The development of occupational contact dermatitis depends on a combination of endogenous (individual susceptibility) and exogenous factors (exposure). Except for an exposure to strong sensitizing substances, occupational contact dermatitis usually develops in steps, frequently starting with atopic hand dermatitis, followed by irritant dermatitis leading to sensitization and eventually allergic contact dermatitis (multistep eczema).
Therefore, susceptibility to irritant dermatitis is of high importance in the natural history of occupational contact dermatitis. The skin of different individuals differs in susceptibility to irritation in a remarkable manner, and a number of individual factors influencing the development of irritant dermatitis that have been identified include age, genetic background, anatomical region exposed and preexisting skin disease.
Although experimental studies did not support any sex difference of irritant reactivity, females turned out to be at risk in some epidemiological studies. Probably increased exposure to irritants at home, caring for children under the age of 4 years, lack of a dishwashing machine and preference of high-risk occupations contribute to the higher incidence of irritant contact dermatitis in females. Recent population-based studies correcting for these factors could not confirm a gender-dependent increase in risk .
The best established individual risk factor that turned out of several studies about occupational hand eczema is atopic dermatitis [18-20]. Age is related to irritant susceptibility in so far as irritant reactivity declines with increasing age. This is true not only for acute but also for cumulative irritant dermatitis . Fair skin, especially skin type I, is supposed to be the most reactive to all types of irritants, and black skin is the most resistant .
The clinical manifestation of irritant contact dermatitis is also influenced by type and concentration of irritant, solubility, vehicle, and length of exposure , as well as temperature and mechanical stress. During the winter months, low humidity and low temperature decrease the water content of the stratum corneum and increase irritant reactivity .
Table 4. Prevention strategies in occupational contact dermatitis
Encapsulation of irritants/allergens Exchange of irritants/allergens Organizational means
Optimization of workflow to reduce exposure to irritants/allergens Personal skin protection Protective garments Gloves
Skin protection products Education
Awareness of skin hazards
Motivation for avoidance and use of skin protection
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