Occupational Aspects of Atopic Eczema with Emphasis on Atopic Hand Eczema

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Atopic Eczema (AE) is a common, chronically relapsing, inflammatory skin disease, clinically characterized by typically distributed eczematous lesions, dry skin, intense pruritus, and a wide variety of pathophysiologic aspects [9]. There is strong evidence that the prevalence of the disease has increased substantially over the past decades [7], which seems to be associated with a change in environmental and lifestyle factors, especially inWestern countries [8]. The clinical phenotype that characterizes atopic eczema is the product of interactions between susceptibility genes, the environment, defective skin barrier function, and immunologic responses [23]. Children with atopic eczema (AE) often struggle at school [35], and adults with AE do their best to keep their job [22]. Looking at AE as a disease with many predisposing, precipitating, and perpetuating factors [40], it is obvious that exogenous factors such as irritants and allergens can precipitate and perpetuate the condition.While it is unlikely that occupational factors are predisposing (although a role of occupational factors operating on the fetus in utero cannot be ruled out), there is a vast body of literature pointing towards certain jobs causing more skin trouble for people with AE. A preliminary reading of this literature generates questions, which one would like to have answered before one is convinced that there is really a problematic association between AE and occupation. One question, for example, is whether the cases described in the literature really have AE. In other words, was AE correctly assessed, without observer bias? Another question is how the cases ended up in their present jobs. In other words, to what extentmayAE have influenced the fact that patients selected or avoided a particular occupation. One would also like to know more about those with AE who do not seem to have a (skin) problem within their occupation; perhaps they use adequate protection measures at work or avoid domestic exposure, or theymay have amilder or different type of AE. Various issues such as a discussion on diagnostic criteria for AE, will be dealt with elsewhere in this book. For the time being, a variability in the assessment of AE, which affects the interpretation of most studies, must be accepted. The following will show that a certain degree of selection and observation bias is inevitable inmost published studies dealing with occupation and AE.