workers with occupational contact dermatitis ( ocd ) may have adverse outcomes .   not only
may they continue to have disease and their overall quality of life may be impacted , but they may also have significant work disruption .
a number of studies have provided disease outcome information and more recently there have been studies demonstrating an impact on quality of life .
there are some studies reporting on work outcomes in populations of workers with ocd and one study examined barriers to return to work [ 110 ] .  
while overall work status has been reported , there is little information about the return to work process .  
the objective of the study was to describe the work outcomes and return to work process in workers with ocd over a six - month period following diagnosis .
potential participants were informed of the purpose , activities , risks , and benefits of the study and their signed consent to participate was obtained .  
once the individual had been assessed and patch testing ordered , they were approached to participate in the study .
patients were invited to participate if ( a ) they had a possible diagnosis of contact dermatitis , ( b ) were employed or had been employed but stopped work because of their skin disease , ( c ) were undergoing patch testing , and , d ) had hand involvement .
this assessment collected information regarding the worker 's clinical history and work status at the time of patch testing .
the first follow - up assessment was carried out at three months by telephone and included a brief questionnaire regarding work status .
the second follow - up assessment was carried out at six months , in person or by telephone , and included a detailed questionnaire about the workplace and return to work , workers ' compensation and health care utilization over the previous six months .
as the main purpose of the study was descriptive , the data were analyzed using standard statistical methods including means and frequencies .
  one hundred workers were enrolled in the study and completed the initial assessment .   as the workers were enrolled prior to final diagnosis , 78 were determined to have ocd following their assessment and patch testing .
of the 78 workers with a diagnosis of ocd , 75 completed the second assessment and 60 workers completed the third assessment .  
the mean age was 40 with a range from 19 to 63 and 64% were male .  
the length of time with the rash prior to assessment at st michael 's was 25 months .
the arm was affected in 26% and the face , neck , or leg in 12% .  
almost all described itching , pain , redness , and scaling , while 86% noted cracking and bleeding and 74% blisters .   when asked about the relationship between symptoms and work
, 91% noted their skin was worse at work and 87% noted improvement on vacation .  
a past history of any atopic condition was reported by 56% of workers including 46% with allergies , 19% with hayfever , 15% with asthma , and 14% with eczema .  
family history of atopic disease was also common with 53% reporting any atopic condition including 19% with eczema .
the mean total time at their current worksite was 79 months ( range 2 to 238 months ) and the mean time at their current job was 65 months ( range 1 to 324 months ) .
these included 91% with exposure to cleaning agents , 77% to metals , 72% to solvents , 46% to oils and greases , 37% to plastics , and 24% to other chemicals .  
eighty - six percent reported wearing gloves at work and 21% reported wearing gloves while working at home .
a diagnosis of irritant contact dermatitis was made in 83% and of allergic contact dermatitis in 51% .  
additional diagnoses included 8% with atopic dermatitis and 5% with psoriasis . at the time of the initial assessment and patch testing 10% were not working .  
of these 75% were not working because of their skin problem .   of those who were working
.   if they were working but had changed job , 67% had done so because of their skin .
forty - four percent reported talking to someone at their workplace about a workers ' compensation claim and 41% reported that a workers'compensation claim had been submitted .
at the three month follow - up interview we were able to contact 75 of the 78 workers .
at this time 26% were not working , 95% of these because of their skin .  
of those who were working , 78% were at the same job as when the problem started .
if they were working but had changed job , all had changed jobs because of their skin .  
information was obtained regarding advice received related to return to work ( rtw ) and the results are presented in table 1 .  
the minority of workers reported receiving recommendations regarding a change of job or job modification and , even if advice had been provided , it was not always implemented .
communication between the various parties involved in rtw was reported by a minority of workers .  
workers reported that the physician wrote a letter or talked to the employer for 23% of the workers .  
forty - four percent of the workers talked with their supervisor ; if the worker belonged to a union , 31% talked with their union ; 19% were involved in a meeting concerning their rtw involving their supervisor and others ; 16% had some discussion about potential problems with rtw ; and for 4% there was some discussion of their rtw with their coworkers .
at the six month follow - up interview we were able to contact 60 of the 78 workers . to provide comparability of results across the 3 visits ,
the results of work status at the initial assessment , at three months and six months for the 60 workers that were assessed at all three visits are presented in table 2 .   at six months
15% were receiving workers ' compensation benefits , 3% employment insurance benefits , and for 10% the company had changed their job and no compensation claim had been filed .   of those who were working ,
.   if they were working but had changed job , 92% had done so because of their skin . with respect to workers ' compensation , 69% reported submitting a claim .
of those who submitted a workers'compensation claim ,   70% were accepted , 6% denied , 15% pending , and 9% did not know the status of their claim .  
in addition to work status , information regarding work practices , communication amongst the parties involved in rtw and interactions with health care providers were obtained .
previous studies have demonstrated significant work disruption in workers with ocd [ 19 ] .  
some workers had already experienced work disruption by the time of their initial assessment and significant further change in work status occurred in the six months following diagnosis . at the time of initial assessment ,
, the percentage not working had increased to 26% and at 6 months , the percentage not working had increased to 38% . at three months after diagnosis , the job modifications suggested including the use of gloves , changing the type of glove used and changes in skin care were suggested in the minority of cases and implemented in even fewer .  
when communication between the various parties was examined at three months , 44% had talked with their supervisor and this increased to 69% by six months .  
similarly , at three months 31% of union members had talked with their union and this increased to 42% at 6 months .  
these gaps include lack of advice provided regarding needed job or workplace change , lack of implementation of modification and suboptimal between the workplace parties who are involved in the rtw process .  
follow - up visits with their family physicians and , dermatologists , reported elsewhere , were 62% and 39% , respectively , even though workers are advised to see their physicians for follow - up .
these findings suggest that there is significant room to improve the rtw ( or stay at work ) process .   further research , focused on the various aspects of rtw , including the identification of barriers and facilitators are needed to improve the rtw process and ultimately achieve better work outcomes for workers with ocd .
 workers with occupational contact dermatitis may have poor outcomes that impact their health , work , and quality of life .   while there is information available on overall return to work , little 
 is known about the actual return to work process . 
 the objectives of the study were to describe the return to work experience and work outcome in workers with contact dermatitis following diagnosis . 
 78 workers with occupational contact dermatitis were followed for 6 months after assessment . 
 information collected included clinical presentation and status , the return to work process and work outcomes . 
 six months after assessment , 38% were not working , almost all because of their skin problem . 
 of the 62% working 32% had changed job , most because of their skin problem .   
 limited advice to enable return to work and communication were reported .    
 these findings suggest that there are gaps in return to work programs for occupational contact dermatitis and further research is needed . 