On the job: Occupational skin diseases easily overlooked

May 1, 2009

Occupational dermatitis is common, but often overlooked by primary care physicians. Therefore, dermatologists' skills are needed to not only diagnose work-related dermatitis, but also to identify the offending agents and manage the condition.

Key Points

Cleveland - Occupational dermatitis is common, but it's often overlooked by primary care physicians. Therefore, dermatologists' skills are needed to not only diagnose work-related dermatitis, but also to identify the offending agents and manage the condition.

"Dermatologists have a critical role to play in the accurate diagnosis of these conditions," says James S. Taylor, M.D., section head of occupational dermatology, Cleveland Clinic, Cleveland.

"They are often misdiagnosed by other physicians as superficial fungal infections, poison ivy or dermatitis from other causes. Less common occupational disorders, such as acne, pigmentation changes or ulcerations, are also likely to be missed," Dr. Taylor tells Dermatology Times. Therefore, such patients are not receiving appropriate treatment.

At high risk are workers in occupations that require wet work, such as hairdressers and healthcare professionals of several types; those exposed to irritant chemicals, such as healthcare workers; those employed in printing, metal work, woodworking, rubber and plastics; those exposed to extreme heat, such as foundry workers; and those who work outdoors, such as foresters and park employees.

"Occupational skin disease can be defined as any skin disorder that is directly caused or significantly aggravated by workplace exposures," Dr. Taylor says.

The most common causes of occupational skin disorders are chemicals that are either irritants or allergens, or both, in some cases.

"Irritants are responsible for 70 percent to 80 percent of chemical-related occupational dermatitis, while allergenic agents account for 20 percent to 30 percent," Dr. Taylor says.

Two common culprits in the beauty industry are glycerol thioglycolate, a common ingredient used in perms, and paraphenylenediamine, used in hair dye.

In addition to chemicals, other common sources of workplace irritant dermatitis include soap, which can contain sensitizing agents such as cocamide diethanolamine, which is used as an emulsifying agent; waterless hand cleaners, which can defat and irritate the skin; and dilute solutions of acids and alkalis.

Common allergens

Common sources of allergic dermatitis include plants, metals, rubber, plastics, glues and dyes. Forest firefighters and other outdoor workers are often exposed to poison ivy, poison oak and poison sumac. Metal allergies can develop from exposure to nickel, cobalt and chrome. Workers who handle various forms of rubber, from tires to latex gloves, can develop allergic dermatitis, which can present as eczema or urticaria. Acrylics and epoxy, which are widely used in workplaces, as well as disperse fabric dyes, can cause allergic dermatitis.

Further, these categories are not mutually exclusive. Exposure to some irritant chemicals can predispose a patient to developing contact dermatitis, and patients who have had either a chemical or thermal burn often develop post-traumatic eczema after healing from the initial insult.

Other sources of occupational dermatitis include mechanical causes, such as trauma, friction or pressure; physical causes, such as extreme heat; and biological causes, such as herpes simplex of the finger, called herpetic whitlow.

After identifying the patient's occupation, the next step is to determine the nature, duration and the extent of exposure to potential causes. The dermatologist should also ask if the patient has had prior contact allergies or other skin disease that may be work-related.

"Also, inquire about second jobs and hobbies, and what type of personal protective equipment the patient uses at work, such as gloves," Dr. Taylor says. "The protective equipment itself can often cause contact dermatitis."

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