title: A farmer's occupational airborne contact dermatitis masqueraded by coexisting rosacea: delayed diagnosis and legal acknowledgement.
abstract: A rare case of coexistence of occupational airborne dermatitis with rosacea is presented in a 41-year-old female farmer. Her first dermatitis symptoms appeared at the age of 10 when she started helping her parents on the farm. Uncovered skin areas of the face, neck, décolleté, forearms and the hands gradually became involved. The dermatitis symptoms were provoked by agricultural dusts (especially of flax and dried herbs). For the subsequent 30 years, the work-related disease remained undiagnosed due to the lack of pre-employment and periodical health check in agriculture. She also suffered from protein contact dermatitis of the hands from cow epithelium. About 20 years after the onset of airborne dermatitis, rosacea developed, possibly secondary to the prolonged treatment. Diagnostic tests carried out at our department confirmed hypersensitivity to occupational allergens: type I allergy to storage mites, moulds, and cow epithelium. A cutaneous late-phase reaction on prick tests and serum precipitins to the bacterium Pantoea agglomerans (Erwinia herbicola) also were found. Among non-occupational hypersensitivities, type I allergy to house dust mites and contact allergy to methylchloroisothiazolinone/methylisothiazolinone (Kathon CG) was found. In connection with these results, the significance of agricultural dusts in farmers' airborne dermatitis is discussed. Also presented are the problems with obtaining acceptance from the State Sanitary Authority for qualification of this case as an occupational disease, which was due to the coexistence of the non-occupational rosacea. Discussed is also the problem of pre-employment exposure to occupational allergens among farmers' children, and the difficulties with delivering occupational health services to self-employed farmers.
authors.affiliation: Department of Occupational Biohazards, Institute of Agricultural Medicine, Lublin, Poland. Radoslaw.Spiewak@plusnet.pl
authors.forename: Radosław
authors.initials: R
authors.lastname: Spiewak
authors.forename: Jacek
authors.initials: J
authors.lastname: Dutkiewicz
mesh_terms: D000328:Adult; D000485:Allergens; D000818:Animals; D002417:Cattle; D003877:Dermatitis, Contact / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D004391:Dust; D004608:Eligibility Determination; D005260:Female; D019597:Flax; D005658:Fungi; D006801:Humans; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D016273:Occupational Exposure; D012393:Rosacea / Q000175:diagnosis* / Q000473:pathology*; D014942:Workers' Compensation
chemical_list: D000485:Allergens; D004391:Dust