Performance of repetitive hand hygiene procedures is required for health care workers (HCWs) to minimize the spread of infection. However, compliance is low due to the irritant contact dermatitis (ICD) that often results. Susceptibility to ICD cannot currently be predicted, in part, because the biological basis of the inter-subject variability is not well understood. We determined the role of TNF-α polymorphism -308 in skin irritation, i.e. ICD and neurosensory irritation (NSI) in healthcare workers. DNA genotyping was done by quantitative polymerase chain reaction to determine the allele at locus -308 on the TNF-α gene. NSI was evaluated with the lactic acid sting test and quantified with a labeled magnitude scale. ICD was evaluated by expert visual grading, digital imaging, trans-epidermal water loss measurements and stratum corneum protein determination. Skin condition was assessed after: (1) performance of repetitive hand hygiene procedures, (2) intensive lotion treatment and (3) repetitive patch testing. TNF-α polymorphism -308 was found to play a significant role in response to irritation in HCWs. The AA/GA genotypes had poorer skin condition after repetitive hand hygiene procedures, had less improvement following lotion treatment, developed more severe irritation from patch testing, had a longer recovery period following patch testing and had a less cohesive stratum corneum barrier. The intensity of NSI was also significantly higher in the AA/GA genotypes. In general, NSI scores were higher in HCWs with more severe ICD. More work is needed to gain a comprehensive understanding of the relationship between NSI and ICD and to understand the mechanisms dictating the relationship between NSI and TNF-α polymorphism -308.
|Advisor:||Wickett, R. Randall|
|Commitee:||Billhimer, Ward L., Hoath, Steven B., Kasting, Gerald B., Visscher, Marty O.|
|School:||University of Cincinnati|
|School Location:||United States -- Ohio|
|Source:||DAI-B 71/04, Dissertation Abstracts International|
|Keywords:||Hand hygiene, Health care workers, Irritant contact dermatitis, Lactic acid sting test, Neurosensory irritation, TNF-alpha polymorphism -308|
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