Post-contact chronic eczema: pension or rehabilitation.

A proportion of patients who suffer from either irritant or allergic contact dermatitis, many of whom have no past or family history of atopy or of any other skin disease, evolve into chronic eczema. Workers' compensation payments are frequently suspended after about 6 to 12 months on the basis of 'endogenous dermatitis'. Patients, often healthy breadwinners in the 30 to 50 age group are deemed unemployable because of persistent active dermatitis. Expensive prolonged litigation frequently follows but the end result is usually a patient who has become a healthy, bored, pensioner/retiree with all the psychological and physical sequelae secondary to inactivity and major lifestyle change. It is now becoming recognized that there are many jobs which a person suffering from various degrees of chronic dermatitis can perform without aggravation of dermatitis. However, widespread acceptance of this tenet requires a change in attitude by all the players in the workers' compensation complex, namely the employer, the insurance company, the medical practitioner, the employee and the union. Fortunately, the emphasis is gradually changing towards multidisciplinary assessment of work potential with appropriate retraining and redeployment of injured workers rather than granting lump sum compensation payouts or pensions.