Experience suggests that many cases of skin disease are diagnosed as occupational when, in reality, they are either completely non-occupational in origin or at least have a significant non-occupational element among the causative factors. Not infrequently action is taken that is counter productive. Inappropriate treatment may actually increase the skin problem. Redeployment or even dismissal may have serious consequences for the employee, be unnecessary and, in many countries, result in significant costs for compensation. At the least there will be retraining costs, either for the affected employee or for his or her replacement.

One of the main reasons for this is that the investigation of the skin problem and the clinical diagnosis often do not take all relevant factors into account. Assumptions are made that may not contribute to the correct assessment of the problem. Even dermatologists are not immune from producing diagnoses that are, at best, not relevant and that sometimes may be misleading.

What is required is a structured approach that attempts to identify all the potentially relevant factors and evaluate their significance. Where clinical diagnosis is sought it must be on the basis of a knowledge by the medical practitioner, preferably a dermatologist, of these factors and an appreciation of their import. Once the diagnosis has been made its relevance to the actual problem cannot be taken for granted, but must be carefully established. Only then can action be considered that hopefully will keep the worker in his or her job but without a reoccurrence of the skin problem. Our experience is that if such a structured approach is adopted much time and cost can be saved and the worker’s career kept intact.

We will propose such a structured approach that attempts to meet the criteria outlined and, through case studies, demonstrate how this can avoid costly mistakes, save the employer time, money and much aggravation and maintain the worker’s quality of work life.