Australas J. Dermatol 1992; 33: 49-50
REPORT OF MEETING Occupational Skin Disease Skin and Cancer Foundation: 4th April 1992 This meeting attracted an overflow audienee of dermatologists, dermatology trainees and specialists in occupational medicine. Dr Robert Adams of Stanford University, and Editor in Chief of the American Journal of Contact Dermatitis was the guest speaker. Dr Adams spoke on 'High Risk Dermatology' discussing some of the problems which affect workers' ability to obtain employment and to continue working in certain occupations. Despite widespread automation, workers' hands are exposed to physical and chemical irritants and to many chemicals which can induce contact allergic dermatitis. Dr Adams spoke of the problems of atopic dermatitis - which he defined as 'An inherited deficit in skin barrier function with decreased resistance to irritants'. He outlined a number of occupations suitable for people with atopic dermatitis, and emphasized that preemployment guidance can help to avoid work which irritates the skin. He did not consider that atopic subjects were significantly less likely to develop allergic contact dermatitis than nonatopies. Dr Adams also discussed common allergens causing dermatitis in industry, and he said that many workers were not referred for patch testing, and were therefore not diagnosed correctly. He finds that "user tests" and seven day open testing of agents in the concentration encountered in work can be helpful, as well as patch testing with the standard tray and with agents related to the worker's occupation. A simulated workers' compensation court followed, in which Dr Adams and Dr Ted Emmett appeared for the worker or the insurance company, with Mr H. Sperling QC acting as President of the Court, and the audience acting as witnesses and finally as adjudicators. It was accepted that a basal cell carcinoma on the arm of a traffic policeman was work related, and that a boat builder's epoxy resin sensitivity would prevent him from continuing in this occupation, but it was regarded that a melanoma arising in a melanotic freckle on the temple of an office worker was not due to working under fluorescent lights. 49
Dr Torkel Fischer, Professor of Occupational Dermatology, Uppsala, and a leading worker in development of the TRUEtest system spoke on the evolution of patch testing methods. Adhesive tape has progressed from allergenic sticking plaster to low allergy 'scan pore", allergens have been upgraded from extemporary preparations to standard test materials and later to the TRUEtest system with chemicals in a gel base, and standard batteries of tests for testing all patients and for use in specific situations have been defined. Dr Fischer answered further questions, relating to formalin in the TRUEtest set (this will be available soon), the problems of the cost of TRUEtest, the low sensitizing capacity of sunscreen chemicals and problems associated with irritant reactions to patch tests. Ms Kathryn Frowen RN spoke of work she had carried out with Dr Rosemary Nixon, studying contact allergy to Epoxy Resins in Melbourne building trades. She noted that a number of smaller companies had not taken part in the survey, and that some severely affected workers could have left the industry. It had been found that out of 242 workers who completed questionnaires, allergy to resins or hardeners had developed in 11.4% and contact urticaria to these agents was present in 0.9%. The general conclusions of the study were important in that more positive reactions occurred to diluted samples of the workers resins and hardeners than to standard agents, reactions to hardeners were quite frequent, and that many of the workers, although sensitive to epoxy chemicals, could continue to work in the industry. Mr M. Ramsay discussed preparation of medical reports in relation to workers' compensation, and he outlined important details which should appear in such reports. He noted that reports should make it clear which statements were first hand - recorded or observed by the doctor writing the report, and which were second hand, having been obtained from other sources. He considered that it would be correct for a doctor to request further information before writing a report, and that if the case involved
REPORT OF MEETING
genuine doubt this could be expressed before the doctor set down his own views on the questions to be answered. He said that assessment of degree of disability was often very difficult, but that this assessment could be of great assistance in reaching a decision about workers' compensation liability. Dr CL Goh spoke on studies he had performed in Singapore on workers exposed to cutting oils, and he noted that the unemployment rate is very low in Singapore, so that few cases of persisting hand dermatitis had been identified - workers had probably moved to other jobs when their dermatitis commenced. He had found that irritant reactions were four times as common as allergic sensitivity, and that when allergy was diagnosed, the precise allergen was not found in 40% of cases. Sensitivity to metals, ethylene diamine and to biocides was found in most cases
50
where the allergen was identified. He had found that problems with Dielectric Fluid (hydrocarbon compounds) were increasing: these fluids are used in an 'electro-discharging' method of boring very fine holes in metals - such as the blades of jet engines. Dr Goh had found that barrier creams had not been more helpful to workers than simple emollient creams, and that simple methods in the factory cold help to lessen dermatitis - such as provision of disposable hand wiping tissues instead of reusing cloth and rags for hand wiping. Dr Adams and Dr Susi Freeman concluded the meeting by referring to their experience with a number of allergens in industry, including biocides, hairdressing chemicals (especially glyceryl mono thioglycollate), kathon, glutaraldehyde, rubber in shoes and clothes, and plants, woods and foods. DAVID S NURSE
REPORT OF MEETING Occupational Skin Disease Skin and Cancer Foundation: 4th April 1992 This meeting attracted an overflow audienee of dermatologists, dermatology trainees and specialists in occupational medicine. Dr Robert Adams of Stanford University, and Editor in Chief of the American Journal of Contact Dermatitis was the guest speaker. Dr Adams spoke on 'High Risk Dermatology' discussing some of the problems which affect workers' ability to obtain employment and to continue working in certain occupations. Despite widespread automation, workers' hands are exposed to physical and chemical irritants and to many chemicals which can induce contact allergic dermatitis. Dr Adams spoke of the problems of atopic dermatitis - which he defined as 'An inherited deficit in skin barrier function with decreased resistance to irritants'. He outlined a number of occupations suitable for people with atopic dermatitis, and emphasized that preemployment guidance can help to avoid work which irritates the skin. He did not consider that atopic subjects were significantly less likely to develop allergic contact dermatitis than nonatopies. Dr Adams also discussed common allergens causing dermatitis in industry, and he said that many workers were not referred for patch testing, and were therefore not diagnosed correctly. He finds that "user tests" and seven day open testing of agents in the concentration encountered in work can be helpful, as well as patch testing with the standard tray and with agents related to the worker's occupation. A simulated workers' compensation court followed, in which Dr Adams and Dr Ted Emmett appeared for the worker or the insurance company, with Mr H. Sperling QC acting as President of the Court, and the audience acting as witnesses and finally as adjudicators. It was accepted that a basal cell carcinoma on the arm of a traffic policeman was work related, and that a boat builder's epoxy resin sensitivity would prevent him from continuing in this occupation, but it was regarded that a melanoma arising in a melanotic freckle on the temple of an office worker was not due to working under fluorescent lights. 49
Dr Torkel Fischer, Professor of Occupational Dermatology, Uppsala, and a leading worker in development of the TRUEtest system spoke on the evolution of patch testing methods. Adhesive tape has progressed from allergenic sticking plaster to low allergy 'scan pore", allergens have been upgraded from extemporary preparations to standard test materials and later to the TRUEtest system with chemicals in a gel base, and standard batteries of tests for testing all patients and for use in specific situations have been defined. Dr Fischer answered further questions, relating to formalin in the TRUEtest set (this will be available soon), the problems of the cost of TRUEtest, the low sensitizing capacity of sunscreen chemicals and problems associated with irritant reactions to patch tests. Ms Kathryn Frowen RN spoke of work she had carried out with Dr Rosemary Nixon, studying contact allergy to Epoxy Resins in Melbourne building trades. She noted that a number of smaller companies had not taken part in the survey, and that some severely affected workers could have left the industry. It had been found that out of 242 workers who completed questionnaires, allergy to resins or hardeners had developed in 11.4% and contact urticaria to these agents was present in 0.9%. The general conclusions of the study were important in that more positive reactions occurred to diluted samples of the workers resins and hardeners than to standard agents, reactions to hardeners were quite frequent, and that many of the workers, although sensitive to epoxy chemicals, could continue to work in the industry. Mr M. Ramsay discussed preparation of medical reports in relation to workers' compensation, and he outlined important details which should appear in such reports. He noted that reports should make it clear which statements were first hand - recorded or observed by the doctor writing the report, and which were second hand, having been obtained from other sources. He considered that it would be correct for a doctor to request further information before writing a report, and that if the case involved
REPORT OF MEETING
genuine doubt this could be expressed before the doctor set down his own views on the questions to be answered. He said that assessment of degree of disability was often very difficult, but that this assessment could be of great assistance in reaching a decision about workers' compensation liability. Dr CL Goh spoke on studies he had performed in Singapore on workers exposed to cutting oils, and he noted that the unemployment rate is very low in Singapore, so that few cases of persisting hand dermatitis had been identified - workers had probably moved to other jobs when their dermatitis commenced. He had found that irritant reactions were four times as common as allergic sensitivity, and that when allergy was diagnosed, the precise allergen was not found in 40% of cases. Sensitivity to metals, ethylene diamine and to biocides was found in most cases
50
where the allergen was identified. He had found that problems with Dielectric Fluid (hydrocarbon compounds) were increasing: these fluids are used in an 'electro-discharging' method of boring very fine holes in metals - such as the blades of jet engines. Dr Goh had found that barrier creams had not been more helpful to workers than simple emollient creams, and that simple methods in the factory cold help to lessen dermatitis - such as provision of disposable hand wiping tissues instead of reusing cloth and rags for hand wiping. Dr Adams and Dr Susi Freeman concluded the meeting by referring to their experience with a number of allergens in industry, including biocides, hairdressing chemicals (especially glyceryl mono thioglycollate), kathon, glutaraldehyde, rubber in shoes and clothes, and plants, woods and foods. DAVID S NURSE
