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  • Presentation

Approaching the Patient with Occupational Contact Dermatitis

Description

Dr. Michael Sheehan discusses the significance of recognizing and managing occupational contact dermatitis (OCD) in patients, emphasizing that such conditions often co-occur with atopic dermatitis or other skin disorders. He highlights the importance of thorough assessments including patch testing, proper patient history gathering, and identifying potential irritants or allergens in the workplace. Sheehan stresses that wet work, such as frequent hand washing in healthcare settings, can greatly increase the risk of skin conditions. He encourages clinicians to involve employers early for support with testing and safety measures, as well as to recommend appropriate protective gear. Through case studies, he explains patterns of dermatitis related to specific occupations and allergens, like rubber accelerators in dental work or cleaners that contain harmful chemicals. Ultimately, health professionals are urged to adopt a proactive approach in patient education regarding avoidance strategies and protective measures against occupational irritants.

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Conclusions

  • Occupational contact dermatitis (OCD) is the most common occupational skin disease, affecting 30% of reported cases and has an incidence rate of 0.5 to 1.9 cases per 1,000 workers per year.
  • OCD cases often involve a mix of irritant and allergic reactions, and can be complicated by underlying conditions like atopic dermatitis or psoriasis.
  • Water is the most common occupational irritant, especially in professions that involve wet work or frequent hand washing.
  • Proper use of personal protective equipment (PPE) is crucial in preventing OCD, yet many workers do not comply with these safety measures.
  • Expanded patch testing improves the likelihood of identifying relevant allergens compared to standard allergen panels.
  • Specific patterns of dermatitis, such as the fine motor grip pattern, can suggest occupational causes and should prompt further investigation.
  • The involvement of employers early in the treatment process can facilitate better management of occupational skin diseases.
  • SDSs (Safety Data Sheets) are essential for identifying potential allergens in the workplace, but often lack comprehensive details about specific allergens.
  • Diepgen TL & Coenraads PJ. Occupational contact dermatitis. In Rustemeyer T, Elsener P, John SM, Maibach HI (Eds.), Kanerva's occupational dermatology (2nd ed ., pp. 51-58).
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  • Marie-Claude Houle, D. Linn Holness, Joel DeKoven. Occupational Contact Dermatitis: An Individualized Approach to the Worker with Dermatitis. Current Dermatology Reports (2021) 10:182-191.
  • Denis Sasseville. Occupational Contact Dermatitis. Allergy, Asthma, and Clinical Immunology, Vol 4, No 2 (Summer), 2008: pp 59-65.
  • James G Marks Jr, Bryan E Anderson, Vincent A DeLeo. Occupational Contact Dermatitis in Dental Personnel: A Retrospective Analysis of the North American Contact Dermatitis Group Data, 2001 to 2018. Occupational Dental Dermatology. 33(1):80-90, January/February 2022.
  • Teichmann et al. An in vivo model to evaluate the efficacy of barrier creams on the level of skin penetration of chemicals. Contact Dermatitis 2006;54: 5-13.
  • Yul W. Yang, MD, PhD; James A. Yiannias, MD; Molly M. Voss, BS; Matthew R. Hall, MD; Molly J. Youssef, MD; Mark D. P. Davis, MD; Dayne H. Voelker, MD; Molly C. Klanderman, PhD, MS; Aaron R. Mangold, MD. Systematic Identification of Copositivity Groups in Standard Series Patch Testing Through Hierarchical Clustering. JAMA Dermatology September 2023 Volume 159, Number 9.