Although human skin can withstand many assaults of a hostile environment, it 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 chemicals, 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 17–1).
Types of contact dermatitis.
GENERAL APPROACH TO DIAGNOSIS & TREATMENT OF OCCUPATIONAL SKIN DISORDERS
The workup and diagnosis of patients with work-related skin disease requires much more time than does a general dermatologic workup. Making a premature diagnosis before studying all the evidence should be resisted because an incorrect diagnosis can have long-lasting and severely detrimental effects. Review of the medical records, patch testing, fungal and bacterial cultures, biopsy, and plant visits often are necessary to reach a correct diagnosis. While an endogenous or constitutional eczema or dermatitis may be the primary cause, detailed analysis of work-relate risk factors should be undertaken where appropriate. Atopic eczema, although inherited, often has onset for the first time in adult life when precipitated by work activities, and aggravation often is considered work-related. Many other constitutional diseases can be considered similarly.
Table 17–1 outlines a typical evaluation of a work-related illness. The following headings can serve as a form for recording the results of the workup. The text under each heading details the information that should be gathered and recorded.
Table Graphic Jump Location Table 17–1.Outline for dermatologic examinations for workers’ compensation patients. ||Download (.pdf) Table 17–1. Outline for dermatologic examinations for workers’ compensation patients.
Medical record review
Support for diagnosis
Factors of disability
Future medical care
History of Injury/Problem & Current Complaints
Learn exactly which anatomic skin site was first affected. With a diagnosis of CD, the eruption should begin at the site of contact with the offending agents. Spreading ...