title: Incidence of hand eczema in female Swedish hairdressers.
abstract: OBJECTIVE
  To estimate the occurrence of hand eczema in hairdressers in Sweden.
  
  
  METHODS
  The occurrence of hand eczema was estimated in a Swedish longitudinal retrospective cohort study including all female graduates from vocational schools for hairdressers from 1970 to 1995. A stratified sample from the general population acted as controls. A self-administered questionnaire including questions on the occurrence of hand eczema, skin atopy, working periods and number of hair treatments performed per week was sent to the participants. Incidence rate ratios (IRRs) of hand eczema were estimated.
  
  
  RESULTS
  The incidence rate of hand eczema in hairdressers was 23.8 cases/1000 person-years, whereas in hairdressers who were aged <25 years it was 37.1/1000 person-years. The corresponding IRR for hairdressers compared with controls was 2.5 (95% confidence interval (CI) 2.2 to 2.8), and that for younger hairdressers was 3.1 (95% CI 2.6 to 3.5). The mean age at onset of hand eczema was 21.6 years for hairdressers and 21.2 years for controls. The 1-year prevalence of hand eczema was 18.0% for hairdressers and 12.1% for controls. A large number of hair treatments involving exposure to skin irritants and sensitisers were reported. The incidence rate of hand eczema was higher among individuals with a history of childhood eczema, both for hairdressers and for controls, giving an (age-adjusted) IRR of 1.9 and 2.2, respectively. The attributable fraction of hand eczema from skin atopy was 9.6%. A synergistic effect of skin atopy and hairdressing was found on the occurrence of hand eczema. The relative excess risk due to interaction was 1.21 (95% CI 0.21 to 2.21; p = 0.01).
  
  
  CONCLUSIONS
  Hairdressers are highly exposed to skin-damaging substances. The self-reported incidence of hand eczema was substantially higher in female hairdressers than in controls from the general population and than that found previously in register-based studies. For many individuals, onset of hand eczema occurs early in life. Only about 10% of the hand eczema cases among hairdressers would be prevented if no one with skin atopy entered the trade.
authors.affiliation: Occupational and Environmental Dermatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. marie-louise.lind@niwl.se
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Lind
authors.forename: Maria
authors.initials: M
authors.lastname: Albin
authors.forename: Jonas
authors.initials: J
authors.lastname: Brisman
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kronholm Diab
authors.forename: Linnéa
authors.initials: L
authors.lastname: Lillienberg
authors.forename: Zoli
authors.initials: Z
authors.lastname: Mikoczy
authors.forename: Jörn
authors.initials: J
authors.lastname: Nielsen
authors.forename: Lars
authors.initials: L
authors.lastname: Rylander
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
authors.forename: Birgitta
authors.initials: B
authors.lastname: Meding
mesh_terms: D000328:Adult; D001505:Beauty Culture / Q000706:statistics & numerical data*; D004485:Eczema / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006225:Hand; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects*; D012189:Retrospective Studies; D013548:Sweden