Treatments to prevent irritant hand dermatitis in the workplace

Occupational irritant hand dermatitis (OIHD) is an inflammatory reaction of the skin occurring in people who regularly come into contact with water, detergents, chemicals, and other irritants during their working day. Occupations at particular risk include hairdressing, nursing, cleaning, building, and the dye, printing, metal, and food industries. The condition is relatively common and affects about 5 to 20 out of 10,000 full-time workers per year. The first signs are red and scaly patches in the finger webs and on the knuckle area of the hands. Itchy blisters and painful cracks and possibly infection are common, and eventually the skin becomes thickened.  

Preventing OIHD from developing is important because it is difficult to clear once it starts.

Although the findings of this review were generally positive we concluded that there is insufficient evidence, at present, for the effectiveness of most of the treatments identified for preventing new cases of OIHD in the workplace. This may be because further research is needed or the studies that have been done did not recruit a large enough number of participants. Larger studies are now needed to determine if primary prevention is helpful and which strategy (e.g. education or barrier creams) is best.

Authors' conclusions: 

Although the findings of this review were generally positive, no statistical significance was reached. We conclude that at present there is insufficient evidence for the effectiveness of most of the interventions used in the primary prevention of OIHD. This does not mean that current measures are necessarily ineffective, as the limited studies to date have been rather small and of poor quality. Larger well designed RCTs are now needed in different workplaces to establish the effectiveness of various preventative strategies.

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Background: 

Occupational irritant hand dermatitis (OIHD) is an important cause of discomfort in the working population. Different preventive measures are in place but it is not clear how effective these are.

Objectives: 

To assess the effect of interventions for preventing OIHD in healthy people who work in occupations where the skin is at risk of damage.

Search strategy: 

In May 2010, we searched the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLlNE and EMBASE. Conference proceedings, and ongoing trials registers were also searched.

Selection criteria: 

Randomised controlled trials (RCTs) studying the effectiveness of barrier creams, moisturisers, gloves, complex educational interventions, and other interventions for the prevention of OIHD.

Data collection and analysis: 

Two authors independently assessed the trials and extracted data.

Main results: 

Four RCTs involving 894 participants from different occupations were included. The primary outcome was numbers of new cases.

One large RCT of 708 print and dye workers compared 2 barrier creams (containing silicone or hydrocarbon) versus no intervention. Fewer workers using barrier creams developed OIHD than those who did not (39.9% versus 45%, (OR 0.75, 95% CI 0.53 to 1.07. P = 0.11) but this was not statistically significant.

In 1 RCT of 54 metal workers less developed OIHD when using an after work emollient or a barrier cream compared to no intervention. There was no statistical difference between the groups at different times of follow-up.

One RCT of 111 cleaners and kitchen workers compared a moisturiser (Locobase™) versus no intervention using a cross-over design. While using the moisturiser no participant developed OIHD. During the control period with no skin treatment, 19 (20.4%) out of 93 participants developed OIHD.

One RCT of 21 hairdressers compared a barrier cream containing aluminium chlorohydrate (Excipial protect™) versus its vehicle. No participant developed OIHD while the products were used.

Only limited side-effects such as transient itching, stinging, and dryness were reported for the interventions.

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