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Although human skin can withstand many of the assaults of a hostile environment; skin is the most commonly injured organ in industry. Skin disorders comprise more than 35% of all occupationally related diseases, affecting annually approximately one worker per thousand. Reporting remains highly incomplete, however, and the hardship and financial loss to workers and employers alike are substantial. Most occupational skin disease results from contact with a chemical substance, of which there are more than 90,000 in the environment today. Under certain conditions, all of them can irritate the skin, and approximately 2000 substances are now recognized as contact allergens. In addition, workers bring to their work preexisting diseases, which can be aggravated by their work.

Contact dermatitis (CD) of the hands is the most common occupational skin disease and atopy is often an important cofactor. CD can be subdivided into irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) (Figure 21–1).

Figure 21–1.

Types of contact dermatitis.


Irritant Contact Dermatitis

Essentials of Diagnosis

Acute and subacute effects

  • Single exposure to a strong irritant is sufficient

  • Usually hands involved

  • Raw appearance and erythema of the affected body part

  • Demarcated areas from the normal skin

  • Cracking\chapping of the affected body part

  • Fissuring

  • Bleeding

  • Pustular skin changes

  • Itching\burning with or without visible skin changes

Chronic effects

  • Repeated exposures required

  • Skin dryness

  • Hyperkeratosis

  • Skin itching (less than in ACD)

  • Skin wrinkling

  • Development of allergic contact dermatitis

General Considerations

ICD is a spectrum of disease processes with a complex pathophysiology, a varied natural history, and divergent clinical appearance. This contrasts with ACD, in which a specific chemical is the central cause. Many factors can induce irritant reactions, either in isolation or in combination. These include the intrinsic nature of the substance (ie, pH, solubility, physical state, and concentration), environmental factors (ie, temperature, humidity, and pressure), predisposing individual characteristics (ie, age, gender, ethnicity, concurrent and preexisting skin disease, and the skin region exposed), and genetic factors such as filaggrin (FLG) gene mutation. Irritant contact dermatitis is a common form of occupational skin disease and, in the United States, accounts for nearly 80% of all occupational dermatitis.

There are at least 14 biologic entities within the irritant dermatitis syndrome.

Acute irritation/corrosion refers to a single exposure of a material that is so irritant that damage is seen within hours to a day or so. Typically, this is caused by exposure to strong acids and bases (Table 21–1). Many other chemicals produce similar exaggerated effects. The likelihood of a mixture producing such acute irritation frequently can be estimated by high concentrations of chemicals with extremes of pH.

Table 21–1.Examples of contact irritants ...

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