Hand dermatitis is relatively common in the general population. Among work-related diseases, it is the most common form of occupational skin disease. Irritant hand dermatitis is the most frequent type. Besides wet work and direct contact to irritating occupational substances frequent hand washing can damage the barrier function of the skin facilitating the manifestation of hand dermatitis that frequently occurs chronically. According to own observations the role of obsessive-compulsive washing as part of an anxiety disorder or personality disorders may not be considered sufficiently. A possible pathogenetic relation between hand dermatitis and psychogenic disorders is discussed in a 22-year old physician's assistant, a 50-year old male nurse working in intensive care, and a 54-year old cleaner. All three patients complained about feelings of revulsion, fear of contamination and a high frequency of hand washing. These cases may encourage dermatologists to consider psychological aspects of hand dermatitis e.g. obsessive compulsive washing, overcome their inhibitions and consider these aspects in an integrated way when planning patient's therapy.

Hand dermatitis is relatively common in the general population. Among work-related diseases, it is the most common form of occupational skin disease. Irritant hand dermatitis is the most frequent type. Besides wet work and direct contact to irritating occupational substances frequent hand washing can damage the barrier function of the skin facilitating the manifestation of hand dermatitis that frequently occurs chronically. According to own observations the role of obsessive-compulsive washing as part of an anxiety disorder or personality disorders may not be considered sufficiently. A possible pathogenetic relation between hand dermatitis and psychogenic disorders is discussed in a 22-year old physician's assistant, a 50-year old male nurse working in intensive care, and a 54-year old cleaner. All three patients complained about feelings of revulsion, fear of contamination and a high frequency of hand washing. These cases may encourage dermatologists to consider psychological aspects of hand dermatitis e.g. obsessive compulsive washing, overcome their inhibitions and consider these aspects in an integrated way when planning patient's therapy.

Fragrances are very common in everyday products. A metalworker with chronic hand eczema and previously diagnosed type IV sensitizations to epoxy resin, balsam of Peru, fragrance mix and fragrance mix II was diagnosed with additional type IV sensitizations to geraniol, hydroxycitronellal, lilial, tree moss, oak moss absolute, citral, citronellol, farnesol, Lyral, fragrance mix II and fragrance mix (with sorbitan sesquioleate). In addition, a type IV sensitization to the skin protection cream containing geraniol and citronellol used at the workplace was detected, and deemed occupationally relevant in this case. The patient could have had contact to fragrances through private use of cosmetics and detergents. On the other hand, the fragrance-containing skin protection cream supports occupational exposure. This case report demonstrates that fragrance contact allergy has to be searched for and clarified individually, which requires a thorough history and a detailed analysis of the work place.