The National Institute of Occupational Safety and Health (NIOSH) included dermatologic disorders on its list of the top 10 work-related diseases and injuries in the United States. Ten percent to 15% of health hazard evaluations by NIOSH involve skin complaints. The economic impact of work-related dermatologic conditions is in the hundreds of millions of dollars per year. Dermatologic injuries from trauma or brief exposure to toxic agents constitute approximately 30% of all injuries. The most common injuries are due to lacerations, punctures, abrasions, and burns. Approximately 40% of all occupational illness is due to skin disease, with about a quarter of these resulting in an average work loss of 10 to 12 days.
Thirty percent of occupational injury and 40% of occupational disease are dermatologic.
Contact dermatitis accounts for 90% of occupational skin disease, with the majority of cases being irritant. The clinical course for occupationally induced contact dermatitis is relatively poor, and this causes the worker to have a guarded prognosis: 25% have clearance of the dermatitis, 50% have improvement but with periodic recurrence, and 25% have persistent and severe dermatitis despite a change in jobs and therapeutic intervention. This creates a significant amount of human suffering, as well as having a negative impact on the workplace and society that results from lost worker productivity, medical care, and disability payments. The highest number of occupational skin diseases from the Bureau of Labor Statistics 1984 Annual Survey occurred in the manufacturing sector, whereas the highest incidence was in the agricultural, forestry, and fishing industry. In 1993 the Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics reported an estimated rate of occupational dermatitis of 1.12/10,000 workers. The largest number of cases occurred in health services, whereas the highest rate was in agricultural crops. The occupation with the largest number of cases was non-construction laborers. Cleaning and polishing agents caused the largest number of cases. More recently workers compensation claims have been used for surveillance of occupational disease to identify specifically affected workers and employers. This strategy has identified high-risk companies and targeted the most frequently implicated occupations and causal agents within those companies.
Occupational skin disease has a guarded prognosis. Despite proper treatment, only 25% of patients have clearance of the dermatitis, even with a change in jobs.
The development of occupational skin disease is multi-factorial in origin and results from the interaction of predisposing risk factors in the worker and agents within the work environment that cause disease.
- Marks JG, Elsner P, DeLeo VA: Etiology of Occupational Skin Disease. Chapter in Contact and Occupational Dermatology Third Edition, Chapter 12, Mosby St. Louis, pp 303-313, 2002.
