This text combines a highly practical approach to the occupational dermatoses with the skill and experience of scientists who have specialized in this area of clinical and experimental dermatology. The spectrum of diseases covered includes allergic and irritant dermatitis, contact urticaria, photodermatoses, systemic reactions due to percutaneous absorption, infectious diseases and skin tumors. Furthermore, diseases predisposing to occupational skin problems such as atopic dermatitis and psoriasis are discussed. This book provides badly needed information for daily patient management and presents precise job descriptions and algorithms how to optimize the diagnostic procedure for high quality patient care and expert opinion in occupational dermatology.
This handbook is the most comprehensive book I know of on the subject of occupational dermatology. Its 1300 pages are divided into four parts. The first part encompasses the epidemiology, treatment, and prognosis of occupational skin diseases, and the second part deals with substances and products that can produce these diseases. The third part describes the antigens and irritants frequently encountered in various work environments. The fourth part has three sections. The first is a dictionary of occupational allergens and their chemical structures, including their Chemical Abstract Service registry numbers, their sources, and pertinent references. The second and third sections are extensive tables of patch-test allergens that include information on concentrations and vehicles for patch testing, the chemical structures of allergens, sources of exposure, and other pertinent data such as synonyms and the clinical presentations of allergic responses. The list encompasses most of the antigens that are commercially available in Europe and some allergens that are not commercially available.
The international cast of contributors is impressive, and the book is carefully crafted to make good use of each writer's expertise. Three of the four editors and many of the contributors are European, which gives the book a distinctive flavor of the investigational experience across the Atlantic. The first two chapters, on the epidemiology of occupational dermatoses, reflect the European experience because of the compulsory registration of occupational diseases in many European countries. Both chapters are an honest expose of the limitations of clinical epidemiology, which depends primarily on patch testing. Several books on the subject published in the United States, such as Occupational Skin Diseases (third edition, edited by Robert M. Adams; Philadelphia: W.B. Saunders), omit extensive discourse on epidemiology because of the limitations of the U.S. statistics on the subject.
Inevitably, this book will be compared with the few others available on the subject. Adams's Occupational Skin Diseases is the best book that emphasizes the American experience with these diseases. Some similarities between the books are obvious, such as the sections on job descriptions and related potential irritants and allergens. The Handbook treats each job description in great detail as an individual chapter with references (chapters 93 through 182 in part 3), whereas Adams's book condenses the job descriptions more succinctly in an appendix, listing all of the references at the end.
The distinguishing features of the Handbook are chapters 183 through 185 in part 3. Chapter 183 is a dictionary of occupational allergens with chemical structures, sources, and references. Chapter 184 is a list of patch-test allergens that includes pertinent information such as synonyms, uses, and cross-reactivity. Chapter 185 provides a comprehensive list of patch-test concentrations and vehicles for testing. For the occupational dermatologist, these features of the Handbook are essential, because patch testing is the most important confirmatory tool in the investigation of contact dermatitis, which in essence accounts for 95 percent of all occupational dermatoses. The extensive list of allergens for patch testing used by the Europeans stands in stark contrast to the limited number of antigens available in the United States, since the Food and Drug Administration proscribes extensive use of antigens for patch testing. We are limited to patch testing with the 25 most common antigens sold commercially in the United States. There is compelling evidence that patch testing with more than these 25 antigens is safe and significantly increases the sensitivity and relevance of patch testing. The data in the Handbook provide a good frame of reference for this assertion.
The Handbook does not delve into the immunology of contact dermatitis, an important topic in an academic setting. The editors may have elected a pragmatic approach to this topic, and the reason their product is a handbook, rather than a textbook, is that it omits some of the basic science of contact dermatitis. Less clear, however, is the reason for the cursory treatment of the role of atopy in the work environment (in part 1), since there is sufficient epidemiologic data for an in-depth analysis of this association. Atopic dermatitis of the hands, the most common manifestation of atopy on adult skin, is considered a premorbid condition that has a substantial impact on the susceptibility of workers to irritants in occupational settings. Adams's book, for example, has excellent coverage of the topic of atopic dermatitis and occupational diseases.
The most important contribution of the Handbook is its factual, well-referenced data. Its illustrations, many of which are in color, concentrate more on the clinical manifestations of skin diseases than on the work-site environments. It would have been more effective to include pertinent illustrations of some of the work-site situations to depict clearly the potential hazards of the various occupational exposures. Adams's book, for example, illustrates the field investigation of occupational exposure with photographs of workers in their job environments.
Because of the dearth of books on the subject, the Handbook of Occupational Dermatology fills a void and should facilitate the efforts of dermatologists and other health professionals working in the field. Furthermore, it complements Adams's book on the same subject by contributing impressive epidemiologic data on the experience with a number of antigens in Europe that have been proscribed in the United States by federal policies and regulations. Despite the deficiencies, such as the absence of basic science, the first section of this handbook has sufficient merit to be included as required material for any teaching course dealing with occupational medicine. It would be a substantial improvement over the synoptic renditions on the vast subject of occupational dermatology in textbooks of occupational medicine.
Ernesto Gonzalez, M.D.
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