Types of Eczema
Occupational Dermatitis

Occupational dermatitis is not one specific type of eczema. It is any type of eczema caused by a person’s workplace. This distinct classification came about because occupational dermatitis has unique causes and a large number of people develop eczema on the job.

Other Names

• • Occupational eczema

Signs and Symptoms
According to estimates, 5% of men and 10% of women in the workforce develop eczema on their hands from workplace exposure. Most often this occurs when something that touches the skin causes irritation (irritant contact dermatitis) or an allergic reaction (allergic contact dermatitis). Occupational dermatitis also frequently develops on the forearms and face. Signs and symptoms of occupational dermatitis include:

• Dry, chapped skin (mild case)
   

• Raw and irritated-looking skin (more severe)
   

• Redness, swelling, scaly skin, wearing away of the top layers of skin, cracks, blisters, and skin ulcers (more severe)
   

• Itching, burning, and/or stinging of the affected skin
   

• If the condition persists for some time, the skin may thicken

Who Gets
Anyone who has frequent exposure to substances that can irritate the skin or who uses strong chemicals on the job can develop occupational dermatitis. With frequent use, even substances as mild as water and detergent can irritate the skin and cause eczema.

Causes
The causes of occupational dermatitis are many and dermatologists often find that more than one cause plays some role. Leading causes include:

• Repeat exposure to substances that over time irritate the skin.
   

• Long-term exposure to a substance that over time becomes an allergen (substance to which the person is allergic).
   

• Airborne particles that become trapped against the skin, such as under the collar or beneath the waistband.
   

• Harsh chemical(s) touches the hands or saturates the clothes, causing eczema.
   

• Working with chemicals that become toxic when exposed to sunlight. Most common amongst roofers and agricultural workers.

Risk Factors

• Occupation. People in certain occupations have a higher risk.
  
  A study of 42,839 patients with contact dermatitis found that about 27% of these people developed eczema from on-the-job exposure. Five occupations — housekeeper, bricklayer, worker in the metallurgic or mechanical industry, hairdresser, and health-care worker — were responsible for more than 60% of these cases.
  
  Studies in the United States, Canada, and Europe conclude that other occupations with a higher-than-average risk include janitors and maids, florists, bakers, bartenders, caterers, cooks, and agricultural workers.
   

• Industry. Working in some industries, especially agriculture and manufacturing, increases the risk.
   

• Age. Several studies suggest that susceptibility decreases with age.
   

• Gender. Women seem to have an increased risk and more intense reactions.
   

• Atopic condition. Persons who have a history of atopic dermatitis, a type of eczema, have an increased risk of developing hand dermatitis, especially if they frequently immerse their hands in water while at work.
   

• Environment. Repeatedly wetting and drying the hands damages the skin’s protective barrier, making it easier for irritants and allergens to penetrate the skin. By contrast, a low-humidity environment also can damage the skin’s protective barrier, making it more susceptible to irritants and allergens.

Duration

• Occupational dermatitis can become chronic (long-lasting) if the irritants or allergens continue to contact the skin and the condition is not effectively treated.
   

• Even the slightest exposure can trigger a flare-up once the skin clears.

How Diagnosed
Diagnosis of an occupational skin disease often requires some detective work by both the patient and the dermatologist. A dermatologist will:

• Take a complete medical history and thoroughly examine the patient’s skin.
   

• Ask questions about when the condition first appeared, when it worsens, and when it gets better.
   

• Order patch testing if allergic contact dermatitis, a common type of eczema, is suspected. Patch testing is a safe and effective way to identify allergens (substances to which a person is allergic).
  
  During a patch test, strips of tape that contain small amounts of several possible allergens, usually 25 to 150, are applied to the patient’s back. The amounts are too small to cause a reaction unless the person is allergic. After 2 days, the patient returns, and the tape is removed. If a small red spot appears, the person is considered allergic to the substance. After 96 hours, the patient is checked again to see if any delayed reactions occur.
  
  Since allergic contact dermatitis occurs so often in some occupations, testing may include a series of potential allergens unique to a profession or industry. Special series of allergens were developed for bakers, hairdressers, as well as people who work with cooling oils, glues, metals, plastics, and rubber.

Treatment
The sooner occupational dermatitis is diagnosed and treated, the better the prognosis. Chronic (long-term) occupational dermatitis can be difficult to treat. Treatment for occupational dermatitis usually involves:

• Avoiding the substance(s) causing the irritation or allergy. The patient must avoid the cause. Avoiding all substances that can trigger a flare-up can be difficult — if not impossible — when the person encounters these substances at work. Dermatologists can help their patients develop an effective “avoidance” strategy. This may include using a barrier cream and wearing gloves or doing some tasks differently. Sometimes changes also are needed at home. The condition can be worsened by direct exposure to things around the home, such as soaps and detergents.
   

• Treatment to help clear the skin. Treatment may include applying emollients and moisturizers frequently throughout the day, using a topical anti-itch product, taking an oral antihistamine to help stop the itch, and applying a topical corticosteroid or calcineurin inhibitor to reduce inflammation. In more severe cases, phototherapy treatments may be used to suppress the person’s overactive immune response. If an infection develops, antibiotics are necessary.
  
  If contact dermatitis persists despite treatment, oral or injectable corticosteroids can be used for a short time to get the inflammation under control.
   

• Following a skin care program. The dermatologist may recommend a skin care program. Following this program can help prevent the condition from getting worse and prevent future outbreaks.

References:
Belsito DV. “Occupational contact dermatitis: Etiology, prevalence, and resultant impairment/disability.” Journal of the American Academy of Dermatology. 2005. August;53(2)303-313.

Belsito DV et al. “Pimecrolimus Cream 1%: A Potential New Treatment for Chronic Hand Dermatitis.” Cutis. 2004. January;73(1):31-38.

Cvetkovski RS et al. “Prognosis of Occupational Hand Eczema.” Archives of Dermatology. 2006. March;142(3):305-311.

Fowler JF et al. “Contact Dermatitis.” Presented as a forum at: The 64^th Annual Meeting of the American Academy of Dermatology. March 2006; San Francisco.

The Lewin Group (prepared for the Society for Investigative Dermatology and the American Academy of Dermatology Association). “The Burden of Skin Diseases.” 2004.p. 37-40.

Sertoli A et al. “Epidemiological survey of contact dermatitis in Italy (1984-1993) by GIRDCA.” American Journal of Contact Dermatitis. 1999. March;10(1):18-30.

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