Aetiological Analysis of 100 Patients with Dermatitis Claiming to Suffer from Prescribed Disease.

Since the National Health Service came into force in 1948, there has been a steady flow of patients referred by the Ministry of Pensions and National Insurance to dermatologists. These patients claim to suffer from a Prescribed Disease, and the dermatologist has to determine whether they have a skin condition produced by certain occupational agents prescribed by the Minister. Basically these have always been dust, liquid, and vapour occurring in occupations where these substances are encountered. Before 1959 Prescribed Disease relating to skin conditions was numbered 24b, but since then it has been numbered 42. This numerical change also carried with it a modification of the definition of the disease and in effect specifically limited diagnosis to cases of non-infective dermatitis. As Prescribed Disease claimants with skin conditions present a constant diagnostic problem, a survey was made of 100 copies ofconsecutive reports on patients who had claimed to have Prescribed Disease 24b, to determine the chief aetiological factors involved in this type of dermatological case and to see to what extent the dermatologist could solve the diagnostic problem and how relevant to the issue is non-infective dermatitis as it applies to Prescribed Disease 42. Patients were within the working age group, 63 being men and 37 women. In 56 patients, in whom the aetiological factors were clearly constitutional or attributable to non-occupational external causes or to industrial injury, Prescribed agents could be firmly excluded as causes of their skin conditions. In 34 cases, Prescribed agents, which were mainly dusts and liquids, could reasonably be implicated as causes. In the remaining 10 cases, however, evidence for and against these agents as causes was about equal, and the diagnosis was settled by giving them the benefit of the doubt. On a dermatological basis, therefore, 90% of the diagnostic problem could be solved. Nine patients in the series were diagnosed as having infective dermatitis due to minor skin trauma initiated by liquids encountered at work. This diagnosis was also in accord with a diagnosis of Prescribed Disease 24b. Since 1959, however, a diagnosis of infective dermatitis has been incompatible with one of Prescribed Disease 42 because this is defined as a non-infective dermatitis. It seems therefore that the definition could be more flexible so as to embrace certain cases of infective dermatitis which can develop from minor skin trauma due to occupational agents.