Contact dermatitis handbook

Some of the information in these beginning chapters is a bit redundant, probably a reflection of the multiauthored nature of this book, and could have been edited more stringently. Arch Dermatol. Coronavirus Resource Center.

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Twitter Facebook. This Issue. November First Page Preview View Large. Access through your institution. Add or change institution. Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. Usually, only one or very few workers will be affected. When thorough patch testing does not identify a contact allergen, the diagnosis might then be ICD.

Strong irritants such as alkalis, acids, and solvents may rapidly induce ICD. Table 3 lists the common irritants from the workplace [ 6 — 8 ]. It is important to note that many substances have irritant properties as well as allergic potential. However, PPE can also be the source of the problem, through the development of a contact allergy to one or more of its components or ICD through friction, pressure, or sweat.

Prolonged glove wearing creates occlusion, preventing normal evaporation from the skin surface and resulting in an accumulation of moisture. Secondary elevated temperature and sweating can lead to increased skin pH and the induction of ICD [ 21 ]. Once the integrity of the skin barrier is breached, there is an increased risk of subsequent contact allergy to PPE, work substances, or topical treatment.

Management of primary contact dermatitis may sometimes result in secondary contact dermatitis. Workers will try different topical remedies before seeking help, including topical antibiotics, moisturizers, and natural products. Topical corticosteroids or antifungals may also be prescribed. All of these have the potential to cause ACD to one or more of their constituents. This should be considered, particularly if the skin condition was noted to worsen with the use of some of these products [ 23 ].

Skin care may also be the cause of ICD. The gold standard in the workup of a worker with possible ACD is patch testing. A standard screening series of allergens is useful to detect most common allergens. Testing with supplemental allergens is recommended in cases of OCD, given the specific contacts that may be encountered in the workplace.

Supplemental series of allergens are available for common occupations, such as hairdressers and dental workers. Commercially produced standardized patch test extracts are not available for a number of potentially allergenic workplace materials.

Therefore, many patients with suspected OCD should be considered for custom testing. This involves patch testing patients with products from work including chemicals, hand cleansers, and personal protective equipment, as well as their personal care products [ 26 ]. Substances not available for testing in standardized series will be identified by reviewing the SDS [ 14 ].

Products may be requested from the workplace and sent to the clinic directly. Suitable ranges of concentrations and vehicles can be obtained by consulting a comprehensive reference manual DeGroot patch testing [ 30 ]. Unidentified substances as well as known irritants should not be tested due to the risk of inducing local or potentially even systemic adverse reactions [ 30 ].

Workplace substances should be diluted appropriately by an interested and experienced chemist or by a compounding pharmacist. Guides for preparation of custom allergens are available, detailing the necessary equipment, dilution methods, and role for extraction [ 31 ]. With proper dilutions, most workplace materials may be tested with classic patch testing occlusive testing. In research settings and for publication purposes, testing controls are necessary to confirm the validity of the reaction and to eliminate the possibility of an irritant reaction.

Although confirmation of test results using these methods are ideal, it is often not feasible in the usual clinical setting. Reflective of real-life exposure to an allergen through the uses of only one product, twice a day for 7 days, on the previously affected skin.

The patient is asked to stop the application of the product when a reaction is noted. Diagnosing OCD may prove to be difficult as there are no characteristic clinical or histological features. Positive answers to 4 or more of the 7 criteria are considered sufficient to establish occupational causation. Clear yes or no answers are not always possible in complicated cases. They thus may be helpful in medicolegal cases [ 39 ].

Mathias criteria for establishing occupational causation and aggravation of contact dermatitis [ 38 ]. Effective communication between the physician, worker, workplace, and insurer is a key principle that supports successful return to work RTW. Clear recommendations for the workplace are indispensable. It provides specific advice to the worker and the employer on recommended preventive strategies including work restrictions to facilitate modified work, choice of PPE, appropriate hand hygiene, and treatment.

A graduated trial of RTW with ongoing skin monitoring to detect early recurrence has been used successfully [ 41 ]. The COVID pandemic has been a pervasive force in the year , and the effects of this pandemic have been a major theme in occupational health.

With respect to hand dermatitis, alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential compared to soaps and synthetic detergents [ 46 ]. In a study in health care professionals, the provision of recommendations which included specific product names was found to be superior to general recommendations alone [ 47 ].

Appropriate management of OCD can then be instituted, with better outcomes for the worker as well as for all parties involved. This article does not contain any studies with human or animal subjects performed by any of the authors. This article is part of the Topical Collection on Contact Dermatitis. Publisher's Note. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

National Center for Biotechnology Information , U. Curr Dermatol Rep. Marie-Claude Houle , D. Linn Holness , and Joel DeKoven. Linn Holness. Author information Article notes Copyright and License information Disclaimer. Toronto, Canada.

Joel DeKoven, Email: ac. Corresponding author. Accepted Jul 9. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source.

Abstract Purpose of Review To provide an up-to-date, customizable approach to the worker presenting with dermatitis. Recent Findings Occupational contact dermatitis OCD is often a result of combined allergic, irritant, and endogenous factors.

Summary OCD is a multifaceted condition with significant consequences for affected workers and their families, employers, and insurers. Keywords: Irritant contact dermatitis, Occupational contact dermatitis, Patch testing. Introduction Occupational contact dermatitis OCD encompasses a vast array of clinical presentations and underlying causes.

Occupational Contact Dermatitis Contact dermatitis can be defined as an inflammatory skin condition, usually eczematous in nature, induced by exposure to an external irritant or allergen. Allergen Potential sources Occupations Rubber accelerators carba mix, thiuram mix, diphenylguanidine Gloves; safety equipment; miscellaneous e.

Open in a separate window. Table 3 Most common occupational irritants. Irritant Sources Water Wet work; frequent hand washing; hand disinfection Work clothing Rubber gloves; rough-textured and woolen clothing; occlusive footwear Friction metal tools, wood, coal, rock Dust Fiberglass; stone dust, chemical dusts, cement dust, sawdust Antimicrobial chemicals Detergents, soaps, cleansers, disinfectants, antiseptics Oil products Hydrocarbons-petroleum and oils Metalworking fluids Cutting oils; cooling fluids Organic matter Food; plants Solvents Gasoline, paint thinners Acids and alkalis Hydrocarbons-petroleum and oils Environment Cool air; low humidity; high humidity.

Early Detection and Prevention Studies have demonstrated a significant time between onset of symptoms and seeking health care, an average of 8. Approach to the Worker with Suspected Occupational Contact Dermatitis OCD is a multifactorial disease and is often a result of combined allergic, irritant, and endogenous factors.

Occupational History A detailed exposure history is essential in the initial and continuing evaluation of the patient with suspected OCD [ 6 ]. Table 1 Occupational history elements.

Clinical Presentations OCD most commonly affects the hands, followed by the wrists, forearms, and face [ 15 ]. Causes of Occupational Contact Dermatitis When OCD is suspected, it is useful to categorize potential causes into 3 main groupings: workplace materials, personal protective equipment PPE , and skin care. Workplace Materials Workplace materials include substances the worker contacts as part of the work practice and as part of work-related hand hygiene. Irritants in the Workplace When thorough patch testing does not identify a contact allergen, the diagnosis might then be ICD.

Table 4 Potential allergens and mechanisms of irritation from personal protective equipment. Skin Care Management of primary contact dermatitis may sometimes result in secondary contact dermatitis. Testing with Workplace Materials Substances not available for testing in standardized series will be identified by reviewing the SDS [ 14 ].

Table 5 Methods for testing custom materials from work. Area is covered by a nonocclusive tape e. Establishing a Diagnosis of Occupational Dermatitis Diagnosing OCD may prove to be difficult as there are no characteristic clinical or histological features. Table 6 Mathias criteria for establishing occupational causation and aggravation of contact dermatitis [ 38 ]. Is the clinical appearance consistent with contact dermatitis? Are there workplace exposures to potential cutaneous irritants or allergens?

Is the anatomic distribution of dermatitis consistent with the form of cutaneous exposure in relation to the job task? Is the temporal relationship between exposure and onset consistent with contact dermatitis?

Are non-occupational exposures excluded as likely causes? Does avoiding exposure lead to improvement of the dermatitis? Do patch tests or provocation tests implicate a specific workplace exposure? Return to Work Management of OCD may require changes in workplace practices to reduce worker exposure to the causative agents and improve skin care practices.

Conclusion OCD is a multifaceted condition with significant consequences for affected workers and their families, employers, and insurers. Compliance with Ethical Standards Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Footnotes This article is part of the Topical Collection on Contact Dermatitis Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Papers of particular interest, published recently, have been highlighted as:. Irritant contact dermatitis. Rev Environ Health. Skotnicki S. Allergic contact dermatitis versus irritant contact dermatitis. May , Revised November Occupational contact dermatitis.

Springer-Verlag Berlin Heidelberg Holness DL. Occupational dermatosis. Curr Allergy Asthma Rep. Occupational contact dermatitis: retrospective analysis of North American Contact Dermatitis Group Data, to J Am Acad Dermatol. Online ahead of print. Occupational and hand dermatitis: a practical approach. Clin Rev Allergy Immunol. Occupational irritant contact dermatitis diagnosed by analysis of contact irritants and allergens in the work environment. Contact Dermatitis. Incidence and prevalence rates for occupational contact dermatitis in an Australian suburban area.

Health care utilization characteristics in patch test patients. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Nicholson PJ. Occupational contact dermatitis: known knowns and known unknowns. Clin Dermatol. Regional Atlas of Contact Dermatitis. Edited by Robin Lewallen and Steven R. The Dermatologist. The beak sign: a clinical clue to airborne contact dermatitis Dermatitis Mar-Apr.

J Clin Aesthet Dermatol. Zirwas MJ. Contact dermatitis to cosmetics. Impact of glove occlusion on cumulative skin irritation with or without hand cleanser-comparison in an experimental repeated irritation model. Occupational dermatitis to facial personal protective equipment in health care workers: a systematic review. Contact dermatitis to medications and skin products.

North American Contact Dermatitis Group patch test results: — Relevance of contact sensitizations in occupational dermatitis patients with special focus on patch testing of workplace materials.