Diane Llewellyn will be a Keynote presenter at the 7th Occupational and Environmental Exposure of Skin to Chemicals (OEESC) Conference. She will be speaking on the ‘New Developments in Prevention of Skin Exposure’.
Diane Llewellyn is a Specialist Inspector with the Health and Safety Executive. She is a Chartered Occupational Hygienist and an affiliate member of the Society of Occupational Medicine. She has worked for HSE since 1978 and has held a variety of posts in the field of Occupational Hygiene. She is based in the Occupational Hygiene Unit in Bootle. Diane has the topic lead for skin issues and has helped to produce much of HSE’s guidance on managing dermal exposures in the workplace.
Over the past few decades scientific papers dealing with dermal exposure to chemicals has increased enormously. Evidence based guidance on the identification and assessment of risk and on the management of disease, once caused, has similarly increased. There have also been many papers on the primary prevention of skin disease. But, could we do more?
In this presentation I will consider the evidence base for primary prevention of occupational skin disease. With a what ‘works’ and what doesn’t ‘work’ and why approach, I will consider some of the more ‘traditional’ methods of controlling exposures before using some very practical examples to explore how advances in industrial technology might give us insights into controlling occupational exposures in the future. I hope this will stimulate a discussion on what more we might do in taking forward this topic.
Prof Thomas Diepgen will be a Keynote presenter at the 7th Occupational and Environmental Exposure of Skin to Chemicals (OEESC) Conference. He will be speaking on ‘UV Exposure’.
Dr. Thomas Diepgen is Professor and Chairman of the Department of Clinical Social Medicine, Occupational & Environmental Dermatology, University Hospital Heidelberg at Ruprecht-Karls University Heidelberg. Research focus in occupational dermatology and prevention, skin cancer, dermato epidemiology, contact allergy. He is vice president and past president of the German Society of Occupational and Environmental Dermatology; treasurer and past president of the European Society of Contact Dermatitis; past chairman of the European Dermato-Epidemiology Network; board member of the European Environmental and Contact Dermatitis Research Group; board member of the International Contact Dermatitis Research group (ICDRG), member of the European Task Force on Atopic Dermatits; co-editor of the Cochrane Skin Group; editor in chief of Occupational and Environmental Dermatology; and member of the Editorial Board of several national and international scientific journals. Dr. Diepgen has authored more than 500 peer-reviewed publications and book chapters in the field of dermatology, allergy and epidemiology.
UV radiation (UVR) is the most important cause of skin ageing and skin can-cer. It causes chronic cutaneous photodamage. The carcinogenic effects of UV radiation on the skin and eyes are well documented both experimentally and epidemiologically. UV radiation acts as a carcinogen both directly, by inducing cell damage (DNA mutations), and indirectly, by inducing immunosuppression (suppression of T lymphocytes).
Nowadays skin cancer (melanoma and non-melanoma skin cancer) is the most common type of cancer in the white populations and its incidence has reached epidemic proportions. The term “nonmelanoma skin cancer (NMSC)” includes especially basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC), which, by far, are the most frequent skin cancers. UV radiation is the most important risk factor for cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Although employees at several workplaces are exposed to increased levels of UV radiation, skin cancer due to long-term intense occupational exposure to UV radiation is often not considered as an occupational disease. The actually available evidence of the epidemiologic literature clearly indicates that occupational UV radiation is a substantial and robust risk factor for the development of cutaneous squamous cell carcinoma (SCC) and also clearly shows a significant risk to develop basal cell carcinoma (BCC). There is enough scientific evidence that outdoor workers have an increased risk to develop work related occupational skin cancer due to natural UV radiation and adequate prevention strategies have to be implemented.
With the revision of the German Ordinance on Occupational Diseases, skin cancer due to UV-irradiation was amended as a new occupational disease to the list of occupational diseases in Germany in January 2015. The new occupational disease BK 5103 has the following wording: “Squamous cell carcinoma or multiple actinic keratosis of the skin caused by natural UV-irradiation”. Aktinic keratosis are to be considered as multiple according to this new occupational diseases if they occur as single lesions of more than five annually, or are confluent in an area > 4 cm2 (field cancerization). It is estimated that more than 2.5 Million employees are exposed to natural UV-irradiation due to their work (outdoor workers) in Germany and therefore have an increased risk of skin cancer.
Diepgen TL, Brandenburg S, Aberer W et al.: Skin cancer induced by natural UV radiation as an occupational disease – Requirements for its notification and recognition. J Dtsch Dermatol Ges 2014;12:1102-6.
Diepgen TL, Fartasch M, Drexler H, Schmitt J: Occupational skin cancer induced by ultraviolet radiation and its prevention. Br J Dermatol 2012;167 (Suppl. 2):76-84
Schmitt J, Seidler A, Diepgen TL, Bauer A. Occupational UV-light exposure increases the risk for the development of cutaneous squamous cell carcinoma: A systematic review and meta-analysis. Br J Dermatol 2011;164:291-307
Chris Packham will be a Keynote presenter at the 7th Occupational and Environmental Exposure of Skin to Chemicals (OEESC) Conference. He will be speaking on the Practical Aspects of Controlling Skin Exposure.
Over thirty years experience and knowledge acquisition on the interaction between the (working) environment and the skin combined with his wide ranging experience in many different technical environments (e.g. oil and gas, precision engineering, pneumatics, metalworking and metal forming, laboratory equipment, compressed air, etc.) gives Chris the ability to identify where risks of damage to health due to skin exposure occur and to devise methods to eliminate or adequately control such exposure. Chris also has considerable experience in working with dermatologists and occupational physicians in investigating suspected occupational skin problems and finding ways that these can then be managed.
Chris is a member of the European Society of Contact Dermatitis, a Fellow of the International Institute of Risk and Safety Management and the Royal Society of Public Health. He is a member of the British Occupational Hygiene Society, the British Cutaneous Allergy Society and an Associate member of the Royal Society of Medicine.
Chris is also well known for his lectures and courses, where he works together with his daughter (Dr. Helen Taylor), a specialist in techniques for skin condition measurement. We now have instruments that can detect sub-clinical damage so that those concerned can take a proactive approach to skin management.
Chris was recently described by a leading European dermatologist as: “the international expert in the field of risk assessment in occupational settings related to skin hazards.”
New developments in control of exposure
Before we can start to identify, develop, evaluate and implement measures to control skin exposure we need to be clear about what we are trying to control. This is not as simple a question as may, at first, appear.
The interaction between the skin and our environment is extremely complex. Many different factors can, either individually or in combinations, affect our skin, and through the skin, internal organs and systems. For example we can have both simultaneous physical and chemical skin exposure which, combined, could result in damage to the health of the person so exposed. Modern knowledge makes it clear that the ‘traditional’ approach of considering skin, inhalation and ingestion as separate is incorrect, but we still do not know enough about the interaction between these and the effect on the skin to be able to apportion the significance of each type of exposure. When we add in other factors, such as psychosomatic reactions, personal predisposition (e.g. atopy), etc. the question as to how and to what extent we need to control exposure of one or more individuals becomes a matter of judgement.
In order to be able to decide how and to what extent we should control exposure we need firstly to be certain that our risk assessment has correctly identified the hazard, extent of exposure, route of exposure and its significance. Only then can we decide what is needed to effectively manage the exposure so as to protect the health of the person or persons exposed. We can then investigate current technology to establish what are our options.
Prof Dr Swen Malte John will be a Keynote presenter at the 7th Occupational and Environmental Exposure of Skin to Chemicals (OEESC) Conference. He will be speaking on the ‘Exposure Related to Skin Diseases’.
Research focus in occupational dermatology and allergology, including the interdisciplinary approaches to the prevention of occupational skin diseases with an emphasis on workers’ education strategies (“Osnabrueck model”).
Coordinator of the Pan-European awareness raising EADV “Healthy Skin@Work”/europrevention campaign, which is an official partner of EU OSHA “Healthy Workplaces”
Chair of a recent EU Horizon 2020 COST Action “StanDerm” (TD 1206) which aims to develop and implement evidence based European standards on prevention of occupational skin diseases, incl. skin cancer by solar UV. StanDerm so far comprises 150 experts in the field from 31 European countries.
Exposure related to skin diseases
In Europe, occupational irritant and allergic contact dermatitis (OCD) constitute up to 35% of all work-related illnesses causing extensive suffering for affected workers. The annual costs by OCD are estimated to vastly exceed 5 billion € in the EU due to medical treatment, sick leave and loss of productivity.
A number of recent studies have demonstrated that early and systematic intervention with a focus on avoiding harmful exposures to the skin can save OCD-patients’ health and jobs, and thus avoid individual suffering as well as diminish costs for society. However, as yet, social insurance systems in many countries do neither enable targeted intervention nor specific preventive measures at the work places. Conversely, gross underreporting masks the true epidemiological dimension of OCD in many countries. Thus, EADV started the “healthy skin @work” campaign to raise awareness, improve options for medical care for affected individuals, and coordinate scientific efforts. “Healthy skin @work” also takes account of the vastly neglected risk of non-melanoma skin cancer by occupational solar UV exposure. This initiative is currently accompanied by a path-breaking EU research project: “Development and Implementation of European Standards on Prevention of Occupational Skin Diseases (COST Action TD 1206: StanDerm)”, so far comprising 31 European countries. StanDerm is a joint coordinated approach to systematically implement and scientifically evaluate compatibility, transferability, and sustainability of OSD-prevention & management concepts, directed to systematic risk assessment for safer work places, identification of pivotal exposures & systematic hazard reduction as well as screening of high-risk populations. This also includes reviewing the scientific evidence for achieving health literacy by workers’ education. These efforts on the scientific level are accompanied by actively involving regulators and policy makers in the process in order to ensure reduction of key exposures on a legal basis, including major culprit allergens like e.g. Methylisothiazolinone, Glycerylmonothioglycolate, epoxy resins as well as solar UV.
The above given examples comprise, like so many, promiscuous exposures which can occur occupationally as well as in the private life; this makes hazard reduction in many cases complex but also, if achieved, even more worthwhile and effective.
Dr Majella Lane will be a Keynote presenter at the 7th Occupational and Environmental Exposure of Skin to Chemicals (OEESC) Conference. She will be speaking on ‘Percutaneous Penetration and Skin Exposure’.
Majella holds a degree in pharmaceutical science and a PhD in membrane transport and her major areas of expertise include delivery of actives to and through the skin, biophysical approaches towards the elucidation of active-skin and formulation-skin interactions, mechanisms of active absorption in skin and topical formulation design and evaluation. Majella acts as a consultant to a number of cosmetic and pharmaceutical companies. She is the Associate Editor of the International Journal of Cosmetic Science and she serves on the editorial board of a number of cosmetic and pharmaceutical science journals. Her research group collaborates worldwide and she also hosts visiting scientists from academia and industry in her laboratory.
Percutaneous penetration with reference to skin exposure
The skin has evolved to keep water in and other xenobiotics or foreign substances out. The outer layer, the stratum corneum, is a unique membrane that is about a sixth of the thickness of a piece of paper. It is composed of dead cells that are filled with keratin and are very dense in nature and it is this thin membrane that is the major barrier to effective percutaneous penetration. Skin penetration of most actives from topical preparations, pharmaceutical or cosmetic formulations does not exceed more than 2-4% of the applied amount. Partly this reflects a lack of focus, historically, on the vehicle or carrier components in which the active is exposed to the skin. Active ingredients vary considerably in water solubility and lipophilicity. The solubility of the active in the vehicle components and vehicle residence time in the skin will be the key determinants of percutaneous penetration of the active. We have recently confirmed this using both in vitro and in vivo studies and specific examples will be given in this presentation. Where the vehicle is volatile in nature there is also the possibility of “stranding” the penetrant in its crystalline form in the outer layers of skin. This will be demonstrated by recent Confocal Raman spectroscopic studies conducted in humans. Nanotechnology continues to revolutionise many aspects of modern life. However, the role of nanotechnology and potential risks to consumers with reference to skin penetration appears to have been overstated. Mathematical models confirm that the rate of diffusion of particles of diameter >1nm is negligible and these will be highlighted. Finally, recent advances in the range and sensitivity of analytical techniques which are already providing better insights into how we may modulate skin exposure will be discussed.
Dr Fred Frasch will be a Keynote presenter at the 7th Occupational and Environmental Exposure of Skin to Chemicals (OEESC) Conference. He will be speaking on the ‘Systemic Uptake of Chemicals from Dermal Exposure’.
Dr. Frasch heads a dermal exposure research team at the US National Institute for Occupational Safety and Health (NIOSH), where he is also Coordinator of the Infectious, Immune and Dermal cross sector of the NIOSH Program Portfolio. His research is focused on mechanistic understanding of the dermal absorption process, particularly as it relates to occupational skin exposures. He will speak on the Systemic Uptake of Chemicals from Dermal Exposure.
Exposure assessment models rely on in vitro experimental data to estimate systemic uptake. This talk will focus on experimental design and interpretation of data from these experiments and will discuss the applicability of in vitro exposures to “real world” exposure scenarios. Specifically, three archetypal exposures will be considered: infinite dose, transient exposure, and finite dose. International regulatory and advisory agencies have published guidelines on the conduct of in vitro experiments, but insufficient guidance has been provided on the interpretation of data from these experiments. Examples, pitfalls and cautionary tales will be provided which should be considered in the assessment of risk from dermal exposure.