Epidemiological analysis of occupational dermatitis notified in Brazil in the period 2007 to 2012*

BACKGROUND Occupational dermatitis affects the quality of life and productivity of workers. Studies on the subject are scarce in Brazil. It is estimated that the disease is underreported and that many affected patients do not seek health care. OBJECTIVES To conduct an epidemiological analysis of occupational dermatitis notified via SINAN in Brazil from January 2007 to December 2012; evaluate the profile of patients assisted; and check the main etiological agents involved. METHODS We analyzed the compulsory notification forms of cases of occupational dermatitis filled nationwide during January 2007 to December 2012. RESULTS During the study period 3027 cases of occupational dermatitis were notified in Brazil. In 61.4% of cases patients were men aged between 35-49 years (39.6%). The most described etiological agent was chromium (13.9%). The location of the body most affected was the hands, with 28.4% of cases. The construction sector is implicated in 28.7% of cases and domestic services by 18%. Allergic contact dermatitis is the most prevalent occupational dermatitis (20.6%) and the region with the highest number of notifications was the Midwest, with 376.4 cases per million inhabitants. CONCLUSIONS The profile of patients most affected by occupational dermatitis in Brazil during the study period was: men with elementary school, aged between 20 and 49 years old and working in the construction industry. The most common occupational dermatitis were allergic contact dermatitis caused by chromium after years of exposure, being the hands and head the parts of the body most affected.


INTRODUCTION
Conceptually, occupational dermatitis (OD) are defined as skin, mucous and attachments changes directly or indirectly caused, conditioned, maintained or aggravated in professional activity or work environment. The etiologic agents are varied and classified into biological, physical or chemical. 1,2 Studies on the subject are scarce in Brazil, and the real risk factors and the prevalence of the disease in the country are unknown. However, it is known that the disease is underreported and that many affected workers do not seek treatment. 3 The quality of life and productivity of workers can be affected by skin diseases, increasing the allocation of resources, either by the employer, employee and/or the health system as a whole. to increase knowledge about the main harm to workers' health.
Considering the need for the availability of consistent information on the profile of workers and the occurrence of work-related ODs to guide health actions and intervention in the working environment and conditions, the objective of this study was to con-    Regarding dermatitis, in this study it was observed 1,148 cases of dermatitis were reported, and the ACDs were the most common (20.6%). Goon et al., in Singapore, described the ICDs as the most incidents (61.2%), and the ACDs, with an incidence of 36%. 6 In Europe, it is also noted that ICDs (80%) prevail over DCAs (10%). 8 It is noteworthy that, for the etiological agents in this investigation, chromium was the main agent identified. The presence of hexavalent chromium in the wet cement (the most widely used in civil construction in Brazil) is an abrasive and alkaline agent that may predispose to ACD. 3,7 The use of rubber gloves on wet or previously damaged skin can also promote the development of ACD. 3    sectors of the metal industry, followed by workers in construction and transport sectors. The economic sector with the highest number of cases is the manufactured sector (10.4%), followed by the construction sector (9.1%). 8 The completion of the epicutaneous test is essential in the investigation of ACD and in the identification of the causative agent. 3,12 However, the test is time-consuming -the reading is done after 96 hours -and needs technical training, material, method, time, interpretation and proper care in its application. In Brazil, its use is still limited and requires improvements. 13  In Greece, Zorba et al. (2013), studying 4,000 workers, identified 39.9% cases of ODs in this population, reporting that the highest rates of prevalence of skin lesions were found in workers of the metal industry, wood industry, automotive industry, construction industry and also cooks (in the automotive and construction industries, all affected individuals were men). 14 Regarding the time of exposure to the causing agent, most cases (51%) reported in Brazil was reported as years of contact, which may also explain the prevalence of ACD in relation to the ICD because the ACD require at least a week to raise awareness and occur after months or years of contact. 3 In the evolution of ODs, it was reported cure in 20.7% of assisted patients, temporary disability in 17.2% of cases and permanent disability in 2% of cases (Table 3).
The economic impact of the disease is inevitable, treatment may be long and eventually the withdrawal of the occupation is necessary.
In some cases it may also be necessary the process of rehabilitation and re-adaptation to work. The information obtained, combined with protective and preventive measures, will contribute to improving the quality of life and productivity of workers. The SINAN app is designed to store, from tools and standardized access codes at national level, the information of notifiable diseases, through their respective notification forms. However, for SINAN fulfill its objectives, the awareness of health workers to properly fill the CNFs is needed.

CONCLUSION
The profile of patients most affected by ODs in Brazil in the period studied was: men with elementary school, aged between 20 and 49 years old, and working in the construction industry. The most frequent ODs were allergic contact dermatitis caused by chromium after years of exposure, and the hands and the head were the parts of the body most affected.
There was also the need for more information and demand for the proper filling of the CNFs.q