Eczema: Is It Occupational?

Eczema or spongiotic dermatitis is a very general term. Most patients will not have occupational causes. 
 
See this page for a definition of spongiotic dermatitis:  http://www.dermnetnz.org/pathology/eczema-path.html
 
See this page from the Mayo Clinic on dermatitis: http://www.mayoclinic.org/diseases-conditions/dermatitis-eczema/basics/definition/con-20032183
 
According to Cecil Medicine, 24th edition, "The more commonly encountered eczemas (Table 446-1) share similar histological characteristics. However, they have varying degrees of edema within the epidermis (spongiosis) and of infiltration with lymphocytes and macrophages in the superficial dermis." The six types of eczema listed in table 446-1 are: nummular dermatitis, dyshidrosis, atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis, and irritant contact dermatitis.
 

There is a useful table in the chapter on "Contact Dermatitis" in Textbook of Clinical Occupational and Environmental Medicine. Table 29.1.4 shows the Mathias criteria for probable occupational causation in terms of seven questions:

  1. Is the clinical appearance consistent with contact dermatitis?
  2. Are there workplace exposures to potential cutaneous irritants or allergens?
  3. Is the anatomic distribution of dermatitis consistent with cutaneous exposure during the job task?
  4. Is the temporal relationship between exposure and onset consistent with contact dermatitis?
  5. Are non-occupational exposures excluded as possible causes?
  6. Does dermatitis improve away from work exposure to the suspected irritant or allergen?
  7. Do patch or provocation tests identify a probable causal agent?
"Answering yes to at least four questions may provide adequate probability for workplace exposure."
 

The abstract of the original Mathias article is here: http://www.ncbi.nlm.nih.gov/pubmed/2523909
 
This is an abstract of a recent study assessing the Mathias criteria: http://www.ncbi.nlm.nih.gov/pubmed/?term=22578296
 
Recent study of occupational irritant contact dermatitis done in Denmark: http://www.ncbi.nlm.nih.gov/pubmed/?term=25302958
 
Recent study of occupational allergic contact dermatitis done in Denmark: http://www.ncbi.nlm.nih.gov/pubmed/?term=23948033
  
There are currently 1015 agents in Haz-Map that are potential skin sensitizers. For the most common ones, see this page: http://www.haz-map.com/workers.htm

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