Atopy in the Morphogenesis and Diagnosis, as a Risk Factor and in the Evaluation of Occupational Contact Dermatitis ofthe Hand

Overview

Atopy interferes with the etiopathogenesis of contact dermatitis of the hand (CDH) by clinical manifestations (atopic skindiathesis – ASDI, atopic eczema of the hand – AEH) or by its mere existence. Skin atopy at least doubles the effects of irritants andoccupational risk factors in occupational where HE/HD is a common problem and interferes causally with the development andcourse of occupational CDH.An above average number of atopic subjects was found in special out-patient clinics for occupational skin diseases (some30–40%), the reported prevalence of HE/HD in atopic subjects was in 1970–1994 14–78% and atopies in subjects with HE/HD insubjects with HE/HD in 1981–1995 27–54%.AEH has no specific pathognomic morphea, however a combination of major knowledge, careful morphological descript (inc.minor signs), topographic analysis, case-history of the working and domestic environment are essential to prevent major diagnosticproblems.Hanifin-Rajk’s criteria are accepted without reservations, the diagnostic ASDI score in the Erlangen concept uses not only minorsigns and helps to discover in time preventively silent atopic subjects. The threshold of irritational reactivity is reduced, irritantsproduce more easily irritational dermatitis of the hand (IDH) and trigger or cause deterioration of existing AEH. Atopic subjectshave at least contact sensitization (IVth type) similary as non-atopic subjects and subsequent allergy causes deterioration of theprognosis.Mucous atopy without atopic skin manifestations is not associated with in increased risk of IDH, frequency of HE/HD is usuallynot higher than in non-atopic subjects. Employees of various industrial branches incl. domestic activities with a history of AE havea higher prevalence of HE/HD than non-atopic subjects.Strong predictors of HE/HD include the presence of AE before the age of 15 years, the concomitant occurrence of eczemaanywhere on the skin and persisting dry/itching skin, weaker predictors include female sex, AE in the family-history and associatedrespiratory allergies. Important general risks include xerosis, water, work in humid environment, detergents, organic solvents,mineral oils, fuels, preservatives, disinfectants, cutting lubricants, cooling liquids and many other (non)industrial chemical subs-tances.Major diagnostic problems arise from differentiation of contact IDH following AEH or primary IDH atopic subjects. ContactHE can be accepted if AE has been cured for some time and if all criteria of an occupational character are met. Acceptance ofacute ID under the same conditions is problematic and can be ruled out unless there is major exposure. The paper emphasizes the necessity of systematic detection of atopic subjects during selection of a manual occupations, workingenlistment, domestic activities, and in all eczematous diseases of the hands, similarly as subsequent preventive care of atopicsubjects at their workplace.Finally the authors review possible causes of the etiopathogenesis of a chronic course and prognosis of (contact) eczematousdermatitis of the hand.

Key words:
atopy, hand, eczema/dermatitis, morphogenesis, atopic criteria, irritants, mucous atopy, epicutaneous tests, riskfactors, occupational character, evaluation