title: Occupational Contact Dermatitis in North American Production Workers Referred for Patch Testing: Retrospective Analysis of Cross-Sectional Data From the North American Contact Dermatitis Group 1998 to 2014.
abstract: BACKGROUND
  Little is known about the epidemiology of contact dermatitis in production workers (PWs).
  
  
  OBJECTIVE
  The aims of this study were to estimate the prevalence of contact dermatitis and characterize clinically relevant and occupationally related allergens among North American PWs undergoing patch testing.
  
  
  METHODS
  This was a retrospective cross-sectional analysis of North American Contact Dermatitis Group data from 1998 to 2014.
  
  
  RESULTS
  Of 39,332 patch-tested patients, 2732 (7.0%) were PWs. Among PWs, most were men (62.4%) and white (83.9%). A history of childhood eczema was uncommon (11.3%). Prevalent occupations included machine operators (27.3%); fabricators, assemblers, and hand-working occupations (16.8%); and precision metalworking occupations (16.1%). The most frequent sites of dermatitis were the hands (53.8%) and arms (29.4%), which were significantly more commonly affected compared with non-PWs (P < 0.0001). Occupationally related skin disease, allergic contact dermatitis, and irritant contact dermatitis were also significantly more common in PWs (49.9% vs 10.6%, 58.9% vs 53.7%, and 32.7% vs 25.7%, respectively; all Ps < 0.0001). Epoxy (15.3%), thiuram mix (8.3%), carba mix (8.1%), formaldehyde (6.3%), and cobalt (5.9%) were the most frequent occupationally related allergens. The top allergen sources included adhesives/glues (16.0%), metalworking fluids/cutting oils (6.8%), and coatings (6.3%).
  
  
  CONCLUSIONS
  Production workers had a high rate of occupationally related skin disease, as well as irritant and allergic contact dermatitis. Involvement of exposed body areas was common. Frequently identified allergens included adhesives/glues, rubber accelerators, metals, and preservatives.
authors.affiliation: From the *HCMC Parkside Occupational and Contact Dermatitis Clinic; †Department of Dermatology, Minneapolis Veterans Affairs Medical Center; and ‡Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN; §Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; ∥Dartmouth-Hitchcock Medical Center, Lebanon, NH; ¶Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada; #Department of Dermatology, Columbia University, New York, NY; **Ohio State University, Columbus; ††University of Louisville, KY; ‡‡Department of Dermatology, Cleveland Clinic, OH; §§Associates in Dermatology, Fort Myers, FL; ∥∥Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles; ¶¶Department of Dermatology, Pennsylvania State University, State College; ##Division of Dermatology, University of Ottawa, Ontario, Canada; ***Department of Dermatology, University of California, San Francisco; and †††Department of Dermatology, University of Cincinnati, OH.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Warshaw
authors.forename: Solveig L
authors.initials: SL
authors.lastname: Hagen
authors.forename: Joel G
authors.initials: JG
authors.lastname: DeKoven
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Zug
authors.forename: Denis
authors.initials: D
authors.lastname: Sasseville
authors.forename: Donald V
authors.initials: DV
authors.lastname: Belsito
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Zirwas
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fowler
authors.forename: James S
authors.initials: JS
authors.lastname: Taylor
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Fransway
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeLeo
authors.forename: James G
authors.initials: JG
authors.lastname: Marks
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Pratt
authors.forename: Howard I
authors.initials: HI
authors.lastname: Maibach
authors.forename: C G Toby
authors.initials: CGT
authors.lastname: Mathias
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D017453:Dermatitis, Irritant / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D066192:Manufacturing Industry; D009656:North America / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D010328:Patch Tests; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D000078329:Workforce
chemical_list: D000485:Allergens