Abstract
Purpose of Review
The purpose of this review is to provide an update on occupational contact dermatitis including gaps in knowledge and practice. Occupational contact dermatitis is the most common occupational skin disease.
Recent Findings
New sources of exposure for known allergens and new allergens are continually being reported. Through clinical databases and surveillance systems, effects of prevention efforts or introduction of new allergens or new uses of known allergens can be monitored. Though the diagnostic process is clear, there are delays in workers seeking care. As early detection and intervention improves outcomes, screening should be implemented. Gaps in primary prevention in the workplace are identified and should be addressed to reduce the burden of disease.
Summary
Surveillance systems support the prevention mandate. Understanding limitations of our knowledge and identifying gaps in practice can lead to initiatives to address research and practice needs and improve prevention of occupational dermatoses.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Rashid RS, Shim TN. Contact dermatitis. BMJ. 2016;353:i3299. https://doi.org/10.1136/bmj.i3299 Useful clinical review.
Royal College of Physicians. Concise guidance to good practice: Number 13: Diagnosis, management and prevention of occupational contact dermatitis. Royal College of Physicians., ISBN. 2011:978–1–86016-3609.
Fillenhan G, Liden C, Anveden Berglind I. Skin exposure to epoxy in the pipe relining trade – an observtional study. Contact Dermatitis. 2012;67:66–72. https://doi.org/10.1111/j.1600-0536.2012.02065.x.
Anveden Berglind I, Lind ML, Liden C. Expoxy pipe relining – an emerging contact allergy risk for workers. Contact Dermatitis. 2012;67:59–65. https://doi.org/10.1111/j.1600-0536.2011.02028.x.
Creytens K, Gilissen L, Huygens S, Goossens A. A new application for epoxy resins resulting in occupational allergic contact dermatitis: the three-dimensional printing industry. Contact Dermatitis. 2017;77:249–351. https://doi.org/10.1111/cod.12840.
Thyssen JP, Sederberg-Olsen N, Thomsen JF, Menne T. Contact dermatitis from methylisothiazolinone in a paint factory. Contact Dermatitits. 2006;54:322–4.
Schwensen JF, Friis UF, Menne T, Flyvholm MA, Johansen JD. Contact allergy to preservatives in patients with occupational contact dermatitis and exposure analysis of preservatives in registered chemical products for occupational use. Contact Dermatitis. 2017;90:319–33. https://doi.org/10.1007/s00420-017-1203-5.
Hagvall L, Brared-Christensson J, Inerot A. Occupational contact dermatitis caused by sodium cocoamphopropionate in a liquid soap used is fast-food restaurants. Contact Dermatitis. 2014;71:122–4. https://doi.org/10.1111/cod.12209.
Pesonen M, Suomela S, Kuuliala O, Aalto-Korte K. Occupational contact allergy to sodium cocoamphopropionate in a hand cleanser. Contact Dermatitis. 2016;74:246–8. https://doi.org/10.1111/cod.12474.
DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group patch test results: 2013–2014. Dermatitis. 2017;28:33–46. https://doi.org/10.1097/DER.000000000000225.
• DeKoven JG, Warshaw EM, Zug KA, et al. North American Contact Dermatitis Group patch test results: 2015–2016. Dermatitis. 2018;29:297–309. https://doi.org/10.1097/DER.000000000000417 Current NACDG patch test results.
• Uter W, Amario-Hita JC, Balato A, et al. European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14. J Eur Acad Deramtol Venereol. 2017;9:1516–25. https://doi.org/10.1111/jdv.14423.12 Current ESSCA patch test results.
Schnuch A, Geier J, Lessmann H, Arnold R, Uter W. Surveillance of contact allergies: methods and results of the Information Network of Departments of Dermatology (IVDK). Allergy. 2012;67:847–57. https://doi.org/10.1111/j.1398-9995.2012.02834.x.
Pesonen M, Jolanki R, Larese Filon F, et al. Patch test results of the European baseline series among patients with occupational contact dermatitis across Europe - analysis of the European Surveillance System on Contact Allergy network, 2002–2010. Contact Dermatitis. 2015;72:154–63. https://doi.org/10.1111/cod.12333.
Warshaw EM, Schram SE, Maibach HI, et al. Occupation-related contact dermatitis in North American health care workers referred for patch testing: cross-sectional data, 1998 to 2004. Dermatitis. 2008;19:261–74.
Molin S, Bauer A, Schnuch A, Geier A. Occupational contact allergy in nurses: results from the Information Network of Departments of Dermatology 2003–2012. Contact Dermatitis. 2015;72:164–71. https://doi.org/10.1111/cod.12330.
Heratizadeh A, Werfel T, Schubert S, Geier J, for the IVDK. Contact sensitization in dental technicians with occupational contact dermatitis. Data of the Information Network of Departments of Dermatology (IVDK) 2001–2015. Contact Dermatitis. 2018;78:266–73. https://doi.org/10.1111/cod.12943.
Warshaw EM, Wang MZ, Mathias CG, et al. Occupational contact dermatitis in hairdressers/cosmetologists: retrospective analysis of cross-sectional data of the north american contact dermatitis group data, 1994–2010. Dermatitis. 2012;23:258–68. https://doi.org/10.1097/DER.0b013e318273a3b8.
Warshaw EM, Kwon GP, Mathias CG, et al. Occupationally related contact dermatitis in North American food services workers referred for patch testing, 1994–2010. Dermatitis. 2013;24:22–8. https://doi.org/10.1097/DER.0b013e31827b14e1.
Warshaw EM, Hagen SL, Sasseville D, et al. Occupational contact dermatitis in mechanics and repairers referred for patch testing: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group 1998. 2014 Dermatitis. 2017;28:47–57 doi: 10/1097/DER.
Warshaw EM, Hagen SL, Belsito DV, et al. Occupational contact dermatitis in North American print machine operators referred for patch testing: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group 1998 to 2014. Dermatitis. 2017;28:195–203. https://doi.org/10.1097/DER.000000000000269.
Warshaw EM, Hagen SL, DeKoven JG, et al. Occupational contact dermatitis in North American production workers referred for patch testing: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group 1998 to 2014. Dermatitis. 2017;28:183–94. https://doi.org/10.1097/DER.000000000000277.
Geier J, Lessmann H, Skudlik C, et al. Occupational contact allergy in bricklayers, tile setter etc. – current spectrum of sensitization and recent time trends. Allergol Select. 2017;1:127–40. https://doi.org/10.5414/ALXO1593E.
Mahler V, Geier J, Schnuch A. Current trends in patch testing – new data from the German Contact Dermatitis Research Group (DKG) and the Information Networks of Departments of Dermatology (IVDK). J Dtsch Dermatol Ges. 2014;12:583–92. https://doi.org/10.1111/ddg.12371.
Alinaghi F, Zachariae C, Thyssen JP, Johnansen JD. Temporal changes in chromium allergy in Denmark between 2002 and 2017. Contact Dermatitis. 2019;80:156–61. https://doi.org/10.1111/cod.13181.
Aerts O, Goossens A, Giordano-Labradie F. Contact allergy caused by methylisothiazolinone: the Belgiun-French experience. Eur J Dermatol. 2015;25:228–33. https://doi.org/10.1684/ejd.2015.2608.
Schwensen JF, Uter W, Bruze M, et al. The epidemic of methylisothiazolinone: a European prospective study. Contact Dermatitis. 2017;76:272–9. https://doi.org/10.1111/cod.12733.
Zirwas MJ, Hamann D, Warshaw EM, et al. Epidemic of isothizaolinone allergy in North America: prevalence data form the North American Contact Dermatitis Group, 2013–2014. Dermatitis. 2017;28:204–9. https://doi.org/10.1097/DER.000000000000288.
Meyer JD, Chen Y, Holt DL, Beck MH, Cherry NM. Occupational contact dermatitis in the UK: a surveillance report from EPIDERM and OPRA. Occup Med. 2000;50:265–73.
McDonald JC, Beck MH, Chen Y, Cherry NM. Incidence by occupation and industry of work-related skin diseases in the United Kingdom, 1996–-2001. Occup Med. 2006;56:398–405.
Stocks SJ, McNamee R, Turner S, Carder M, Agius RM. Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK? Occup Environ Med. 2012;69:150–2. https://doi.org/10.1136/oem-2011-100220.
Urwin R, Warburton K, Carder M, Turner S, Agius R, Wilkinson SM. Methylchloroisothiazolinone and methylisothiazolinone contact allergy: an occupational perspective. Contact Dermatitis. 2015;72:381–6. https://doi.org/10.1111/cod.12379.
Stocks DJ, McNamee R, Turner S, Carder M, Agius RM. The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996–2012 and interrupted times series analysis. Br J Dermatol. 2015;173:165–71. https://doi.org/10.1111/bjd.13719.
Ofenloch R, Apfelbacher C, Weisshaar E. Hand eczema registries: background, value and future prospects: registry data in hand eczema research. Hautarzt. 2018;69:809–14. https://doi.org/10.1007/s00105-018-4245-z.
Luk NMT, Lee HC, Luk CK, et al. Hand eczema among Hong Kong nurses: a self-report questionnaire survey conducted in a regional hospital. Contact Dermatitis. 2011;65:329–35. https://doi.org/10.1111/j.1600-0536.2011.01961.x.
Visser MJ, Verbeck MM, van Dijk FJH, Bakker JG, Bos JD, Kezic S. Wet work and hand eczema in apprentice nurses: part 1 of a prospective cohort study. Contact Dermatitis. 2014;70:44–55. https://doi.org/10.1111/cod.12131.
• Nichol K, Copes R, Kersey K, Eriksson J, Holness DL. Screening for hand dermatitis in healthcare workers: comparing workplace screening with dermatologists photo screen. Contact Dermatitis. 2019;80:374–81. https://doi.org/10.1111/cod.13231 Current prevalence of hand dermatitis in healthcare workers.
Nicholson PJ, Llewellyn D, English JS. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticarial. Contact Dermatitis. 2010;63:177–86. https://doi.org/10.1111/j.1600-0536.2010.01763.x.
Adisesh A, Robinson E, Nicholson PJ, Sen D, Wilkinson M, on behalf of the Standards of Care Working Group. UK standards of care for occupational contact dermatitis and occupational contact urticaria. Br J Dermatol. 2013;168:1167–75. https://doi.org/10.1111/bjjd.12256.
Johnston GA, Exton LS, Mohd Mustapa MF, et al. British Association of Dermatologists’ guidelines for the management of contact dermatitis. Br J Dermatol. 2017;176:317–29. https://doi.org/10.1111/bjd.1239.
Diepgen TL, Andersen KE, Chosidow O, et al. Guidelines for diagnosis, prevention and treatment of hand eczema – short version. J Dtsch Dermatol Ges. 2015;13:77–85. https://doi.org/10.1111/ddg.12510.
Brasch J, Becker D, Aberer W, et al. Guideline contact dermatitis SI-guidelines of the German Contact Allergy Group (DKG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. Allergo J Int. 2014;23:126–38.
Fonacier L, Berstein DI, Pacheco K, et al. Contact dermatitis: a practice parameter update – 2015. J Allergy Clin Immunol Pract. 2015;3(Supp):S1–S39. https://doi.org/10.1016/jaip.2015.02.009.
Alfonso JH, Bauer A, Bensefa-Colas L, et al. Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe – position paper of COST Action StanDerm (TD1206). J Eur Acad Dermatol Venereol. 2017;Supp;4:31–43. https://doi.org/10.1111/jdv.14319.
Budd D, Kudla I, Holness DL. Workplace survey: guiding principles from occupational dermatology. In: John SM, et al., editors. Kanerva’s Occupational Dermatology. Switzerland AG: Springer Nature; 2019. https://doi.org/10.1007/978-3-319-40221-5221-1.
Holness DL. Health care services use by workers with work-related contact dermatitis. Dermatitis. 2004;15:18–24.
Holness DL, Tabassum S, Tarlo SM, Liss GM, Silverman F, Manno M. Dermatologist and family practitioner practice patterns for occupational contact dermatitis. Australas J Dermatol. 2007;48:22–7.
Johansen JD, Aalto-Lorte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice. Contact Dermatitis. 2015;73:195–221. https://doi.org/10.1111/cod.12432.
Lachapelle JJ-M, Maibach HI. Patch testing and prick testing. 3rd ed. Heidelberg: Springer; 2012.
Warshaw EM, Nelson D. Prevalence of patch testing and methodology of dermatologists in the US: results of a cross-sectional survey. Am J Contact Dermat. 2002;13:53–8 Or Warshaw EM, Moore JB, Nelson D. Patch testing practices of American Contact Dermatitis Society members: a cross-sectional survey. Am J Contact Dermat. 2003;14:5–11.
Farrell AL, Warshaw EM, Zhao Y, Nelson D. Prevalence and methodology of patch testing by allergists in the United States: results of a cross-sectional survey. Am J Contact Dermat. 2002;13:157–63.
Zhu TH, Suresh R, Farahnik B, et al. Survey of patch test business models in the United States by the American Contact Dermatitis Society. Dermatitis. 2018;29:85–8. https://doi.org/10.1097/DER.000000000000355.
Meyer MD, McDonald H, Watsky K. Utilization and geographic variation of patch testing among Medicare beneficiaries. Dermatitis. 2016;27:234–6.
• Arrandale VH, Holness DL. Using health insurance administrative data to explore patch testing utilization in Ontario, Canada – an untapped resource. Contact Dermatitis. 2019;80:386–90. https://doi.org/10.1111/cod.13229 Use of large administrative database to study patch test utilization and practice.
Mathias CG. Contact dermatitis and workers’ compensation: criteria for establishing occupational causation and aggravation. J Am Acad Dermat. 1989;20:842–8.
Ingber A, Merims S. The validity of the Mathias criteria for establishing occupational causation and aggravation of contact dermatitis. Contact Dermatitis. 2004;51:9–12.
• Kudla I, Houle M-C, Velykoredko Y, et al. Introducing a “workplace prescription” to facilitate return to work for workers with occupational contact dermatitis. J Cut Med Surg. 2017;21:573–5. https://doi.org/10.1177/1203475417716328 Practical tool to assist with RTW.
Chen J, Gomez P, Kudla I, DeKoven J, Holness DL, Skotnicki S. Return to work for nurses with hand dermatitis. Dermatitis. 2016;27:308–12. https://doi.org/10.1097/DER.000000000000215.
Keegel T, Cahill J, Noonan A, et al. Incidence and prevalence rates for occupational contact dermatitis in an Australian suburban area. Contact Dermatitis. 2005;52:254–9.
Hald M, Agner T, Blands J. Johnansen JD on behalf of the Danish Contact Dermatitis Group. Delay in medical attention to hand eczema: a follow-up study. Brit J Dermatol. 2009;161:1294–300. https://doi.org/10.1111/j.1365-2133.2009.09402.x.
Rusca C, Hinnen U, Elsner P. ‘Patient’s delay’ – analysis of the preclinical phase of occupational dermatoses. Dermatology. 1997;194:50–2.
Malkonen T, Alanko K, Jolanki R, et al. Long-term follow-up study of occupational hand eczema. Br J Dermatol. 2010;163:999–1006. https://doi.org/10.1111/1365-2133-2010.09987.x.
Lerbaek A, Kyvik KO, Ravn H, Menne T, Agner T. Clinical characteristics and consequences of hand eczema – an 8-year follow-up study of a population-based twin cohort. Contact Dermatitis. 2008;58:210–6. https://doi.org/10.1111/j.1600-0536.2007.01305.x.
Nurmohamed S, Bodley T, Thompson A, Holness DL. Health care utilization characteristics in patch test patients. Dermatitis. 2014;25:268–72. https://doi.org/10.1097/DER.000000000000059.
Bathe A, Diepgen TL, Matterne U. Subjective illness perceptions in individuals with occupational skin disease: a qualitative investigation. Work. 2012;43:159–69.
Emmett EA. Dermatological screening. J Occup Med. 1986;28:1045–50.
Susitaival P, Flyvolm MA, Meding B, Kanerva L, et al. Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure. Contact Dermatitis. 2003;49:70–6.
Olesen CM, Agner T, Ebbehoj NE, Caroe TK. Factors influencing the prognosis for occupational hand eczema – new trends. Br J Dermatol. 2019. https://doi.org/10.1111/bjd.17870.
Holness DL Harniman E, DeKoven J, Skotnicki Grant S, Beaton D, Nixon R, Switzer-McIntyre S. Hand and upper extremity function in workers with hand dermatitis. Dermatitis. 2013;24:131–6. https://doi.org/10.1097/DER.0b013e3182910416.
Holness DL, Nethercott JR. Work outcome in workers with occupational skin disease. Am J Ind Med. 1995;27:807–15.
Diepgen TL, Scheidt R, Weisshaar E, John SM, Hieke K. Cost of illness from occupational hand eczema in Germany. Contact Dermatitis. 2013;69:99–106. https://doi.org/10.1111/cof.12038.
• Caroe TK, Ebbehoj NE, Bonde JP, Agner T. Occupational hand eczema and/or contact urticaria: factors associated with change of profession or not remaining in the workforce. Contact Dermatitis. 2018;78:55–63. https://doi.org/10.1111/cod.12869 Recent article on outcomes.
Boehm D, Schmid-Ott G, Finkekdey F, et al. Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema. Contact Dermatitis. 2012;67:184–92. https://doi.org/10.1111/j.1600-0536.2012.02062.x.
Mascaro JM, Querol I, Lindner L, Prior M, Oliver J, Halbach RP. Costs of patinets with occupational severe chronic hand eczema refractory to topical corticosteroids for employer’s mutual insurance companies in Spain. Value Health. 2009;12:A453–4.
Sithamparaanadarajah R. Controlling skin exposure to chemicals and wet work: a practical book. Stourbridge: RMS Publishing Limited; 2008.
•• Bauer A, Ronsch H, Elsner P, et al. Interventions for preventing occupational irritants hand dermatitis. Cochrance Database Syst Rev. 2018;4:CD004414. https://doi.org/10.1002/14651858 CD004414. Recent update of Cochrane systematic review for prevention of occupational irritants contact dermatitis.
Gupta T, Arrandale VH, Kudla I, Holness DL. Gaps in workplace education practices for prevention of occupational skin disease. Ann Work Expo Health. 2018;62:243–7. https://doi.org/10.1093/annweh/wx093.
Zack B, Arrandale VH, Holness DL. Skin specific training experience of workers being assessed for contact dermatitis. Occup Med. 2018;68:203–6. https://doi.org/10.1093/occmed/kqy022.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The author declares no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
Research involving human subjects, human material, or human data, has been performed in accordance with the Declaration of Helsinki and has been approved by an appropriate ethics committee.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Allergic Skin Diseases
Rights and permissions
About this article
Cite this article
Holness, D.L. Occupational Dermatosis. Curr Allergy Asthma Rep 19, 42 (2019). https://doi.org/10.1007/s11882-019-0870-6
Published:
DOI: https://doi.org/10.1007/s11882-019-0870-6