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Workshop Discussions
Opportunities for Effective Actions to Reduce the Burden of Harmful
Exposures of the Skin to Chemicals:
- III. Clinicians evaluating and promoting the health of individuals
or populations
Typical Steps:
A. Recognition that exposure of skin to chemical(s) can be harmful
1. Knowledge of clinicians
2. Educational materials for clinicians
a. (list citations for informational items here)
b. …
3. Continuing medical education
a. (list courses here)
b. …
B. Receiving Patients or Recruiting Populations - Processes vary by
whether the clinician provides primary care or receives patients by
referral; whether the practice is private, hospital/university-based
or influenced heavily by managed care; and by the demographics of potential
patient populations. Guidelines for receiving patients or recruiting
populations vary:
1. General Practitioners/Primary Care Physicians
a. (list citations for informational items here)
b. …
2. Dermatologists
a. (list citations for informational items here)
b. …
3. Occupational/Environmental Physicians
a. (list citations for informational items here)
b. …
4. Clinical Epidemiologists
a. (list citations for informational items here)
b. …
5. Occupational Nurses
a. (list citations for informational items here)
b. …
6. Other Clinicians
a. (list citations for informational items here)
b. …
C. Health evaluation
1. History - Emphasis on occupational and environmental exposures,
as appropriate
a. (list citations for informational items here)
b. …
2. Physical exam
a. (list citations for informational items here)
b. …
3. Initial working diagnosis
a. Local skin effect (dermatitis, urticaria, infection, other)
i. (list citations for informational items here)
ii. …
b. Systemic toxicity potentially caused by chemical exposure of
the skin
i. (list citations for informational items here)
ii. …
4. Confirmatory testing
a. Local skin effect (skin patch testing, use test, skin prick test,
biopsy, culture, immunoassays)
i. (list citations for informational items here)
ii. …
b. Systemic toxicity (blood parameters, urinanalysis, biomonitoring)
i. (list citations for informational items here)
ii. …
5. Final diagnosis
6. Treatment – Varies with diagnosis; Guidelines are available to
clinicians and may be outside the scope of this conference
D. Determining etiology (is condition caused by chemical exposure of
the skin)
1. Role of confirmatory testing in providing specific etiologic information
a. (list citations for informational items here)
b. …
2. Role of return to work/return to exposures and follow-up
a. (list citations for informational items here)
b. …
3. Issues of resources (e.g., time), compensation, managed care directives
in investigative pursuits
a. (list citations for informational items here)
b. …
E. Investigating Causes in Detail and Recommending Prevention Strategies
– See Opportunity for Effective Action by
Individuals/Employers/Supervisors/Insurers/Site Owners maintaining a
safe and healthful site
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