Prevention and therapy

Abstract

Preventive dermatology, which is claimed to play a key role in the global management of skin diseases, is not yet accepted as a routine procedure in many aspects of daily life [1]. The prevention of irritant and/or allergic contact dermatitis is briefly and incompletely reviewed in several textbooks on occupational and contact dermatitis [2, 3]. It is therefore imperative to view the prevention of occupational (and nonoccupational) dermatitis as the cornerstone and/ or the final aim of many research projects in the field [4]. Various considerations must be borne in mind, particularly in occupational dermatology: □Contact dermatitis entails both individual aspects (some workers suffer many interruptions to their normal activities over the course of a year due to contact dermatitis) and socioeconomic aspects. □The subject of prevention is usually divided into two sections: collective (or general) and individual protection measures [2]. There is a general principle: collective prevention and protection measures are usually more effective than individual measures, since the latter depend upon the personal will and constant application of each individual worker. Supervision and surveillance are crucial in this matter. □The development of occupational medicine has afforded a safer working environment in most industrialized countries than was common a few years ago. Occupational physicians are well aware of general issues such as avoidance (or reduction to an acceptable level) of toxic substances in the working environment, reduction of noise, vibration and/or stress. Nevertheless, they feel less confident when tackling skin problems and seek advice from a dermatologist trained in the management of such situations. □Some categories of workers are not submitted to regular medical control at work; they may develop dermatitis that is not then treated at an early stage. On the other hand, this situation may differ considerably from one country to another. In this chapter, the problem of preventing contact dermatitis will be discussed in terms of primary, secondary, and tertiary prevention. This approach permits a better evaluation of the situations encountered in daily life; it is particularly important for preventing and/or controlling outbreaks of irritant and/or allergic contact dermatitis that occur in various circumstances, covered by the areas of topical treatment of skin disease, dermatocosmetology and occupational dermatology. In the next section we focus on the primary, secondary and tertiary prevention of allergic contact dermatitis. This concept can obviously be adapted for preventing irritant contact dermatitis as well as nonimmunological or immunological contact urticaria.