Occupational and environmental health: recognizing and preventing disease and injury, 5th edition. Levy BS, Wegman DH, Baron SL, Sokas RK, eds. Philadelphia PA: Lippincott Williams & Wilkins, 2005 Nov; :598-611
The skin plays an important role in providing a protective, living barrier between the external environment of the world around us and the internal environment of the human body. As a first-line protective barrier, the cutaneous surface is subjected to the hostile forces of the external environment and, as such, can be directly injured or damaged by these environmental forces. In general, the causes of environmental skin disorders can be grouped into the following categories: 1. Physical insults: friction, pressure, trauma, vibration, heat, cold, variations in humidity, ultraviolet/visible/infrared radiation, ionizing radiation, and electric current. 2. Biologic causes: plants, bacteria, rickettsia, viruses, fungi, protozoa, parasites, and arthropods. 3. Chemical insults: water, inorganic acids, alkalis, salts of heavy metals, aliphatic acids, aldehydes, alcohols, esters, hydrocarbons, solvents, metallo-organic compounds, lipids, aromatic and polycyclic compounds, resin monomers, and proteins. These insults are present everywhere in the environment, and the settings where they may threaten the skin include the home setting, during outdoor leisure activities, while involved in hobbies, and the work environment, which is likely to be the most important setting where physical, biological, and chemical insults can affect the skin. Occupational dermatology is the facet of dermatology that deals with skin diseases whose etiology or aggravation is related to some exposure in the workplace. By its nature, occupational dermatology is also related to occupational and preventive medicine. The ideal role of a medical practitioner involved in occupational dermatology is not only to diagnose and treat patients but also to determine the etiology of the occupational skin disease and to make recommendations for its prevention. Making the diagnosis and offering treatment, determining etiology, and recommending preventive measures can all be difficult undertakings. Environmental and occupational skin diseases can manifest themselves in a variety of ways. This chapter will emphasize skin conditions caused by environmental agents that have a direct effect on the skin. These include irritant contact dermatitis, allergic contact dermatitis, contact urticaria, skin infections, skin cancers, and a large group of miscellaneous skin diseases. Certain common skin diseases, such as atopic dermatitis and psoriasis, are exacerbated by environmental factors, but their etiology remains unclear and they will not be covered here.