Marrakchi S, Maibach H I
Department of Dermatology, University of California, San Francisco.
Dermatol Clin. 1994 Jul;12(3):477-84.
Occupational contact dermatitis remains an important cause of disability. Eight steps in an operational definition of OCD are as follows: 1. Relevant clinical history 2. Relevant morphology 3. Positive diagnostic patch test with appropriate vehicle and concentration 4. Repeat patch test when excited skin syndrome is suspected 5. Positive provocative use test or repeat open application test to refine clinical relevance 6. Serial dilutions, when necessary, of the chemical tested 7. Reviewing controls for nonirritating concentrations when this is not known by the investigator 8. Generally, clearing of the dermatitis when allergen is removed, or exposure significantly decreased The diagnosis is not always easy. Well-conducted clinical investigations are needed, including clinical history, clinical examination, and patch testing with careful follow-up. However, many of the chemicals reported in the literature as sensitizers induce only sporadic allergic reactions. Thus, epidemiologic animal and human studies are necessary to determine the capacity of the chemicals used in industry to induce contact dermatoses. It is necessary to standardize the predictive tests to compare results among laboratories and to predict the potential for sensitization.
