Occupational Dermatology
Occupational medicine specializes in treating patients with injuries and illnesses from exposures in the workplace. People often encounter very harsh environments in the workplace. Although today’s workplace in general is considerably tamer than that of t
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Athena Theodosatos and Robert Haight
11.1 Introduction Occupational medicine specializes in treating patients with injuries and illnesses from exposures in the workplace. People often encounter very harsh environments in the workplace. Although today’s workplace in general is considerably tamer than that of the past, skin problems remain a serious issue.1 The bureau of labor statistics (BLS) calculates the frequency of work-related injuries and illnesses for private industry. According to BLS, skin diseases accounted for 15.6% of the nonfatal illnesses in private industry in 2004.2 This is hardly insignificant. Many occupational medicine physicians rarely see skin disorders. This might be because occupational skin problems are from specific exposures which are associated with specific industries. These industries do not have a uniform geographic distribution.2
friction, electricity, and ionizing radiation can, under some circumstances, be occupational. Water can even cause skin lesions under the right conditions. Toxins and infectious agents are found in some workplaces. The classic occupational skin diseases were chloracne and chrome ulcers. Those diseases are rare in the developed world today. Less acute skin lesions such as hyperpigmentation, leukoderma, alopecia, and lichenification can be occupational.1–3 Other dermatoses are the major differential to consider when evaluating occupational skin disorders. Any nondermatologist who deals with occupational skin lesions must be able to differentiate them from dermatitis and the other common nonwork-related diagnoses. This means that the physician needs to be able recognize and understand them.
11.2.1 Relevant History 11.2 Diagnosis Occupational dermatology includes a broad spectrum of disorders but the majority are acute and chronic contact dermatitis. The most commonly cited are irritant contact dermatitis and allergic contact dermatitis. Since sunlight can be an occupational exposure, skin disorders caused by the sun can therefore be considered work-related for some jobs. Likewise, skin injuries from other physical agents like hot, cold, pressure, A. Theodosatos (*) Department of Family Medicine, Florida Hospital, Winter Park, FL, USA e-mail: [email protected]
Occupational skin disorders require a detailed history of the skin findings and a work history. The basic questions to consider when evaluating an occupational skin disorder include: • What does the patient do for a living? • How long has the patient been doing this job? (the position) • What is the patient exposed to at work? (Chemicals? Physical agents?) • What personal protective equipment does the patient use at work? • Has there been any change to any of the processes at work? • Do other people at work have similar skin conditions? • What is the patient exposed to outside of work?
R. A. Norman (ed.), Preventive Dermatology, DOI: 10.1007/978-1-84996-021-2_11, © Springer-Verlag London Limited 2010
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• Has the patient had a work-related skin disorder in the past? • Has the pati
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