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      Prevalence of skin sensitization and dermatitis among epoxy‐exposed workers in the wind turbine industry*

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          Summary

          Background

          A high prevalence of skin sensitization and dermatitis has been reported among workers exposed to epoxy components.

          Objectives

          To estimate the risk of skin sensitization and dermatitis among workers exposed to epoxy components during production of wind turbine blades while using comprehensive safety measures.

          Methods

          A cross‐sectional study of 180 highly epoxy‐exposed production workers and 41 nonexposed office workers was conducted at two wind turbine blade factories in Denmark. Participants underwent a skin examination, were tested with a tailored patch test panel including epoxy‐containing products used at the factories, and answered a questionnaire.

          Results

          Sixteen production workers (8·9%) were sensitized to an epoxy component compared with none of the office workers. Skin sensitization was more frequent within the first year of exposed employment. Strong selection bias by atopic status was indicated. Among nonatopic workers, the prevalence of dermatitis was higher among production workers (16·4%) than among office workers [6·5%, odds ratio (OR) 2·3, 95% confidence interval (CI) 0·6–9·1] and higher among the sensitized workers (43·8%) than the nonsensitized workers (14·6%, OR 4·5, 95% CI 1·6–12·7). Resins based on diglycidyl ether of bisphenol A and F were the most frequent sensitizers. One of the four workers sensitized to epoxy components used at the factories did not react to the epoxy resin of the TRUE test ® panel.

          Conclusions

          Despite comprehensive skin protection, sensitization and dermatitis are prevalent among highly epoxy‐exposed workers in the wind turbine industry in Denmark. Our findings document the need for intensified preventive efforts and emphasize the importance of tailored patch testing.

          What is already known about this topic?

          • Epoxy components are well‐known sensitizers of the skin.

          • A high prevalence of skin sensitization and dermatitis has been reported among workers exposed to epoxy components.

          • Comprehensive protective equipment is recommended when working with epoxy components.

          What does this study add?

          • Despite comprehensive skin protection, skin sensitization and dermatitis are prevalent among epoxy‐exposed workers.

          • We found that 40% of workers sensitized to epoxy products had dermatitis.

          • Only 75% of the sensitized workers were detected by the epoxy resin of the TRUE test ®, which emphasizes the importance of tailored testing.

          Abstract

          Linked Comment: R. Brans. Br J Dermatol 2022; 187:842–843.

          Plain language summary available online

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          Most cited references43

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          European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice.

          Jeanne Johansen, Kristiina Aalto-Korte, Tove Agner … (2015)
          The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.
          Article 0 comments Cited 188 times – based on 0 reviews     Review now
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            Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure.

            B. Olafsson, P Susitaival, Mikael Svensson … (2003)
            Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.
            Article 0 comments Cited 65 times – based on 0 reviews     Review now
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              Analysis of sparse data in logistic regression in medical research: A newer approach

              Honagalli S Devika, L. Jeyaseelan, G Sebastian (2016)
              Background and Objective: In the analysis of dichotomous type response variable, logistic regression is usually used. However, the performance of logistic regression in the presence of sparse data is questionable. In such a situation, a common problem is the presence of high odds ratios (ORs) with very wide 95% confidence interval (CI) (OR: >999.999, 95% CI: 999.999). In this paper, we addressed this issue by using penalized logistic regression (PLR) method. Materials and Methods: Data from case-control study on hyponatremia and hiccups conducted in Christian Medical College, Vellore, Tamil Nadu, India was used. The outcome variable was the presence/absence of hiccups and the main exposure variable was the status of hyponatremia. Simulation dataset was created with different sample sizes and with a different number of covariates. Results: A total of 23 cases and 50 controls were used for the analysis of ordinary and PLR methods. The main exposure variable hyponatremia was present in nine (39.13%) of the cases and in four (8.0%) of the controls. Of the 23 hiccup cases, all were males and among the controls, 46 (92.0%) were males. Thus, the complete separation between gender and the disease group led into an infinite OR with 95% CI (OR: >999.999, 95% CI: 999.999) whereas there was a finite and consistent regression coefficient for gender (OR: 5.35; 95% CI: 0.42, 816.48) using PLR. After adjusting for all the confounding variables, hyponatremia entailed 7.9 (95% CI: 2.06, 38.86) times higher risk for the development of hiccups as was found using PLR whereas there was an overestimation of risk OR: 10.76 (95% CI: 2.17, 53.41) using the conventional method. Simulation experiment shows that the estimated coverage probability of this method is near the nominal level of 95% even for small sample sizes and for a large number of covariates. Conclusions: PLR is almost equal to the ordinary logistic regression when the sample size is large and is superior in small cell values.
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Alexandra G. Christiansen:
                ORCID: https://orcid.org/0000-0003-1787-6669
                alexpe@rm.dk
                Journal
                Journal ID (nlm-ta): Br J Dermatol
                Journal ID (iso-abbrev): Br J Dermatol
                Journal ID (doi): 10.1111/(ISSN)1365-2133
                Journal ID (publisher-id): BJD
                Title: The British Journal of Dermatology
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0007-0963
                ISSN (Electronic): 1365-2133
                Publication date (Electronic): 16 September 2022
                Publication date (Print): December 2022
                Volume: 187
                Issue: 6 ( doiID: 10.1111/bjd.v187.6 )
                Pages: 988-996
                Affiliations
                [ 1 ] Department of Occupational Medicine, Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
                [ 2 ] Department of Occupational Medicine, The Regional Hospital Goedstrup University Research Clinic Herning Denmark
                [ 3 ] Department of Dermatology Aarhus University Hospital Aarhus Denmark
                [ 4 ] National Research Centre for the Working Environment Copenhagen Denmark
                [ 5 ] Department of Occupational and Environmental Medicine, Danish Ramazzini Centre Aalborg University Hospital Aalborg Denmark
                [ 6 ] Department of Public Health, Danish Ramazzini Centre Aarhus University Aarhus Denmark
                [ 7 ] Department of Occupational and Environmental Dermatology Lund University, Skane University Hospital Malmö Malmö Sweden
                [ 8 ] Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
                [ 9 ] Institute of Clinical Medicine Aarhus University Aarhus Denmark
                Author notes
                [*] [* ] Correspondence

                Alexandra Golabek Christiansen.

                Email: alexpe@ 123456rm.dk

                Author information
                https://orcid.org/0000-0003-1787-6669
                Article
                Publisher ID: BJD21830 Other ID: BJD-2022-0741.R2
                DOI: 10.1111/bjd.21830
                PMC ID: 10087335
                PubMed ID: 35972390
                SO-VID: 48728a66-6ad4-459a-aa97-40ada0abc498
                Copyright © © 2022 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date revision received : 12 August 2022
                Date received : 04 April 2022
                Date accepted : 14 August 2022
                Page count
                Figures: 0, Tables: 5, Pages: 996, Words: 8083
                Funding
                Funded by: Siemens Gamesa Renewable Energy
                Funded by: The Working Environment Research Fund
                Award ID: 20175100924
                Categories
                Subject: Medical Dermatology
                Subject: Original Articles
                Subject: Medical Dermatology
                Custom metadata
                source-schema-version-number 2.0
                cover-date December 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.7 mode:remove_FC converted:11.04.2023

                ScienceOpen disciplines: Dermatology
                Data availability:
                ScienceOpen disciplines: Dermatology

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