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Am Fam Physician. 1998;57(2):342

Irritant contact dermatitis of the hands, particularly in the finger webs and on the fingertips, is an occupational exposure for which some protective creams have been shown to be effective. However, before these creams can reduce the risk of contact dermatitis, they must be applied frequently and in sufficient amounts to all areas that need protection. Wigger-Alberti and associates prospectively studied the effectiveness of protective cream in reducing contact dermatitis.

A total of 150 volunteers were recruited from a metalworking factory, several construction sites and a university hospital housekeeping department. The study subjects' hands underwent constant exposure to irritating substances such as metalworking fluid, cement or painting colors. The protective cream used in the study was mixed with vitamin A acetate to obtain fluorescence under Wood's lamp so that the amount of coverage could be evaluated. Under normal light, the preparation was invisible. At least 51 of 56 areas of the hands had to be covered for the hands to be considered sufficiently protected. Volunteers also answered a questionnaire about their history and knowledge of the use of protective creams.

Results of the study showed that almost 100 percent of the volunteers had applied a sufficient amount of cream to the palms of the hands. However, considerable differences were apparent in the amounts applied to the dorsal aspects of the hands and wrists. All volunteers had incomplete application on the dorsal aspects of the fingers and in the interdigital spaces, except for the area between the thumb and the index finger.

Metalworkers had the highest rate of coverage but, even in this group, coverage in the interdigital spaces ranged only from 54 to 70 percent. Hospital cleaners and construction workers had only 50 to 60 percent coverage and 34 to 42 percent coverage, respectively, in the interdigital spaces. Most volunteers were surprised to see how many areas they had missed. The volunteers' hands seemed to be protected comparably to workers wearing gloves with many holes.

Data from the questionnaire showed that 38 percent of hospital cleaners and metalworkers reported a history of irritant contact dermatitis, compared with 24 percent of construction workers. Sixty-four percent of the metalworkers stated that they had been informed about the use of skin protection at their workplace, but 78 percent stated they were occasional or regular users of a protective cream. Differences in coverage may reflect the influence of previous information given about the necessity and the correct use of protective creams. However, regardless of information received by all three groups, the application was less than satisfactory. The dorsum of the hands was particularly under-protected.

The authors conclude that education appears to be one of the basic elements in preventing occupational irritant contact dermatitis. Physicians and individuals who provide job training should give specific instructions on the use of occupational skin protection for workers at high risk for contact dermatitis.

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Copyright © 1998 by the American Academy of Family Physicians.

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