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Occupational dermatoses

Beltrani, Vincent S.

Current Opinion in Allergy and Clinical Immunology: April 2003 - Volume 3 - Issue 2 - p 115-123
Occupational disease
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Purpose of review All terms referring to job-related (occupational) rashes are clearly defined. Ranking as the second most common occupational disorder, the importance of occupational dermatoses is illustrated.

Recent findings 90-95% of occupational dermatoses result from a contact-type dermatitis. Until recently, 4/5 cases were believed to be of the irritant, rather than allergic type of contact dermatitis, however, with more extensive patch testing, more than half the cases were found to be allergic.

Summary The direct causes of occupational dermatoses: chemical, mechanical, physical, and biological in nature are presented. The implications of assigning the degree and type of occupational dermatoses are explained. Workmans compensation is based on a no-fault arrangement, stating that unrestricted treatment and compensation is allowable only when negligence on the part of the employer is proven. Employee benefits are then determined by the duration and degree of disability sustained - all of which becomes litigational. Predisposing host factors, i.e. intellectual ability, anatomic site, atopy, skin pigmentation, age of skin, and immunosuppression (by disease or medication) are usually ignored. Environmental factors at the workplace must be considered conducive to occupational diseases. The full spectrum of irritant contact dermatitis is discussed with examples of each described. Allergic contact dermatitis and patch testing - the gold standard for identification of putative allergens is extensively discussed. Differentiating irritant contact dermatitis from allergic contact dermatitis is elucidated. The other non-contact type skin reactions are briefly mentioned.

Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York, USA

Correspondence to Vincent S. Beltrani, MD, FAAAI, Associate Clinical Professor, Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, NY, USA E-mail: alderm31@earthlink.net

© 2003 Lippincott Williams & Wilkins, Inc.