環保清潔隊員手部皮膚炎及足部黴菌疾病調查

Department or Graduate Institute of Occupational Medicine and Industrial Hygiene

College of Public Health National Taiwan University

Master Thesis

Hand Dermatitis and Foot Fungal Diseases in Environmental Sanitation Workers

Pei-Ying Huang

100 5

1994

2009 6 11

346 274

Logistic regression

19.0% 22.6% 30

aOR [95%CI] = 2.66 [1.11-6.20]

aOR [95%CI] = 2.03 [0.98-4.22]

aOR [95%CI] = 5.94 [1.04-33.90] aOR [95%CI] = 10.29 [1.35 -78.25]

aOR [95%CI] = 2.32 [1.13-4.75]

aOR [95%CI] = 2.98 [1.03-8.62]

47.8% 31.0%% 50

OR [95%CI] = 2.89 [1.05-8.74] ) OR [95%CI] = 3.80 [1.18-16.96]

21 30 body mass index BMI

25 aOR [95%CI] = 2.34 [1.39-4.00]

aOR [95%CI] = 3.59 [1.17-11.26]

30 2

Abstract

Background: A nationwide survey in Taiwan in 1994 showed a high prevalence of work-related upper extremity symptoms in sanitary and pollution control personnel. In addition, a high prevalence of foot fungal infection was suggested in our pilot study for environmental sanitation workers. Identifying risk factors may provide us with

prevention methods and improve workplace health.

Objectives: To determine the prevalence of hand dermatitis, work-related hand symptoms and foot fungal diseases and to identify risk factors.

Methods: The cross-sectional study recruited current environmental sanitation workers engaged in a number of tasks, which were street-cleaning, gutter-cleaning, garbage can cleaning, disposal of general waste, resource recycling, food waste recycling, and removal of street ads. The study involved a structured questionnaire and a skin

examination. The questionnaire consisted of personal exposures, allergic conditions, and hand skin symptoms in the past 12 months. The skin examination was conducted by the author. The study was conducted from June 2009 to November 2009. A total of 346 workers were randomly selected and the data of 274 eligible participants were analyzed.

The association of risk factors and diseases were presented as an odds ratio utilizing logistic regression analysis.

Results and Discussion: The prevalence of work-related hand symptoms in the past 12 months current hand dermatitis were 19.0% and 22.6%, respectively. Contact to

detergent over 0.5 hour significantly increased the risk for hand dermatitis (aOR [95%CI]

= 2.66 [1.11-6.20]). Contact with water for more than 2 hours at work showed a borderline increase of risk (aOR [95%CI] = 2.03 [0.98-4.22]). Using rubber (aOR [95%CI] = 5.94 [1.04-33.90]) or latex gloves (aOR [95%CI] = 10.29 [1.35 -78.25]) at work increased the risk of hand dermatitis. Frequent leakage of gloves at work

predisposed to work-related hand symptoms (aOR [95%CI] = 2.32 [1.13-4.75]).

Workers mainly involved in gutter cleaning also had a higher risk. (aOR [95%CI] = 2.98 [1.03-8.62])

The prevalence of tinea pedis and toenail onychomycosis were 47.8% and 31.0%, respectively. Age was the most significant risk factor, especially for workers over 50 years old, with odds ratios 2.89 (95%CI =1.05-8.74) for tinea pedis and 3.80 (95%CI

=1.18-16.96) for onychomycosis. Body mass index (BMI) over 25 kg/m² increased the risk for tinea pedis (aOR [95%CI] = 2.34 [1.39-4.00]). Longer duration of wearing

Conclusion:

Approximately 20% of environmental sanitation workers experienced work-related hand symptoms and hand dermatitis. The study showed the risk factors were contact to

detergent and water, wearing rubber or latex gloves, and frequent experience of leakage while wearing gloves. Gutter cleaning may be a risk task. About 50% workers were diagnosed as having foot fungal infection. The risk increased with age. BMI over 25 kg/m²predisposed to tinea pedis, suggesting weight reduction may lower prevalence.

Key words: environmental sanitation workers; hand dermatitis; hand eczema, occupation; work; tinea pedis; onychomycosis; risk factors

……….……….i

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... 6

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2.4 ... 6

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2.4.2 ... 7

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2.4.4 ... 7

2.5 ... 7

2.6 ... 7

2.7 ... 8

─ ─ ... 9

3.1 ... 9

3.2 ... 9

3.3 ... 9

3.7 ... 11

3.8 ... 11

3.9 ... 13

3.10 ... 14

─ ─ ... 15

4.1 ... 15

4.2 ... 15

4.3 ... 15

4.4 ... 16

4.5 ... 16

4.6 ... 16

4.7 ... 16

4.8 ... 18

4.9 ... 18

... 20

... 46

... 49

……….25

………27

……….28

………30

(n=274) ………...32

50%

……….33

(n=274) ………34

……….35 1

………37

………39 (n=274) ………40

…………..41

………..42

…….43

………44

……….45

1.1

1.1.1

1 Meding 21.3%

2

6-15%^3-66

43%⁷⁷ 1994

14.6%

4.3% ⁸⁸ 1997

9

1.1.2

2 20

72.0% 63.3% 58.7%

57.4% ¹¹

7

122

Singgih

92% 8%

4 13

ʻ˄ʼ

ʻ˅ʼ ʻ

ʼ

̃˿˴̆̇˼˶˼̍˸̅̅ ʻˆʼ ʻ

ʼ

ʼ ˈ

ˆ˃ ʻ˦˾˼́ʳ̃̅˼˶˾ʳ̇˸̆̇ʼ

˜˺˘ ^˄ˇˀ˄ˈ

1.1.3

166

Spearman’s correlation coefficient 0.68 0.72

Spearman’s correlation coefficient 0.37

177

Pearson’s rank correlation 0.52 0.68 0.40 Pearson’s rank correlation 0.25

18

199

1.1.4

80-90% 5-17% 3-5%

2.1-9.1%

2.9-61%^20-32

20, 33

Distal and lateral subungual onychomycosis

White superficial onychomycosis Proximal subungual onychomycosis Total dystrophic onychomycosis ³⁴⁴

Interdigital Mocassin Vesiculobullous

35-36

Scaling

37

1.1.6

200

29, 38-400

20-40%

31, 33

Zaias Trichophyton rubrum ⁴¹

42 Zaitz

HLA-DR53 Trichophyton rubrum

43 Tursen Apolipoprotein E ⁴⁴

1.1.7

86 21% ⁹ 98

7 96

36.5% 27.5% 49.0%

1.1.8

1.2

2.2

2.3

20, 455

1043

346 1

2.4

2.4.1

Hand eczema severity indexx HECSI Held

46 interclass correlation

coefficientt ICC HECSI ICC 0.79

ICC 0.84 ICC: 0.90

hand eczema severity index scorere HECSI

score

( )

2.4.2

2.4.3

KOH

70% 40%⁴⁷

2.4.4

2.5

2.6

2009 6 2009 11

JMP5.0 univariate logistic regression

1 2

0% 1~50% 51~100%

1 2

BMI

forward stepwise regression

adjusted population attributable risk percent, aPAR% SAS 9.1

adjusted relative riskk Mplus indirect model mediation P < 0.05

─

─

3.1

1043

72 199 72 181

70 256 60 200

72 207 346 33 1

8 30

274

3.2

47.1 SD:9.8 10 55%%

86%

3.3

32.2% 19.5%

15.1% 13.3% 50%

95 51 39

36

3.4

94 34.3% 15.7%

13.5% 10.2% 10.2%

52 19.0%

64 23.4% 62 22.6%

OR [95%CI] = 2.09

[1.01-4.30] 30 OR [95%CI] = 2.67 [1.14-6.07]

30 aOR [95%CI] = 2.66 [1.11-6.20]

aOR [95%CI] = 2.03 [0.98-4.22]

aPAR% 30 aPAR% 9.2%

30 9.2%

2 aPAR% 9.2%%% 9.2%

31% p=0.44

aOR [95%CI] = 10.29 [1.35-78.25]

aOR [95%CI] = 5.94 [1.04-33.90]

aOR [95%CI] = 5.00 [0.88-28.35]

3.6

21-30 51-61 OR

[95%CI] = 4.03 [1.33-11.67] 10 OR [95%CI] = 3.49 [1.86-6.82]

OR [95%CI] = 0.28 [0.11-0.71]

OR [95%CI] = 2.55 [1.29-4.95]

OR [95%CI] = 4.45 [0.80-24.67]

OR [95%CI] = 2.21 [1.13-4.25]

aOR [95%CI] = 2.32 [1.13-4.75]

(Adjusted population attributable risk)

5.3% 30 aOR

[95%CI] = 2.46 [0.89-6.47]

3.7

0% 1-50% 51-100%

51-100%

OR [95%CI] = 2.98 [1.03-8.62] 6

3.8

34.3% 19%

22.6%

1994

14.6% ⁸ 1997

9

3-6

100

TRGS 531

488

30

155

45, 49-53

hardening effect or accommodation

544

544

Nordic Occupational Skin Questionnaire NOSQ-2002 ⁵⁵

45, 56-577

Anveden

11

3.9

30 2

10

1.

polyvinyl chloride nitrile neoprene

2.

3.

4.

─

─

4.1

131 47.8% 85 31.0%

145 52.9%

(Interdigital) (69.5%) 32.8% 16.0%

8.4% Distal and lateral subungual

75.3% Total dystrophic 9.4%

5%

4.2

51

2.89 95%CI = 1.05-8.74 3.80 95%CI = 1.18-16.96

2.34 95%CI = 1.07-5.24 2.51 95%CI = 1.11-6.06

4.3

BMI 25kg/m²

OR [95%CI] = 2.00 [1.24-3.25] BMII

BMI aOR [95%CI] = 2.34 [1.39-4.00] BMI 25kg/m²

aPAR% 12.5% BMI 25kg/m²

12.5%

4.5

aOR [95%CI] = 3.59 [1.17-11.26]

4.6

4.7

2.1-9.1% 3.8-61% ²⁰

47.8%% 31.0%%

Distal and lateral subungual 75.3%

Total dystrophicc 9.4% Chi

Distal and lateral subungual

80.4% Total dystrophic 13.6%³⁴

69.5% 32.8% 16.0%

8.4%

20, 26, 29, 38-40

51

21 30 2.89

3.80 Sigurgeirsson 50

2.74²⁹⁹

40 25kg/m² BMI 25kg/m²

588

31, 599

BMI 25kg/m² aPAR%

12.2%

600

33, 37, 400

266

14 9 64% 7 50%

77% 44%

OR [95%CI] = 2.02 [0.68-6.73] OR [95%CI] = 2.32 [0.77-6.97]

TH1 ^61-622

63 37

6 5 83% 3

50%

222 311

20-40%%

333

BMI 25 kg/m²

pH ^{644 65}

4.8

4.9

50 BMI 25 kg/m²

1. BMI 25 kg/m² 2. 50

3.

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2-1

2-2

2-3

2-4

2-5 Distal subungual

[ ] Singgih et all 1986

[⁴]

n=356

12% 10%

10%

53%

Gawkrodger et all 1986

[⁶]

12%

Meding 1990 [²]

20-65

n=16600 11%

21.3%

Nielsen 1996

[⁷] n=1166

43%

1999 [⁹]

n=1275

Shao et all 2001 [⁸]

n=18942 4.3%

14.6%

all 1957 [²¹]

n=2101

Hope et all 1985 [²²]

n=514 (1)

(2)

71%

69%

28%%

61%

Roberts et all 1992

[²³]

≥16

n=9332

2.8% 2.6%

Heikkila et all 1995

[²⁴]

6~80

n=800

13.0% 4.3%

Sais et all 1995

[²⁵]

>15

n=10007

( ) 2.6%

( ) 1.7%

Gupta et all 1998

[²⁶]

n=550

46%

26%

Perea et all 2000

[²⁰]

20

n=1000

2.8%

4.0%% 1.7%

2.9%

4.2%% 1.7%

Caputo et all 2001

[²⁷]

n=87793

36.2%

36.7%

Maruyama et all 2003

[²⁸]

n=346 24.9%% 3.1%

Sigurgeirsson et all 2002

[³²]

≥16

n=2484 17.2%

13.2%

Cohen et all 2005

[³⁰]

n=223 60.1%

27.3%

Biljan et all 20088 Crotia [³¹]

Crotia n=1702

49%

( )(( ± 47.1± 9.8)

21-30 18 (6.6)

31-40 60 (21.9)

41-50 62 (22.6)

51-61 132 (48.2)

≤10 123 (44.9)

>10 151 (55.1)

83 (30.3) 68 (24.8) 81 (29.6) 37 (13.5)

50%

(%)

50%

( ) (%)

32.2 (40.2) 95 (34.8)

19.5 (32.9) 51 (18.7)

15.1 (29.2) 39 (14.3)

13.3 (25.8) 36 (13.2)

7.2 (19.6) 19 (7.0)

5.8 (18.4) 12 (4.4)

4.7 (15.5) 9 (3.3)

2.0 (10.9) 7 (2.6)

1 94 34.3 43 15.7 37 13.5 28 10.2 28 10.2 12 4.4 10 3.7

8 2.9

4 1.5

2 0.7

1 52 19.0

64 23.4 62 22.6 11 4.0

8 2.9

4 1.5

*

* 1%

274

(%)

62 (22.6%) OR (95%CI)

a

aOR (95%CI) ( )

21-30 18 5 (27.8) 1.31 (0.39-3.78)

31-40 60 14 (23.3) 1.03 (0.39-3.78)

41-50 62 13 (21.0) 0.90 (0.42-1.85)

51-61 132 30 (22.7) 1

≤10 123 30 (24.4) 1.20 (0.68-2.12)

>10 151 32 (21.2) 1

83 21 (25.3) 0.91 (0.39-2.27) 68 16 (23.5) 0.83 (0.33-2.13) 81 15 (18.5) 0.61 (0.25-1.57)

37 10 (27.0) 1

217 45 (20.7) 1

56 17 (30.4) 1.67 (0.85-3.18)

259 60 (23.2) 1

14 2 (14.3) 0.55 (0.08-2.10)

267 59 (22.1) 1

6 3 (50.0) 3.53 (0.64-19.5)

<1 // 218 47 (21.6) 1

1-2 // 48 12 (25.0) 1.21 (0.57-2.46)

>2 // 8 3 (37.5) 2.18 (0.44-9.23)

b

≤2 // 234 48 (20.5) 1 1

>2 // 40 14 (35.0) 2.09 (1.01-4.30)* 2.03 (0.98-4.22)^§

c

≤0.5 // 244 50 (20.5) 1 1

>0.5 // 27 11 (40.7) 2.67 (1.14-6.07)* 2.66 (1.11-6.20)*

<20 // 251 56 (22.3) 1 1

≥20 // 23 6 (26.1) 1.22 (0.43-3.12) 1.20 (0.41-3.09)

21 2 (9.5) 1 1

157 34 (21.7) 2.63 (0.58-11.83) 5.00 (0.88-28.35)^§ 83 21 (25.3) 3.22 (0.71-15.49) 5.94 (1.04-33.90)*

13 5 (38.5) 5.94 (0.95-37.22) 10.29 (1.35-78.25)*

21 2 (9.5) 0.73 (0.16-2.33) 0.44 (0.08-1.61)

183 38 (20.8) 1 1

68 20 (22.1) 1.62 (0.85-3.03) 1.58 (0.82-2.97)

* p<0.05, § p<0.1

a.

b. >0.5 /

(Adjusted population attributable risk) 9.2% ( )

c. >2 //

(Adjusted population attributable risk) 9.2% ( )

1

274

(%)

52 (19.0) OR (95%CI)

a

aOR (95%CI) ( )

21-30 18 7 (38.9) 4.03 (1.33-11.67)*

31-40 60 17 (28.3) 2.50 (1.18-5.33)*

41-50 62 10 (16.1) 1.22 (0.51-2.78)

51-61 132 18 (13.6) 1

≤10 123 36 (29.3) 3.49 (1.86-6.82)*

>10 151 16 (10.6) 1

83 11 (13.3) 0.28 (0.11-0.71)*

68 9 (13.2) 0.28 (0.10-0.74)*

81 18 (22.2) 0.53 (0.22-1.25)

37 13 (35.1) 1

217 34 (15.7) 1

56 18 (32.1) 2.55 (1.29-4.95)*

259 51 (19.7) 1

14 1 (7.1) 0.31 (0.02-1.63)

267 49 (18.4) 1

6 3 (50.0) 4.45 (0.80-24.67)^§

<1 // 218 36 (16.5) 1

1-2 // 48 13 (27.1) 1.88 (0.88-3.84)^§

>2 // 8 3 (37.5) 3.03 (0.60-12.93)

≤2 // 234 44 (18.8) 1 1

>2 // 40 8 (20.0) 1.08 (0.44-2.41) 0.93 (0.33-2.33)

≤0.5 // 244 43 (17.6) 1 1

>0.5 // 27 9 (33.3) 2.33 (0.95-5.44)^§ 2.46 (0.89-6.47)^§

<20 // 251 47 (18.7) 1 1

≥20 // 23 5 (21.7) 1.21 (0.38-3.20) 0.79 (0.22-2.37)

21 3 (14.3) 1 1

157 28 (17.8) 1.30 (0.41-5.82) 2.51 (0.70-14.57) 83 18 (21.7) 1.66 (0.49-7.65) 3.24 (0.84-17.97) 13 3 (23.1) 1.80 (0.29-11.42) 3.20 (0.45-24.56)

b

21 3 (14.3) 0.89 (0.20-2.83) 0.51 (0.09-1.95)

183 29 (15.8) 1 1

68 20 (29.4) 2.21 (1.13-4.25)* 2.32 (1.13-4.75)*

*p<0.05 § p<0.1

a.

b.

(Adjusted population attributable risk) 5.3% ( )

(%)

a

aOR (95%CI) (%)

b

aOR (95%CI)

0 142 29 (20.4) 1 28 (19.7) 1

1-50 50 14 (28.0) 1.52 (0.70-3.19) 11 (22.0) 1.04 (0.43-2.40) 51-100 81 18 (22.2) 1.04 (0.52-2.03) 12 (14.8) 0.61 (0.27-1.32)

c

0 185 41 (22.2) 1 31 (16.8) 1

1-50 68 15 (22.1) 1.05 (0.52-2.05) 12 (17.6) 1.05 (0.48-2.29) 51-100 20 5 (25.0) 1.22 (0.38-3.40) 8 (40.0) 2.98 (1.03-8.62)*

0 220 50 (22.7) 1 45 (20.5) 1

1-50 48 10 (20.8) 0.90 (0.40-1.89) 6 (12.5) 0.56 (0.19-1.43) 51-100 5 1 (20.0) 0.97 (0.05-6.78) 0 (0.0) --

0 160 31 (19.4) 1 27 (16.9) 1

1-50 75 19 (25.3) 1.38 (0.71-2.66) 16 (21.3) 1.30 (0.60-2.74) 51-100 38 11 (28.9) 1.83 (0.79-4.05) 8 (21.1) 1.32 (0.50-3.28)

0 184 42 (22.8) 1 35 (19.0) 1

1-50 63 14 (22.2) 0.92 (0.44-1.82) 11 (17.5) 0.80 (0.34-1.74) 51-100 26 5 (19.2) 0.85 (0.27-2.26) 5 (19.2) 1.15 (0.34-3.34)

0 220 48 (21.8) 1 43 (19.5) 1

1-50 45 11 (24.4) 1.17 (0.52-2.45) 7 (15.6) 0.77 (0.27-1.93) 51-100 8 2 (25.0) 1.28 (0.18-5.79) 1 (12.5) 0.74 (0.04-4.96)

0 213 53 (24.9) 1 39 (18.3) 1

1-50 51-100

52 8 (15.4) 0.59 (0.25-1.29) 11 (21.2) 1.32 (0.58-2.88)

8 0 (0.0) -- 1 (12.5) 0.56 (0.03-3.64)

*p<0.05.

a.

b.

c. trend test 2.23 (95%CI:

0.83-5.84), p=0.11 (

( ) (%) (%) (Interdigital) 91 (69.5) (Distal and lateral subungual) 64 (75.3)

(Mocassin) 43 (32.8) (Total dystrophic) 8 (9.4)

(Vesiculobullous) 21 (16.0) 3 (3.5)

(Scaling) 11 (8.4) (White superficial) 2 (2.4)

2 (1.5) (Proximal subungual) 0 (0)

8 (9.4)





























(n=131)

(%) OR (95%CI) aOR^a(95%CI) ( )

21-30 18 6 (33.3) 1 1

31-40 60 18 (30.0) 0.86 (0.28-2.78) 0.88 (0.27-3.13) 41-50 62 29 (46.8) 1.76 (0.60-5.60) 2.32 (0.70-8.56) 51-61 132 78 (59.1) 2.89 (1.05-8.74)* 3.11 (0.90-11.97)^§

83 51 (61.4) 2.34 (1.07-5.24)* 1.05 (0.37-2.98) 68 35 (51.5) 1.56 (0.70-3.54) 0.96 (0.37-2.51) 81 28 (34.6) 0.77 (0.35-1.74) 0.59 (0.25-1.43)

37 15 (40.5) 1 1

(BMI)^b

≤25 kg/m² 141 56 (39.7) 1 1

>25 kg/m² 132 75 (56.8) 2.00 (1.24-3.25)* 2.34 (1.39-4.00)*

217 103 (47.5) 1

56 28 (50.0) 1.11 (0.61-2.00)

259 122 (47.1) 1

14 9 (64.3) 2.02 (0.68-6.73)

267 126 (47.2) 1 1

6 5 (83.3) 5.59 (0.89-107.91) 5.59 (0.85-109.95)

250 118 (47.2) 1

10 5 (50.0) 1.12 (0.30-4.11)

113 56 (49.6) 1

29 12 (41.4) 0.72 (0.31-1.63) 132 63 (47.7) 0.93 (0.56-1.54)

*p<0.05, §p<0.1

a. BMI

b. BMI>25 (Adjusted population

attributable risk) 12.2% ( )

(%) OR (95%CI) aOR (95%CI) ( )

21-30 18 3 (16.7) 1 1

31-40 60 12 (20.0) 1.25 (0.34-6.01) 1.43 (0.35-5.90) 41-50 62 13 (21.0) 1.33 (0.37-6.34) 1.48 (0.34-6.49) 51-61 132 56 (42.4) 3.80 (1.18-16.96)* 4.05 (0.91-17.98)^§

83 40 (48.2) 2.51 (1.11-6.06)* 0.99 (0.33-3.02) 68 16 (23.5) 0.83 (0.33-2.13) 0.46 (0.16-1.36) 81 18 (22.2) 0.77 (0.32-1.94) 0.63 (0.24-1.64)

37 10 (27.0) 1 1

(BMI)

≤25 kg/m² 141 42 (29.8) 1 1

>25 kg/m² 132 43 (32.6) 1.14 (0.68-1.90) 1.34 (0.77-2.33)

217 66 (30.4) 1

56 18 (32.1) 1.08 (0.57-2.02)

259 78 (30.1) 1 1

14 7 (50.0) 2.32 (0.77-6.97) 1.94(0.62-6.06)

267 82 (30.7) 1

6 3 (50.0) 2.26 (0.41-12.41)

250 77 (30.8) 1

10 4 (40.0) 1.50 (0.37-5.39)

113 38 (33.6) 1

29 7 (24.1) 0.63 (0.23-1.54) 132 40 (30.3) 0.86 (0.50-1.47)

§ p<0.1

a: BMI

(%) (%)

274 131 (47.8) aOR^a(95%CI) 85(31.0) aOR^b(95%CI)

127 66 (52.0) 1 45 (35.4) 1

146 65 (44.5) 0.86 (0.51-1.45) 40 (27.4) 0.88 (0.51-1.54)

176 81 (46.0) 1 51 (29.0) 1

97 50 (51.5) 1.56 (0.91-2.69) 34 (35.1) 1.52 (0.86-2.68)

≤2 // 234 107 (45.7) 1 68 (29.1) 1

>2 // 40 24 (60.0) 1.75 (0.84-3.71) 17 (42.5) 1.76 (0.84-3.65)

133 64 (48.1) 1 38 (28.6) 1

138 66 (47.8) 0.92 (0.54-1.54) 45 (32.6) 1.13 (0.65-1.97)

<2 // 263 128 (48.7) 1 83 (31.6) 1

≥2 // 9 2 (22.2) 0.42 (0.06-1.96) 1 (11.1) 0.30 (0.61-5.97)

a: BMI

b: BMI

192 7.3 (1.7) 89 (46.4) 1.01 (0.30-3.42) 54 (28.1) 0.37 (0.10-1.33) 8 5.4 (2.0) 4 (50.0) 1.49 (0.19-15.65) 2 (25.0) 0.48 (0.03-4.12) 12 4.2 (2.5) 6 (50.0) 1.13 (0.10-9.41) 6 (50.0) 5.95 (0.70-50.51) 90 6.2 (3.4) 42 (46.7) 1.55 (0.52-4.75) 28 (31.1) 3.59 (1.17-11.26)^* 130 4.1 (2.7) 53 (40.8) 0.63 (0.24-1.61) 35 (26.9) 0.72 (0.25-1.94) 36 5.8 (4.1) 20 (55.6) 0.39 (0.06-2.31) 17 (47.2) 1.39 (0.21-8.58)

* p<0.05.

a: BMI

b: BMI

(%) (%) aOR^a(95%CI) (%) aOR^b(95%CI)

0 142 61 (43.0) 1 42 (29.6) 1

1-50 50 24 (48.0) 1.30 (0.64-2.63) 18 (36.0) 1.45 (0.69-2.98) 51-100 81 46 (56.8) 1.73 (0.69-3.15) 25 (30.9) 1 (0.54-1.88)

0 185 95 (51.4) 1 62 (33.5) 1

1-50 68 27 (39.7) 0.66 (0.36-1.21) 20 (29.4) 0.99 (0.51-1.87) 51-100 20 9 (45.0) 0.77 (0.28-2.09) 3 (15.0) 0.34 (0.07-1.11)

0 1-50 51-100

220 102 (46.4) 1 71 (32.3) 1

48 25 (52.1) 1.07 (0.54-2.10) 11 (22.9) 0.55 (0.25-1.16) 5 4 (80.0) 4.87(0.57-103.37) 3 (60.0) 2.18(0.23-20.50)

0 160 79 (49.4) 1 58 (36.3) 1

1-50 75 35 (46.7) 0.85 (0.46-1.55) 18 (24.0) 0.55 (0.28-1.05) 51-100 38 17 (44.7) 1.03 (0.47-2.22) 9 (23.7) 0.60 (0.24-1.40)

0 184 96 (52.2) 1 57 (31.0) 1

1-50 63 25 (39.7) 0.60 (0.31-1.13) 17 (27.0) 1.03 (0.51-2.01) 51-100 26 10 (38.5) 0.59 (0.23-1.43) 11 (42.3) 1.83 (0.74-4.43)

0 220 108 (49.1) 1 71 (32.3) 1

1-50 45 19 (42.2) 0.66 (0.32-1.33) 13 (28.9) 0.86 (0.40-1.80) 51-100 8 4 (50.0) 0.58(0.10-3.40) 1 (12.5) 0.20 (0.01-1.37)

0 1-50

213 104 (48.8) 1 69 (32.4) 1

52 24 (46.2) 0.92 (0.47-1.76) 14 (26.9) 0.81 (0.39-1.63) 51-100 8 3 (37.5) 0.37 (0.06-1.78) 2 (25.0) 0.56 (0.08-2.65)

a. BMI

b. BMI

1. Hand, wrist:

no disease

callus dryness injury related wound actinic keratosis acute paronychia chronic paronychia contact urticaria

tinea manuum onychomycosis candida intertrigo hand eczema (ڃ࿠ 2-8)

2. Hand eczema severity index (HECSI) score (ਊޢԫ௑ᒳᇆᙁԵᣤૹ৫) Clinical signs Fingertips Fingers Finger

web

Palm Back of hands

Wrists

Erythema (E) (0-3) ^{211 221 231 241 251 261}

Infiltration/

papulation(I) (0-3)

212 222 232 242 252 262

Vesicles (V) (0-3) ^{213 223 233 243 253 263}

Fissures (F) (0-3) ^{214 224 234 244 254 264}

Scaling (S) (0-3) ^{215 225 235 245 255 265}

Oedema (O) (0-3) ^{216 226 236 246 256 266}

Sum=(E+I+V+F+S+O)

Extent (Ex) (0-4) ^{217 227 237 247 257 267}

Tota; HESCI score Sum X Ex

E, I,V,F,S,O: 0: no skin changes, 1: mild disease 2: moderate 3: severe Affected area: 0: 0%; 1: 1-25%, 2: 26-50%; 3: 51-75%; 4: 76-100%

3.

4.

5.

6.

definite occupational related possible occupational related not occupational related Unkown

7. Subtype:

Irritant contact dermatitis (ICD) Allergic contact dermatitis (ACD) Atopic hand eczema (AHE) Discoid hand eczema

Vesicular hand eczema Hyperkeratotic hand eczema Unspecified

9 Feet

No disease

Eczema Pompholyx Unspecified sole dorsum side Tylosis Paronychia

Tinea pedis Onychomycosis

10. Onychomycosis type DSO WSO PSO total dystrophic 11. Involved toenails: Right 1, 2, 3, 4, 5

12. Involved toenails: Left 1, 2, 3, 4, 5

13. Tinea pedis type Interdigital Mocassin Vesiculobullous type 14. Tinea pedis score

Right plantar surface

Right interdigital space

Right toes

Left plantar surface

Left

interdigital space

Left toes

Erythema (0,1,2)

1411 1421 1431 1441 1451 1461

Scaling (0,1,2)

1412 1422 1432 1442 1452 1462

Vesicles (0,1,2)

1413 1423 1433 1443 1453 1463

Number of interdigital involvement (0,1,2,3,4) Right foot ¹⁴⁴⁴

Left foot ¹⁴⁵⁵

15. Deformity of toes No Yes 16. Tinea pedis: Itching:

17. Tinea pedis: Pain:

18. No Yes

19. Take picture

20. Other areas No disease Yes eczema Atopic

dermatitis

Seborrheic dermatitis

Tinea folliculitis Others

Face 11 21 31 41 51 61

Neck 12 22 32 42 52 62

Chest 13 23 33 43 53 63

Back 14 24 34 44 54 64

Arms 15 25 35 45 55 65

Forearms 16 26 36 46 56 66

Thighs 17 27 37 47 57 67

legs

Others: ^{19 29 39 49 59 69}