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Atopic Dermatitis

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Kanerva's Occupational Dermatology

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Abstract

Previous atopic hand dermatitis and/or flexural eczema increases the risk of developing irritant contact dermatitis at least twofold in individuals exposed to irritants and wet work.

In contrast to allergic contact dermatitis to haptens, individuals suffering from atopic dermatitis are prone to protein contact dermatitis and contact urticaria to occupational allergens like food stuff or latex proteins.

It is often difficult to decide whether occupational exposure or constitutional factors have a greater impact for the development of hand eczema in atopic individuals. The diagnostic workup should therefore lead to a distinct diagnosis and allow to quantify the impact of occupational and nonoccupational factors. An exposure-independent course and persistence of eczema after discontinuation of work suggest a preponderance of atopic skin disposition over occupational exposure.

With regard to atopy and dependent on the morphology of skin lesions as well as the course of the disease, hand eczema may be classified as chronic irritant contact dermatitis with atopic skin disposition, irritant-induced atopic hand eczema, or atopic hand eczema.

It is a matter of debate whether “dyshidrotic” vesicular hand eczema without a strict exposure-dependent course, with no relevant contact sensitization and normal IgE levels represents “intrinsic” atopic hand eczema or a distinct entity.

Since several factors contribute to the development of occupational contact dermatitis, a general exclusion of persons with atopic skin disposition or atopic dermatitis from risk occupations is not effective in terms of primary prevention. Instead, individual advice should rather be given to persons at risk and technical, organizational, and personal protection measures, as well as repeated follow-up examinations have to be considered.

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Authors and Affiliations

  1. Department of Allergology and Occupational Dermatology, Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Germany

    Kristine Breuer (Privatdozentin)

  2. Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany

    Thomas Werfel

Authors
  1. Kristine Breuer
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  2. Thomas Werfel
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Correspondence to Kristine Breuer .

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Editors and Affiliations

  1. Department of Dermatology and Allergology, VU University Medical Center, Amsterdam, The Netherlands

    Thomas Rustemeyer

  2. Department of Dermatology, University Hospital Jena, Jena, Germany

    Peter Elsner

  3. Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany

    Swen-Malte John

  4. Department of Dermatology, University of California, San Francisco, CA, USA

    Howard I. Maibach

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Breuer, K., Werfel, T. (2012). Atopic Dermatitis. In: Rustemeyer, T., Elsner, P., John, SM., Maibach, H.I. (eds) Kanerva's Occupational Dermatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02035-3_20

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  • DOI: https://doi.org/10.1007/978-3-642-02035-3_20

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