Dermatite de Contacto Alérgica em Profissionais de Saúde
Resumo
Introdução: A dermatite de contacto alérgica (DCA) constitui patologia profissional particularmente frequente em profissionais de saúde. Os alergénios responsáveis podem variar ao longe do tempo, com a exposição ocupacional e com o tipo de trabalho.
Objectivos e Métodos: Com o objetivo de avaliar a realidade local, foi feita uma análise retrospetiva dos profissionais de saúde que realizaram testes epicutâneos no Serviço de Dermatologia do Centro Hospitalar e Universitário de Coimbra (CHUC), num período de 6 anos (2010-2015), por suspeita de dermatite de contacto alérgica. Os doentes foram todos testados com uma Série Básica e com séries complementares orientadas pela história clínica.
Resultados: Dos 1858 doentes testados, 125 (6,7%) eram profissionais de saúde, 114 de género feminino/11 masculino, idade média de 39,26±12,5 anos, maioritariamente enfermeiras (56), assistentes técnicos (48) e médicos (21), 71 com dermatite das mãos (56.8%), 22 com dermatite atópica e/ou outros sinais de atopia (17,6%). Noventa (72%) revelaram pelo menos um patch test (PT) positivo, 47 dos quais (52,2%) com relevância profissional. Doentes com dermatite das mãos tiveram mais frequentemente PT positivo (76,1%). Os metais causaram maior número de PT positivos (total 51; Ni-41, maioritariamente com relevância passada, Co-8; Cr-2), seguidos das fragrâncias (total 30; mistura de fragrâncias (FM)-I-10; Myroxylon pereirae-8; lyral-5; FM-II-4; citronellol-3), conservantes (total 29, dos quais 20 à metilisotiazolinona (MI) e/ou clorometilisotiazolinona/MI (MCI/MI)), borrachas (24; P-fenilenodiamina (PPD)/Isopropil-PPD-9) e medicamentos tópicos (total 14; iodopovidona 5). As principais causas da DCA profissional foram os desinfetantes/sabonetes líquidos e produtos de higiene dos doentes (15), borracha das luvas/calçado (12) e medicamentos sistémicos ou tópicos (8 antissépticos e 3 antibióticos parentéricos). Os principais alergénios com relevância profissional foram a MI e/ou MCI/MI (15), lanolina (9), formaldeído e/ou libertadores (7), iodopovidona (5), carbamatos (4), FM-I (3), cefalosporinas (3) e acrilatos (3 dentistas e/ou assistentes dentários). Em 37 dos 42 casos avaliados, houve uma melhoria franca ou resolução da DCA, após evicção do alergénio causal, nomeadamente o conservante MCI/ MI contido num sabonete líquido sob a designação de “Acticide® MV”.
Conclusões: A dermatite das mãos, a principal apresentação da DCA em profissionais de saúde, não mostrou relação com atopia e foi mais frequentemente associada a PT positivos. PT positivos a isotiazolinonas e libertadores de formaldeído foram mais frequentes entre profissionais de saúde do que na população geral estudada, muito provavelmente devido à exposição cumulativa, pessoal e profissional, a estes conservantes em sabonetes líquidos de uso pessoal e hospitalar. O PT foi crucial para orientar individualmente os doentes e para alertar a comunidade hospitalar para a presença de alergénios no local de trabalho e estabelecer medidas preventivas mais adequadas.
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Referências
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.
;72:496-506.
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.
;69:164-71.
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.
;61:145-51.
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.
;19:261-74.
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
;15(2):124-30.
Ale IS, Maibacht HA. Diagnostic approach in allergic
and irritant contact dermatitis. Expert Rev Clin Immunol.
;6:291-310.
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
-7.
Ibler KS, Jemec GB, Agner T. Exposures related to hand
eczema: a study of healthcare workers. Contact Dermatitis.
;66:247-53.
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.
;55:329-37.
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
;18:679-82.
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.
;73:195-221.
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.
;75:223-9.
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.
;29):940-7.
. Boonstra MB, Christoffers WA, Coenraads PJ, Schuttelaar
ML. Patch test results of hand eczema patients: relation
to clinical types. J Eur Acad Dermatol Venereol.
;29:940-7.
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.
;173:11.
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.
;69:271-5.
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.
;73:150-6.
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.
;67:149-56.
Gielen K, Goossens A. Occupational allergic contact dermatitis
from drugs in healthcare workers. Contact Dermatitis.
;45:273-9.
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.
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