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As the largest organ of the body, the skin is the first line of defense after exposure to a variety of industrial chemicals. Contact dermatitis makes up over 90% of all occupational skin diseases, with a majority (about 80%) due to a non-immunologic cause (irritant). This accounts for about six million nonfatal injuries/illnesses annually with an estimated (direct and indirect) cost to our economy up to one billion dollars.

However, it is allergic contact dermatitis (ACD) that poses unique therapeutic dilemmas. It has been estimated that the prevalence of ACD of the hands range from 2.7 to 12 cases per 1000 population. First described in 1895, over 3000 chemicals have been documented to be specific causes of ACD. While patch testing was initiated in the 1930’s, it did not become standardized in the U.S. until the 1990’s with the advent of the thin-layer rapid use epicutaneous (TRUE) test along with the Finn Chamber. Virtually all occupations are at risk and thus the primary care physician must recognize, treat and prevent this condition.

Dr. Scheman and colleagues give a very detailed approach and overview of the clinical problems associated with ACD. I know that this will be a vital reference for any clinician for years to come.