Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2009-153c, 2009 Sep; :CD-ROM
The Indexed Dermal Bibliography (1995-2007) is a tool that directs workers, employers, industrial hygienists, researchers, and policy makers to information resources on occupational skin exposures to chemicals, including health effects surveillance, exposure characterization, hazard identification, risk assessment, and risk control and management. 1.1 Background: More than 13 million workers in the United States are potentially exposed to chemicals at work via the skin. A worker's skin may be exposed to harmful chemicals through direct contact with contaminated surfaces, deposition of aerosols, and immersion in or splashes from liquids. Some chemicals cause contact dermatitis via direct skin contact. Contact dermatitis is one of the more frequently reported occupational illnesses, accounting for 10%.15% of all occupational diseases, at an estimated annual cost in the United States (U.S.) of at least $1 billion. Many chemicals readily pass through the skin (called dermal penetration). Some of these chemicals are then taken up into the blood stream or by skin or immune cells (this is called dermal absorption). Dermal absorption can cause systemic health effects or can contribute to the effects of chemicals absorbed in the lungs by inhalation. Chemicals are often absorbed through the skin without being noticed by the worker. In some cases, the skin is a more significant route of exposure than the respiratory tract. This is particularly true for nonvolatile chemicals that are relatively toxic and that remain on work surfaces for long periods of time. 1.2 Purpose of the Dermal Resource Guide: The Indexed Dermal Bibliography is designed to serve as a resource for information on dermal exposure for those who work in (1) at-risk occupations, (2) positions to investigate or control worker skin exposure to harmful chemicals, and (3) research settings or positions to set policy on dermal exposures. The Indexed Dermal Bibliography provides lists and descriptions of resources by topic for people looking for specific information on dermal exposure anticipation, recognition, evaluation, and control. The Indexed Dermal Bibliography is not designed to be an exhaustive listing of materials from the dermal exposure literature, but rather a representative list of available dermal exposure resources. The Indexed Dermal Bibliography contains review articles and summaries of educational information. Individual research studies are not included here. In addition, the accuracy of information presented in the references has not been evaluated. 1.3 Intended Uses and Audiences: The Indexed Dermal Bibliography is designed to provide descriptions of resources available for two different audiences: the general audience and the professional audience. Resources for the general audience are for those who have limited technical background or formal training in identifying and controlling harmful skin exposures. The general audience may include workers, small business employers, supervisors, worksite owners, insurers, and manufacturers of industrial chemicals. Resources for the professional audience are for those who typically use technical information for evaluating, recognizing, and controlling harmful skin exposures. The professional audience may include industrial hygienists, occupational epidemiologists, dermatologists, occupational physicians and nurses, academic researchers, toxicologists, and policy makers. In some cases resources for these two audiences are not mutually exclusive. General audience members are encouraged to look at the professional resources when they are interested in more detailed or technical information. Conversely, professionals looking for background information for training, education, or communication purposes may find relevant information in the resources for the general audience. 1.4 Topics: The Indexed Dermal Bibliography lists resources that address a number of broad topics. The topics differ somewhat between general and professional audiences, but typically address the following: 1. Overview of dermal exposure. 2. Surveillance and clinical aspects of dermal exposures. 3. Dermal exposure characterization. 4. Dermal hazard identification. 5. Dermal exposure risk assessment. 6. Dermal exposure risk management. These topics were specified during a workshop held at the International Conference on Occupational and Environmental Exposure of Skin to Chemicals: Science and Policy, held September 11, 2002 in Crystal City, Virginia.