Occupational eczema is a chronic sluggish inflammatory skin disease that develops during professional activity due to exposure to irritating substances. It often occurs against the background of allergic dermatitis. It is characterized by redness of the skin, the formation of bubbles and papules, wetness and itching. In the diagnosis of professional eczema, the main importance is to determine the factors provoking the disease by interviewing the patient and conducting allergic tests. Treatment is carried out with antihistamines, sedatives, glucocorticoids, local antipruritic and astringent agents. Physiotherapy, laser therapy and cryotherapy on the affected areas of the skin are widely used.
L30.8 Other refined dermatitis
Occupational eczema is an allergodermatosis etiologically associated with the influence of production factors (chemical, physical, bacteriological). The disease affects the adult able-bodied population, which makes eczema a socially significant multidisciplinary problem. Medical aspects related to professional eczema are studied by practical dermatology, allergology, occupational pathology. When identifying signs of the disease, the issue of the employee’s professional suitability is resolved.
Most often, workers of the chemical, pharmaceutical, machine-building industries, as well as medical institutions suffer from professional eczema. The disease develops as a result of allergic sensitization of the body with constant exposure to harmful occupational factors. Moreover, the monovalent nature of sensitization at the beginning of the disease gradually transforms into a polyvalent one, leading to an allergic reaction to various exogenous influences.
The factors causing the development of professional eczema include: chromium and nickel salts, some dyes, cement, turpentine, formaldehyde, synthetic epoxy resins, bakelite glue and other chemicals. The occurrence of professional eczema is facilitated by moist or dry air of the workplace, exposure to dust on the skin, frequent injury to the skin.
People with liver and gastrointestinal diseases (chronic hepatitis, cirrhosis, cholecystitis, pancreatitis, peptic ulcer), endocrine disorders (diabetes mellitus, endocrine obesity), vegetative dysfunction (vegetative-vascular dystonia), non-sanitized foci of chronic infection (chronic tonsillitis, otitis, sinusitis, periodontitis), allergic diseases (pollinosis, allergic rhinitis, bronchial asthma).
Occupational eczema, as a rule, occurs against the background of already existing allergic contact dermatitis. It is characterized by a long-term chronic course, in which periods of exacerbation and remission are distinguished. Remission occurs when the exposure to harmful production factors ceases when the patient moves to another job or on vacation. Exacerbation of professional eczema is observed with repeated exposure to disease-provoking factors.
The clinical picture of professional eczema is similar to the manifestations of true eczema. Exacerbation begins with redness and puffiness of the skin, on which vesicles and papules then appear. The process is characterized by pronounced itching. The opening of the bubbles is accompanied by the formation of small erosions and wetness. At the beginning of professional eczema, inflammatory skin changes occur only in areas directly in contact with the provoking factor. With repeated exacerbations, other areas of the skin are also involved in the process.
Over time, skin thickening occurs in the lesions with an increase in the skin pattern and the appearance of inflammatory cyanotic coloration. There is peeling and dryness of the skin, cracks form on it. The patient is concerned about burning and severe itching. It is possible to attach an infection with the development of streptococcal impetigo or pyoderma.
Occupational eczema is diagnosed on the basis of anamnesis, examination, dermatoscopy and allergic tests. To identify the connection of the disease with professional activity and to determine possible factors provoking it, a dermatologist conducts a thorough interview of the patient. Then an allergological examination is performed with substances that affect the patient during his professional activity. It allows you to determine which factors are allergens.
Detection of foci of chronic infection and concomitant eczema diseases may require consultation with a gastroenterologist, endocrinologist, examination by an otolaryngologist and dentist, ultrasound of the abdominal cavity, gastroscopy and other examinations.
Despite the variety of modern methods of treatment that dermatology possesses, the therapy of professional eczema is not an easy task. Unlike allergic dermatitis, the manifestations of professional eczema do not go away when the factor provoking them is eliminated. This is due to the polyvalent nature of sensitization and requires adequate complex therapy.
In the treatment of professional eczema, glucocorticosteroids are used: prednisone, triamcinolone, dexamethasone, corticotropin. Antihistamines (mebhydroline, diphenhydramine, promethazine) are prescribed to reduce the sensitization of the body and itching. Methods of extracorporeal hemocorrection have a good effect in terms of hyposensitization. Vitamin therapy is recommended, with severe itching — sedatives.
Locally, in the acute period of professional eczema, Burov liquid, 0.1% copper sulfate, 1% tannin, 0.25% silver nitrate, 0.1% zinc sulfate is prescribed. Itching has an itchy effect of 1% r-r citric acid, 1% r-r menthol, ointment or paste with diphenhydramine. After the acute period subsides, indifferent pastes and ointments are used with the addition of ichthyol, naphthalan, sulfur or salicylic acid.
Among the methods of physiotherapy for professional eczema, diadynamotherapy, electroson, ultrasound, phonophoresis, microwave therapy, inductothermy, mud therapy and therapeutic baths with a solution of tannin, eucalyptus, oak bark, radon baths are used. Cryotherapy and laser treatment of eczema are used.