Workplace health surveillance for occupational skin diseases: diagnostic accuracy and reliability of a teledermatology tool

Occupational skin diseases is one of the most commonest occupational disease groups accounting for about a fifth of all occupational diseases in the UK. Current guidance from the HSE for skin health surveillance is the skin inspection by a responsible person in the workplace. The use of teledermatology can be attractive to reliably conduct skin surveillance in the workplace, and a tool box to take reproducible standardised photographs from the hands of workers in the workplace was developed. Aim of this thesis was to assess diagnostic accuracy and validity of this toolkit with visual inspection as criterion standard for the presence of minor or major hand dermatitis and by scoring the hands and photographs with the validated Hand Eczema Severity Index. Workers from four different occupations were recruited over a 7 month period and 332 workers were assessed on a repeatedly basis producing 1212 assessments. Skin hydration and transepidermal water loss was measured and a symptoms questionnaire was completed by every participant. A high prevalence of skin problems was found in our study: 70% of the participants presented at least once over the study period with minor or major skin symptoms. A high intrarater reliability compared to the visual assessment was shown for the teledermatologic assessment with an agreement of 88%, kappa of 0.79, and a positive likelihood ratio of 7.4 and negative likelihood ratio of 0.07; about 5% of participants with normal skin were over-diagnosed compared to the visual inspection. The interrater reliability was low. The biophysical parameter did not distinguish between normal and affected skin. The tool kit has shown to produce reliable and standardised high quality photographs, the assessment of the photographs showed a very good intrarater agreement to the criterion standard. The toolkit would allow regular skin surveillance with minimal interruption in the workplace and with reliable results from the assessment. - See more at: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.558583#sthash.kaY13i0M.dpuf