Occupational Hand Dermatitis

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Occupational Hand Dermatitis

• Dr Lorne D. Hurst FRCP(C)

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WCB

• You do provide
• Professional evaluation
• Professional opinion

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WCB

• You do not determine
• Causation
• Compensability
• Nor disability
• ( done by a case manager)

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WCBkeep answers

• Organized
• Concise
• Yet global
• Substantiate with examples
• respectful defensible to patient and WCB

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WCB

• When did it start
• What makes it better
• What makes it worse
• Relevant PMHx

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WCB

• What do you see
• How has it changed
• with - alteration of work
• - therapy
• ? risk of serious sequelae

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PHIA

• If patient makes WCB claim
• you do not need a release form to send info to
  WCB ( but let patient know what is being released)

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• Hand Eczema
• Affects about 1 of the population
• Especially those involved in wet work

• Hand Dermatitis

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complaint

• Itchy
• Painful
• Bleeding

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exam

• Acute
• Erythema
• Edema
• Vesiculation

• Chronic
• Hyperkeratotic
• Desquamation
• Fissuring

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• Irritant
• Localized to site of contact
• Acute becomes chronic

• Allergic
• Spreads beyond site of contact
• New acute areas developing to periphery

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Skin biopsy

• Irritant and Allergic contact derm have similar
  histologic appearance (/- eosinophils) so seldom
  helpful

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Therapy

• Review MSD sheets( Patch testing)
• Remove offending agent
• Barrier creams
• Gloves latex (allergy), vinyl (tear), nitrile
  ()

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Therapy

• Topical steroids (/- tar)
• - initially short duration with potent
  steroid, 1-4 weeks
• - taper to low strength for a long period
• - ensure adequate quantity
• Systemic antibiotics

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Therapy

• Systemic
• steroids ( short term/rebound)
• Cell cept, low SE but
• Methotrexate, toxic

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Therapy

• UVB time consuming
• PUVA possible increase SCC
• Radiation possible increase SCC