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Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability.

Cutaneous irritant and allergic responses account for the vast majority of cases of occupational contact dermatitis (OCD). Although the pathophysiologic responses to these two different exposures are distinct, the clinical differentiation between chronic cumulative irritant contact dermatitis and allergic contact dermatitis can be difficult and frequently requires patch testing. This article reviews the recommended algorithms that clinicians should utilize to assess whether a worker suffers from OCD. The prevalence of OCD, its predisposing factors (both endogenous and exogenous), and prognosis are discussed in depth. Finally, issues surrounding the assessment of impairment and disability resulting from OCD are summarized.

Age Factors↗

Perioral dermatitis: etiology and treatment.

Ninety-five patients with perioral dermatitis were studied from an epidemiological aspect. Consistent clearing of the eruption was obtained with oral tetracycline in combination with a topical sodium sulfacetamide-sulfur-hydro-cortisone lotion. Comparison of the study group of patients to a group of 50 control patients revealed highly significant quantitative differences in the cosmetic preparations used by the two groups. This latter finding would suggest that lubricating and moisturizing products play some part in the etiology of perioral dermatitis.

Administration, Topical↗

Atopic dermatitis-etiology and clinical management.

Atopic dermatitis is primarily an allergic problem, similar in most of its aspects to that of allergic bronchial asthma. It should be studied and treated like asthma, with especial emphasis on the significance of inhalant allergens. It is doubtful that psychic factors are of importance in primary genesis of the disease although they may be involved in exacerbation of it.

Allergens↗

Atopic dermatitis: etiology and pathogenesis.

Atopic dermatitis is a recognizable phenotype that most likely results from several mechanisms. An increasing number of children with atopic dermatitis are recognized as having immune defects, although the exact incidence of such immunodeficiency states among patients with atopic dermatitis is unknown. Children with atopic dermatitis who suffer recurrent or persistent infections should undergo immunologic evaluation. Ideally, this should include evaluation of cell-mediated immunity as well as neutrophil and monocyte chemotaxis. Further investigation into the beta-blockade theory may enhance our understanding of atopic dermatitis. Careful attention to factors exacerbating atopic dermatitis is essential in understanding this problem. Abnormal sweating, dry skin, sensitivity to contactants, and emotional stress should always be considered in evaluation of children with atopic dermatitis.

Child↗

[Compositae dermatitis].

INTRODUCTION: Compositae dermatitis is an allergic contact dermatitis caused by plant species of the Compositae family. The first report of a cutaneous reaction to the Chrysanthemum genus was made by Howe JS in 1887. In 1895 Maiden JH reported about skin lesions among men working with Tagetes minuta. Case reports of contact allergic-ragweed dermatitis appeared in the American literature as early as 1919. The North American feverfew--Parthenium Hysterophorus was brought to India from America in 1956 and it caused thousands of cases of so-called parthenium dermatitis. Ragweed and parthenium dermatitis became prototypes for the classic, so-called "airborne" Compositae dermatitis, that affects primarily exposed skin surfaces, and produces a universal erythroderma. EPIDEMIOLOGY: The frequency of contact allergy to Compositae in Europe is higher than previously believed. It occurs most frequently in middle-aged and elderly persons, but also in all age groups. During the two past decades a more equal sex ratio has been established. The prevalence varies from 0.7-1.4% in the general population, up to 4.5% among occupationally exposed persons. Compositae allergy is among the top ten contact sensitivities in Europe. In North Europe plants were the cause of 4.4% cases of occupational allergic contact dermatitis. ETIOLOGY AND PATHOGENESIS: Among cultivated Compositae plants, Chrysanthemum is considered to be a major sensitizer in Europe (60%). Among the edible types, it is lettuce--Lactuca sativa and endive Cichorium endivia (20-30%), and wild-growing feverfew--Tanace--tum parthenium (70-90%), tansy--Tanacetum vulgare (54%), and dandelion--Taraxacum officinale (65%). Sesquiterpene lactones are the main sensitizers of the Compositae family. Other components, thiophenes and acetylenes are said to elicit only phytophotodermatitis, but recent studies have demonstrated that some thiophenes and benzofuran derivates possess not only phototoxic activity, but also sensitizing properties. Photosensitivity is present in 22-75% Compositae sensitive individuals. Extracts from Compositae are known to be phototoxic in vitro. Photoreactivity of alpha-methylene-gamma-la-ctone group of sesquiterpene-lactone directed towards the DNA base thymine, thus producing intermolecular 2 + 2 photoadducts (antigen within the cell), was also thought to be related to photosensitivity. Clinical manifestations vary from generalized eczema (20-30%), eczema of hands and face (24%), hand (36-44%), or facial eczema (11-28%). 65% of patients have vesicular hand eczema. DIAGNOSIS: Routine patch testing with sesquiterpene lactone mix, aimed testing with Compositae extracts screening mix, Compositae plants, and with their extracts, whereas the treatment of choice is a specific allergen-immunotherapy.

Allergens↗