Author(s): Carman, H., Fourie, A.

Source: Occup Health Southern Afr. 2023; 29(1)

Abstract: Atopic dermatitis, a chronic recurrent inflammatory skin disease, typically occurs in childhood, but also affects 1–3% of adults. Adult-onset atopic dermatitis has been described and accepted as an entity, and does not necessarily conform to the criteria tabled in the various guidelines published in the literature. Workers with occupational dermatitis in Gauteng are referred to the National Institute for Occupational Health. Of those diagnosed with contact dermatitis, many are also deemed to have atopic dermatitis. We present two cases that were initially diagnosed as occupational contact dermatitis but were then shown to have adult-onset atopic dermatitis. In these patients, the condition was chronic, recurrent, and persisted after removal from the workplace. They did not have preexisting atopic eczema and the eczema seemed to be precipitated by factors in the work environment. The condition forced both patients to stop working. Both were resistant to normal treatment with topical emollients and steroid creams; one was also resistant to immunosuppressive drugs. Newer biological drugs are registered in South Africa for the treatment of atopic dermatitis but are not affordable for the majority of patients. These patients illustrate the problem with adhering strictly to the literature guidelines when diagnosing atopic eczema in day-to-day practice. They also illustrate the possibility of adult-onset atopic eczema in an occupational setting. In both our patients, work factors seemed to precipitate its development, and they were initially diagnosed with occupational contact dermatitis.

Keywords: atopic eczema; atopic dermatitis; work-related dermatitis; irritant contact dermatitis; allergic contact dermatitis