Irritant or allergic contact dermatitis of the hands is by far the most common type of occupational skin disease. In clinical studies with hand eczema patients, both an overrepresentation of subjects with sensitive skin (mostly patients with atopic dermatitis) and an excess of certain high-risk occupations have been noted. A systematic search for population-based epidemiological studies, which are interpretable in terms of analytic epidemiology, addressed hairdressers, nurses and metal workers (car manufacturing) compared to "unexposed" office workers. A heterogeneous definition of "hand eczema", sensitive skin (atopy/atopic dermatitis) and exposure is evident from these studies. Furthermore, various different risk measures have been used, often without adjustment for potential confounders such as age and sex. Despite overall limited comparability resulting from such heterogeneity of study designs, it may be concluded that both previous atopic (hand or flexural) eczema and excessive "wet work" (e.g. more than 2 hours per day) are associated with at least a doubling of the risk of occupational contact dermatitis. In occupations where many are exposed to excessive wet work, the attributable risk (AR) associated with this factor is higher than the AR associated with atopic eczema. Primary prevention should thus aim at reducing excessive amounts of wet work, as far as this is possible. Irrespective of wet work, risk group-adapted primary prevention should furthermore be implemented, e.g. intensified skin protection and early (self-) diagnosis of initial irritant skin damage especially in employees with sensitive skin.
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