As a considerable number of apprentice nurses had already developed hand eczema during traineeships, more attention should be paid to skin protection in vocational education.

SummaryBackground/objectivesEnvironmental exposure and personal susceptibility both contribute to the development of hand eczema. In this study, we investigated the effect of loss-of-function mutations in the filaggrin gene (FLG), atopic dermatitis and wet work exposure on the development of hand eczema in apprentice nurses.MethodsDutch apprentice nurses were genotyped for the four most common FLG mutations; atopic dermatitis and hand eczema history were assessed by questionnaire. Exposure and hand eczema during traineeships were assessed with diary cards.ResultsThe prevalence of hand eczema during traineeships was higher among subjects with a history of hand eczema reported at inclusion. Hand washing during traineeships and at home increased the risk of hand eczema. After adjustment for the effects of exposure and FLG mutations, an odds ratio of 2.5 (90% confidence interval 1.7–3.7) was found for a history of atopic dermatitis. In this study, an increased risk of hand eczema conferred by FLG mutations could not be shown, but subjects with concomitant FLG mutations and atopic dermatitis showed the highest risk of hand eczema during traineeships.ConclusionA history of atopic dermatitis, a history of hand eczema and wet work exposure were the most important factors increasing the risk of hand eczema during traineeships.

onventional autopsy is a valuable tool, particularly for quality control in health care (1-3). Nevertheless, autopsy rates have been rapidly decreasing for various reasons, such as lack of interest of clinicians and next of kin due to overconfidence in premortem diagnostics, reluctance of family members to provide consent to autopsy because of the invasiveness of the procedure, reluctance of pathologists to perform autopsies, budgetary issues, and ideological opposition to postmortem investigation (4-11). Hence, noninvasive or minimally invasive alternative autopsy methods are being developed (12). The entire body can be visualized with postmortem CT and MRI (13-15), and imaging-guided biopsy can be performed to obtain tissue for histologic examination (16). In addition, CT angiography can be performed (17-23). Some of these methods are already used to support or even substitute for the forensic autopsy (24-26). In the clinical setting, noninvasive or minimally invasive autopsies of fetuses, newborns, and infants (27) have gained acceptance with parents and physicians along with political and public interest (28). However, they are still rarely applied in adult patients.

OSD definitions vary between European countries and are not directly comparable, which hampers comparisons between statistics collected in different countries. Awareness of this fact and further efforts for standardization are necessary.

The majority of the patients with vitiligo from this study did not mention provoking factors, but the ones who did point to emotional stress in more than half of the cases. Of the 29 patients who assigned chemical provoking factors, solvents were mainly indicated. However, a presumed relationship with the chemical could be corroborated in only four patients.