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Purpose of Review
The purpose of this review is to provide an update on occupational contact dermatitis including gaps in knowledge and practice. Occupational contact dermatitis is the most common occupational skin disease.
New sources of exposure for known allergens and new allergens are continually being reported. Through clinical databases and surveillance systems, effects of prevention efforts or introduction of new allergens or new uses of known allergens can be monitored. Though the diagnostic process is clear, there are delays in workers seeking care. As early detection and intervention improves outcomes, screening should be implemented. Gaps in primary prevention in the workplace are identified and should be addressed to reduce the burden of disease.
Surveillance systems support the prevention mandate. Understanding limitations of our knowledge and identifying gaps in practice can lead to initiatives to address research and practice needs and improve prevention of occupational dermatoses.
KeywordsOccupational contact dermatitis Irritant contact dermatitis Allergic contact dermatitis Patch testing Outcomes Prevention
Compliance with Ethics Guidelines
Conflict of Interest
The author declares no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
Research involving human subjects, human material, or human data, has been performed in accordance with the Declaration of Helsinki and has been approved by an appropriate ethics committee.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Royal College of Physicians. Concise guidance to good practice: Number 13: Diagnosis, management and prevention of occupational contact dermatitis. Royal College of Physicians., ISBN. 2011:978–1–86016-3609.Google Scholar
- 7.Schwensen JF, Friis UF, Menne T, Flyvholm MA, Johansen JD. Contact allergy to preservatives in patients with occupational contact dermatitis and exposure analysis of preservatives in registered chemical products for occupational use. Contact Dermatitis. 2017;90:319–33. https://doi.org/10.1007/s00420-017-1203-5.CrossRefGoogle Scholar
- 10.DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group patch test results: 2013–2014. Dermatitis. 2017;28:33–46. https://doi.org/10.1097/DER.000000000000225.
- 11.• DeKoven JG, Warshaw EM, Zug KA, et al. North American Contact Dermatitis Group patch test results: 2015–2016. Dermatitis. 2018;29:297–309. https://doi.org/10.1097/DER.000000000000417 Current NACDG patch test results.
- 12.• Uter W, Amario-Hita JC, Balato A, et al. European Surveillance System on Contact Allergies (ESSCA): results with the European baseline series, 2013/14. J Eur Acad Deramtol Venereol. 2017;9:1516–25. https://doi.org/10.1111/jdv.14423.12 Current ESSCA patch test results.
- 14.Pesonen M, Jolanki R, Larese Filon F, et al. Patch test results of the European baseline series among patients with occupational contact dermatitis across Europe - analysis of the European Surveillance System on Contact Allergy network, 2002–2010. Contact Dermatitis. 2015;72:154–63. https://doi.org/10.1111/cod.12333.CrossRefGoogle Scholar
- 17.Heratizadeh A, Werfel T, Schubert S, Geier J, for the IVDK. Contact sensitization in dental technicians with occupational contact dermatitis. Data of the Information Network of Departments of Dermatology (IVDK) 2001–2015. Contact Dermatitis. 2018;78:266–73. https://doi.org/10.1111/cod.12943.CrossRefGoogle Scholar
- 18.Warshaw EM, Wang MZ, Mathias CG, et al. Occupational contact dermatitis in hairdressers/cosmetologists: retrospective analysis of cross-sectional data of the north american contact dermatitis group data, 1994–2010. Dermatitis. 2012;23:258–68. https://doi.org/10.1097/DER.0b013e318273a3b8. CrossRefGoogle Scholar
- 20.Warshaw EM, Hagen SL, Sasseville D, et al. Occupational contact dermatitis in mechanics and repairers referred for patch testing: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group 1998. 2014 Dermatitis. 2017;28:47–57 doi: 10/1097/DER.Google Scholar
- 21.Warshaw EM, Hagen SL, Belsito DV, et al. Occupational contact dermatitis in North American print machine operators referred for patch testing: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group 1998 to 2014. Dermatitis. 2017;28:195–203. https://doi.org/10.1097/DER.000000000000269.
- 22.Warshaw EM, Hagen SL, DeKoven JG, et al. Occupational contact dermatitis in North American production workers referred for patch testing: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group 1998 to 2014. Dermatitis. 2017;28:183–94. https://doi.org/10.1097/DER.000000000000277.
- 23.Geier J, Lessmann H, Skudlik C, et al. Occupational contact allergy in bricklayers, tile setter etc. – current spectrum of sensitization and recent time trends. Allergol Select. 2017;1:127–40. https://doi.org/10.5414/ALXO1593E.
- 28.Zirwas MJ, Hamann D, Warshaw EM, et al. Epidemic of isothizaolinone allergy in North America: prevalence data form the North American Contact Dermatitis Group, 2013–2014. Dermatitis. 2017;28:204–9. https://doi.org/10.1097/DER.000000000000288.
- 31.Stocks SJ, McNamee R, Turner S, Carder M, Agius RM. Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK? Occup Environ Med. 2012;69:150–2. https://doi.org/10.1136/oem-2011-100220.
- 33.Stocks DJ, McNamee R, Turner S, Carder M, Agius RM. The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996–2012 and interrupted times series analysis. Br J Dermatol. 2015;173:165–71. https://doi.org/10.1111/bjd.13719.CrossRefGoogle Scholar
- 37.• Nichol K, Copes R, Kersey K, Eriksson J, Holness DL. Screening for hand dermatitis in healthcare workers: comparing workplace screening with dermatologists photo screen. Contact Dermatitis. 2019;80:374–81. https://doi.org/10.1111/cod.13231 Current prevalence of hand dermatitis in healthcare workers.CrossRefGoogle Scholar
- 39.Adisesh A, Robinson E, Nicholson PJ, Sen D, Wilkinson M, on behalf of the Standards of Care Working Group. UK standards of care for occupational contact dermatitis and occupational contact urticaria. Br J Dermatol. 2013;168:1167–75. https://doi.org/10.1111/bjjd.12256.
- 40.Johnston GA, Exton LS, Mohd Mustapa MF, et al. British Association of Dermatologists’ guidelines for the management of contact dermatitis. Br J Dermatol. 2017;176:317–29. https://doi.org/10.1111/bjd.1239.
- 42.Brasch J, Becker D, Aberer W, et al. Guideline contact dermatitis SI-guidelines of the German Contact Allergy Group (DKG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. Allergo J Int. 2014;23:126–38.CrossRefGoogle Scholar
- 43.Fonacier L, Berstein DI, Pacheco K, et al. Contact dermatitis: a practice parameter update – 2015. J Allergy Clin Immunol Pract. 2015;3(Supp):S1–S39. https://doi.org/10.1016/jaip.2015.02.009.
- 44.Alfonso JH, Bauer A, Bensefa-Colas L, et al. Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe – position paper of COST Action StanDerm (TD1206). J Eur Acad Dermatol Venereol. 2017;Supp;4:31–43. https://doi.org/10.1111/jdv.14319.CrossRefGoogle Scholar
- 45.Budd D, Kudla I, Holness DL. Workplace survey: guiding principles from occupational dermatology. In: John SM, et al., editors. Kanerva’s Occupational Dermatology. Switzerland AG: Springer Nature; 2019. https://doi.org/10.1007/978-3-319-40221-5221-1.
- 46.Holness DL. Health care services use by workers with work-related contact dermatitis. Dermatitis. 2004;15:18–24.Google Scholar
- 50.Warshaw EM, Nelson D. Prevalence of patch testing and methodology of dermatologists in the US: results of a cross-sectional survey. Am J Contact Dermat. 2002;13:53–8 Or Warshaw EM, Moore JB, Nelson D. Patch testing practices of American Contact Dermatitis Society members: a cross-sectional survey. Am J Contact Dermat. 2003;14:5–11.Google Scholar
- 51.Farrell AL, Warshaw EM, Zhao Y, Nelson D. Prevalence and methodology of patch testing by allergists in the United States: results of a cross-sectional survey. Am J Contact Dermat. 2002;13:157–63.Google Scholar
- 52.Zhu TH, Suresh R, Farahnik B, et al. Survey of patch test business models in the United States by the American Contact Dermatitis Society. Dermatitis. 2018;29:85–8. https://doi.org/10.1097/DER.000000000000355.
- 54.• Arrandale VH, Holness DL. Using health insurance administrative data to explore patch testing utilization in Ontario, Canada – an untapped resource. Contact Dermatitis. 2019;80:386–90. https://doi.org/10.1111/cod.13229 Use of large administrative database to study patch test utilization and practice.CrossRefGoogle Scholar
- 55.Mathias CG. Contact dermatitis and workers’ compensation: criteria for establishing occupational causation and aggravation. J Am Acad Dermat. 1989;20:842–8.Google Scholar
- 58.Chen J, Gomez P, Kudla I, DeKoven J, Holness DL, Skotnicki S. Return to work for nurses with hand dermatitis. Dermatitis. 2016;27:308–12. https://doi.org/10.1097/DER.000000000000215.
- 60.Hald M, Agner T, Blands J. Johnansen JD on behalf of the Danish Contact Dermatitis Group. Delay in medical attention to hand eczema: a follow-up study. Brit J Dermatol. 2009;161:1294–300. https://doi.org/10.1111/j.1365-2133.2009.09402.x.
- 62.Malkonen T, Alanko K, Jolanki R, et al. Long-term follow-up study of occupational hand eczema. Br J Dermatol. 2010;163:999–1006. https://doi.org/10.1111/1365-2133-2010.09987.x.
- 64.Nurmohamed S, Bodley T, Thompson A, Holness DL. Health care utilization characteristics in patch test patients. Dermatitis. 2014;25:268–72. https://doi.org/10.1097/DER.000000000000059.
- 65.Bathe A, Diepgen TL, Matterne U. Subjective illness perceptions in individuals with occupational skin disease: a qualitative investigation. Work. 2012;43:159–69.Google Scholar
- 68.Olesen CM, Agner T, Ebbehoj NE, Caroe TK. Factors influencing the prognosis for occupational hand eczema – new trends. Br J Dermatol. 2019. https://doi.org/10.1111/bjd.17870.
- 71.Diepgen TL, Scheidt R, Weisshaar E, John SM, Hieke K. Cost of illness from occupational hand eczema in Germany. Contact Dermatitis. 2013;69:99–106. https://doi.org/10.1111/cof.12038.
- 74.Mascaro JM, Querol I, Lindner L, Prior M, Oliver J, Halbach RP. Costs of patinets with occupational severe chronic hand eczema refractory to topical corticosteroids for employer’s mutual insurance companies in Spain. Value Health. 2009;12:A453–4.Google Scholar
- 75.Sithamparaanadarajah R. Controlling skin exposure to chemicals and wet work: a practical book. Stourbridge: RMS Publishing Limited; 2008.Google Scholar
- 76.•• Bauer A, Ronsch H, Elsner P, et al. Interventions for preventing occupational irritants hand dermatitis. Cochrance Database Syst Rev. 2018;4:CD004414. https://doi.org/10.1002/14651858 CD004414. Recent update of Cochrane systematic review for prevention of occupational irritants contact dermatitis.
- 77.Gupta T, Arrandale VH, Kudla I, Holness DL. Gaps in workplace education practices for prevention of occupational skin disease. Ann Work Expo Health. 2018;62:243–7. https://doi.org/10.1093/annweh/wx093.