Friction from paper and cardboard causing occupational dermatitis in non-atopic individuals.

Conflict of interest: The authors declare no conflict of interests. patients (83%). In 5 (2.5%) of these patients, frictional trauma caused by occupational paper and cardboard handling was identified as the primary cause of hand eczema. Data for these patients are presented here. Patient characteristics and occupational factors are summarized in Table 1. None of the patients had a history of atopic dermatitis or other endogenous dermatoses. With regard to handling paper and cardboard, only 1 patient (case 4) had a relevant positive patch test reaction (++) to colophonium. The eczema reported by the patients was characterized by initial dryness, scaling, erythema, and fissures. None of the patients reported vesicles on areas exposed to paper and cardboard handling. Morphological features at the clinical examinations were dominated by hyperkeratotic scaling and variable degrees of fissuring. The areas affected byhyperkeratoses are summarized in Table 2. The most severe reactions observed were on the finger pulps in 4 patients. In all patients, both hands were involved, with minor asymmetry. A variable degree of involvement of the lateral aspects of the fingers was observed in the 3 patients handling cardboard boxes. Most markedly, the hyperkeratoses observed in case 5