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Rashid et al provide a helpful update about contact dermatitis; however, some points would benefit from further discussion. [1] The authors' statements about atopy and atopic dermatitis as risk factors are based on two papers, one involving a single small study and a single class of chemical. Both topics have been addressed in a systematic review [2] which noted that exposure to skin irritants and allergens at work is the most significant independent risk factor for developing occupational contact dermatitis. Personal risk factors have been purported to exist, e.g. atopy, a previous history of eczema or dermatitis, dry skin and hyperhidrosis. Such risk factors are often described with references to narrative reviews and book chapters; however, there is little original scientific research that explores these endogenous risk factors directly. Hence, inferences about the role of atopy must be interpreted with caution. [2] The systematic review concluded that a history of atopic dermatitis, particularly in adulthood, appears to be an independent risk factor for the development of occupational contact dermatitis. [2]
Rashid et al also recommend that doctors enquire about the use of personal protective equipment, (PPE) but do not elaborate, and I appreciate word limits constrain discussion. It is important that health professionals understand that PPE can both protect against and cause contact dermatitis. A systematic review notes that some items of PPE, notably latex gloves, can cause occupational contact dermatitis and occupational contact urticaria. [3] PPE only protects when selected correctly, worn properly, removed safely, and either replaced or maintained regularly. [2] Wearing occlusive gloves as a solitary measure does not reduce the incidence of irritant occupational contact dermatitis. [4] However there is strong evidence that limited wearing of gloves can help to reduce the incidence of irritant occupational contact dermatitis - when coupled with other preventive measures. [2] Hence PPE should not be relied upon and focus ought to be on eliminating, substituting, or containing the hazard. Another systematic review concluded that wearing cotton glove liners can prevent development of the impaired skin barrier function that can be caused by prolonged wearing of occlusive gloves. [5] A national guideline recommends that appropriate gloves and cotton liners should be provided where the risk of occupational contact dermatitis cannot be eliminated. [6]
Given that access to occupational physicians in the UK is poor GPs may find themselves as the only source of medical advice for management of their patients once a diagnosis of occupational contact dermatitis has been established. [7] A single case of occupational contact dermatitis can indicate risk to others in the workplace. Doctors should persuade their patient to report their problem to their employer so that they can arrange occupational health advice and arrange a suitable and sufficient risk assessment. The employer has a legal duty under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013 to report cases of occupational dermatitis to the Heath and Safety Executive. Patients may also be entitled to Industrial Injury Disablement Benefit.
1. Rashid RS, Shim TN.Contact dermatitis. BMJ. 2016; 353: i3299.
2. Nicholson PJ, Llewellyn D, English JS. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis 2010: 63: 177–186.
3. NHSPlus /Royal College of Physicians. Latex Allergy: Occupational Health Aspects of Management: A National Guideline. Royal College of Physicians, London, 2008.
4. Sprince N L, Palmer J A, Popendorf W et al. Dermatitis among automobile production machine operators exposed to metal-working fluids. Am J Ind Med 1996: 30: 421–429.
5. Saary J, Qureshi R, Palda V et al. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol 2005: 53: 845–855.
6. Smedley J; OHCEU Dermatitis Group; BOHRF Dermatitis Group. Concise guidance: diagnosis, management and prevention of occupational contact dermatitis. Clin Med (Lond) 2010; 10: 487-90.
7. King I, Nicholson P. Getting a grip on guidelines: occupational contact dermatitis and urticaria. Br J Gen Pract. 2010;60:398-9.
Re: Contact dermatitis
Rashid et al provide a helpful update about contact dermatitis; however, some points would benefit from further discussion. [1] The authors' statements about atopy and atopic dermatitis as risk factors are based on two papers, one involving a single small study and a single class of chemical. Both topics have been addressed in a systematic review [2] which noted that exposure to skin irritants and allergens at work is the most significant independent risk factor for developing occupational contact dermatitis. Personal risk factors have been purported to exist, e.g. atopy, a previous history of eczema or dermatitis, dry skin and hyperhidrosis. Such risk factors are often described with references to narrative reviews and book chapters; however, there is little original scientific research that explores these endogenous risk factors directly. Hence, inferences about the role of atopy must be interpreted with caution. [2] The systematic review concluded that a history of atopic dermatitis, particularly in adulthood, appears to be an independent risk factor for the development of occupational contact dermatitis. [2]
Rashid et al also recommend that doctors enquire about the use of personal protective equipment, (PPE) but do not elaborate, and I appreciate word limits constrain discussion. It is important that health professionals understand that PPE can both protect against and cause contact dermatitis. A systematic review notes that some items of PPE, notably latex gloves, can cause occupational contact dermatitis and occupational contact urticaria. [3] PPE only protects when selected correctly, worn properly, removed safely, and either replaced or maintained regularly. [2] Wearing occlusive gloves as a solitary measure does not reduce the incidence of irritant occupational contact dermatitis. [4] However there is strong evidence that limited wearing of gloves can help to reduce the incidence of irritant occupational contact dermatitis - when coupled with other preventive measures. [2] Hence PPE should not be relied upon and focus ought to be on eliminating, substituting, or containing the hazard. Another systematic review concluded that wearing cotton glove liners can prevent development of the impaired skin barrier function that can be caused by prolonged wearing of occlusive gloves. [5] A national guideline recommends that appropriate gloves and cotton liners should be provided where the risk of occupational contact dermatitis cannot be eliminated. [6]
Given that access to occupational physicians in the UK is poor GPs may find themselves as the only source of medical advice for management of their patients once a diagnosis of occupational contact dermatitis has been established. [7] A single case of occupational contact dermatitis can indicate risk to others in the workplace. Doctors should persuade their patient to report their problem to their employer so that they can arrange occupational health advice and arrange a suitable and sufficient risk assessment. The employer has a legal duty under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013 to report cases of occupational dermatitis to the Heath and Safety Executive. Patients may also be entitled to Industrial Injury Disablement Benefit.
1. Rashid RS, Shim TN.Contact dermatitis. BMJ. 2016; 353: i3299.
2. Nicholson PJ, Llewellyn D, English JS. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis 2010: 63: 177–186.
3. NHSPlus /Royal College of Physicians. Latex Allergy: Occupational Health Aspects of Management: A National Guideline. Royal College of Physicians, London, 2008.
4. Sprince N L, Palmer J A, Popendorf W et al. Dermatitis among automobile production machine operators exposed to metal-working fluids. Am J Ind Med 1996: 30: 421–429.
5. Saary J, Qureshi R, Palda V et al. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol 2005: 53: 845–855.
6. Smedley J; OHCEU Dermatitis Group; BOHRF Dermatitis Group. Concise guidance: diagnosis, management and prevention of occupational contact dermatitis. Clin Med (Lond) 2010; 10: 487-90.
7. King I, Nicholson P. Getting a grip on guidelines: occupational contact dermatitis and urticaria. Br J Gen Pract. 2010;60:398-9.
Competing interests: No competing interests