Contact dermatitis in the United States: epidemiology, economic impact, and workplace prevention.

Contact dermatitis in the United States poses a significant public health concern. This article provides a definition of contact dermatitis and its associated risk factors. The authors discuss the epidemiology of occupational contact dermatitis including its incidence and prevalence, and describe how estimates are calculated in the United States. The burden of disease on the individual, and its economic impact and cost to society, are also elucidated. A review of preventive measures to help reduce contact dermatitis in the workplace and an additional section on patch testing concludes the article.

Economic burden of dermatitis in US workers [corrected].

OBJECTIVE: To estimate the economic burden associated with dermatitis in those aged 16 to 65 years and working in seven industry sectors (DW). METHODS: The 2004 Medical Expenditure Panel Survey and the cost-of-illness method, which aggregates health care costs and productivity losses, were used. RESULTS: The economic burden of DW was ~$1.2 billion, representing 10.5% of the cost of all skin diseases and disorders (SDD). In all private industry (ie, the sum of the seven sectors examined), cost per employed person was ~$11 for DW and $109 for SDD. In the all-services sector, one of the seven examined, cost per employed person was ~$15 for DW and $113 for SDD. CONCLUSIONS: This study provides the first published estimate of the economic burden of DW, based on a representative sample of the US population.

[Economic aspects of allergies: status and prospects for Austria]. / Volkswirtschaftliche Aspekte von Allergien. Ausgangslage und Ausblick für Osterreich.

According to epidemiological studies there has been an increase of allergic diseases and corresponding costs. Health economics analyses intend to offer decision guidance towards a more efficient and effective resource distribution, in the conflicting relationship of medicine and economics. In analogy with the "Global Initiative for Asthma (GINA)-study", one arrives at costs of Euro 227.7-455.4 million for the Austrian health system in 2004 for asthma. Direct costs of allergies in general are in part available from health insurance carriers. Between 1998 and 2005 the number of nasal preparations and antiobstructive therapies prescribed rose by 15% and 50% respectively, whilst the costs of these drugs dramatically increased by 96% and 70% respectively. Expenditure on anti-histamines rose by 31% between 2002 and 2004, whereas costs of topical and systemic anti-allergic drugs remained constant. Costs of allergies also include additional costs carried by the individuals affected, which must be added to those covered by the national health insurance carriers. Furthermore, patients with allergies more frequently turn to alternative and complimentary medicine to treat their condition (above all homeopathic remedies, massages and ointments) than people not suffering from allergies. Indirect costs due to allergies are, for instance, those caused by sick leave and loss of productivity. A continual systematic evaluation of available data on allergies in Austria could contribute to more effective implementation of medicines.

Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987-1998.

BACKGROUND: Occupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL. METHOD: Occupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987-1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed. RESULTS: The claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants). CONCLUSIONS: In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common.

Compensatability and contact dermatitis in the canning industry.

If reports from the Workmen's Compensation Commissioner are compared with international figures, dermatitis in South African industry appears to be underestimated. Compensation for occupational dermatitis in South Africa relies on the presence of a positive patch test. A prevalence study at a canning factory in the western Cape showed high rates of dermatoses. No association could be shown between dermatitis, intertrigo or chronic paronychia and patch-test positivity. It is argued that patch-test positivity is purely coincidental to the dermatoses and that patch testing has little role to play where the majority of occupational dermatoses are irritant in nature. Reform of the system of compensation for occupational skin disorders is urgently needed and should be integrated in workplace-based preventive and curative programmes.

Contact dermatitis and workers' compensation: criteria for establishing occupational causation and aggravation.

Contact dermatitis is the most common form of occupationally acquired skin disease. Eligibility for coverage under the workers' compensation laws of all states requires only reasonable probability that dermatitis directly resulted from, or was aggravated by, employment. The responsibility for this determination ultimately resides with the examining physician, who must critically evaluate the medical history and cutaneous findings. This article proposes seven objective criteria that may be used to assess the probability of a causal relationship with employment.

Permanent disability from skin diseases. A study of 564 patients registered over a six year period.

An analysis of causes of permanent disability indicates which diseases most frequently result in chronicity and inability to work. A nation-wide study comprising all applications for permanent disability pension due to skin diseases in the period 1970--1976 was carried out. A total of 564 persons applied. The most common diagnosis was contact dermatitis followed by psoriasis and connective-tissue diseases. Allergic contact dermatitis alone accounted for 222 cases. 70% of these were due to nickel and chromium allergy. In all the diagnostic groups there was a preponderance of women except for hyperkeratotic hand eczema and genodermatoses. The frequency of the individual disorders in the present study is discussed in relation to their prevalence and prognosis in the literature.