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Clinical Reviews in Allergy & Immunology

, Volume 56, Issue 1, pp 60–71 | Cite as

Occupational and Hand Dermatitis: a Practical Approach

  • Heather P. LampelEmail author
  • Helen B. Powell
Article

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.

Keywords

Occupational Contact dermatitis Hand Allergen Irritant 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    SEER Training: Layers of the skin (n.d.) Retrieved from https://training.seer.cancer.gov/melanoma/anatomy/layers.html
  2. 2.
    Bhatia R, Sharma VK, Ramam M, Sethuraman G, Yadav CP (2015) Clinical profile and quality of life of patients with occupational contact dermatitis from New Delhi, India. Contact Dermatitis 73(3):172–181.  https://doi.org/10.1111/cod.12411 CrossRefGoogle Scholar
  3. 3.
    Koch P (2001) Occupational contact dermatitis. Am J Clin Dermatol 2(6):353–365.  https://doi.org/10.2165/00128071-200102060-00002 CrossRefGoogle Scholar
  4. 4.
    Diepgen TL, Coenraads PJ (1999) The epidemiology of occupational contact dermatitis. Int Arch Occup Environ Health 72(8):496–506.  https://doi.org/10.1007/s004200050407 CrossRefGoogle Scholar
  5. 5.
    Caroe TK, Ebbehoj N, Agner T (2013) A survey of exposures related to recognized occupational contact dermatitis in Denmark in 2010. Contact Dermatitis 70(1):56–62CrossRefGoogle Scholar
  6. 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
  7. 7.
    Ibler KS, Jemec GBE, Flyvholm MA, Diepgen TL, Jensen A, Agner T (2012) Hand eczema: prevalence and risk factors of hand eczema in a population of 2274 healthcare workers. Contact Dermatitis 67(4):200–207CrossRefGoogle Scholar
  8. 8.
    Luk N-MT, Lee H-CS, Luk C-KD, Cheung YYA, Chang MC, Chao VKD, Ng SC, Tang LSN (2011) Hand eczema among Hong Kong nurses: a self-report questionnaire survey conducted in a regional hospital. Contact Dermatitis 65(6):329–335CrossRefGoogle Scholar
  9. 9.
    Luckhaupt SE, Dahlhamer JM, Ward BW et al (2010) Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey. Am J Ind Med 56(6):625–634CrossRefGoogle Scholar
  10. 10.
    Keegel T, Moyle M, Dharmage S, Frowen K, Nixon R (2009) The epidemiology of occupational contact dermatitis (1990–2007): a systematic review. Int J Dermatol 48(6):571–578CrossRefGoogle Scholar
  11. 11.
    Keegel T, Cahill J, Noon A et al (2005) Incidence and prevalence rates for occupational contact dermatitis in an Australian suburban area. Contact Dermatitis 52(5):254–259CrossRefGoogle Scholar
  12. 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
  13. 13.
    Febriana SA, Hardyanto S, Coenraads PJ (2014) Occupational skin hazards and prevalence of occupational skin diseases in shoe manufacturing workers in Indonesia. Int Arch Occup Environ Health 87(2):185–194CrossRefGoogle Scholar
  14. 14.
    Visser MJ, Verberk MM, van Dijk FJ, Bakker JG, Bos JD, Kezic S (2013) Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study. Contact Dermatitis 70(1):44–55CrossRefGoogle Scholar
  15. 15.
    Timmerman JG, Heederik D, Spee T, van Rooy FG, Krop EJM, Rustemeyer T, Smit LAM (2017) Contact dermatitis is an unrecognized problem in the construction industry: comparison of four different assessment methods. Am J Ind Med 60(10):879–888CrossRefGoogle Scholar
  16. 16.
    Timmerman JG, Heederik D, Spee T, Smit LAM (2014) Skin symptoms in the construction industry: occurrence and determinants. Am J Ind Med 57(6):660–668CrossRefGoogle Scholar
  17. 17.
    Özyazıcıoğlu N, Sürenler S, Tanrıverdi G (2010) Hand dermatitis among paediatric nurses. J Clin Nurs 19((11–12))Google Scholar
  18. 18.
    Quandt SA, Newman JC, Pichardo-Geisinger R et al (2013) Self-reported skin symptoms and skin-related quality of life among Latino immigrant poultry processing and other manual workers. Am J Ind Med 57(5):605–614CrossRefGoogle Scholar
  19. 19.
    Arcury TA, Quandt SA, Mellen BG (2003) An exploratory analysis of occupational skin disease among Latino migrant and seasonal farmworkers in North Carolina. J Agric Saf Health 9(3):221–232CrossRefGoogle Scholar
  20. 20.
    Lampel HP, Patel N, Boyse K, O’Brien SH, Zirwas MJ (2007) Prevalence of hand dermatitis in inpatient nurses at a United States hospital. Dermatitis 18(3):140–142CrossRefGoogle Scholar
  21. 21.
    Cvetkovski R, Rothman K, Olsen J et al (2005) Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema. Br J Dermatol 152(1):93–98.  https://doi.org/10.1111/j.1365-2133.2005.06415.x CrossRefGoogle Scholar
  22. 22.
    Meding B, Lantto R, Lindahl G, Wrangsjö K, Bengtsson B (2005) Occupational skin disease in Sweden—a 12-year follow-up. Contact Dermatitis 53(6):308–313.  https://doi.org/10.1111/j.0105-1873.2005.00731.x CrossRefGoogle Scholar
  23. 23.
    Shah D (2009) Health worker effect phenomenon. Indian J Occup Environ Med 13(2):77–79CrossRefGoogle Scholar
  24. 24.
    Mathias CG (1985) The cost of occupational skin disease. Arch Dermatol 121(3):332–334.  https://doi.org/10.1001/archderm.121.3.332 CrossRefGoogle Scholar
  25. 25.
    Blanciforti LA (2011) Eonomic burden of dermatitis in US workers. J Occup Environ Med 53(1):99.  https://doi.org/10.1097/jom.0b013e318209a6b9 CrossRefGoogle Scholar
  26. 26.
    Rietschel RL, Mathias CG, Fowler JF Jr et al (2002) North American Contact Dermatitis Group. Relationship of occupation to contact dermatitis (OCD): evaluation in patients tested from 1998 to 2000. Am J Contact Dermat 13(4):170–176CrossRefGoogle Scholar
  27. 27.
    Pesonen M, Jolanki R, Filon FL et al (2015) Patch test results of European baseline series among patients with occupational contact dermatitis across Europe—analyses of European Surveillance System on Contact Allergy network, 2002-2010. Contact Dermatitis 72(3):154–163CrossRefGoogle Scholar
  28. 28.
    Bangsgaard N, Thysse JP, Menne T et al (2012) Contact allergy to epoxy resin: risk occupations and consequences. Contact Dermatitis 67(2):73–77.  https://doi.org/10.1111/j.1600-0536.2012.02072.x CrossRefGoogle Scholar
  29. 29.
    Arrandale VH, Liss GM, Tario SM et al (2012) Occupational contact allergens: are they also associated with occupational asthma? Am J Ind Med 55(4):353–360CrossRefGoogle Scholar
  30. 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
  31. 31.
    Reich HC, Warshaw EM (2010) Allergic contact dermatitis from formaldehyde textile resins. Dermatitis 21(2):65–76.  https://doi.org/10.2310/6620.2010.09077 Google Scholar
  32. 32.
    Aalto-Korte K, Kuuliala O, Suuronen K, Alanko K (2008) Occupational contact allergy to formaldehyde and formaldehyde releasers. Contact Dermatitis 59(5):280–289.  https://doi.org/10.1111/j.1600-0536.2008.01422.x CrossRefGoogle Scholar
  33. 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. 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
  35. 35.
    Dekoven JG, Warshaw EM, Belsito DV et al (2017) North American Contact Dermatitis Group Patch Test Results 2013–2014. Dermatitis 28(1):33–46.  https://doi.org/10.1097/DER.0000000000000225 CrossRefGoogle Scholar
  36. 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
  37. 37.
    Aalto-Korte K, Pesonen M, Kuuliala O, Suuronen K (2014) Occupational allergic contact dermatitis caused by coconut fatty acids diethanolamide. Contact Dermatitis 70(3):169–174CrossRefGoogle Scholar
  38. 38.
    Aalto-Korte K, Pesonon M, Kuuliala O et al (2013) Contact allergy from metalworking fluid traced to tall oil fatty acids monoethanolamide. Contact Dermatitis 69(5):316–317CrossRefGoogle Scholar
  39. 39.
    Suuronen K, Aalto-Korte K, Suomela S (2014) Contact allergy to capryldiethanolamine in metalworking fluids. Contact Dermatitis 72(2):120–121CrossRefGoogle Scholar
  40. 40.
    Hagvall L, Bråred-Christensson J, Inerot A (2014) Occupational contact dermatitis caused by sodium cocoamphopropionate in a liquid soap used in fast-food restaurants. Contact Dermatitis 71(2):122–124CrossRefGoogle Scholar
  41. 41.
    Swinnen I, Ghys K, Kerre S, Constandt L, Goossens A (2014) Occupational airborne contact dermatitis from benzodiazepines and other drugs. Contact Dermatitis 70(4):227–232CrossRefGoogle Scholar
  42. 42.
    Burches E, Revert A, Martin J et al (2015) Occupational systemic allergic dermatitis caused by sevoflurane. Contact Dermatitis 71(1):62–63CrossRefGoogle Scholar
  43. 43.
    Alwan W, Banerjee P, White IR (2014) Occupational contact dermatitis caused by omeprazole in a veterinary medicament. Contact Dermatitis 71(6):376–376CrossRefGoogle Scholar
  44. 44.
    Al-Falah K, Schachter J, Sasseville D (2014) Occupational allergic contact dermatitis caused by omeprazole in a horse breeder. Contact Dermatitis 71(6):377–378CrossRefGoogle Scholar
  45. 45.
    De Mozzi P, Johnston GA (2014) An outbreak of allergic contact dermatitis caused by citral in beauticians working in a health spa. Contact Dermatitis 70(6):377–379CrossRefGoogle Scholar
  46. 46.
    Pesonen M, Suomela S, Kuuliala O, Henriks-Eckerman ML, Aalto-Korte K (2014) Occupational contact dermatitis caused by D-limonene. Contact Dermatitis 71(5):273–279CrossRefGoogle Scholar
  47. 47.
    Montgomery RL, Agius R, Wilkinson SM, Carder M (2017) UK trends of allergic occupational skin disease attributed to fragrances 1996-2015. Contact Dermatitis 78:33–40.  https://doi.org/10.1111/cod.12902 CrossRefGoogle Scholar
  48. 48.
    Schwensen JF, Menné T, Andersen KE, Sommerlund M, Johnasen JD (2014) Occupations at risk of developing contact allergy to isothiazolinones in Danish contact dermatitis patients: results from a Danish multicenter study (2009-2012). Contact Dermatitis 71(5):295–302CrossRefGoogle Scholar
  49. 49.
    Maor D, Nixon R (2015) Allergic contact dermatitis to methylchloroisothiazolinone/methylisothiazolinone in cooling tower technicians. Dermatitis 26(1):62–64CrossRefGoogle Scholar
  50. 50.
    Friis UF, Menné T, Flyvholm MA (2014) Isothiazolinones in commercial products at Danish workplaces. Contact Dermatitis 71(2):65–74.  https://doi.org/10.1111/cod.12235 CrossRefGoogle Scholar
  51. 51.
    Madsen JT, Broesby-Olsen S, Andersen KE (2014) Undisclosed methylisothiazolinone in an ultrasound gel causing occupational allergic contact dermatitis. Contact Dermatitis 71(5):312–313CrossRefGoogle Scholar
  52. 52.
    McMullen E, Gawkrodger DJ (2006) Physical friction is under-recognized as an irritant that can cause or contribute to contact dermatitis. Br J Dermatol 154(1):154–156.  https://doi.org/10.1111/j.1365-2133.2005.06957.x CrossRefGoogle Scholar
  53. 53.
    Friis UF, Menné T, Schwensen JF, Flyvholm MA, Bonde JPE, Johansen JD (2014) Occupational irritant contact dermatitis diagnosed by analysis of contact irritants and allergens in the work environment. Contact Dermatitis 71(6):364–370CrossRefGoogle Scholar
  54. 54.
    Ramsing DW, Agner T (1996) Effect of glove occlusion on human skin (II). Contact Dermatitis 34(4):258–262CrossRefGoogle Scholar
  55. 55.
    Meding B, Jarvholm B (2002) Hand eczema in Swedish adults—changes in prevalence between 1983 and 1996. J Investig Dermatol 118(4):719–723.  https://doi.org/10.1046/j.1523-1747.2002.01718.x CrossRefGoogle Scholar
  56. 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
  57. 57.
    Friis UF, Menné T, Flyvholm MA, Bonde JPE, Johansen JD (2015) Difficulties in using the material safety data sheets to analyse occupational exposures to contact allergens. Contact Dermatitis 72(3):147–153.  https://doi.org/10.1111/cod.12314 CrossRefGoogle Scholar
  58. 58.
    deGroot AC (2008) Patch testing: test concentrations and vehicles for 4350 chemicals, 3rd edn. acdegroot publishing, WapserveenGoogle Scholar
  59. 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
  60. 60.
    Mathias CG (1989) Contact dermatitis and workers’ compensation: criteria for establishing occupational causation and aggravation. J Am Acad Dermatol 20(5):842–848CrossRefGoogle Scholar
  61. 61.
    Ingber A, Merims S (2004) The validity of the Mathias criteria for establishing occupational causation and aggravation of contact dermatitis. Contact Dermatitis 51(1):9–12CrossRefGoogle Scholar
  62. 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. 63.
    Forsberg K, Mansdorf SZ (2001) Quick selection guide to chemical protective clothing. Wiley, HobokenGoogle Scholar
  64. 64.
    Zack B, Arrandale VH, Holness DL (2017) Preventing occupational skin disease: a review of training programs. Dermatitis 28(3):169–182CrossRefGoogle Scholar
  65. 65.
    Clemmensen KK, Randdboll I, Ryborg MF, Ebbehoj NE, Agner T (2015) Evidence-based training as primary prevention of hand eczema in a population of hospital cleaning workers. Contact Dermatitis 72(1):47–54CrossRefGoogle Scholar
  66. 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
  67. 67.
    van Gils RF, Groenewoud K, Boot CR et al (2012) Process evaluation of an integrated, multidisciplinary intervention programme for hand eczema. Contact Dermatitis 66(5):254–263CrossRefGoogle Scholar
  68. 68.
    Chen J, Gomez P, Kudla I, DeKoven J, Holness DL, Skotnicki S (2016) Return to work for nurses with hand dermatitis. Dermatitis 27(5):308–312.  https://doi.org/10.1097/DER.0000000000000215 CrossRefGoogle Scholar
  69. 69.
    Mauro M, De Giusti V, Bovenzi M et al (2017) Effectiveness of a secondary prevention protocol for occupational contact dermatitis. J Eur Acad Dermatol Venereol 31(4):656–663.  https://doi.org/10.1111/jdv.13947 CrossRefGoogle Scholar
  70. 70.
    Schliemann S, Petri M, Elsner P (2014) Preventing irritant contact dermatitis with protective creams: influence of the application dose. Contact Dermatitis 70(1):19–26CrossRefGoogle Scholar
  71. 71.
    Adisesh A, Robinson E, Nicholson PJ, Sen D, Wilkinson M, Standards of Care Working Group (2013) UK standards of care for occupational contact dermatitis and occupational contact urticaria. Br J Dermatol 168(6):1167–1175CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Sona DermatologyRaleighUSA
  2. 2.University of North Carolina School of MedicineChapel HillUSA

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