Occupational Dermatosis

  • Dorothy Linn HolnessEmail author
Allergic Skin Diseases (L Fonacier and A Wollenberg Section Editors)
Part of the following topical collections:
  1. Topical Collection on Allergic Skin Diseases


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.

Recent Findings

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.


Occupational 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

  1. 1.
    • Rashid RS, Shim TN. Contact dermatitis. BMJ. 2016;353:i3299. Useful clinical review.CrossRefPubMedGoogle Scholar
  2. 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
  3. 3.
    Fillenhan G, Liden C, Anveden Berglind I. Skin exposure to epoxy in the pipe relining trade – an observtional study. Contact Dermatitis. 2012;67:66–72. Scholar
  4. 4.
    Anveden Berglind I, Lind ML, Liden C. Expoxy pipe relining – an emerging contact allergy risk for workers. Contact Dermatitis. 2012;67:59–65. Scholar
  5. 5.
    Creytens K, Gilissen L, Huygens S, Goossens A. A new application for epoxy resins resulting in occupational allergic contact dermatitis: the three-dimensional printing industry. Contact Dermatitis. 2017;77:249–351. Scholar
  6. 6.
    Thyssen JP, Sederberg-Olsen N, Thomsen JF, Menne T. Contact dermatitis from methylisothiazolinone in a paint factory. Contact Dermatitits. 2006;54:322–4.CrossRefGoogle Scholar
  7. 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. Scholar
  8. 8.
    Hagvall L, Brared-Christensson J, Inerot A. Occupational contact dermatitis caused by sodium cocoamphopropionate in a liquid soap used is fast-food restaurants. Contact Dermatitis. 2014;71:122–4. CrossRefPubMedGoogle Scholar
  9. 9.
    Pesonen M, Suomela S, Kuuliala O, Aalto-Korte K. Occupational contact allergy to sodium cocoamphopropionate in a hand cleanser. Contact Dermatitis. 2016;74:246–8. CrossRefGoogle Scholar
  10. 10.
    DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group patch test results: 2013–2014. Dermatitis. 2017;28:33–46.
  11. 11.
    • DeKoven JG, Warshaw EM, Zug KA, et al. North American Contact Dermatitis Group patch test results: 2015–2016. Dermatitis. 2018;29:297–309. Current NACDG patch test results.
  12. 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. Current ESSCA patch test results.
  13. 13.
    Schnuch A, Geier J, Lessmann H, Arnold R, Uter W. Surveillance of contact allergies: methods and results of the Information Network of Departments of Dermatology (IVDK). Allergy. 2012;67:847–57. Scholar
  14. 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. Scholar
  15. 15.
    Warshaw EM, Schram SE, Maibach HI, et al. Occupation-related contact dermatitis in North American health care workers referred for patch testing: cross-sectional data, 1998 to 2004. Dermatitis. 2008;19:261–74.CrossRefGoogle Scholar
  16. 16.
    Molin S, Bauer A, Schnuch A, Geier A. Occupational contact allergy in nurses: results from the Information Network of Departments of Dermatology 2003–2012. Contact Dermatitis. 2015;72:164–71. Scholar
  17. 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. Scholar
  18. 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. CrossRefGoogle Scholar
  19. 19.
    Warshaw EM, Kwon GP, Mathias CG, et al. Occupationally related contact dermatitis in North American food services workers referred for patch testing, 1994–2010. Dermatitis. 2013;24:22–8. CrossRefGoogle Scholar
  20. 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. 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.
  22. 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.
  23. 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.
  24. 24.
    Mahler V, Geier J, Schnuch A. Current trends in patch testing – new data from the German Contact Dermatitis Research Group (DKG) and the Information Networks of Departments of Dermatology (IVDK). J Dtsch Dermatol Ges. 2014;12:583–92. Scholar
  25. 25.
    Alinaghi F, Zachariae C, Thyssen JP, Johnansen JD. Temporal changes in chromium allergy in Denmark between 2002 and 2017. Contact Dermatitis. 2019;80:156–61. Scholar
  26. 26.
    Aerts O, Goossens A, Giordano-Labradie F. Contact allergy caused by methylisothiazolinone: the Belgiun-French experience. Eur J Dermatol. 2015;25:228–33. Scholar
  27. 27.
    Schwensen JF, Uter W, Bruze M, et al. The epidemic of methylisothiazolinone: a European prospective study. Contact Dermatitis. 2017;76:272–9. CrossRefGoogle Scholar
  28. 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.
  29. 29.
    Meyer JD, Chen Y, Holt DL, Beck MH, Cherry NM. Occupational contact dermatitis in the UK: a surveillance report from EPIDERM and OPRA. Occup Med. 2000;50:265–73.CrossRefGoogle Scholar
  30. 30.
    McDonald JC, Beck MH, Chen Y, Cherry NM. Incidence by occupation and industry of work-related skin diseases in the United Kingdom, 1996–-2001. Occup Med. 2006;56:398–405.CrossRefGoogle Scholar
  31. 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.
  32. 32.
    Urwin R, Warburton K, Carder M, Turner S, Agius R, Wilkinson SM. Methylchloroisothiazolinone and methylisothiazolinone contact allergy: an occupational perspective. Contact Dermatitis. 2015;72:381–6. Scholar
  33. 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. Scholar
  34. 34.
    Ofenloch R, Apfelbacher C, Weisshaar E. Hand eczema registries: background, value and future prospects: registry data in hand eczema research. Hautarzt. 2018;69:809–14. Scholar
  35. 35.
    Luk NMT, Lee HC, Luk CK, et al. Hand eczema among Hong Kong nurses: a self-report questionnaire survey conducted in a regional hospital. Contact Dermatitis. 2011;65:329–35. Scholar
  36. 36.
    Visser MJ, Verbeck MM, van Dijk FJH, Bakker JG, Bos JD, Kezic S. Wet work and hand eczema in apprentice nurses: part 1 of a prospective cohort study. Contact Dermatitis. 2014;70:44–55. Scholar
  37. 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. Current prevalence of hand dermatitis in healthcare workers.CrossRefGoogle Scholar
  38. 38.
    Nicholson PJ, Llewellyn D, English JS. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticarial. Contact Dermatitis. 2010;63:177–86. Scholar
  39. 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.
  40. 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.
  41. 41.
    Diepgen TL, Andersen KE, Chosidow O, et al. Guidelines for diagnosis, prevention and treatment of hand eczema – short version. J Dtsch Dermatol Ges. 2015;13:77–85. Scholar
  42. 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. 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.
  44. 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. Scholar
  45. 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.
  46. 46.
    Holness DL. Health care services use by workers with work-related contact dermatitis. Dermatitis. 2004;15:18–24.Google Scholar
  47. 47.
    Holness DL, Tabassum S, Tarlo SM, Liss GM, Silverman F, Manno M. Dermatologist and family practitioner practice patterns for occupational contact dermatitis. Australas J Dermatol. 2007;48:22–7.CrossRefGoogle Scholar
  48. 48.
    Johansen JD, Aalto-Lorte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice. Contact Dermatitis. 2015;73:195–221. CrossRefGoogle Scholar
  49. 49.
    Lachapelle JJ-M, Maibach HI. Patch testing and prick testing. 3rd ed. Heidelberg: Springer; 2012.CrossRefGoogle Scholar
  50. 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. 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. 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.
  53. 53.
    Meyer MD, McDonald H, Watsky K. Utilization and geographic variation of patch testing among Medicare beneficiaries. Dermatitis. 2016;27:234–6.CrossRefGoogle Scholar
  54. 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. Use of large administrative database to study patch test utilization and practice.CrossRefGoogle Scholar
  55. 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
  56. 56.
    Ingber A, Merims S. The validity of the Mathias criteria for establishing occupational causation and aggravation of contact dermatitis. Contact Dermatitis. 2004;51:9–12.CrossRefGoogle Scholar
  57. 57.
    • Kudla I, Houle M-C, Velykoredko Y, et al. Introducing a “workplace prescription” to facilitate return to work for workers with occupational contact dermatitis. J Cut Med Surg. 2017;21:573–5. Practical tool to assist with RTW.CrossRefGoogle Scholar
  58. 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.
  59. 59.
    Keegel T, Cahill J, Noonan A, et al. Incidence and prevalence rates for occupational contact dermatitis in an Australian suburban area. Contact Dermatitis. 2005;52:254–9.CrossRefGoogle Scholar
  60. 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.
  61. 61.
    Rusca C, Hinnen U, Elsner P. ‘Patient’s delay’ – analysis of the preclinical phase of occupational dermatoses. Dermatology. 1997;194:50–2.CrossRefGoogle Scholar
  62. 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.
  63. 63.
    Lerbaek A, Kyvik KO, Ravn H, Menne T, Agner T. Clinical characteristics and consequences of hand eczema – an 8-year follow-up study of a population-based twin cohort. Contact Dermatitis. 2008;58:210–6. Scholar
  64. 64.
    Nurmohamed S, Bodley T, Thompson A, Holness DL. Health care utilization characteristics in patch test patients. Dermatitis. 2014;25:268–72.
  65. 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
  66. 66.
    Emmett EA. Dermatological screening. J Occup Med. 1986;28:1045–50.CrossRefGoogle Scholar
  67. 67.
    Susitaival P, Flyvolm MA, Meding B, Kanerva L, et al. Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure. Contact Dermatitis. 2003;49:70–6.CrossRefGoogle Scholar
  68. 68.
    Olesen CM, Agner T, Ebbehoj NE, Caroe TK. Factors influencing the prognosis for occupational hand eczema – new trends. Br J Dermatol. 2019.
  69. 69.
    Holness DL Harniman E, DeKoven J, Skotnicki Grant S, Beaton D, Nixon R, Switzer-McIntyre S. Hand and upper extremity function in workers with hand dermatitis. Dermatitis. 2013;24:131–6. Scholar
  70. 70.
    Holness DL, Nethercott JR. Work outcome in workers with occupational skin disease. Am J Ind Med. 1995;27:807–15.CrossRefGoogle Scholar
  71. 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.
  72. 72.
    • Caroe TK, Ebbehoj NE, Bonde JP, Agner T. Occupational hand eczema and/or contact urticaria: factors associated with change of profession or not remaining in the workforce. Contact Dermatitis. 2018;78:55–63. Recent article on outcomes.CrossRefGoogle Scholar
  73. 73.
    Boehm D, Schmid-Ott G, Finkekdey F, et al. Anxiety, depression and impaired health-related quality of life in patients with occupational hand eczema. Contact Dermatitis. 2012;67:184–92. Scholar
  74. 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. 75.
    Sithamparaanadarajah R. Controlling skin exposure to chemicals and wet work: a practical book. Stourbridge: RMS Publishing Limited; 2008.Google Scholar
  76. 76.
    •• Bauer A, Ronsch H, Elsner P, et al. Interventions for preventing occupational irritants hand dermatitis. Cochrance Database Syst Rev. 2018;4:CD004414. CD004414. Recent update of Cochrane systematic review for prevention of occupational irritants contact dermatitis.
  77. 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.
  78. 78.
    Zack B, Arrandale VH, Holness DL. Skin specific training experience of workers being assessed for contact dermatitis. Occup Med. 2018;68:203–6. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Dalla Lana School of Public Health and Department of MedicineUniversity of TorontoTorontoCanada
  2. 2.Division of Occupational Medicine, Department of MedicineSt Michael’s HospitalTorontoCanada
  3. 3.MAP Centre for Urban Health Solutions, St Michael’s HospitalLi Ka Shing Knowledge InstituteTorontoCanada

Personalised recommendations