Cross-sectional study on determinants of contact dermatitis on the hands of construction workers: etiologic studies and development of a diagnostic tool

Occupational contact dermatitis (OCD) is one of the most prevalent occupational
diseases in many countries and accounts for more than 95% of all occupational
dermatoses. In the general population, hand dermatitis prevalence is estimated
to be around 4%. Recently, we analyzed data from a questionnaire that is
administered as part of a regular program of voluntary occupational health
examinations (PAGO). Amongst 110,024 construction yard workers, skin symptoms
on the hands or fingers were reported by 25%. Dermatitis symptoms are very
intermittent, making diagnosis challenging. However, as ongoing exposure may
lead to chronic OCD, it is of outstanding interest to diagnose OCD at an early
stage and to offer specialized health care to prevent OCD from becoming
chronic.

Primary objective is to determine the actual occurrence of and risk factors for
OCD on the hands of Dutch construction workers.
With these new insights into the risk factors for OCD, we aim to develop 1) a
new diagnostic tool to be used by occupational physicians to screen
construction workers for predictors of OCD, and 2) a predictive tool for
companies to assess the risk reduction, for instance by implementing protective
measures.
The first is a triage tool to diagnose construction workers with OCD. It is
meant to be used by occupational physicians to identify workers with a high
risk for having OCD. They can then be referred to a specific health care
provider, i.e. a (occupational) dermatologist. The second tool is an extension
of the *Stoffenmanager Bouwnijverheid* which is to be used by construction
companies. It is meant to register hazardous substances and products and to
propose safer working methods with those substances. The planned extension is
focused on contact dermatitis and the risks of material handling and the risk
reduction by implementing protective measures.

Observational cross-sectional study among 1000 construction workers.
Participants will be enrolled
1) while attending a regular program of voluntary occupational health
examinations (PAGO), or
2) during a visit at construction companies.
Participants will fill in a questionnaire, either digitally or on paper. Photos
of the hands will be made, which will be diagnosed on OCD by a team consisting
of a dermatologist and an occupational physician. Blood will be collected via
venapunction to determine atopic status and to genotype loss-of-function
mutations in the FLG gene.

For subjects attending the PAGO: as the study takes place within the regular
medical check-up, participation does not yield any risk for the study
participants. Two extra blood tubes (1 * 6 mL and 1 * 4 mL) will be collected,
but no additional venapunction is required. For subjects participating at the
toolbox meetings: two blood tubes (1 * 6 mL and 1 * 4 mL) will be collected via
venapunction. The risks related to venapunction are negligible. Participation
in the study will take around 20-25 minutes of time. Possible benefits for
participants and other construction workers are a greater chance of diagnosing
current skin disease, prevention of potential chronic OCD, as well as a better
awareness of the existence of skin disease and harmful dermal exposures in the
construction industry.