Determinants of hand dermatitis
Hand dermatitis is a disease with a multifactorial aetiology.
Personal and work-related factors interact in a complex
manner. Tulipalin A seems to be a main factor with
52.1% of the workers with major or minor hand dermatitis
being sensitized for tulipalin A. In these workers, this
allergen elicits hand dermatitis to a lesser or larger extent
in combination with irritative factors. The sap seems to
have an irritant effect as was mentioned by several
workers. However, the pH is practically neutral (6.6).
The hands of the workers became moistened by the sap of
Aktroemeria through intensive contact all day. Wet hands
are more liable to skin damage due to maceration of the
skin and better penetration of chemicals.
Mechanical insults by the knife and stalks were another
important determinant. The combination of mechanical
insults and chemical factors probably caused the clinical
picture of 'chronic palmar irritant dermatitis'.
The findings that dry, chapped hands showed a significant
relationship with hand dermatitis while skin type did
not, suggest that this condition was caused by workrelated
factors (like washing hands and climatic circumstances)
.. However, no definite conclusions can be drawn
with regard to the causal relationship. Dry, chapped
hands might be a predisposing factor for the development
of hand dermatitis, but it may also be an early manifestation
or a consequence of hand dermatitis, or a feature of
atopic dermatitis.25
The same problem applied for the
frequency of washing hands. Washing the hands more
often than five times a day could contribute to hand
dermatitis. It is also possible that minor hand dermatitis
resulted in washing the hands more often, because dirt
was more difficult to remove.
The cultivation of other plants could influence hand
dermatitis as well, not only due to the plant itself but also
to circumstances which differed from the cultivation of
the Aktroemeria. Contact with pesticides or soil were, for
instance, factors of minor importance in the cultivation of
the Aktroemeria, but they might play a more important
role in other cultivations.
Some Aktroemeria varieties were mentioned as causing
more symptoms than other varieties. A reason for this
could be that these cultivated varieties (or some of them)
could not be extracted, but had to be cut off, which
resulted in a higher exposure to sap. Other
reasons could be a more sapful plant and a higher concentration
of tulipalin A.9
-
26
If this last suggestion is correct, it
may be worthwhile breeding varieties with a low content
of tulipalin A.26
The findings that atopic dermatitis showed a significant
relationship with major hand dermatitis and that atopic mucosal symptoms did not, is in accordance with the
literature. Nilsson et al?1
and Rysted et al.28 demonstrated
that atopic dermatitis is a more important determinant
than atopic mucosal symptoms.
Age did not show a significant relationship with hand
dermatitis. In the literature there is no agreement regarding
this determinant.
19>
20'
24
-
29
However, one of these
studies24
showed that the age effect disappeared when
correcting for occupation. This is in accordance with our
results, because our study is carried out within one
occupation.
The use of skin care products showed a significant
relationship with hand dermatitis. It is possible that skin
care products cause hand dermatitis, but it is more likely
that hand dermatitis leads to an increase in use of skin
care products.
Rubber gloves, even from household thickness, are
penetrated easily by tulipalin A in a short time.30
This
type and comparable gloves were often used, especially in
those with hand dermatitis. Despite that, 75% noticed
protection from the gloves. A reason could be that penetration
of tulipalin A is hampered by dirt on the gloves.
Nitril or 4H-gloves do give longer protection; they have
a break-through time of approximately 4 h.