Sona Dermatology, 9104 Falls of Neuse Rd, Suite 310, Raleigh, NC, 27615, USA.
University of North Carolina School of Medicine, 321 S Columbia Street, Chapel Hill, NC, 27516, USA.
Clin Rev Allergy Immunol. 2019 Feb;56(1):60-71. doi: 10.1007/s12016-018-8706-z.
Occupational skin disease is common. It affects workers more often than reported. Contact dermatitis, both irritant and allergic, accounts for the majority of occupational skin diagnoses. Occupational contact dermatitis (OCD) frequently affects the hands and may have a profound impact on an employee's ability to perform a job. Severe OCD can affect a worker's activities of daily living and can even lead to job loss. Numerous irritants have been described in the workplace, from the common (wet work) to the more obscure (warm, dry air). Several contact allergens may be work-related, and the majority of established occupational allergens are also known nonoccupational allergens. Emerging occupational allergens are continually described in the literature. Patch testing is the gold standard for the workup of allergic contact dermatitis. Patch testing in the setting of OCD may require extended or unique allergen trays, as well as a thorough occupational history and collection of workplace Material Safety Data Sheets (MSDS). These MSDS contain valuable information but may not be complete or accurate. Proof of occupational causation can be aided by employing the Mathias criteria. Certain industries and occupations are associated with higher rates of OCD, and as expected, the industries with direct contact with irritants and allergens are highly represented. The differential diagnosis for occupational dermatitis is broad and should be considered when evaluating an employee with suspected OCD. Some other diagnoses to consider include atopic dermatitis, psoriasis, and manifestations of internal disease, as well as an overlap syndrome of more than one diagnosis. OCD treatment should ideally follow the public health hazard controls' stepwise approach. Prevention and early intervention are key to promoting occupational health and preventing OCD. Multidisciplinary teams have been successful in the treatment of OCD, and newly described topical treatments may provide additional modalities for use in the occupational setting.
职业性皮肤病很常见，其发病率高于报告率。接触性皮炎（包括刺激性和变应性）占职业性皮肤病诊断的大多数。职业性接触性皮炎（OCD）常累及手部，可对员工的工作能力产生重大影响。严重的 OCD 可影响患者的日常生活活动，甚至导致失业。工作场所中存在许多刺激物，从常见的（湿工作）到较不常见的（温暖、干燥的空气）。有一些接触性过敏原可能与工作相关，大多数已确定的职业性过敏原也是已知的非职业性过敏原。在文献中不断描述新的职业性过敏原。斑贴试验是变应性接触性皮炎检查的金标准。在 OCD 的情况下进行斑贴试验可能需要延长或特殊的过敏原斑试盒，以及详细的职业史和收集工作场所材料安全数据表 (MSDS)。这些 MSDS 包含有价值的信息，但可能不完整或不准确。采用 Mathias 标准可以帮助证明职业性病因。某些行业和职业与 OCD 的发生率较高相关，如预期的那样，直接接触刺激物和过敏原的行业的发病率很高。职业性皮炎的鉴别诊断很广泛，在评估疑似 OCD 的患者时应考虑到这一点。一些其他需要考虑的诊断包括特应性皮炎、银屑病和内部疾病的表现，以及一种以上诊断的重叠综合征。OCD 的治疗理想情况下应遵循公共卫生危害控制的逐步方法。预防和早期干预是促进职业健康和预防 OCD 的关键。多学科团队在 OCD 的治疗中取得了成功，新描述的局部治疗方法可能为职业环境中的使用提供额外的治疗方式。
