Occupational Skin Disease Associated With Chemical Exposure: Causal Assessment, Prevention, and Medico-Legal Documentation
DOI:
https://doi.org/10.64784/343Palabras clave:
occupational dermatoses, occupational contact dermatitis, chemical exposure, irritant contact dermatitis, allergic contact dermatitis, wet work, patch testing, occupational allergens, occupational medicine, occupational health, workplace prevention, Mathias criteria, medico-legal documentationResumen
Occupational dermatoses associated with chemical exposure represent an important clinical and occupational health problem due to their frequency, recurrent nature, functional consequences, and medico-legal implications. This study analyzed the relationship between workplace exposure and the development or aggravation of occupational skin disease through an integrated framework combining dermatological diagnosis, occupational exposure assessment, preventive strategies, and causal documentation. Particular attention was given to irritant and allergic contact dermatitis, wet work, individual susceptibility, occupational allergens, patch testing, and the Mathias criteria. The reviewed evidence showed that atopic dermatitis and wet work are relevant risk factors for occupational irritant contact dermatitis, while the profile of occupational allergens varies according to professional activity and includes epoxy resins, rubber accelerators, formaldehyde, metals, preservatives, and other chemical agents. Patch testing was identified as a fundamental diagnostic tool; however, positive reactions required correlation with actual workplace exposure, clinical distribution, temporal relationship, and occupational relevance. Preventive interventions, including moisturizers, barrier preparations, educational programs, personal protective equipment, and exposure reduction, showed potential to decrease occupational hand dermatitis, although the effectiveness of individual measures varied across studies. The evaluation of occupational causality was strengthened when clinical findings, exposure history, improvement away from work, re-exposure, and diagnostic testing were considered together. The Mathias criteria provided a structured framework for supporting causal assessment and medico-legal documentation. Overall, the findings support a multidisciplinary approach in which dermatology, occupational medicine, prevention, and medico-legal evaluation are integrated to improve recognition of occupational dermatoses, reduce recurrent exposure, and provide consistent documentation for clinical and occupational decision-making.
Referencias
• Behroozy, A., & Keegel, T. G. (2014). Wet-work exposure: A main risk factor for occupational hand dermatitis. Safety and Health at Work, 5(4), 175–180. doi:10.1016/j.shaw.2014.08.001
• Chu, C., Marks, J. G., Jr., & Flamm, A. (2020). Occupational contact dermatitis: Common occupational allergens. Dermatologic Clinics, 38(3), 339–349. doi:10.1016/j.det.2020.02.002
• Hollins, L. C., & Flamm, A. (2020). Occupational contact dermatitis: Evaluation and management considerations. Dermatologic Clinics, 38(3), 329–338. doi:10.1016/j.det.2020.02.001
• Holness, D. L. (2019). Occupational dermatosis. Current Allergy and Asthma Reports, 19(9), 42. doi:10.1007/s11882-019-0870-6
• Ingber, A., & Merims, S. (2004). The validity of the Mathias criteria for establishing occupational causation and aggravation of contact dermatitis. Contact Dermatitis, 51(1), 9–12. doi:10.1111/j.0105-1873.2004.00273.x
• Jacobsen, G., Rasmussen, K., Bregnhøj, A., Isaksson, M., Diepgen, T. L., & Carstensen, O. (2022). Causes of irritant contact dermatitis after occupational skin exposure: A systematic review. International Archives of Occupational and Environmental Health, 95(1), 35–65. doi:10.1007/s00420-021-01781-0
• Karagounis, T. K., & Cohen, D. E. (2023). Occupational hand dermatitis. Current Allergy and Asthma Reports, 23(4), 201–212. doi:10.1007/s11882-023-01070-5
• Lampel, H. P., & Powell, H. B. (2019). Occupational and hand dermatitis: A practical approach. Clinical Reviews in Allergy & Immunology, 56(1), 60–71. doi:10.1007/s12016-018-8706-z
• Lee, J., Lin, R., & Maderal, A. (2025). Update on occupational dermatitis: Reviewing toxic substances from OSHA standards. International Journal of Dermatology, 64(1), 72–78. doi:10.1111/ijd.17413
• Lund, T., Petersen, S. B., Flachs, E. M., Ebbehøj, N. E., Bonde, J. P., & Agner, T. (2020). Risk of work-related hand eczema in relation to wet work exposure. Scandinavian Journal of Work, Environment & Health, 46(4), 437–445. doi:10.5271/sjweh.3876
• Mathias, C. G. T. (1989). Contact dermatitis and workers’ compensation: Criteria for establishing occupational causation and aggravation. Journal of the American Academy of Dermatology, 20(5 Pt 1), 842–848. doi:10.1016/S0190-9622(89)70096-7
• Milam, E. C., Nassau, S., Banta, E., Fonacier, L., & Cohen, D. E. (2020). Occupational contact dermatitis: An update. The Journal of Allergy and Clinical Immunology: In Practice, 8(10), 3283–3293. doi:10.1016/j.jaip.2020.08.004
• Nicholson, P. J., Llewellyn, D., & English, J. S. (2010). Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis, 63(4), 177–186. doi:10.1111/j.1600-0536.2010.01763.x
• Saary, J., Qureshi, R., Palda, V., DeKoven, J., Pratt, M., Skotnicki-Grant, S., & Holness, L. (2005). A systematic review of contact dermatitis treatment and prevention. Journal of the American Academy of Dermatology, 53(5), 845.e1–845.e13. doi:10.1016/j.jaad.2005.04.075
• Schubert, S., Geier, J., Skudlik, C., Reich, A., Hansen, A., Buhl, T., Mempel, M., Schön, M. P., John, S. M., & Brans, R. (2020). Relevance of contact sensitizations in occupational dermatitis patients with special focus on patch testing of workplace materials. Contact Dermatitis, 83(6), 475–486. doi:10.1111/cod.13688
• Schütte, M. G., Tamminga, S. J., de Groene, G. J., Kezic, S., & van der Molen, H. F. (2023). Work-related and personal risk factors for occupational contact dermatitis: A systematic review of the literature with meta-analysis. Contact Dermatitis, 88(3), 171–187. doi:10.1111/cod.14253
• Sedeh, F. B., Michaelsdóttir, T. E., Jemec, G. B. E., Mortensen, O. S., & Ibler, K. S. (2023). Prevalence, risk factors, and prevention of occupational contact dermatitis among professional cleaners: A systematic review. International Archives of Occupational and Environmental Health, 96(3), 345–354. doi:10.1007/s00420-022-01937-6
• Suneja, T., & Belsito, D. V. (2008). Occupational dermatoses in health care workers evaluated for suspected allergic contact dermatitis. Contact Dermatitis, 58(5), 285–290. doi:10.1111/j.1600-0536.2007.01315.x
• Visser, M. J., Verberk, M. M., van Dijk, F. J. H., Bakker, J. G., Bos, J. D., & Kezic, S. (2014). Wet work and hand eczema in apprentice nurses; Part I of a prospective cohort study. Contact Dermatitis, 70(1), 44–55. doi:10.1111/cod.12131
• Wiszniewska, M., & Walusiak-Skorupa, J. (2015). Recent trends in occupational contact dermatitis. Current Allergy and Asthma Reports, 15(7), 43. doi:10.1007/s11882-015-0543-z
