Are obsessive‐compulsive disorders and personality disorders sufficiently considered in occupational dermatoses? A discussion based on three case reports

Abstract

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.

Comparative Study of Quality of Life and Obsessive-Compulsive Tendencies in Patients With Chronic Hand Eczema and Lichen Simplex Chronicus

“…In patients with CHE, the role of obsessive-compulsive washing as part of an anxiety disorder or personality disorder is most likely a contributing or maintaining factor systematically underestimated in the pathogenesis of the disease and in the therapeutic management. 16 Obsessive-compulsive trait in patients with LSC supports an important role in triggering and maintaining the itch-scratch vicious cycle. Patients with LSC presented higher levels of obsessivecompulsive personality traits than the CHE patients.…”

Occupational Contact Dermatitis: General Aspects

“…If all measures fail, the case should be carefully reevaluated, preferably in a center specialized on occupational dermatology. There may be a missed allergen at work or at home, the endogenous part of the disease may have turned out to be overwhelming, the patient's compliance may have decreased, orin rare casesthe patient produces artifacts in order to obtain legal compensation [76,77]. The persistence of skin symptoms after all occupational exposures have been discontinued is now classified as "persistent postoccupational dermatitis (PPOD)" and may be more common than previously thought [78][79][80].…”

Obsessive‐compulsive disorder in dermatology

“…There have been reports of atopic dermatitis, irritant toxic dermatitis, or dry skin eczema (eczéma craquelé) of the hands in patients with washing compulsion . Especially with regard to certain professions, for example, in the healthcare, cosmetic, and hairdressing sector, this is of great clinical, but also sociomedical relevance . It is therefore not surprising that hand dermatitis in the context of compulsive washing in OCD patients is one of the most common visible symptoms.…”