Fourth Edition
James G
Marks
Jr
MD
Professor Department of Dermatology The Pennsylvania State University College of Medicine Milton S. Hershey Medical Center
Hershey,
Pennsylvania,
USA
Bryan E
Anderson
MD
Professor Department of Dermatology The Pennsylvania State University College of Medicine Milton S. Hershey Medical Center
Hershey,
Pennsylvania,
USA
Vincent A
DeLeo
MD
Professor Emeritus Department of Dermatology Mount Sinai School of Medicine and Clinical Professor at Keck School of Medicine University of Southern California
Los Angeles,
California,
USA
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Contact and Occupational Dermatology
First Edition: 1992 (Published by Mosby)
Second Edition: 1997 (Published by Mosby)
Third Edition: 2002 (Published by Mosby)
Fourth Edition: 2016
9789351529361
Printed at
5Preface
The purpose of the fourth edition of Contact and Occupational Dermatology remains the same as for the previous editions. This introductory textbook is intended to be used by clinicians in their everyday practice when evaluating patients with contact and occupational dermatoses. We hope the logical approach to the patient and the “user-friendly” format presented herein are helpful in managing these patients.
The fourth edition is organized for the physician to use in the diagnosis and management of suspected contact and/or occupational dermatitis. The evaluation and management of these patients requires (1) a detailed history and skin examination, (2) patch testing with trays of allergens, (3) education of the patient by providing exposure and Contact Allergen Management Program (CAMP) lists, and (4) appropriate therapy and prevention.
The contact dermatitis patient should be scheduled for an appointment when enough time is allotted to take an extended history (Chapters 2 and 13) and when assistance is available to apply patch tests (Chapter 3). We recommend that readers photocopy the history form that is provided in Chapter 2 and use it for their patients. In addition to the history, the distribution of dermatitis is important in directing patch testing, and Chapter 4 suggests which trays to use based on regional dermatitis distribution. In patients with suspected occupation-induced contact dermatitis, the selection of patch test trays is directed by the patient's occupation (Chapter 15).
The allergens in the text have been grouped together in Chapters 5 through 11 based on the tray in which they are found. When patch testing patients, it is helpful to think in terms of trays (e.g. Standard) rather than specific allergens (e.g. Quaternium-15). With the exception of a few allergens, such as Nickel, it is generally impossible to predict which specific chemical is causing the allergic contact dermatitis.
A patch test recording form is provided in Chapter 3 so that a standard format is used to document patch test reactions. Once a positive patch test result has been obtained, the exposure history is correlated with the allergen to determine relevance of the allergen to the patient's dermatitis. The relationship may not be obvious. The allergen exposure lists are helpful for the patient to pinpoint sources of the allergen that is causing dermatitis, as well as for avoiding contact with allergen in the future. We often review the literature concerning a particular allergen and recommend reading the section of the book that discusses the allergen.
Once an accurate diagnosis is made, appropriate therapy and preventive measures can be instituted (Chapters 2 and 14). Often avoidance of the irritant or allergen is curative. This, however, may not be easy (for example, in the case of a worker who may need to change professions). In other patients, judicious use of chronic treatment, for example, topical steroids, is necessary to control the dermatitis. It must be remembered that the prognosis of occupationally induced skin disease is guarded.
We hope this text helps the reader evaluate and manage the contact dermatitis patient by integrating the history, the distribution of dermatitis, and the occupation when choosing trays of allergens for patch testing. When we have a positive patch test reaction, we read more about 6the allergen. We review the allergen exposure list with the patient and provide a copy of this list. For some patients, new or rare allergens may be discovered. These cases require further investigation in more encyclopedic textbooks and in journal articles.
We thank those individuals who used the previous editions. We have incorporated many of their suggestions into this fourth edition. We have purposely not expanded the book dramatically since there are excellent encyclopedic texts on contact dermatitis that have been published. We think the concise and organized discussions with up-to-date information are sufficient for use with most patients encountered by the readers of this book.
We wish to acknowledge those people whose efforts have contributed greatly to producing this edition. Our families, again, gave us the worthwhile support and time necessary to write this volume.
James G Marks Jr MD
Bryan E Anderson MD
Vincent A DeLeo MD
7Acknowledgments