Proposal of a Hand Eczema Score for Occupational Screenings
Proposal of a Hand Eczema Score for Occupational Screenings
Background Skin scoring systems have to meet specific demands depending on their particular settings and indications, e.g. occupational screenings vs. clinical examinations, evaluating progress of treatment or supervision of preventive strategies. Until now, most scoring systems have been developed for severe cases of hand eczema. A validated quantitative scoring system for early hand eczema is still missing.
Objectives The present cross-sectional study was aimed at assessing the practical value of a quantitative hand eczema score for occupational screenings (HEROS) at the workplace and its potential for identifying individuals at increased risk of work-related skin disease.
Methods Both hands of 800 male metal workers were examined for characteristic morphological patterns of hand dermatitis and quantified with HEROS. The score was validated by testing inter- and intraobserver reliability in random samples. Results of validation were compared with three already validated skin scores for distinct hand eczema (Osnabrück hand eczema severity index, hand eczema severity index, Manuscore).
Results The score values ranged from 0 to 82 (theoretical maximum 2260), reflecting the skin condition of healthy, fit-for-work subjects. Inter- and intraobserver reliability was good to excellent. Results for reliability of the HEROS were in line with all three validated scores for hand eczema. The predictive value for identifying persons at increased risk for developing hand eczema was low.
Conclusions The HEROS seems to be an adequate tool for observer near-independent assessment of early hand eczema, especially for quantifying minimal skin impairment. Therefore, we propose the implementation of this scoring system for quantifying early hand dermatitis in occupational screenings.
Despite considerable knowledge on risk factors and prevention of occupational skin diseases obtained from clinical, epidemiological and experimental studies, the frequency of hand eczema (HE) – the most common form of occupational skin disease – remains high and has even increased in some populations. Occupational skin diseases represent approximately 40% of occupational illness; varying percentages in different countries are associated with the extent and type of industrialization. The annual incidence of occupational skin diseases is reported to be 9·1–31·7 per 100 000 workers. Except for female sex atopic dermatitis, wet work and contact allergy are the most relevant risk factors for HE. Employees of the metal working industry are at increased risk for occupational HE. In a sample of 1110 metal worker apprentices a 1-year cumulative incidence of 9·2% [95% confidence interval (CI) 7·8–10·7] was reported.
In a substantial number of patients HE develops into a chronic condition even when the initial causative agent is avoided. Particularly for young professionals, the socioeconomic impact caused by sick leave, disability and job change is extremely high. In contrast to other occupational diseases, preventive strategies (e.g. technical or organizational) often allow workers concerned to retain their employment.
Recently, a total of 69 articles reporting on 45 different methods for quantifying HE was identified. Among these, most were developed for severe HE. Three skin scores that have already been validated assessed the severity of distinct HE [Osnabrück hand eczema severity index (OHSI), hand eczema severity index (HECSI), Manuscore]. However, subjects in occupational screenings are almost healthy and fit for work, so 'minimal impaired skin condition' is the finding most frequently obtained in their medical check-ups. A precise scoring system for quantifying this 'minimal impairment' which can be understood as initial HE is still missing. The variety of morphologies and severity makes it difficult to define a widely accepted, standardized definition of the term 'HE'.
The present cross-sectional study in 800 male metal workers was aimed at assessing the practical value of a skin score for early HE in screenings at the workplace and its potential for identifying individuals at increased risk of work-related skin disease.
Abstract and Introduction
Abstract
Background Skin scoring systems have to meet specific demands depending on their particular settings and indications, e.g. occupational screenings vs. clinical examinations, evaluating progress of treatment or supervision of preventive strategies. Until now, most scoring systems have been developed for severe cases of hand eczema. A validated quantitative scoring system for early hand eczema is still missing.
Objectives The present cross-sectional study was aimed at assessing the practical value of a quantitative hand eczema score for occupational screenings (HEROS) at the workplace and its potential for identifying individuals at increased risk of work-related skin disease.
Methods Both hands of 800 male metal workers were examined for characteristic morphological patterns of hand dermatitis and quantified with HEROS. The score was validated by testing inter- and intraobserver reliability in random samples. Results of validation were compared with three already validated skin scores for distinct hand eczema (Osnabrück hand eczema severity index, hand eczema severity index, Manuscore).
Results The score values ranged from 0 to 82 (theoretical maximum 2260), reflecting the skin condition of healthy, fit-for-work subjects. Inter- and intraobserver reliability was good to excellent. Results for reliability of the HEROS were in line with all three validated scores for hand eczema. The predictive value for identifying persons at increased risk for developing hand eczema was low.
Conclusions The HEROS seems to be an adequate tool for observer near-independent assessment of early hand eczema, especially for quantifying minimal skin impairment. Therefore, we propose the implementation of this scoring system for quantifying early hand dermatitis in occupational screenings.
Introduction
Despite considerable knowledge on risk factors and prevention of occupational skin diseases obtained from clinical, epidemiological and experimental studies, the frequency of hand eczema (HE) – the most common form of occupational skin disease – remains high and has even increased in some populations. Occupational skin diseases represent approximately 40% of occupational illness; varying percentages in different countries are associated with the extent and type of industrialization. The annual incidence of occupational skin diseases is reported to be 9·1–31·7 per 100 000 workers. Except for female sex atopic dermatitis, wet work and contact allergy are the most relevant risk factors for HE. Employees of the metal working industry are at increased risk for occupational HE. In a sample of 1110 metal worker apprentices a 1-year cumulative incidence of 9·2% [95% confidence interval (CI) 7·8–10·7] was reported.
In a substantial number of patients HE develops into a chronic condition even when the initial causative agent is avoided. Particularly for young professionals, the socioeconomic impact caused by sick leave, disability and job change is extremely high. In contrast to other occupational diseases, preventive strategies (e.g. technical or organizational) often allow workers concerned to retain their employment.
Recently, a total of 69 articles reporting on 45 different methods for quantifying HE was identified. Among these, most were developed for severe HE. Three skin scores that have already been validated assessed the severity of distinct HE [Osnabrück hand eczema severity index (OHSI), hand eczema severity index (HECSI), Manuscore]. However, subjects in occupational screenings are almost healthy and fit for work, so 'minimal impaired skin condition' is the finding most frequently obtained in their medical check-ups. A precise scoring system for quantifying this 'minimal impairment' which can be understood as initial HE is still missing. The variety of morphologies and severity makes it difficult to define a widely accepted, standardized definition of the term 'HE'.
The present cross-sectional study in 800 male metal workers was aimed at assessing the practical value of a skin score for early HE in screenings at the workplace and its potential for identifying individuals at increased risk of work-related skin disease.
