Occupational Allergic Contact Dermatitis in Healthcare Workers

  • Vítor Pinheiro Interno de Formação Específica em Medicina do Trabalho no CHUC, Serviço de Saúde Ocupacional. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Catarina Pestana Interno de Formação Específica em Medicina do Trabalho no CHUC, Serviço de Saúde Ocupacional. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Francisco Marques Interno de Formação Específica em Medicina do Trabalho no CHUC, Serviço de Saúde Ocupacional. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • André Pinho Serviço de Dermatologia. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Isabel Antunes Interno de Formação Específica em Medicina do Trabalho no CHUC, Serviço de Saúde Ocupacional. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Margarida Gonçalo Serviço de Dermatologia. Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Clínica de Dermatologia. Faculdade de Medicina. Universidade de Coimbra, Coimbra, Portugal
Keywords: Allergens, Dermatitis, Allergic Contact, Health Personnel, Occupational Exposure, Occupational Health, Patch Tests


Introduction: Occupational allergic contact dermatitis (ACD) is frequent among health care workers (HCW) and culprit allergens may vary with time, occupational setting and exposure hazards.

Objectives and Methods: In order to characterize the main contact allergens in HCW with dermatitis and its occupational relevance, we performed a retrospective analysis of clinical data and patch test (PT) results from HCW who were studied in the Department of Dermatology of Coimbra Hospital and University Centre (CHUC) between 2010-2015. All patients were tested with a baseline and additional series, according to the tasks developed.

Results: Among 1858 patch tested patients, 125 (6.7%) were HCW, 114 females/11 males, mean age 39,26±12,5 years, mainly nurses (56), technical assistants (48) and doctors (21), 71 with hand dermatitis (56,8%), 22 with atopic dermatitis and/or other atopic symptoms (17,6%). Ninety patients (72%) had at least one positive PT, 47 (37,6%) with occupational relevance. Patients with hand dermatitis were significantly more likely to have positive PT (76.1%). We observed 51 positive PT to metals (Ni-41, most with past relevance, Co-8; Cr -2), 30 to fragrances (FM-I-10; Myroxylon pereirae-8; lyral-5; FM-II-4; citronellol-3), 29 to preservatives (mostly methylisothiazolinone (MI) and/or chloromethylisothiazolinone (MCI)-20), 24 to rubber chemicals (P-phenylenediamine (PPD)/Isopropyl-PPD-9), and 14 to topical medicaments (iodopovidone - 5; caine mix - 4). The main occupational causes of ACD were hand soaps/disinfectants and patients’ hygiene products (15), protective gloves/shoes-9 and topical or systemic drugs (antiseptics-8 and parenteral antibiotics-3). Main allergens with occupational relevance were MI and/or MCI/MI (15), although isolated MI was tested only after mid 2012, lanolin and/or amerchol L101 (9), formaldehyde and/or formaldehyde releasers (7), iodopovidone (5), thiuram mix (5), carbamates (4), FM-I (3), cephalosporins (3) and (meth)acrylates (3 dentists/dental technicians). In 37 out of 42 evaluated cases there was marked improvement/resolution of the dermatitis, namely after eviction of the hospital hand soap which contains MCI/ MI under the designation of Acticide® MV.

Conclusions: Hand dermatitis was the main presentation of ACD in HCW with no apparent relation with atopy. Isothiazolinones and formaldehyde releasers induced more positive PT and were more frequent among HCW than in the whole population studied very probably due to the cumulative exposure to these preservatives in personal and occupational hand soaps and hygiene products. PT was important to orient eviction in each individual case but also for the hospital community to understand the presence of moderate or potent sensitizers in the work place and, therefore, establish the most adequate preventive measures.


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Pesonen M, Jolanki R, Larese Filon F, Wilkinson M, Krecisz

B, Kiec-Swierczynska M, et al. Patch test results of the

European baseline series among patients with occupational

contact dermatitis across Europe - analyses of the European

Surveillance System on Contact Allergy network,

-2010. Contact Dermatitis. 2015;72:154-63.

Pestana C, Gomes R, Pinheiro V, Gouveia M, Antunes I,

Goncalo M. Main Causes of Occupational Allergic Contact

Dermatitis: A Three Year Study in the Center of Portugal.

Acta Med Port. 2016;29:449-55.

Diepgen TL. Occupational skin diseases. J Dtsch Dermatol

Ges. 2012;10:297-313; quiz 314-5.

Diepgen TL, Coenraads PJ. The epidemiology of occupational

contact dermatitis. Int Arch Occup Environ Health.


Schnuch A, Uter W, Geier J, Frosch PJ, Rustemeyer T. Contact

allergies in healthcare workers. Results from the IVDK.

Acta Derm Venereol. 1998;78:358-63.

Molin S, Bauer A, Schnuch A, Geier J. Occupational contact

allergy in nurses: results from the Information Network

of Departments of Dermatology 2003-2012. Contact

Dermatitis. 2015;72:164-71.

van der Meer EW, Boot CR, van der Gulden JW, Jungbauer

FH, Coenraads PJ, Anema JR. Hand eczema among

healthcare professionals in the Netherlands: prevalence,

absenteeism, and presenteeism. Contact Dermatitis.


Lau MY, Burgess JA, Nixon R, Dharmage SC, Matheson

MC. A review of the impact of occupational contact dermatitis

on quality of life. J Allergy. 2011;2011:964509.

Matterne U, Apfelbacher CJ, Soder S, Diepgen TL, Weisshaar

E. Health-related quality of life in health care

workers with work-related skin diseases. Contact Dermatitis.


Brutti CS, Bonamigo RR, Cappelletti T, Martins-Costa GM,

Menegat AP. Occupational and non-occupational allergic

contact dermatitis and quality of life: a prospective study.

An Bras Dermatol. 2013;88:670-1.

Warshaw EM, Schram SE, Maibach HI, Belsito DV, Marks

JG, Jr., Fowler JF, et al. Occupation-related contact dermatitis

in North American health care workers referred for

patch testing: cross-sectional data, 1998 to 2004. Dermatitis.


Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational

skin disease among Australian healthcare workers: a

retrospective analysis from an occupational dermatology

clinic, 1993-2014. Contact Dermatitis. 2016;75:213-22.

Malik M, English J. Irritant hand dermatitis in health care

workers. Occup Med. 2015;65:474-6.

Kadivar S, Belsito DV. Occupational dermatitis in health

care workers evaluated for suspected allergic contact dermatitis.

Dermatitis. 2015;26:177-83.

Martin SF. Immunological mechanisms in allergic

contact dermatitis. Curr Opin Allergy Clin Immunol


Ale IS, Maibacht HA. Diagnostic approach in allergic

and irritant contact dermatitis. Expert Rev Clin Immunol.


Peng W, Novak N. Pathogenesis of atopic dermatitis. Clin

Exp Allergy. 2015;45:566-74.

Alchorne Ade O, Alchorne MM, Silva MM. Occupational

dermatosis. An Bras Dermatol. 2010;85:137-45; quiz


Ibler KS, Jemec GB, Agner T. Exposures related to hand

eczema: a study of healthcare workers. Contact Dermatitis.


Alamgir H, Yu S, Chavoshi N, Ngan K. Potential allergy

and irritation incidents among health care workers. Aaohn

J. 2008;56:281-8.

Smedley J, Williams S, Peel P, Pedersen K. Management of

occupational dermatitis in healthcare workers: a systematic

review. Occup Environ Med. 2012;69:276-9.

Holness DL. Occupational skin allergies: testing and treatment

(the case of occupational allergic contact dermatitis).

Curr Allergy Asthma Rep. 2014;14:410.

Bauer A, Geier J, Mahler V, Uter W. Contact allergies in the

German workforce : Data of the IVDK network from 2003-

Hautarzt. 2015;66):652-64.

Mahler V, Geier J, Schnuch A. Current trends in patch

testing - new data from the German Contact Dermatitis

Research Group (DKG) and the Information Network of

Departments of Dermatology (IVDK). J Dtsch Dermatol

Ges. 2014;12:583-92.

Mahler V, Dickel H, Diepgen TL, Hillen U, Geier J, Kaufmann

R, et al. Statement of the German Contact Dermatitis

Research Group (DKG) and the German Dermatological

Society (DDG) on liability issues associated with patch testing

using a patient's own materials. J Dtsch Dermatol.

Ges 2016 (in press)

Schnuch A, Uter W, Lessmann H, Geier J. Clinical epidemiology

and prevention of contact allergies. The Information

Network of Departments of Dermatology

(IVDK) as a register and surveillance system. Bundesgesundheitsblatt

Gesundheitsforschung Gesundheitsschutz.


Schnuch A, Geier J, Lessmann H, Arnold R, Uter W. Surveillance

of contact allergies: methods and results of the

Information Network of Departments of Dermatology

(IVDK). Allergy. 2012;67:847-57.

Schubert S, Bauer A, Molin S, Skudlik C, Geier J. Occupational

contact sensitization in female geriatric nurses: Data

of the Information Network of Departments of Dermatology

(IVDK) 2005-2014. J Eur Acad Dermatol Venereol.

(in press).

Uter W, Geier J, Bauer A, Schnuch A. Risk factors associated

with methylisothiazolinone contact sensitization. Contact

Dermatitis. 2013;69:231-8.

Goncalo M, Ferguson J, Bonevalle A, Bruynzeel DP, Gimenez-

Arnau A, Goossens A, et al. Photopatch testing: recommendations

for a European photopatch test baseline

series. Contact Dermatitis. 2013;68:239-43.

Bruynzeel DP, Ferguson J, Andersen K, Goncalo M, English

J, Goossens A,et al. Photopatch testing: a consensus

methodology for Europe. J Eur Acad Dermatol. Venereol


Johansen JD, Aalto-Korte K, Agner T, Andersen KE, Bircher

A, Bruze M, et al, European Society of Contact

Dermatitis guideline for diagnostic patch testing - recommendations

on best practice. Contact Dermatitis.


Agarwal US, Besarwal RK, Gupta R, Agarwal P, Napalia

S. Hand eczema. Indian J Dermatol. 2014;59:213-24.

Mahler V. Hand dermatitis--differential diagnoses, diagnostics,

and treatment options. J Dtsch Dermatol Ges.

;14:7-26; quiz 27-8.

Andrade P, Goncalo M. Fixed drug eruption caused by

etoricoxib--2 cases confirmed by patch testing. Contact

Dermatitis. 2011;64:118-20.

Ibler KS, Jemec GB, Garvey LH, Agner T. Prevalence

of delayed-type and immediate-type hypersensitivity in

healthcare workers with hand eczema. Contact Dermatitis.


Teixeira V, Coutinho I, Goncalo M. Allergic contact dermatitis

to metals over a 20-year period in the Centre of

Portugal: evaluation of the effects of the European directives.

Acta Med Port. 2014;27:295-303.

Boonstra MB, Christoffers WA, Coenraads PJ, Schuttelaar

ML. Patch test results of hand eczema patients: relation

to clinical types. J Eur Acad Dermatol Venereol.


. Boonstra MB, Christoffers WA, Coenraads PJ, Schuttelaar

ML. Patch test results of hand eczema patients: relation

to clinical types. J Eur Acad Dermatol Venereol.


Bensefa-Colas L, Telle-Lamberton M, Paris C, Faye S, Stocks

SJ, Luc A, et al. Occupational allergic contact dermatitis

and major allergens in France: temporal trends for the

period 2001-2010. Br J Dermatol. 2014;171:1375-85.

Gameiro A, Coutinho I, Ramos L, Goncalo M. Methylisothiazolinone:

second 'epidemic' of isothiazolinone sensitization.

Contact Dermatitis. 2014;70:242-3.

Goncalo M, Goossens A. Whilst Rome burns: the epidemic

of contact allergy to methylisothiazolinone. Contact

Dermatitis. 2013;68:257-8.

Schwensen JF, Uter W, Bruze M, Svedman C, Goossens

A, Wilkinson M, et al. The epidemic of methylisothiazolinone:

a European prospective study. Contact Dermatitis.

(in press)

Goncalo M. Methylisothiazolinone in rinse-off products:

additional fuel to the world epidemics of allergic

contact dermatitis to isothiazolinones. Br J Dermatol.


Leiva-Salinas M, Frances L, Silvestre JF. Update on allergic

contact dermatitis due to methylchloroisothiazolinone/

methylisothiazolinone and methylisothiazolinone. Actas

Dermosifiliogr. 2014;105:840-6.

Lundov MD, Thyssen JP, Zachariae C, Johansen JD. Prevalence

and cause of methylisothiazolinone contact allergy.

Contact Dermatitis. 2010;63:164-7.

Lundov MD, Opstrup MS, Johansen JD. Methylisothiazolinone

contact allergy--growing epidemic. Contact Dermatitis.


Lammintausta K, Aalto-Korte K, Ackerman L, Alanko K,

Berry P, Hasan T, Kaminska R, Korhonen L, Laukkanen A,

Liippo J, Pesonen M, Rantanen T, Riekki R, Suuronen K.

An epidemic of contact allergy to methylisothiazolinone in

Finland. Contact Dermatitis. 2014;70:184-5.

Vauhkala AR, Pesonen M, Suomela S, Kuuliala O,

Suuronen K, Aalto-Korte K. Occupational contact allergy

to methylchloroisothiazolinone/methylisothiazolinone

and methylisothiazolinone. Contact Dermatitis.


Aalto-Korte K, Ackermann L, Henriks-Eckerman ML, Valimaa

J, Reinikka-Railo H, et al. 1,2-benzisothiazolin-3-

-one in disposable polyvinyl chloride gloves for medical

use. Contact Dermatitis. 2007;57:365-70.

Carøe TK, Ebbehøj N, Agner T. A survey of exposures related

to recognized occupational contact dermatitis in Denmark

in 2010. Contact Dermatitis. 2014;70:56-62.

Skoet R, Olsen J, Mathiesen B, Iversen L, Johansen JD,

Agner T. A survey of occupational hand eczema in Denmark.

Contact Dermatitis. 2004;51:159-66.

Geier J, Lessmann H, Mahler V, Pohrt U, Uter W, Schnuch

A. Occupational contact allergy caused by rubber

gloves--nothing has changed. Contact Dermatitis.


Gielen K, Goossens A. Occupational allergic contact dermatitis

from drugs in healthcare workers. Contact Dermatitis.


Antunes J, Silva R, Pacheco D, Travassos R, Filipe P. Occupational

contact allergy to cephalosporins. Dermatol Online

J. 2011;17:13.

Foti C, Bonamonte D, Trenti R, Vena GA, Angelini G. Occupational

contact allergy to cephalosporins. Contact

Dermatitis. 1997;36:104-5.

Rai R, Dinakar D, Kurian SS, Bindoo YA. Investigation of

contact allergy to dental materials by patch testing. Indian

Dermatol Online J. 2014;5:282-6.

Ramos L, Cabral R, Goncalo M. Allergic contact dermatitis

caused by acrylates and methacrylates - a 7-year study.

Contact Dermatitis. 2014;71:102-7.

Holness DL. Return-to-work barriers for workers with contact

dermatitis. Contact Dermatitis. 2003;49:273-5.

How to Cite
Pinheiro, V., Pestana, C., Marques, F., Pinho, A., Antunes, I., & Gonçalo, M. (2017). Occupational Allergic Contact Dermatitis in Healthcare Workers. Journal of the Portuguese Society of Dermatology and Venereology, 75(1), 49-58. https://doi.org/10.29021/spdv.75.1.718
Grupo Português de Estudo das Dermites de Contacto (GPEDC)