included inpatient and outpatient care

87% remained in workforce

Weisshaar et al., Contact Dermatitis 2013;68:169-174.

Netherlands included a dermatologist, education nurse, occupational medicine physician

Van Gils et al., Contact Dermatitis 2012 66(4) and 66(5).

Canadian model

Gomez et al., Dermatitis 2011;22(3).

Prevention

Evidence-based intervention

1 hour voluntary hand protective behavior lecture/ intervention

Full-time hospital cleaners

At 3 months post-intervention

Decreased hand cleansing

Better knowledge of hand preservation

Improved hand dermatitis

Clemmensen et al., Contact Dermatitis 72, 47-54.

Occupational Dermatitis Resources

Quick Selection Guide to Chemical Protective Clothing by Forsberg and Mansdorf

Contact and Occupational Dermatology by Marks, Elsner, DeLeo

ACDS website

OSHA, NIOSH

Article December 2011 The Dermatologist

Summary

Allergic and irritant contact dermatitis can be difficult to distinguish

We are constantly being exposed to new allergens, often earlier in life

Occupational contact dermatitis is underreported

Patch testing for ACD is the gold standard

Can try TRUE test, consider referral for comprehensive panels

Novel allergens in the workplace

Summary

Think outside the box

Try a stepwise approach

Elimination

Treatment

Escalate treatment

Will be chronic if exposure continues

You can make a huge difference in patient’s quality of life

References

Marks et al., 2002. Marks J.G., Elsner P., DeLeo V.A.: Contact and Occupational Dermatology, 3rd ed. St Louis, Mosby, 2002.

Nelson and Yiannias, 2009. Nelson S.A., Yiannias J.A.: Relevance and avoidance of skin-care product allergens: Pearls and pitfalls. Dermatol Clin 2009; 27(3):329-336.

Thin-layer rapid-use epicutaneous test. Thin-layer rapid-use epicutaneous test (TRUE-test) : Available at:[accessed 03.07.11] http://www.truetest.com/PatientPDF/File18.pdf

Zug et al., 2009. Zug K.A., Warshaw E.M., Fowler J.F., et al: Patch-test results of the North American Contact Dermatitis Group 2005-2006. Dermatitis 2009; 20:149-160.

Emmett EA. Occupational contact dermatitis I. Incidence and return to work pressures. Am J Contact Dermatitis 2002;13:30–4.

Bureau of Labor Statistics. Occupational injuries and illnesses in the United States. [Bulletin 2512]. Washington (DC): US Department of Labor, Bureau of Labor Statistics; 1999.

Lushniak BD. The epidemiology of occupational contact dermatitis. Dermatol Clin1995; 13:671–9.

Skoet R, Olsen J, Mathiesen B, et al. A survey of occupational hand eczema in Denmark. Contact Dermatitis 2004;51(4):159–66.

Staton I, Ma R, Evans N, et al. Dermal nickel exposure associated with coin handling and in various occupational settings: assessment using a newly developed finger immersion method. Br J Dermatol 2006;154(4):658–64.

Veien NK, Menne T. Treatment of hand eczema. Skin Therapy Lett 2003;8(5):4–7. 137.

Warshaw E. Therapeutic options for chronic hand dermatitis. Dermatol Ther2004;4:17240–50.

Schalock PC, Zug KA, Carter JC, et al. Efficacy and patient perception of Grenz ray therapy in the treatment of dermatoses refractory to other medical therapy. Dermatitis 2008;19(2):90–4.

Abramovits W, Granowski P. Innovative management of severe hand dermatitis. Dermatol Clin 28 (2010) 453-65.

Blanciforti, L. Economic burden of dermatitis in US workers. JOEM 52. (11):1045-54. 2010.

References

Sprigle AM, Marks JG Jr, Anderson BE. Prevention of nickel release with barrier coatings. Dermatitis. 2008,19(1):28-31.

Diepgen T.L., Coenraads P.J.: The epidemiology of occupational contact dermatitis. Int Arch Occup Environ Health 72. (8): 496-506.1999.

Keil J.E., Shmunes E.: The epidemiology of work-related skin disease in South Carolina. Arch Dermatol 119. (8): 650-654.1983.

Mathias C.G.: Occupational dermatoses. J Am Acad Dermatol 19. (6): 1107-1114.1988.

Goh C.L.: An epidemiological comparison between occupational and non-occupational hand eczema. Br J Dermatol 120. (1): 77-82.1989.

Marks J.G., Elsner P., DeLeo V.A.: Contact & occupational dermatology. 3rd ed Mosby St. Louis, (MO)2002.

Holness D.L.: Characteristic features of occupational dermatitis: epidemiologic studies of occupational skin disease reported by contact dermatitis clinics. Occup Med 9. (1): 45-52.1994.

Belsito D.V.: Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability. J Am Acad Dermatol 53. (2): 303-313.2005.

Kanerva L., Estlander T., Jolanki R.: Occupational skin disease in Finland. An analysis of 10 years of statistics from an occupational dermatology clinic. Int Arch Occup Environ Health 60. (2): 89-94.1988.

Sertoli A., Gola M., Martinelli C., et al: Epidemiology of contact dermatitis. Semin Dermatol 8. (2): 120-126.1989.

Rietschel R.L., Mathias C.G., Fowler , Jr. , Jr.J.F., et al: Relationship of occupation to contact dermatitis: evaluation in patients tested from 1998 to 2000. Am J Contact Dermatitis 13. (4): 170-176.2002.

Nethercott J.R., Holness D.L.: Disease outcome in workers with occupational skin disease. J Am Acad Dermatol 30. (4): 569-574.1994.

Mathias C.G., Morrison J.H.: Occupational skin diseases, United States. Results from the Bureau of Labor Statistics Annual Survey of Occupational Injuries and Illnesses, 1973 through 1984. Arch Dermatol 124. (10): 1519-1524.1988.

Koch P.: Occupational contact dermatitis. Recognition and management. Am J Clin Dermatol 2. (6): 353-365.2001.

Bureau of Labor Statistics : Occupational Injuries and illnesses in the United States. Available at: http://www.bls.gov/iif

Lushniak B.D.: Occupational contact dermatitis. Dermatol Ther 17. (3): 272-277.2004.

Mathias C.G.: The cost of ccupational skin disease. Arch Dermatol 121. (3): 332-334.1985.

Cvetkovski R.S., Rothman K.J., Olsen J., et al: Relation between diagnoses on severity, sick leave, and loss of job among patients with occupational hand eczema. Br J Dermatol 152. (1): 93-98.2005.

Thank you!

[email protected]

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3/27/2015

2



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

3



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

4



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

5



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

6



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

7



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

8



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

9



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

10



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

11



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

12



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

13



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

14



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

15



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

16



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

17



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

18



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

19



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

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1

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19

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21

22

1

2

23

1

2

24

25

1

2

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27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

20



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

3/27/2015

21



Duke University



May 3, 2015

Disclosures




Objectives







Why should we care?


Healthy People 2020










Contact Dermatitis












Occupational CD



68% due to wet work








Self-treated













80-90% of cases






Overlap common












Alkalis

Soaps

Detergents

Cleansers

Acids

Hydrocarbons

Petroleum

Oils

Solvents





Examples

Fabric

Paper

Metal objects

Driving


Gloves





Wet work

Irritant chemicals

Solvents

Food

Detergents

Gloves

Mechanical trauma

Air (warm, dry)


Occupations


Hairdressers

Musicians



Factory workers

Electronics workers

Cleaners/Washers

Housekeepers

Printers

Builders



Hairdressers

Nursing

Doctors

Mechanics

Cooks

Cleaners

Painters

Plumbers



Healthcare

Cleaning

Kitchen work



Shoe manufacturer

Indonesia









Healthcare workers



23% in first year

25% in second year

31% in third year



ACD vs ICD

Photo Quiz



Irritant



Allergic


Irritant


Allergic




CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


FALSE


CD Misconceptions


CD Misconceptions


NOT NECESSARILY



Can be patchy!

CD Misconceptions






Coleman, 1982






T.R.U.E. Test


Allerderm product


36 allergens

Comes pre-filled


Patch testing



Patch testing



Patch testing



Patch testing



Patches are marked


Patch testing



Areas remarked


Patch testing




Patch testing





Patch testing








Mathias Criteria





Mathias Criteria




Mathias Criteria



Allergens


Nickel sulfate

Balsam of Peru

Fragrance mix I

Quaternium-15

Neomycin

Bacitracin

Formaldehyde

Cobalt chloride

Fragrance mix II

p-Phenylenediamine


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel

Quaternium-15







Carba Mix

Thiuram Mix

Epoxy Resin

Formaldehyde

Nickel


Epoxy resin

Thiuram Mix

Carba Mix

Nickel sulfate

Cobalt chloride



P-phenylenediamine

Formaldehyde

Glutaraldehyde



Rubber allergens




Coconut derivatives


May not react to:


Not in MSDS


Coconut derivatives


Surfactant





Coconut derivatives

Cocamide MEA




Coconut derivatives


Surfactant





Monoethanolamine




Benzodiazepines





Sevofluorane



Surgeon



Omeprazole

Horse trainer






Fragrance

Citral

Hands and arms



D- limonene




Occupations

Painting


Machine operating

Cosmetology


Sources


Cleaners

Polishing liquids








Allergens

Tricresyl phosphate

Cleaning occupation

In vinyl gloves

Plasticizer



Blue Collar Workers


Epoxy resins






Epoxy: construction

MCI/MI: Painting



Blue Collar Workers


Sweden












New sensitizers:








Ammonium persulfate




Food Industry

Cobalt in a baker


Food Industry

Pizza makers


Ammonium persulfate


Wine maker



Heathcare workers

Chlorhexidine

Australian study





1. Elimination

2. Substitution

3. Isolation





Mandated


Chemical properties

Physical hazards

Route of entry


Carcinogenicity

Clean-up practices

Control measures

Contact information

Not required

If proprietary




Diagnosis- MSDS

Diagnosis- MSDS


AVOIDANCE!

Allergens

Irritants


Avoidance





Legislation




Ointment



For body:

















Barrier creams







Appropriate gloves






Tacrolimus 0.1%

Pimecrolimus 0.1%


Shea butter

Aquaphor

Petrolatum


Triamcinolone 0.1%



Clocortolone cream





Excimer laser

308 nm


Methotrexate



Acitretin


2-4 month course

Cyclosporine

2.5-5 mg/kg daily

Azathioprine

1-3 mg/kg daily


Treatment







Canadian model


Prevention












ACDS website

OSHA, NIOSH


Summary







Summary



Elimination

Treatment

Escalate treatment



References















References



















Thank you!

[email protected]

1

2

3

4

5

6

1

2

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

1

2

23

1

2

24

25

1

2

26

27

1

2

28

1

2

29

30

1

2

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

1

2

70

71

72

73

74

1

2

75

76

1

2

77

78

79

80

81

82

83

1

2

84

85

1

2

86

1

2

87

88

89

1

2

90

1

2

91

92

93

94

1

2

95

96

97

98

1

2

3

4

99

100

101

102

103

1

2

104

1

2

105

106

107

108

1

2

109

110

1

2

111

112

113

114

1

2

115

1

2

116

117

118

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