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Occupational dermatitis in a hairdresser

BMJ 2007; 335 doi: (Published 23 August 2007) Cite this as: BMJ 2007;335:399
  1. Allison Worth, research fellow1,
  2. S Hasan Arshad, reader in allergy2,
  3. Aziz Sheikh, professor of primary care research and development1
  1. 1Allergy and Respiratory Research Group, Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh EH8 9DX
  2. 2Infection, Inflammation and Repair Research Division, School of Medicine, University of Southampton, Southampton
  1. Correspondence to: A SheikhAziz.Sheikh{at}

    A 25 year old hairdresser complains of a rash on her hands. She thinks she might be allergic to the solutions she uses at work.

    What issues you should cover

    Defining the problem—Up to 50% of hairdressers develop dermatitis of the hand within three years of starting work, usually either irritant contact dermatitis resulting from chemical damage or allergic contact dermatitis from a delayed (type IV) hypersensitivity reaction. Distinguishing between these is difficult on clinical grounds but is important because of a worse prognosis in the allergic form if exposure to the allergen is not eliminated.

    How is the problem affecting her?—Her symptoms may be affecting her day to day life. She may be distressed and embarrassed and may fear for future employment prospects.

    Take a detailed occupational history—Has she had skin problems before? Symptoms that develop after a new job is started or that improve when she is away from work indicate an occupational problem. Which solutions does she think …

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