Intended for healthcare professionals

Education And Debate

ABC of Work Related Disorders: Occupational Dermititis

BMJ 1996; 313 doi: (Published 24 August 1996) Cite this as: BMJ 1996;313:487
  1. Ian R White, consultant dermatologist
  1. St John's Institute of Dermatology, St Thomas's Hospital, London.

    Sheeted eczema over dorsal aspect of hand and up forearm due to allergic contact dermatitis to a carbamate accelerator in protective rubber gloves.

    Many dermatoses may have occupational relevance, but the overwhelming majority are dermatitic. In current terminology “dermatitis” is used synonymously with “eczema” to describe inflammatory reactions in the skin with a particular spectrum of clinical and histopathological characteristics.

    Dermatitis may be endogenous or exogenous, or a combination of these, and may be aggravated by pathogens.

    A dermatitis may be entirely endogenous (constitutional) or be entirely exogenous (contact). Exogenous dermatitis may be caused by irritant or allergic contact reactions. A dermatitis often has a multifactorial aetiology and may be aggravated by the presence of pathogens such as Staphylococcus aureus. When considering a hand eczema it is always worth investigating the possible role of contributory factors and assessing the importance of these. Atopic hand eczema is a common example of an endogenous eczema in which exogenous factors normally compound the situation.

    An occupational dermatitis is one where the inflammatory reaction is caused entirely by occupational contact factors or where such agents are partly responsible by contributing to the reaction on compromised skin. In most cases occupationally related dermatitis affects the hands alone, though there may be spread onto the forearms. Occasionally, the face may be the prime site of inflammation (for example, with airborne contact factors), and other sites may be affected.

    Dermatitis of occupational cause may be suspected when

    • Dermatitis first occurred while employed

    • There is a history of aggravation by work

    • There may be, at least initially, improvement (or clearance) when not at work

    • There is exposure to irritant factors or potential allergens

    • Work is in an “at risk” occupation

    Irritant contact dermatitis

    Irritant contact dermatitis is caused by direct chemical or physical damage to the skin. Everyone is susceptible to …

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