A farmer's occupational airborne contact dermatitis masqueraded by coexistingrosacea: delayed diagnosis and legal acknowledgement.
Jacek Dutkiewicz 1, Radosław Spiewak 2 1 - 2 - Department of Occupational Biohazards, Institute of Agricultural Medicine, Lublin,Poland. Radoslaw.Spiewak@plusnet.pl Ann Agric Environ Med 2004; 11 (2): ICID: 142647
A rare case of coexistence of occupational airborne dermatitis with rosaceais presented in a 41-year-old female farmer. Her first dermatitis symptoms appeared at the age of 10when she started helping her parents on the farm. Uncovered skin areas of the face, neck, décolleté,forearms and the hands gradually became involved. The dermatitis symptoms were provoked by agriculturaldusts (especially of flax and dried herbs). For the subsequent 30 years, the work-related disease remainedundiagnosed due to the lack of pre-employment and periodical health check in agriculture. She also sufferedfrom protein contact dermatitis of the hands from cow epithelium. About 20 years after the onset of airbornedermatitis, rosacea developed, possibly secondary to the prolonged treatment. Diagnostic tests carriedout at our department confirmed hypersensitivity to occupational allergens: type I allergy to storagemites, moulds, and cow epithelium. A cutaneous late-phase reaction on prick tests and serum precipitinsto the bacterium Pantoea agglomerans (Erwinia herbicola) also were found. Among non-occupational hypersensitivities,type I allergy to house dust mites and contact allergy to methylchloroisothiazolinone/methylisothiazolinone(Kathon CG) was found. In connection with these results, the significance of agricultural dusts in farmers'airborne dermatitis is discussed. Also presented are the problems with obtaining acceptance from theState Sanitary Authority for qualification of this case as an occupational disease, which was due tothe coexistence of the non-occupational rosacea. Discussed is also the problem of pre-employment exposureto occupational allergens among farmers' children, and the difficulties with delivering occupationalhealth services to self-employed farmers.