[Allergy or atopy-occupational dermatitis is often more complex than initially thought]

A 58-year-old man who worked as varnisher and application technician for many years developed 4 months after changing employer and occupation (now working as plant operator for mortar bottling plants) vesicular hand eczema and eczema on his limbs for the first time. The patient underwent a tertiary individual prevention (TIP: an in-patient treatment financed by German statutory occupational accident insurance). The patient had pronounced atopic skin diathesis which, however, had never manifested itself in the form of eczema. Type IV hypersensitivity to epoxy resin and epoxy resin components was diagnosed which is why spreading contact dermatitis was suspected. The pulpitis seen during TIP was classified as partly atopic partly allergic in origin. Nonetheless after complete healing and resuming work at an epoxy resin-free workplace, he developed vesicular atopic hand eczema. Therefore, even if type IV allergy is identified, allergic contact dermatitis cannot automatically be assumed. Even after many years of professional activity, atopy on the hands can manifest itself in the form of vesicular hand eczema.