Occupational Dermatology
The National Institute of Occupational Safety and Health (NIOSH) included
dermatologic disorders on its list of the top 10 work-related diseases and
injuries in the United States. Ten percent to 15% of health hazard
evaluations by NIOSH involve skin complaints. The economic impact of
work-related dermatologic conditions is in the hundreds of millions of dollars
per year. Dermatologic injuries from trauma or brief exposure to toxic
agents constitute approximately 30% of all injuries. The most common
injuries are due to lacerations, punctures, abrasions, and burns.
Approximately 40% of all occupational illness is due to skin disease, with about
a quarter of these resulting in an average work loss of 10 to 12 days.
Thirty percent of occupational injury and 40% of occupational disease are
dermatologic.
Contact dermatitis accounts for 90% of occupational skin disease, with the
majority of cases being irritant. The clinical course for occupationally
induced contact dermatitis is relatively poor, and this causes the worker to
have a guarded prognosis: 25% have clearance of the dermatitis, 50% have
improvement but with periodic recurrence, and 25% have persistent and severe
dermatitis despite a change in jobs and therapeutic intervention. The
creates a significant amount of human suffering, as well as having a negative
impact on the workplace and society that results from lost worker productivity,
medical care, and disability payments. The highest number of occupational
skin diseases from the Bureau of Labor Statistics 1984 Annual Survey occurred in
the manufacturing sector, whereas the highest incidence was in the agricultural,
forestry, and fishing industry. In 1993 the Annual Survey of Occupational
Injuries and Illnesses from the Bureau of Labor Statistics reported an estimated
rate of occupational dermatitis of 1.12/10,000 workers. The larges number
of cases occurred in health services, whereas the highest rate was in
agricultural crops. The occupation with the largest number of cases was
nonconstruction laborers. Cleaning and polishing agents caused the largest
number of cases. More recently workers' compensation claims have been used
for surveillance of occupational disease to identify specifically affected
workers and employers. This strategy has identified high-risk companies
and targeted the most frequently implicated occupations and causal agents within
those companies.
Occupational skin disease has a guarded prognosis. Despite proper
treatment, only 25% of patients have clearance of the dermatitis, even with a
change in jobs.
The development of occupational skin disease is multifactorial in origin and
results from the interaction of predisposing risk factors in the worker and
agents within the work environment that cause disease.
- Marks JG, Elsner P, DeLeo VA: Etiology of Occupational
Skin Disease. Chapter in Contact and Occupational Dermatology Third Edition, Chapter
12, Mosby St. Louis, pp 303-313, 2002.
