Hand eczema in metalworker trainees--an analysis of risk factors

The present study, as part of PROMETES (Swiss Prospective Metal Worker Eczema Study), was performed to examine risk factors for the development of occupational hand dermatitis in metal-worker trainees. Since this disease is very common, a high standard of preventive measures is necessary, especially for persons with an endogenous disposition for the development of eczema, e.g., atopics. Within the cohort of 201 healthy young men, 47 (23%) showed at least mild signs of hand eczema at 1 point of the 2.5 year observation period. Various occupational and domestic exposures, skin protection behaviour, regeneration time, and smoking habits, as well as atopic disposition, were studied with regard to their influence on the skin condition of the metalworker trainees. By multivariate analysis, we determined 3 important risk factors for the development of hand eczema in the cohort. (i) We showed once more the important influence of an atopic disposition as a major risk factor for occupational contact dermatitis. (ii) Furthermore, the results suggest that, apart from chemical irritants, mechanical factors should not be underestimated in their role as irritants to the epidermal barrier. (iii) Additionally, an insufficient amount of skin recovery time seems to support a cumulative sub-irritant effect on the skin, which may lead to irritant contact dermatitis.