Occupational and Hand Dermatitis: a Practical Approach

Abstract

Occupational skin disease is common. It affects workers more often than reported. Contact dermatitis, both irritant and allergic, accounts for the majority of occupational skin diagnoses. Occupational contact dermatitis (OCD) frequently affects the hands and may have a profound impact on an employee's ability to perform a job. Severe OCD can affect a worker's activities of daily living and can even lead to job loss. Numerous irritants have been described in the workplace, from the common (wet work) to the more obscure (warm, dry air). Several contact allergens may be work-related, and the majority of established occupational allergens are also known nonoccupational allergens. Emerging occupational allergens are continually described in the literature. Patch testing is the gold standard for the workup of allergic contact dermatitis. Patch testing in the setting of OCD may require extended or unique allergen trays, as well as a thorough occupational history and collection of workplace Material Safety Data Sheets (MSDS). These MSDS contain valuable information but may not be complete or accurate. Proof of occupational causation can be aided by employing the Mathias criteria. Certain industries and occupations are associated with higher rates of OCD, and as expected, the industries with direct contact with irritants and allergens are highly represented. The differential diagnosis for occupational dermatitis is broad and should be considered when evaluating an employee with suspected OCD. Some other diagnoses to consider include atopic dermatitis, psoriasis, and manifestations of internal disease, as well as an overlap syndrome of more than one diagnosis. OCD treatment should ideally follow the public health hazard controls' stepwise approach. Prevention and early intervention are key to promoting occupational health and preventing OCD. Multidisciplinary teams have been successful in the treatment of OCD, and newly described topical treatments may provide additional modalities for use in the occupational setting.

Occupational contact dermatitis in Triveneto: Analysis of patch test data of the North Eastern Italian Database from 1996 to 2016

“…Regarding the diagnosis, we find that ACD is predominant in our population (56.5% vs 43.5%) with a slightly higher proportion, as compared to ICD, among individuals with OCD (OR 1.14; 95%CI 1.04–1.26). Generally, ICD is the most common type of CD reported in literature, accounting for 60–80% of all CD, while ACD accounts for the remaining 20–40%, 6,41,51 but the proportion may vary widely across studies, depending on the occupations that prevail and the hazards to which people are exposed, the centers that report cases, and differences in the diagnostic criteria 4,5,52,53 . In comparison, a previous Italian study from Sertoli et al found that ACD clearly predominates over ICD (64,4% vs 34,6%, respectively) 14 .…”

“…The incidence rates reported so far underestimate the actual frequency of the phenomenon due to underdiagnosis and underreporting 5,6,8,10,12 . The most reliable studies provided a range of estimates of 11 to 86 cases/100000 workers per year, depending on the country 5‐7 …”

“…It represents the majority of occupational skin diseases (OSDs), accounting for 70% to 95% of all reported cases in Western European countries and is classified, depending on the etiology, into irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) 2‐5 . It usually develops on areas of direct skin contact, with hands as the primary site of involvement in 80% of the cases, 3‐6 followed by wrists, arms, and face 7 . Workers are often affected at the beginning of their career and the prognosis is commonly very poor 8‐10 .…”

“…Even if OSD ranks among the five most frequently notified and recognized occupational diseases in Europe, 11 the true frequency of OCD has not been well defined, partly because of difference in definitions, diagnostic criteria, data collection methods, reporting systems, degree of industrialization, and limited surveillance data 4,7 . The incidence rates reported so far underestimate the actual frequency of the phenomenon due to underdiagnosis and underreporting 5,6,8,10,12 . The most reliable studies provided a range of estimates of 11 to 86 cases/100000 workers per year, depending on the country 5‐7 …”

Characteristics and incidence of contact dermatitis among hairdressers in north‐eastern Italy

“…48,49 CD is mostly located on the hands, followed by the face (for airborne contamination, secondary contact through hands, or by direct exposure, ie, make-up), as those parts of the body are most exposed to external agents. 50 Hands and forearms are the most common sites of OCD in manual workers who are exposed to water, detergents, solvents, irritants, and sensitizers, as are hairdressers. 7,44,51 The prevalence of hand dermatitis in hairdressers in the present study (55.6%) is within the same range found in previous investigations.…”