Occupational and Hand Dermatitis: a Practical Approach
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.
KeywordsOccupational Contact dermatitis Hand Allergen Irritant
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.SEER Training: Layers of the skin (n.d.) Retrieved from https://training.seer.cancer.gov/melanoma/anatomy/layers.html
- 6.US Bureau of Labor Statistics. 2014 Survey of occupational injuries & illnesses. Summary estimates charts package. Curr Popul Surv 2015:1Y16. Available at: http://www.bls.gov/iif/oshwc/osh/os/osch0054.pdf. Accessed November 18, 2017
- 12.Chen YX, Gao BA, Cheng HY, Li LF (2017) Survey of occupational allergic contact dermatitis and patch test among clothing employees in Beijing. Biomed Res Int 2017:10 pagesGoogle Scholar
- 17.Özyazıcıoğlu N, Sürenler S, Tanrıverdi G (2010) Hand dermatitis among paediatric nurses. J Clin Nurs 19((11–12))Google Scholar
- 30.Goyer N, Bégin D, Beaudry C et al (2006) Prevention guide: formaldehyde in the workplace. Available at http://biology.mcgill.ca/safety/Formaldehyde_guide.pdf. Retrieved on November 19, 2017
- 33.Cameo Chemicals “1-(3-CHLOROALLYL)-3,5,7-TRIAZA-1-AZONIAADAMANTANE CHLORIDE” Website. Available at: https://cameochemicals.noaa.gov/chemical/18075. Accessed November 18, 2017
- 34.Chempoint “Suttocide A Hydroxymethylglycinate” Website. Available at: https://www.chempoint.com/products/catalog/ashland/ashland-personal-care-preservatives/suttocide-a-sodium-hydroxymethylglycinate. Accessed November 18, 2017
- 36.Chemo Nickel Test. Chemotechnique Diagnostics. Available at: https://www.chemotechnique.se/ckfinder/userfiles/files/Nickel%20Test%20Package%20Insert,%20version%201%20-%20Digital.pdf. Accessed November 18, 2017
- 56.Weidinger S, Illig T, Baurecht H, Irvine AD, Rodriguez E, Diaz-Lacava A, Klopp N, Wagenpfeil S, Zhao Y, Liao H (2006) Loss-of-function variations within the filaggrin gene predispose for atopic dermatitis with allergic sensitizations. J Allergy Clin Immunol 118(1):214–219. https://doi.org/10.1016/j.jaci.2006.05.004 CrossRefGoogle Scholar
- 58.deGroot AC (2008) Patch testing: test concentrations and vehicles for 4350 chemicals, 3rd edn. acdegroot publishing, WapserveenGoogle Scholar
- 59.Thin-layer rapid-use epicutaneous test. Thin-layer rapid-use epicutaneous test (TRUE-test). Available at: https://www.smartpractice.com/dermatologyallergy/pdfs/TRUE%20TEST%20Prescribing%20Information.pdf. Accessed November 19, 2017
- 62.Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health (NIOSH) “Hierarchy of Controls” Website. Available at: https://www.cdc.gov/niosh/topics/hierarchy/default.html. Accessed November 5, 2017
- 63.Forsberg K, Mansdorf SZ (2001) Quick selection guide to chemical protective clothing. Wiley, HobokenGoogle Scholar
- 66.Weisshaar E, Skudlik C, Scheidt R, Matterne U, Wulfhorst B, Schönfeld M, Elsner P, Diepgen TL, John SM, for the ROQ Study Group (2013) Multicentre study rehabilitation of occupational skin diseases—optimization and quality assurance of inpatient management (ROQ)—results from 12-month follow-up. Contact Dermatitis 68(3):169–174CrossRefGoogle Scholar