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| Fig. 65.1 Acute toxic insult–form of irritant contact dermatitis in a cement worker who developed cement burns from fresh cement getting into his boots. |
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| Fig. 65.2 Chronic allergic contact dermatitis. A, A case in an orthodontist who was allergic to nickel and to the glutaraldehyde used to sterilize his instruments. Note how the scaling dermatitis can mimic irritation. B, This patient developed sensitization to chromium, which was used to tan the leather in his work boots. The dorsal foot distribution is typical for a shoe contact dermatitis. |
Contact dermatitis accounts for >90% of occupational skin disease (OSD) cases. The most common location of jobrelated contact dermatitis is workers’ hands. It is generally accepted that 80% of the contact dermatitis cases are irritant (Fig. 65-1), while 20% are allergic (Fig. 65-2). Recent studies have challenged those figures, demonstrating that up to 40% of work-related skin diseases were from allergic contact dermatitis (ACD). Pure allergic contact dermatitis in the occupational setting is uncommon because a component of irritant contact dermatitis (ICD) is frequently present. Bureau of Labor and Statistics data show that OSD accounted for 16.5% of all occupational illnesses in 2005. Some have estimated the true number of cases to be 10 to 50 times higher than that due to underreporting and underdiagnosis. The “standard” allergens patch test screens for only approximately 75% of common allergens, so additional specialized testing with industrial chemicals to which the worker is exposed is frequently warranted. Testing should only be done with known materials in accepted concentrations.
Lushniak, BD: Occupational contact dermatitis,
Dermatol Ther 17:272–277, 2004.
