Lampel Occ Derm UpdateAAD 2018F S061... · lReview top and emerging occupational allergens and irritants ... cosmetology nSchwensen JF et al ... and avoidance of skin-care product

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Occupational Contact Dermatitis Update S061- Contact Dermatitis Heather P. Lampel, MD, MPH, FAAD, FACOEM February 19, 2018

Disclosures l I have no relevant financial relationships to disclose l I will be discussing off-label use of patch testing and off-label

treatment of contact dermatitis l I will mention companies l Merz- Consultant (Fees)

Objectives l Discuss the epidemiology of occupational contact dermatitis (OCD) l Review top and emerging occupational allergens and irritants l Highlight high-risk occupations for OCD l Outline the differences in work-up of occupational dermatitis l Present new data on treatment approaches

Epidemiology of Occupational Contact Dermatitis

Contact Dermatitis l Contact dermatitis (CD) is reported to account for up to 30% of all

occupational disease in industrialized nations l CD is the most common occupational skin disorder n About 95% of all cases of occupational skin diseases l Caroe et al., Contact Dermatitis 70, 56-62.

Occupational CD Epidemiology l Occupational skin disease- 15.2% of all private nonfatal

occupational injury l US Bureau of Labor Statistics 2014 Survey

l Incidence rate of 0.5-1.9 cases per 1000 full-time workers per year l 1 year prevalence estimate of 20% l 21-22% in healthcare workers l Ibler et al., Contact Dermatitis 2012;67:200-207. l Luk et al., Contact Dermatitis 2011;65:329-335.

Occupational CD Epidemiology l True epidemiologic data are lacking l Likely underestimated due to underreporting n Mild cases specifically n Bureau of Labor Statistics has rigorous inclusion criteria n May not be obviously work-related (delayed-onset) n Self-treated n Only requiring first aid excluded

l Underestimated by 85-88% n Luckhaupt et al., Am J Ind Med 2012.

Recent Occupational Studies l Shoe manufacturer n Indonesia n 29% OCD point prevalence n Febriana et al., Int Arch Occup Environ Health 2014; 87.

l Poultry processing and manual laborers n 1 year prevalence 23% skin symptoms n Quandt et al., Am J Indust Medicine 2014; 57.

Recent Occupational Studies l Construction Industry n 25.4% point prevalence of hand skin symptoms n Timmerman et al., Am J Ind Med 2014; 57.

l Construction Industry n Self-reported hand CD at a point prevalence rate 32.9% n But experts reported a higher point prevalence rate of 61.4% n Timmerman et al., Am J Ind Med 2017;60(10).

Occupational CD Epidemiology l Survey of established cases of Occupational CD reported that over

one year: l 19.9% reported prolonged sick leave l 23% reported job loss

Occupational CD Epidemiology l 1985 Mathias estimated annual costs of Occupational CD to be

between $222 million and $1 billion l 2004 NIOSH estimates $1.2 billion

Occupational CD Epidemiology l Hands are usually involved n 80-90% of cases n Great impact on quality of life

Contact Dermatitis Overview l Irritant contact dermatitis accounts for 60-80% of all CD l 70% of all OCD in Denmark l 68% due to wet work l Caroe et al., Contact Dermatitis 70, 56-62.

l Allergic contact dermatitis accounts for remaining 20-40% l Overlap common

Occupational Irritants l Alkalis n Soaps n Detergents n Cleansers

l Acids

l Hydrocarbons n Petroleum n Oils

l Solvents

Occupational Irritants l Frictional Dermatitis l Repetitive handling of objects or materials l Likely underappreciated

l Examples l Fabric l Paper l Metal objects l Driving

Occupational Irritants l Gloves l Prolonged contact with skin affects the epidermal barrier l May be irritant itself l May make epidermal barrier more susceptible to allergens or other irritants

Irritants- Recent Literature l Wet work l Irritant chemicals n Solvents n Food n Detergents

l Gloves l Mechanical trauma l Air (warm, dry) l Friis et al., Contact Dermatitis 71, 364-370.

Occupations

Occupations at High-Risk for Hand Dermatitis l Hairdressers l Musicians l Food Industry workers l Agricultural workers l Factory workers l Electronics workers l Cleaners/Washers l Housekeepers l Printers l Builders l Medical and Dental workers

Occupations at Risk for ICD l Hairdressers l Nursing l Doctors l Mechanics l Cooks l Cleaners l Painters l Plumbers

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

Healthcare workers l Dutch apprentice nurses followed prospectively n 1 year period prevalence of hand eczema l 23% in first year l 25% in second year l 31% in third year

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

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

Mechanics and Repairers- NACDG l 691 of 38,784 patients (1.8%) patch tested were mechanics/

repairers l Hand involvement (59.5%) l Occupationally relevant allergens: n Carba mix n Thiuram mix n Methylchloroisothiazolone/methylisothiazolone

l Allergen sources: Gloves, automotive vehicles, solvents, oils, lubricants, and fuels

l Warshaw et al., Dermatitis 28(1), 47-57.

Production Workers- NACDG l 2732 of 39,332 patients (7.0%) patch tested were production

workers l Hand (53.8%) and arm (29.4%) involvement l Workers had more ACD and ICD l Warshaw et al., Dermatitis 28(3), 183-194.

l Occupationally relevant allergens: n Epoxy n Thiuram mix n Carba mix n Formaldehyde n Cobalt

l Allergen sources: Adhesives/glues, metalworking fluids/cutting oils, coatings

Allergens

Top 10 Overall Allergens in North America 1. Nickel sulfate 2. Fragrance mix I 3. Methyliso-thiazolinone 4. Neomycin 5. Bacitracin 6. Cobalt chloride

7. Balsam of Peru 8. p-Phenylenediamine 9. Formaldehyde 10. Methylchloroiso-thiazolinone/Methylisothiazolinone

Top Workplace Allergens- Canada l Epoxy resin l Thiuram Mix l Carba Mix l Nickel sulfate l Cobalt chloride l Potassium dichromate l Glyceryl thioglycolate l P-phenylenediamine l Formaldehyde l Glutaraldehyde l Arrandale et al Am J Ind Med 2012; 55:353-60.

Top Workplace Allergens- USA l Carba Mix

l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel

Formaldehyde-Releasers l Carba Mix

l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel l Quaternium-15 l Imidazolidinyl urea (Germall 115) l Diazolidinyl urea (Germall II) l DMDM hydantoin (Glydant) l 2-Bromo-2-nitropropane-1,3-diol (Bronopol) l Sodium hydroxymethyl glycinate


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel

Emerging Occupational Allergens

Coconut Derivatives Cocamide diethanolamine (DEA) l Surfactant in industrial, household and cosmetic products l 19 of 25 reactions in Finland study were noted to be occupational,

with most exposures noted to be in the metal industry in soaps and metalworking fluids

l Aalto-Korte K et al. Contact Dermatitis. 2014;70(3).

Cocamide monoethanolamide (MEA) l Recently described allergen found in metalworking fluid l Aalto-Korte K et al. Contact Dermatitis. 2013;69(5).

Coconut Derivatives Capryldiethanolamine l Occupational allergen in metalworking fluids l Not listed on the MSDS l Suuronen K et al. Contact Dermatitis. 2014;72(2).

Sodium cocoamphopropionate l Surfactant derived from coconut fatty acids condensed with amino-

ethyl ethanolamines l In soaps, shampoos and conditioners l Occupational allergen in Swedish fast-food workers l Hagvall L et al. Contact Dermatitis. 2014;71(2).

Medications l Benzodiazepines- facial airborne contact from crushing pills in a

cohort of patients n Swinnen I et al. Contact Dermatitis. 2014;70(4).

Medications l Sevofluorane- airborne allergic contact dermatitis in a surgeon n Burches E et al. Contact Dermatitis. 2015;71(1).

Medications l Omeprazole-used to treat and prevent stomach ulcers in horses-

OCD in a horse caregiver and in a horse trainer n Alwan W et al. Contact Dermatitis. 2014;71(6). n Al-Falah K et al. Contact Dermatitis. 2014;71(6).

Fragrances l Citral- OCD in spa beauticians n De Mozzi P et al.Contact Dermatitis. 2014;70(6).

l d- limonene- OCD from machine cleaners, hand soaps, moisturizers, surface cleanser, and dishwashing soaps n  Pesonen M et al. Contact Dermatitis. 2014;71(5).

Fragrances l United Kingdom study of OCD 1996-2015 n  Beauticians, hairdressers and beauty industry workers had a 47-times higher incidence rate ratio of allergy to fragrance when compared to the average rate of all other occupations combined

n Montgomery RL et al. Contact Dermatitis. 2018;78(1).

Isothiazolinones l Increasing in OCD n Pesonen M et al. Contact Dermatitis. 2015;72(3).

l Paints, varnishes, cleaners and cleansers, and polishing liquids n Friis UF et al. Contact Dermatitis. 2014;71(2).

Isothiazolinones l High risk industries: painting, welding (blacksmiths), machine

operating, cosmetology n Schwensen JF et al. Contact Dermatitis. 2014;71(5).

l Working in a water cooling tower n Maor D et al. Dermatitis. 2015;26(1).

l Unique case- ultrasonographer’s ultrasound gel n  Suuronen K et al. Contact Dermatitis. 2014;72(2).

Preferred Approach to Occupational Exposure

Treatment l Avoidance n Harder with omnipresent allergens (epoxy versus rubber allergens)

l MSDS in workplace

Material Safety Data Sheets Mandated l Hazardous chemical name l Chemical properties l Physical hazards l Route of entry l Known exposure limits l Carcinogenicity l Clean-up practices l Control measures l Contact information

Material Safety Data Sheets Mandated l Hazardous chemical name l Chemical properties l Physical hazards l Route of entry l Known exposure limits l Carcinogenicity l Clean-up practices l Control measures l Contact information Not required l If proprietary l Specific name often avoided (general category used) l Irritants and sensitizers if <1% concentration l Often do not address prevention of sensitization and irritancy

MSDS

Treating Hand Dermatitis- What’s new l Barrier creams- Repair versus Protect n Repair creams with ceramides n Rebuild integrity of skin

Treating Hand Dermatitis- What’s new l Barrier creams- Repair versus Protect n Barrier “protect” creams with dimethicone l Prevention of irritant contact dermatitis l At high dose of application (2-20x actual application) can help prevent ICD l Schliemann et al., Contact dermatitis 70, 19-26.

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

n At least recommend moisturizing

Treating Hand Dermatitis- What’s new l Cotton liners under gloves n Adisesh et al., Br J Dermatol 2013.

Treatment- What’s New l Multidisciplinary teams aid in successful return to work n German model included inpatient and outpatient care l 87% remained in workforce l Weisshaar et al., Contact Dermatitis 2013;68:169-174.

n Netherlands included a dermatologist, education nurse, occupational medicine physician l Van Gils et al., Contact Dermatitis 2012 66(4) and 66(5).

n Canadian models l Multidisciplinary n Gomez et al., Dermatitis 2011;22(3).

l Graduated approach to RTW- 78% returned to job, 17% went to administrative role n Chen et al., Dermatitis 2016;27(5).

Prevention l Evidence-based intervention- “Education” n 1 hour voluntary hand protective behavior lecture/ intervention n Full-time hospital cleaners

l At 3 months post-intervention n Decreased hand cleansing n Better knowledge of hand preservation n Improved hand dermatitis

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

Prevention l Review of skin protection and disease prevention training

programs n Fairly difficult to create consensus n Focused mostly on ICD n Need for more data and programs to determine effectiveness

l Zack et al., Dermatitis 2017;28(3).

Prevention l Personal protective equipment n Match task with glove n “Quick Selection Guide to Chemical Protective Clothing” by Forsberg and Mansdorf

l Legislation

Occupational Dermatitis Resources l Quick Selection Guide to Chemical Protective Clothing by

Forsberg and Mansdorf l Contact and Occupational Dermatology by Marks, Elsner, DeLeo l Patch Testing. Test Concentration and Vehicles for 4350

Chemicals by de Groot l ACDS website- contactderm.org l OSHA, NIOSH

Legislation l Filon et al., Dermatitis 28(5), 327-328.

Summary l Occupational contact dermatitis is underreported l Irritant and allergic contact dermatits l Novel and emerging allergens in the workplace l Follow hazard controls approach l Work with employer for RTW

References l Marks et al., 2002. Marks J.G., Elsner P., DeLeo V.A.: Contact and

Occupational Dermatology, 3rd ed. St Louis, Mosby, 2002. l 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.

l 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

l 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.

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

l 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.

l Lushniak BD. The epidemiology of occupational contact dermatitis. Dermatol Clin 1995; 13:671–9.

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

l 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.

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

l Warshaw E. Therapeutic options for chronic hand dermatitis. Dermatol Ther 2004;4:17240–50.

l 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.

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

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

References l Sprigle AM, Marks JG Jr, Anderson BE. Prevention of nickel

release with barrier coatings. Dermatitis. 2008,19(1):28-31. l Diepgen T.L., Coenraads P.J.: The epidemiology of occupational

contact dermatitis. Int Arch Occup Environ Health 72. (8): 496-506.1999.

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

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

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

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

l 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.

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

l 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.

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

l 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.

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

l 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.

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

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

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

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

l 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.

l Luckhaupt, S. E., Dahlhamer, J. M., Ward, B. W., Sussell, A. L., Sweeney, M. H., Sestito, J. P. and Calvert, G. M. (2013), Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey. Am. J. Ind. Med., 56: 625–634.

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MSDS

















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42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

7

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

8

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

9

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

10

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

11

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

12

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

13

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

14

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

15

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

16

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

17

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

18

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

1/27/18

19

























l Acids


l Solvents






Occupations















Allergens





l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel


l Thiuram Mix

l Epoxy Resin

l Formaldehyde



l Thiuram Mix

l Epoxy Resin

l Formaldehyde

l Nickel





























MSDS

















l Legislation









































Thank you!

1

2

3

4

5

6

1

2

7

8

1

2

9

1

2

10

11

12

13

14

1

2

15

1

2

16

17

1

2

18

19

1

2

20

1

2

21

22

23

1

2

24

25

1

2

26

1

2

27

28

29

30

31

1

2

32

33

34

1

2

3

4

35

1

2

3

4

36

37

38

39

40

41

42

43

44

45

1

2

46

1

2

3

4

47

48

49

50

51

52

53

54

55

56

57

58

1

2

59

60

61

Documents

Lampel Occ Derm UpdateAAD 2018F S061... · lReview top and emerging occupational allergens and irritants ... cosmetology nSchwensen JF et al ... and avoidance of skin-care product