Occupational contact dermatitis

Abstract

Occupational contact dermatitis (OCD) is a skin disorder characterized by a red, sore, or inflamed skin after a direct contact with a substance. It is either of allergic (ACD) or irritative (ICD) nature, and they account for over 90% of all work-related skin disorders. The most frequent causes of occupational ACD are metals (nickel, chrome, cobalt), resins (epoxy resin, acrylic resin), rubber-based materials, agrichemicals, and plants; it is mostly characterized by scaly red (erythema) to pink areas of elevated skin that can be papules and/or plaques, vesicles (or blisters), and pruritus (itch). ICD, the most common occupational skin disorder (OSD), is five times more frequent than ACD and is characterized by scaling, erythema, and a mild edema at the site of contact with the irritant substance. The differential diagnosis between ACD and ICD is made mainly based on the clinical features and, eventually, patch testing (when positive, ACD will be the diagnosis). If pruritus appears as the dominant symptom in ACD, however, ICD patients often have burning feeling and pain. Another clinical feature that may facilitate the diagnosis consists of the status of the border of the skin lesions (erythema). In case of ICD, borders are less distinct, whereas distinct lines, angles, and borders are characteristics of ACD. In occupational settings with risk of OCD, a number of preventives measures can be implemented to reduce the risk; they include pre-employment screening which can help to identify predisposed subjects, the use of personal protective devices and creams (appropriate gloves, mask, barrier cream, after-work cream, etc.), and technical measures and work organization in order to reduce exposure to the sensitizer or irritant substance. Regarding OCD treatment, therapy based on corticosteroids is the first choice. Ultraviolet B (UVB) therapy based on UVB (medium wave length) and psoralen plus UVA (PUVA) is reported to be beneficial particularly for hand dermatitis, whereas a systemic treatment can be recommended for very severe and recalcitrant OCD.