Occupational and environmental health: recognizing and preventing disease and injury, 6th edition. Levy BS, Wegman DH, Baron SL, Sokas RK, eds. New York: Oxford University Press, 2011 Jan; :476-491
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 also subject 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 and occupational skin disorders can be grouped into the following categories: 1. Physical insults: Friction, pressure, trauma, vibration, heat, cold, variations in humidity, radiation (ultraviolet, visible, infrared, and ionizing), and electric current; 2. Biologic causes: Plants, bacteria, rickettsia, viruses, fungi, protozoa, parasites, and arthropods; and 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 in every aspect of our environment and can affect the skin in the home setting, during outdoor and leisure activities, while involved in hobbies, and in the work environment. Occupational dermatology is the facet of dermatology that deals with skin diseases whose etiology or aggravation is related to some exposure in the workplace. The role of a health care practitioner involved in occupational dermatology is not only to diagnose and treat patients but also to determine the etiology of occupational skin diseases and make recommendations for their prevention. Making the diagnosis and offering treatment, determining etiology, and recommending preventive measures all can 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.