Difference between hand and forearm transepidermal water loss and skin pH as an improved method to biomonitor occupational hand eczema: our findings in healthcare workers

The aim of this cross-sectional field study was to establish the condition of hand and forearm skin barrier among dentists and physicians and how it may be associated with personal and work-related factors. The study consisted of an occupational questionnaire, clinical examination of skin on hands, and transepidermal water loss (TEWL) and pH measurements on hands and forearms. The participants were divided in the following groups (N=37 each, N=148 in total): physicians, medical surgeons, dentists, and dental surgeons. We calculated the difference between hand and forearm TEWL and pH (ΔTEWL and ΔpH, respectively) and divided it by the forearm values (ΔTEWL% and ΔpH%, respectively). There was a clear trend of increasing median ΔTEWL%, starting from physicians with non-surgical specialisation (56 %) to medical surgeons (65 %), dentists (104 %), and dental surgeons (108 %), with the latter two groups showing particularly worrisome signs of work-related skin barrier impairment, since they had double the TEWL on hands than on forearms. Although less prominent, the same worsening trend was noted for skin pH, with dental surgeons having on average a 0.3 points higher skin pH on hands than on forearms. These findings were mainly associated with prolonged glove use and male sex. Our findings also suggest that comparing TEWL and pH between hands and forearms can better establish occupational skin barrier impairment on hands.