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

Hand and forearm transepidermal water loss (TEWL) among healthcare professionals by sex and glove use (N=148)

	Sex		Glove use (h)
	Men N=67	Women N=81	0–1 h N=26	1–4 h N=35	>4 h N=87
Hand TEWL [g/m2/h] Median (IQR; total range)	26.99 (19.21–36.56; 9.55–75.54) a	18.70 (14.63–24.53; 8.91–46.77)	17.98 (13.88–24.97; 8.91–57.70)	19.79 (16.11–29.71; 11.67–75.54)	21.77 (17.00–32.41; 9.55–59.95)
Compromised skin barrier (hand TEWL >30 g/m2/h) N (%)	30 (45)a	9 (11)	3 (12)	9 (26)	27 (31)
ΔTEWL* Median (IQR, total range)	14.94 (7.09–23.65; −12.27–43.02)a	7.95 (3.78–11.23; −14.80–29.03)	6.58 (1.85–10.65; −14.80–28.96)b	7.99 (5.23–14.02; −12.27–37.91)b	10.95 (5.70–19.57; −6.17–43.02)b
ΔTEWL%** [%] Median (IQR, total range)	113 % (65–234; −38 –549)a	63 % (41–106; −34–311)	62 % (17–109; −32–394)b	64 % (49–109; −38–336)b	104 % (50–183; −34–549)b
Hand skin pH Median (IQR, total range)	5.01 (4.59–5.37; 4.01–6.50)a	5.36 (5.14–5.63; 4.06–6.39)	5.21 (4.82–5.40; 4.09–6.16)	5.07 (4.74–5.57; 4.01–6.18)	5.25 (5.01–5.59; 4.23–6.50)
Compromised skin acidity (hand pH >5.5) N (%)	13 (19)a	30 (37)	4 (15)	10 (29)	29 (33)
ΔpH*** Median (IQR, total range)	0.23 (−0.02–0.48; −0.47–1.79)	0.11 (−0.22–0.59; −0.87–1.39)	0.06 (−0.22–0.31; −0.51–0.74)b	0.16 (−0.16–0.35; −0.87–1.40)b	0.27 (−0.02–0.66; −0.79–1.79)b
ΔpH%**** [%] Median (IQR, total range)	5 % (0–11; −10–38)	2 % (−4–12; −18–29)	1 % (−5–6; −8–17)b	3 % (−3–8; −18–31)b	5 % (0–14; −15–38)b

Hand and forearm transepidermal water loss (TEWL) by groups of healthcare professionals (N=148)

	Physicians, non–surgeon specialisations N=37	Physicians, surgeons N=37	Dentists, non–surgeon specialisations N=37	Dentists, surgeons N=37
Hand TEWL [g/m2/h] Median (IQR; total range)	19.73 (14.22–24.97; 8.91–57.70)a	19.78 (16.08–26.99; 11.03–75.54)	20.76 (17.79–30.02; 9.55–57.87)	25.80 (19.24–34.31; 9.91–59.95)
Compromised skin barrier (hand TEWL >30 g/m2/h) N (%)	5 (14)a	8 (22)a	10 (27)	16 (43)
Forearm TEWL [g/m2/h] Median (IQR; total range)	11.45 (9.65–14.76; 5.89–57.37)	12.08 (9.70–14.22; 4.84–57.71)b	9.86 (7.93–12.75; 5.31–45.02)	10.48 (8.64–12.93; 6.98–45.11)
ΔTEWL* [g/m2/h] Median (IQR, total range)	7.20 (2.73–10.67; −14.8–28.96)a; b	7.21 (4.54–16.85; −12.27–43.02)a	9.99 (4.00–19.52; 0.98–37.86)	13.39 (7.78–24.16; 0.41–37.91)
ΔTEWL%** [%] Median (IQR; total range)	56 (24–106; −34–394)a; b	65 (42–107; −38–407)a	104 (48–189; 3–549)	108 (67–184; 4–383)

Personal characteristics of the participants (N=148), their habits related to skin health, and their skin condition

	Physicians, non-surgeon specialisations N=37	Physicians, surgeons N=37	Dentists, non-surgeon specialisations N=37	Dentists, surgeons N=37
Men, N (%)	5 (14)	24 (65)	11 (30)	27 (73)
Age [years]	41 (31–46; 27–57)	39 (32–53; 28–63)	39 (33–47; 25–63)	37 (34–43; 28–62)
Median (IQR; total range)
History of atopic dermatitis, N (%)	2 (5)	2 (5)	8 (22)	2 (5)
One or more skin lesions on clinical examination, N (%)*	15 (41)	15 (41)	22 (59)	17 (46)
Washing hands >20 times per day, N (%)	14 (38)	10 (27)	15 (41)	17 (46)
Disinfecting hands >10 times/day, N (%)	17 (46)	13 (35)	6 (16)	16 (43)
Gloves – time worn per day, N (%)
0–1h	25 (68)	1 (3)	0 (0)	0 (0)
1–4h	8 (22)	18 (49)	4 (11)	5 (14)
>4h/h	4 (11)	18 (49)	33 (89)	32 (86)

Hand and forearm pH by groups of healthcare professionals (N=148)

	Physicians, non–surgeon specialisations N=37	Physicians, surgeons N=37	Dentists, non–surgeon specialisations N=37	Dentists, surgeons N=37
Hand skin pH Median (IQR, total range)	5.25 (4.84–5.43; 4.06–6.16)b	5.07 (4.76–5.43; 4.01–6.18)b	5.33 (5.15–5.60; 4.38–6.50)a	5.22 (4.69–5.57; 4.26–6.23)
Compromised skin acidity (hand pH >5.5) N (%)	8 (22)	9 (24)	14 (38)	12 (32)
Forearm skin pH Median (IQR, total range)	5.10 (4.65–5.53; 4.26–5.97)	4.92 (4.51–5.22; 3.74–6.31)	5.04 (4.69–5.54; 4.16–6.33)a	4.70 (4.37–5.32; 4.01–5.88)
ΔpH* Median (IQR; total range)	0.12 (−0.14–0.31; −0.87–0.90)a	0.16 (−0.20–0.39; −0.63–1.40)	0.30 (−0.11–0.64; −0.78–1.79)	0.27 (0.01–0.72; −0.79–1.30)
ΔpH%** [%] Median (IQR, total range)	2 (−3–7; −18–19)a	3 (−4–8; −12–31)	6 (−2–14; −2–38)	6 (0–15; −15–29)