Essentials of occupational contact dermatitis.

Occupational skin disease constitutes a disproportionately large percentage of all occupational illnesses. It is beneficial for the nurse to have a clear understanding of the relationship between the worker and occupational contact dermatitis. This article describes background information, diagnostic testing, and preventive measures.     

Prevention of irritant contact dermatitis.

The prevention of skin diseases is accepted as an important part of occupational dermatology. Irritant dermatitis in particular, is a skin disease which can be avoided by preventional measures. Hence, an early introduction of trainees to preventional measures seems to be necessary to avoid bad habits which then become a matter of routine. The role of the dermatologist is not only the identification of individuals with a higher risk for developing irritant dermatitis, he should also inform his patients about the relevant irritants in their occupation (or of irritants in the household or leisure activities). Prevention by collective measures must be combined with individual measures (like gloves and protective clothing, correct skin cleaning and external creams). Periodical training and motivation of individuals at most risk is of utmost importance, because the best preventive measures are of no effect when they are not used regularly.     

U.K. standards of care for occupational contact dermatitis and occupational contact urticaria

The diagnosis of occupational contact dermatitis (OCD) and occupational contact urticaria (OCU) is a process that involves fastidious clinical and occupational history taking, clinical examination, patch testing and skin‐prick testing. A temporal relationship of work and/or the presence of a rash on the hands only raises suspicion of an occupational cause, and does not necessarily confirm an occupational causation. The identification of allergy by patch or prick tests is a major objective, as exclusion of an offending allergen from the environment can contribute to clinical recovery in the individual worker and avoidance of new cases of disease. This can be a complex process where allergens and irritants, and therefore allergic and irritant contact dermatitis, may coexist. This article provides guidance to healthcare professionals dealing with workers exposed to agents that potentially cause OCD and OCU. Specifically it aims to summarize the 2010 British Occupational Health Research Foundation (BOHRF) systematic review, and also to help practitioners translate the BOHRF guideline into clinical practice. As such, it aims to be of value to physicians and nurses based in primary and secondary care, as well as occupational health and public health clinicians. It is hoped that it will also be of value to employers, interested workers and those with responsibility for workplace standards, such as health and safety representatives. Note that it is not intended, nor should it be taken to imply, that these standards of care override existing statutory and legal obligations. Duties under the U.K. Health and Safety at Work Act 1974, the Management of Health and Safety at Work Regulations 1999, the Control of Substances Hazardous to Health Regulations 2002, the Equality Act 2010 and other relevant legislation and guidance must be given due consideration, as should laws relevant to other countries.     

Prognosis of occupational chromate dermatitis

To elucidate further the natural history and prognosis of occupational chromate dermatitis, 120 affected patients, diagnosed between 1980 and 1989, were reviewed. The incidence of chromate dermatitis in Western Australia appeared to remain unchanged over the decade. 65% of patients were construction workers with cement-induced chromate dermatitis. Workers at greatest risk of sensitization were those mixing bagged cement at the work site. The median age at onset of symptoms was 34 years, with 48% having been exposed to chromate for 5 years or less. Only 37% presented to the dermatologist within 12 months of developing symptoms. 76% of patients had ongoing dermatitis at the time of review. Although 48% of the study population had completely changed their occupation to avoid chromate exposure, symptoms persisted in 69%. A delayed diagnosis of chromate sensitivity was noted to be a predictor of chronicity. In view of the potential chronicity of chromate dermatitis and its associated social and occupational impairment, we recommend the addition of ferrous sulphate while mixing bagged cement at the work site. This simple technique targets the workers at greatest risk of becoming sensitized.     

Mercury exanthem as occupational dermatitis

A patient developed an exanthem after inhalation of mercury vapors. Clinically and histopathologically the exanthem resembled an erythema exudativum multiformelike drug eruption.     

Leukoderma following occupational allergic contact dermatitis

We describe 2 cases of occupational allergic contact dermatitis followed by leukoderma. The 1st case was a 49-year-old wood machinist who developed leukoderma in areas of contact dermatitis involving his lips, neck, hands and forearms and was found to be allergic to colophony and pine sawdust on patch testing. The 2nd case involved a 44-year-old man who worked as an epoxy applicator in a ceramics factory. He developed depigmentation in areas of contact dermatitis involving his face, hands, forearms, back, thighs and legs and was found on patch testing to be allergic to epoxy resin. The appearance of contact leukoderma may be indistinguishable from idiopathic vitiligo. However the prognosis for repigmentation may be better in contact leukoderma than in idiopathic vitiligo.     

Career counsellors and occupational contact dermatitis

Career counsellors are in a unique position to provide timely preventive advice to young people at risk of developing occupational contact dermatitis. Career counsellors need to be aware of risk factors for this condition, including atopic eczema, and of high-risk occupations, such as hairdressing. A cross-sectional survey of 82 career counsellors was conducted at an Australian career counsellors' conference. 24 (29%, 95% confidence interval (95% CI) 19-40%) correctly identified eczema as a risk factor. 25 (30%, 95% CI 21-41%) indicated consideration of past skin problems during career counselling. 30 (36%, 95% CI 25-47%) correctly reported at least 1 high-risk occupation, with hairdressing being most frequently identified. Only 3 of the 82 (4%, 95% CI 0-7%) correctly answered all 3 questions.     

Incidence rates of occupational allergic contact dermatitis caused by metals.

BACKGROUND: Data on the incidence rates (IR) of occupational dermatoses are scarce. MATERIAL AND METHODS: We calculated the IR of occupational allergic contact dermatitis (ACD) caused by chromium, nickel and cobalt by occupation, during a 7-year period (1991-1997) from the data of the Finnish Register of Occupational Diseases and from the statistics on the working population in different occupations. RESULTS: A total of 2543 cases of occupational ACD were reported during 1991-1997. Cr caused 143 (5.6%) cases of ACD, Ni 176 cases (6.9%) and Co 41 cases (1.6%) of ACD. Women had greater number of occupational ACD from nickel, whereas occupational ACD from chromate and cobalt was more frequent in men. The ranking list of the IR of occupational ACD caused by Cr per 10,000 working years was (incidence rate in parenthesis) (1) tanners, fellmongers, and pelt dressers (12.20); (2) cast concrete product workers (6.94); (3) leather goods workers (4.71), (4) metal plating and coating workers (3.66); (5) bricklayers (3.44); (6) reinforcement concreters (2.79); and (7) building workers (1.32). The corresponding ranking list for Ni was (1) footwear workers (2.55); (2) machine and metal product assemblers (2.40); (3) electrical and teletechnical equipment assemblers (2.03); (4) precision instrument mechanics (1.73); (5) postal officials (1.48); (6) hairdressers, beauticians, and bath attendants (1.24); (7) industrial tailors and seamstresses (1.08); and (8) waiters in cafes and snack bars (1.04). The corresponding ranking list for Co was (1) printers (0.80); (2) turners, machinists, and toolmakers (0.36); and (3) machine and engine mechanics (0.17). CONCLUSION: The Finnish Register of Occupational Diseases forms a good basis for calculating IR. As IR illustrates the risk to become sensitized, preventive measures should be directed at occupations with the highest IR.