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Occupational skin disease is common. It affects workers more often than reported. Contact dermatitis, both irritant and allergic, accounts for the majority of occupational skin diagnoses. Occupational contact dermatitis (OCD) frequently affects the hands and may have a profound impact on an employee's ability to perform a job. Severe OCD can affect a worker's activities of daily living and can even lead to job loss. Numerous irritants have been described in the workplace, from the common (wet work) to the more obscure (warm, dry air). Several contact allergens may be work-related, and the majority of established occupational allergens are also known nonoccupational allergens. Emerging occupational allergens are continually described in the literature. Patch testing is the gold standard for the workup of allergic contact dermatitis. Patch testing in the setting of OCD may require extended or unique allergen trays, as well as a thorough occupational history and collection of workplace Material Safety Data Sheets (MSDS). These MSDS contain valuable information but may not be complete or accurate. Proof of occupational causation can be aided by employing the Mathias criteria. Certain industries and occupations are associated with higher rates of OCD, and as expected, the industries with direct contact with irritants and allergens are highly represented. The differential diagnosis for occupational dermatitis is broad and should be considered when evaluating an employee with suspected OCD. Some other diagnoses to consider include atopic dermatitis, psoriasis, and manifestations of internal disease, as well as an overlap syndrome of more than one diagnosis. OCD treatment should ideally follow the public health hazard controls' stepwise approach. Prevention and early intervention are key to promoting occupational health and preventing OCD. Multidisciplinary teams have been successful in the treatment of OCD, and newly described topical treatments may provide additional modalities for use in the occupational setting.

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Exposure to chemical carcinogens in rubber manufacturing remains a serious occupational health concern. Workers are exposed to these carcinogens via skin or inhalation. Rubber manufacturing work is associated with a high prevalence of dermatologic diseases such as eczema, allergic contact dermatitis and atopic dermatitis. The role that epidermal exposure plays in the development of malignancies historically associated with the rubber industry is less certain. We present a case relevant to this discussion and review the role of skin exposure in the rubber industry, providing an overview of the cutaneous and systemic manifestations of occupational exposures in modern day rubber workers.

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Although a significant number of nickel dermatitis cases are seen clinically, most cases are neither patch-tested nor captured in the literature, allowing for a prospering hidden nickel epidemic. We present a qualitative review utilizing the public medical library of peer-reviewed US adult nickel dermatitis cases with the goal of identifying regional variations and trends. Between 1962 and 2015, 18,251 adult patients were reported to be sensitized to nickel. The number of articles has exponentially increased over the past 5.5 decades as 4.3% of total cases were reported between the 1960s and 1990s, 31.3% between 2000 and 2009, and 64.3% were reported between 2010 and 2015. Geographically, 27 US states have had at least 1 reported case of adult nickel dermatitis. Rising rates of US nickel dermatitis noted in our findings further highlight the need for medical professionals, legislators, and manufacturers to advocate for regulation of nickel-containing items.

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In 2001, gold was named Contact Allergen of the Year. More than a decade later, we continue to face several challenges in defining the role of gold in contact allergy. First, interpretation of gold reactions in the setting of epicutaneous patch testing may be difficult; in addition to being a common irritant, gold may be associated with significantly delayed and persistent reactions. Second, although gold compounds are commonly positive on patch testing, clinical relevance is relatively low and may be challenging to determine. Third, the complex interplay between gold and the human body is still poorly understood. In this review, we provide an overview of the literature concerning gold patch test positivity and present recommendations for epicutaneous patch testing with gold.

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Medications can cause photosensitivity. Several of these medications, specifically the nonsteroidal anti-inflammatory medications (NSAIDs), may be taken by athletes to treat joint and muscle discomfort. Many athletic events occur outdoors, which in turn exposes athletes to sunlight. Athletes taking NSAIDs and performing extensive outdoor activities may be at higher risk for phototoxic drug reactions. Clinicians may wish consider the potential for patient photosensitivity when recommending prescription and non-prescription medications to outdoor athletes.

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Hand dermatitis is a common skin complaint. We use our hands to explore our environment; subsequently, our hands are in frequent contact with potential allergens and irritants. Patients with hand dermatitis may present to their allergist with this complaint. Approaching the diagnosis and treatment of hand dermatitis can be challenging, as both internal and external factors may contribute to the overall condition. Furthermore, the differential diagnosis of hand dermatitis is broad and the cause often multifactorial. Obtaining a thorough history and performing a focused examination may help the clinician differentiate between multiple causes of hand dermatitis. Numerous treatment options exist for hand dermatitis, and new potential treatments are in development as well. We aim to provide the allergist with a streamlined toolkit for help in the diagnosis and management of hand dermatitis.

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BACKGROUND: The systemic toxicity of phthalates has been extensively reported. Although rarely sensitizing, phthalates have been implicated in promoting the development of both atopy and contact dermatitis in animal models. Dermal absorption of phthalates may contribute to overall chemical burden. Infants may be particularly susceptible to chemical exposures. Baby skin care products may be a significant source of phthalate exposure. OBJECTIVE: We measured the phthalate content of 30 skin care products intended for babies and children. METHODS: Nineteen leave-on and 11 wash-off baby skin care products were analyzed for 17 unique phthalates by an independent laboratory using standard gas chromatographic mass spectrometry. RESULTS: Of 30 products tested, four had phthalate levels above the reporting limit (0.1-0.5 ppm); of these, only one had levels above 1 ppm (44 ppm). There was no statistical significance of phthalate detection in leave-on versus wash-off products (p = .578). CONCLUSION: The majority (26 of 30) of the baby skin care products analyzed did not have detectable phthalate levels. Four products had detectable phthalate levels. In baby skin care products, levels of the 17 phthalates tested are low overall, but occasional products may contain higher phthalate levels. Monitoring products to ensure safety standards are met may be warranted.

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Hand dermatitis is a common disease of the skin resulting in significantly decreased quality of life. Allergic contact dermatitis is a frequent cause of hand dermatitis. Recent studies have revealed that biocides used as preservatives are frequent allergens affecting the hands. This article reviews common biocides implicated in hand dermatitis.

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BACKGROUND: Hand dermatitis is a significant problem among inpatient nurses. Accurate population-based data on the prevalence and risk factors for hand dermatitis in this group are lacking. OBJECTIVE: To determine the prevalence of hand dermatitis in inpatient nurses at a US hospital. METHODS: Each nursing unit in a single hospital was visited twice by a single physician. All nurses working at the time of each visit were questioned and examined. No nurses were enrolled twice. RESULTS: Fifty-five percent (92 of 167) of the nurses had hand dermatitis. Among intensive care unit (ICU) nurses, the prevalence was 65% (35 of 54); among non-ICU nurses, the prevalence was 50% (57 of 113). In nurses with self-reported atopic dermatitis, the prevalence was 71% (12 of 17); in nurses without self-reported atopic dermatitis, it was 53% (80 of 150). Data collection on variables such as hand hygiene and glove use relied on subject recall and was considered unreliable. There was a low prevalence of atopic patients. CONCLUSIONS: Hand dermatitis affects over 50% of inpatient nurses. Hand dermatitis appears to be more common in the ICU setting and in nurses with a self-reported history of atopy.

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