The prevention of contact allergy

Introduction
Occupational contact dermatitis (OCD) is the leading cause of work related health problems in Europe, the US and many other countries. Depending on the kind of occupational exposure a proportion of up to 50% is allergic contact dermatitis (ACD).

Methods
Frequently, ACD at workplaces follows initial disease stages of irritant contact dermatitis (ICD). ICD facilitates the development of allergic sensitization. Thus, all attempts have to be made to avoid irritant precursor lesions, reducing cutaneous inflammation and strengthening skin barrier properties; the latter cannot be achieved by the use of local corticosteroids.

Results
Once ACD has occurred long term prognosis worsens, a chronic course and job loss may result even more likely. Obviously, the primary focus of ACD prevention has to be risk-avoidance by organisational and technical measures, involving manufacturers of potentially allergenic products like permanent wave solutions, cements, gloves, jewellery or cutting fluids. Recent data is available from countries where such initiatives in selected settings and occupations have proved extremely successful in reduction of allergy. Secondly, adequate skin protection by personal protective closing including suitable gloves is essential. Early detection of OCD and consecutive patient management is essential in order to avoid secondary ACD. All these measures will have to be accompanied by workers’ education, as frequently lack of information concerning allergenic hazards and their avoidance is the reason for insufficient skin protection. This particularly holds true in small and medium sized enterprises, as they frequently lack comprehensive health care programmes.

Discussion
Thus recently, in Europe the “healthy skin@work” campaign was launched as a co-ordinated scientific effort for the benefit of individuals at risk in order to raise awareness to the options of prevention. This is also an issue of a recent WHO occupational health activity concerning the global perspectives of OCD/ACD prevention.