**4. Occupational contact dermatitis**

Work-related dermatoses, in particular hand dermatitis, are still among the most prevalent occupational diseases. Understanding the epidemiology of OCD is essential to determine etiologic factors of the disease and to make recommendations for its prevention.

Fig. 2. Incidence rates of ICD and ACD in the occupational groups with the highest risk for occupational skin diseases (Diepgen & Coenraads PJ, 2000).

Different professions have differing risks for occupational skin disease. Those at the highest risk for a contact dermatitis are hairdressers (yearly rate 120/100,000), printers (rate

1999).

Coenrads, 2000):

**5. Conclusion** 

**6. Acknowledgment** 

this manuscript.

**7. References** 


Epidemiology of Contact Dermatitis 13

**Metal workers** are exposed to numerous exogenous factors that play a substantial role in the development of ACD as well as ICD. Even though nickel is regarded as the most frequent source of all reported metal allergies, metal-work fluids are the most important cause of irritant hand dermatitis (also exposed to other chemical irritants, such as cleaning detergents, solvents and degreasers) (Itschner L et al, 1996). Metal polishers remove excess metal and surface defects from various items such as the accessory parts of cars. The most commonly polished metals are aluminium, brass, bronze and zinc (Adams

The total economic impact of OCD is high according to the following costs (Diepgen &

Numerous studies have investigated the prevalence and risk factors of hand eczema in the general population. Contact sensitization has become a significant public health problem. In many parts of the world, more than 20% of the adult population is suffering from contact allergy. The profile of sensitizations may differ in each country. However, nickel sulphate is the most prevalent allergen practically everywhere. Patch testing remains the gold standard for the diagnosis of ACD. Quality control of patch testing is both a prerequisite for, and an objective of, clinical epidemiology of contact dermatitis. Publications based on data of patients visiting dermatology clinics and/or patch testing units cannot be used to directly

We would like to thank the following individuals and associations for their collaboration, teaching and daily efforts, as well as for the material provided: the European Society of Contact Dermatitis (ESCD), the Dermatology Workgroup of the European Academy of Allergy and Clinical Immunology (EAACI), the Skin Allergy Committee of the Spanish Society of Allergology and Clinical Immunology (SEAIC), especially Dr. Pilar Iriarte Sotés (Arquitecto Marcide - Profesor Novoa Santos Hospital Complex, Ferrol, Spain); and the Spanish Workgroup on Contact Dermatitis (GEIDC) of the Spanish Academy of Dermatology and Venereology (AEDV). Their final input was crucial for the preparation of

Adams RM (1990). Metal polishers. In: Adams RM (ed) Occupational skin disease, 2nd ed;

Saunders, Philadelphia, pp 638-639, ISBN 0-7216-2926-1.


**4.2 Social and economic impact of contact dermatitis** 


derive population related incidence or prevalence estimates.

71/100,000), machine tool operatives (rate 56/100,000), chemical/petroleum plant operatives (rate 45/100,000), assemblers (rate 35/100,000), and machine tool setters (rate 34/100,000) (Cherry et al, 2000). Accurate estimates of the incidence of occupational skin disease are difficult to find but a recent report from the EPIDERM and OPRA occupational skin disease surveillance project suggests a rate of 13 per 100 000 per year 5 and a prevalence of 15 per 10,000 of those ever employed has been quoted (Cherry et al, 2000).

Occupational disease registries provide national incidence data based on the notification of occupational skin diseases and are available in many countries. Although the comparison of national data are hampered by differences across countries in reporting and the definition of occupational diseases, the average incidence rate of registered occupational contact dermatitis in some countries lies around 0.5-1.9 cases per 1,000 fulltime workers per year (Dickel et al, 2002; Halkier-Sorensen, 1996). The highest incidence rates were seen in hairdressers (Diepgen et al, 2000). In Figure 2, the incidence rates of ICD and ACD of employees of the twelve groups with the highest risk for an occupational skin disease are presented.

#### **4.1 OCD in different work forces**

The majority of work-related dermatoses, in particular hand dermatitis, comprise contact dermatitis (90-95%); the rest are of other dermatoses such as contact urticaria, oil acne, chloracne, chemically-induced leucoderma, and infections. In this section, different "workrelated OCD" are discussed.

**Health care workers** (especially nurses) are often affected by OCD, whose "occupational sensitization pattern" comprises thiuram (rubber compounds), thiomersal (vaccine preservative) and several biocides (glutaraldehyde, formaldehyde, glyoxal and benzalkonium chloride) (Schnuch A et al, 1998). Operating-room staff is a subset of healthcare workers (preparation and clean up may involve exposure to cleaning and disinfecting agents, and some workers may also have exposure to sterilizing agents, such as glutaraldehyde, and some workers may use ethylene oxide).

The frequency of OCD **in dental personnel** (dentists, dental assistants, dental technicians and orthodontics) has steadily increased over the last decades and currently considered to be about 40% (Uveges et al, 1995).

Hand eczema is a well-known and potentially severe drawback to the **hairdressing profession**. Hair cosmetic producers provide the hairdresser with a great variety of chemicals to fulfil stylist and customer desires. Smit et al studied a cohort of apprentice hairdressers (n=74) and nurses (n=111) and found an average incidence rate of hand dermatitis of 32.8 cases/100 person-years for the hairdressers, compared with 14.5 cases/100 person-years for the nurses (Smit et al, 1994).

**Construction workers** (bricklayers, manufacturers of concrete elements…) are in contact with wet cement products in the form of mortar or concrete. ACD due to hexavalent chromium in cement is still the most important contact allergy. Also, other substances have been identified (e.g., cobalt, tuber additives, epoxy resin, hexamenthylendiamine and isophorondiamine) (Geier & Struppek, 1995).

71/100,000), machine tool operatives (rate 56/100,000), chemical/petroleum plant operatives (rate 45/100,000), assemblers (rate 35/100,000), and machine tool setters (rate 34/100,000) (Cherry et al, 2000). Accurate estimates of the incidence of occupational skin disease are difficult to find but a recent report from the EPIDERM and OPRA occupational skin disease surveillance project suggests a rate of 13 per 100 000 per year 5 and a prevalence

Occupational disease registries provide national incidence data based on the notification of occupational skin diseases and are available in many countries. Although the comparison of national data are hampered by differences across countries in reporting and the definition of occupational diseases, the average incidence rate of registered occupational contact dermatitis in some countries lies around 0.5-1.9 cases per 1,000 fulltime workers per year (Dickel et al, 2002; Halkier-Sorensen, 1996). The highest incidence rates were seen in hairdressers (Diepgen et al, 2000). In Figure 2, the incidence rates of ICD and ACD of employees of the twelve groups with the highest risk for an occupational

The majority of work-related dermatoses, in particular hand dermatitis, comprise contact dermatitis (90-95%); the rest are of other dermatoses such as contact urticaria, oil acne, chloracne, chemically-induced leucoderma, and infections. In this section, different "work-

**Health care workers** (especially nurses) are often affected by OCD, whose "occupational sensitization pattern" comprises thiuram (rubber compounds), thiomersal (vaccine preservative) and several biocides (glutaraldehyde, formaldehyde, glyoxal and benzalkonium chloride) (Schnuch A et al, 1998). Operating-room staff is a subset of healthcare workers (preparation and clean up may involve exposure to cleaning and disinfecting agents, and some workers may also have exposure to sterilizing agents, such as

The frequency of OCD **in dental personnel** (dentists, dental assistants, dental technicians and orthodontics) has steadily increased over the last decades and currently considered to

Hand eczema is a well-known and potentially severe drawback to the **hairdressing profession**. Hair cosmetic producers provide the hairdresser with a great variety of chemicals to fulfil stylist and customer desires. Smit et al studied a cohort of apprentice hairdressers (n=74) and nurses (n=111) and found an average incidence rate of hand dermatitis of 32.8 cases/100 person-years for the hairdressers, compared with 14.5 cases/100

**Construction workers** (bricklayers, manufacturers of concrete elements…) are in contact with wet cement products in the form of mortar or concrete. ACD due to hexavalent chromium in cement is still the most important contact allergy. Also, other substances have been identified (e.g., cobalt, tuber additives, epoxy resin, hexamenthylendiamine and

glutaraldehyde, and some workers may use ethylene oxide).

of 15 per 10,000 of those ever employed has been quoted (Cherry et al, 2000).

skin disease are presented.

related OCD" are discussed.

be about 40% (Uveges et al, 1995).

person-years for the nurses (Smit et al, 1994).

isophorondiamine) (Geier & Struppek, 1995).

**4.1 OCD in different work forces** 

**Metal workers** are exposed to numerous exogenous factors that play a substantial role in the development of ACD as well as ICD. Even though nickel is regarded as the most frequent source of all reported metal allergies, metal-work fluids are the most important cause of irritant hand dermatitis (also exposed to other chemical irritants, such as cleaning detergents, solvents and degreasers) (Itschner L et al, 1996). Metal polishers remove excess metal and surface defects from various items such as the accessory parts of cars. The most commonly polished metals are aluminium, brass, bronze and zinc (Adams 1999).
