Ratio of irritant contact dermatitis to allergic contact dermatitis in occupational skin disease
2003; Elsevier BV; Volume: 49; Issue: 2 Linguagem: Inglês
10.1067/s0190-9622(03)00856-9
ISSN1097-6787
AutoresHeinrich Dickel, Swen Malte John,
Tópico(s)Occupational exposure and asthma
ResumoWe read with great interest the article by Kucenic and Belsito,1Kucenic M.J. Belsito D.V. Occupational allergic contact dermatitis is more prevalent than irritant contact dermatitis A 5-year study.J Am Acad Dermatol. 2002; 46: 695-699Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar suggesting a higher incidence of allergic (ACD) compared to irritant contact dermatitis (ICD) in occupational skin disease (OSD). In our opinion, the study needs clarification. The observed incidence depends on the population under observation and the completeness of ascertainment. The majority of studies cited by Kucenic and Belsito concerning a predominance of ACD in OSD as well as their own study are based upon patients from tertiary care and specialized centers. Because of a selection and referral bias, respectively, only very limited statements about the epidemiology of OSD are possible; at best these studies are representative of the patient populations of the reporting clinics. One explanation for the observed ACD-predominance in the above mentioned studies may be a remarkable tolerance toward early irritant eczema in workers at high risk (eg, construction workers) who only consult a dermatologist in long-standing cases, when allergic eczema already has occurred.To assess the actual incidence of ICD and ACD in OSD it is necessary to perform working population-based studies. Such studies have recently been undertaken in large-scale populations,2Meyer J.D. Chen Y. Holt D.L. Beck M.H. Cherry N.M. Occupational contact dermatitis in the UK a surveillance report from EPIDERM and OPRA.Occup Med (Lond). 2000; 50: 265-273Crossref PubMed Scopus (104) Google Scholar, 3Dickel H. Kuss O. Schmidt A. Kretz J. Diepgen T.L. Importance of irritant contact dermatitis in occupational skin disease.Am J Clin Dermatol. 2002; 3: 283-289Crossref PubMed Scopus (146) Google Scholar suggesting that ICD is the most common type of occupational contact dermatitis. However, our study3Dickel H. Kuss O. Schmidt A. Kretz J. Diepgen T.L. Importance of irritant contact dermatitis in occupational skin disease.Am J Clin Dermatol. 2002; 3: 283-289Crossref PubMed Scopus (146) Google Scholar in 5285 individuals with an initial report of an OSD shows a very complex picture: incidence of ICD versus ACD is job-dependent. In the metalworking industry, for example, ICD was primarily caused by contact with cutting fluids, although a higher rate of ACD must be considered to be caused by undetected allergens (lack of information about ingredients of cutting fluids). On the other hand, in hairdressers, tile setters and terrazzo workers, solderers, and electroplaters ACD was more frequently diagnosed than ICD. One may speculate whether this mirrors reality or whether these are occupational groups with well known and easy-to-identify allergens.Available official statistics normally are insufficient for the required task, because they are incomplete and flawed from an occupational and dermatological viewpoint.4Taylor J.S. Occupational disease statistics. In perspective.Arch Dermatol. 1988; 124: 1557-1558Crossref PubMed Scopus (26) Google Scholar In their recent study of US workers’ compensation data, Kaufman et al5Kaufman J.D. Cohen M.A. Sama S.R. Shields J.W. Kalat J. Occupational skin diseases in Washington State, 1989 through 1993 Using workers’ compensation data to identify cutaneous hazards.Am J Public Health. 1998; 88: 1047-1051Crossref PubMed Scopus (51) Google Scholar were unable to accurately distinguish between ICD and ACD; information on patch testing was not recorded on a regular basis.In conclusion, irritating and sensitizing factors play an inseparable role in work flow and preventive intervention should therefore simultaneously have different focuses in order to have a correct alignment and promising effect on lowering equally the incidence of ICD and ACD in a working population. We read with great interest the article by Kucenic and Belsito,1Kucenic M.J. Belsito D.V. Occupational allergic contact dermatitis is more prevalent than irritant contact dermatitis A 5-year study.J Am Acad Dermatol. 2002; 46: 695-699Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar suggesting a higher incidence of allergic (ACD) compared to irritant contact dermatitis (ICD) in occupational skin disease (OSD). In our opinion, the study needs clarification. The observed incidence depends on the population under observation and the completeness of ascertainment. The majority of studies cited by Kucenic and Belsito concerning a predominance of ACD in OSD as well as their own study are based upon patients from tertiary care and specialized centers. Because of a selection and referral bias, respectively, only very limited statements about the epidemiology of OSD are possible; at best these studies are representative of the patient populations of the reporting clinics. One explanation for the observed ACD-predominance in the above mentioned studies may be a remarkable tolerance toward early irritant eczema in workers at high risk (eg, construction workers) who only consult a dermatologist in long-standing cases, when allergic eczema already has occurred. To assess the actual incidence of ICD and ACD in OSD it is necessary to perform working population-based studies. Such studies have recently been undertaken in large-scale populations,2Meyer J.D. Chen Y. Holt D.L. Beck M.H. Cherry N.M. Occupational contact dermatitis in the UK a surveillance report from EPIDERM and OPRA.Occup Med (Lond). 2000; 50: 265-273Crossref PubMed Scopus (104) Google Scholar, 3Dickel H. Kuss O. Schmidt A. Kretz J. Diepgen T.L. Importance of irritant contact dermatitis in occupational skin disease.Am J Clin Dermatol. 2002; 3: 283-289Crossref PubMed Scopus (146) Google Scholar suggesting that ICD is the most common type of occupational contact dermatitis. However, our study3Dickel H. Kuss O. Schmidt A. Kretz J. Diepgen T.L. Importance of irritant contact dermatitis in occupational skin disease.Am J Clin Dermatol. 2002; 3: 283-289Crossref PubMed Scopus (146) Google Scholar in 5285 individuals with an initial report of an OSD shows a very complex picture: incidence of ICD versus ACD is job-dependent. In the metalworking industry, for example, ICD was primarily caused by contact with cutting fluids, although a higher rate of ACD must be considered to be caused by undetected allergens (lack of information about ingredients of cutting fluids). On the other hand, in hairdressers, tile setters and terrazzo workers, solderers, and electroplaters ACD was more frequently diagnosed than ICD. One may speculate whether this mirrors reality or whether these are occupational groups with well known and easy-to-identify allergens. Available official statistics normally are insufficient for the required task, because they are incomplete and flawed from an occupational and dermatological viewpoint.4Taylor J.S. Occupational disease statistics. In perspective.Arch Dermatol. 1988; 124: 1557-1558Crossref PubMed Scopus (26) Google Scholar In their recent study of US workers’ compensation data, Kaufman et al5Kaufman J.D. Cohen M.A. Sama S.R. Shields J.W. Kalat J. Occupational skin diseases in Washington State, 1989 through 1993 Using workers’ compensation data to identify cutaneous hazards.Am J Public Health. 1998; 88: 1047-1051Crossref PubMed Scopus (51) Google Scholar were unable to accurately distinguish between ICD and ACD; information on patch testing was not recorded on a regular basis. In conclusion, irritating and sensitizing factors play an inseparable role in work flow and preventive intervention should therefore simultaneously have different focuses in order to have a correct alignment and promising effect on lowering equally the incidence of ICD and ACD in a working population. •••ReplyJournal of the American Academy of DermatologyVol. 49Issue 2Preview Full-Text PDF
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