Occupational Contact Dermatitis 英文参考文献.docVIP

ORIGINAL ARTICLE OccupationalContactDermatitis DenisSasseville,MD,FRCPC Occupationalcontactdermatitisaccountsfor90%ofallcasesofwork-relatedcutaneousdisorders.Itcanbedividedintoirritantcontact dermatitis,whichoccursin80%ofcases,andallergiccontactdermatitis.Inmostcases,bothtypeswillpresentaseczematouslesions on exposed parts of the body, notably the hands. Accurate diagnosis relies on meticulous history taking, thorough physical examination,carefulreadingofMaterialSafetyDataSheetstodistinguishbetweenirritantsandallergens,andcomprehensivepatch testingtoconfirmorruleoutallergicsensitization.Thisarticlereviewsthepathogenesisandclinicalmanifestationsofoccupational contactdermatitisandprovidesdiagnosticguidelinesandarationalapproachtomanagementoftheseoftenfrustratingcases. Keywords: allergiccontactdermatitis,irritantcontactdermatitis,occupational,workrelated IrritantContactDermatitis T he skin is our primary interface with the external environment and, in general, performs quite effi- Irritantcontactdermatitis(ICD)isthemostcommontype of occupational skin disorder, traditionally held account- able for approximately 80% of all cases (Table 2). It is causedbythedirectcytotoxicactionoftheoffendingagent on the cells of the epidermis and dermis. Visible skin changes are the result of alterations in the epidermal barrier,cellulardestruction,transepidermal waterloss,and inflammation secondary to non-immunologic release of vasoactive peptides and proinflammatory cytokines. Irritants are mostly chemicals, in solid, liquid, or gaseousphase,butalsoincludemineralorvegetalparticles that abrade or get imbedded in the skin. Immediate irritants are corrosive substances that produce chemical burns within minutes to hours of a single exposure. Cumulative irritants are weaker substances such as detergents or solvents that require repeated application to exert their noxious effects (Table 3). The threshold for irritation varies from one individual to another, and a single individual m