Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Dermatitis


Related Terms

  • Atopic Dermatitis
  • Contact Dermatitis
  • Eczema
  • Photodermatitis
  • Seborrheic Dermatitis
  • Stasis Dermatitis

Differential Diagnosis

Specialists

  • Dermatologist

Comorbid Conditions

Factors Influencing Duration

The length of disability may be influenced by the cause of the dermatitis, severity of symptoms, location and extent of the lesions, response to treatment, job requirements, and workplace environment (overly dry or humid conditions can make dermatitis worse).

Medical Codes

ICD-9-CM:
692.83 - Contact Dermatitis and Other Eczema Due to Metals; Jewelry
692.89 - Contact Dermatitis and Other Eczema, Other; Dermatitis Due to: Cold Weather, Dyes, Hot Weather, Preservatives

Overview

Dermatitis is a general term for inflammation of the skin. Although an allergic reaction can cause dermatitis, it often occurs without any known cause. The main forms of dermatitis are contact dermatitis, seborrheic dermatitis, photodermatitis, eczema (atopic dermatitis), perioral dermatitis, and stasis dermatitis.

Accounting for 90% of all occupational skin disease, contact dermatitis occurs when skin comes in direct contact with an irritating or allergenic substance (Michael). Irritant contact dermatitis is a local inflammatory reaction that can result in overly dry (xerosis) or moist (maceration) skin changes. Common irritants include detergents, nickel (found in jewelry and underwear fastenings), certain chemicals, latex rubber gloves, condoms, certain cosmetics, and medications designed for use on the skin (topical). Facial contact dermatitis often stems from fragrances, cosmetics, or preservatives in personal care products. Dermatitis caused by an irritant develops within minutes or hours after exposure.

Direct contact with plants such as poison oak and ivy (including inhalation of smoke from burning plants) can cause allergic contact dermatitis. Other common causes of allergic contact dermatitis include metal compounds, skin medications, and creams. Symptoms may range from a mild, temporary redness to severe swelling and blisters. Allergic contact dermatitis usually occurs within 24 to 48 hours after contact. Continued exposure can result in chronic dermatitis.

Dandruff, the most common seborrheic dermatitis, is characterized by dry or greasy scaling of the scalp. Sometimes itching occurs but without hair loss. The face and chest can also be affected. Although the exact cause is unknown, the rash often develops during times of stress.

Photodermatitis is the reaction of skin to photochemical activity such as sunlight, x-rays, or ultraviolet light. Certain oral medications can make the skin more sensitive to sunlight. Skin reactions include redness, peeling, rash (hives), blisters, and thickened, scaly patches.

Eczema (atopic dermatitis) refers to a chronic, itchy inflammation of the upper layers of skin that often occurs in individuals with many other allergic disorders. Although the exact cause of atopic dermatitis is unknown, immunologic, genetic, physiologic, and pharmacologic factors play a role. The hallmark symptom of atopic dermatitis is itching of apparently healthy skin. Emotional stress, changes in temperature or humidity, bacterial skin infections, and contact with irritating clothing (especially wool), can make itching worse. The resultant scratching causes a rash that can be found on regions of the body that are either damp (groin, buttocks, soles of feet, cheeks) or dry (hands, tops of feet, lower legs).

Perioral dermatitis is indicated by a rash or irritation on the face, particularly around the facial lines from the nose to the sides and on the borders of the lips and the chin. The rash is characterized by small red bumps, mild peeling, and mild itching and burning. The cause is unknown, but some cosmetics, moisturizers, and dental products with fluoride may be responsible. Hormones, sunlight, and stress may also play a role.

Stasis dermatitis is caused by poor blood circulation and typically produces itchy, red, scaly patches on the lower legs. Over time, the skin turns dark brown. Increased swelling caused by the pooling blood can lead to severe skin damage, including weeping, crusts, fissures, and scratches (excoriations).

Incidence and Prevalence: Eczema (atopic dermatitis) is a very common disease that affects an estimated 15 million people in the US ("Atopic Dermatitis").

Source: Medical Disability Advisor



Causation and Known Risk Factors

Eczema (atopic dermatitis) affects men and women equally. Although it is estimated that 65% of those affected develop symptoms in the first year of life and 90% develop symptoms before the age of 5, it can occur at any age. If eczema appears after the age of 30, which is uncommon, it is often due to exposure of the skin to harsh or wet conditions. People who live in cities or in dry climates are more prone to develop the condition. Cosmetics and fragrances are risk factors for dermatitis. Individuals who work with chemicals in the manufacture of clothing are at greater risk of developing dermatitis. Children of parents who had eczema (atopic dermatitis) or other allergies are more likely to develop this disease ("Atopic Dermatitis").

Seborrheic dermatitis is more common in men than in women and occurs most frequently between the ages of 30 and 60 ("Seborrheic Dermatitis").

Perioral dermatitis is most common in young women ("Perioral Dermatitis").

Source: Medical Disability Advisor



Diagnosis

History: The hallmark sign of dermatitis is a rash that can vary considerably, depending on the cause. Symptoms usually include itching, burning, and stinging. The individual may report a recent change in detergent, soap, cosmetics, jewelry, or topical medication. Individuals with poison oak or ivy dermatitis often report that they had been working or recreating outdoors. Symptoms of seborrheic dermatitis include a red, scaly, itchy rash that usually starts on the scalp and / or face (particularly the nose and eyebrows), chest, and back. The main symptoms of eczema (atopic dermatitis) are dry, itchy skin and rashes on the face.

Physical exam: A total skin examination should be performed. The affected area may be red and irritated. Small blisters may be present, broken open, or crusted over. The appearance of irritant contact dermatitis depends on the cause. Individuals with eczema (atopic dermatitis) may also have excoriations caused by scratching. Photodermatitis is characterized by sunburn that may blister or take on the appearance of contact dermatitis. Perioral dermatitis is characterized by a small red rash around the sides of the nose, the borders of the mouth, and the chin. Stasis dermatitis, being localized on the legs, may be accompanied with swelling (edema) in the lower legs and ankles.

Tests: Skin patch tests may be performed, as needed, to identify the source of the irritation or allergic reaction. Suspect substances, kept in place with identifying tapes, are applied to the skin on the individual's back. The skin is inspected several days later to see if any of the substances caused a reaction. Photo patch tests in which treated patches of skin are exposed to ultraviolet light may be performed in individuals with photodermatitis.

Source: Medical Disability Advisor



Treatment

Since treatment depends on the underlying cause of the inflammation, it must be tailored in each case.

If the agent causing contact dermatitis can be avoided, the skin inflammation will usually clear within a few weeks. Soaking in cool water can help relieve symptoms. Calamine lotion can dry lesions and help control the itching. Antihistamines help relieve itching, especially at night. For severe cases, topical or oral corticosteroids may be prescribed. An oral antibiotic may be needed for a brief period to control a secondary infection.

Seborrheic dermatitis of the scalp is treated with medicated shampoo.

In the treatment of eczema (atopic dermatitis), new medications known as topical immunomodulators help control inflammation and reduce immune system reactions when applied to the skin. Topical or oral corticosteroids may also help relieve itching. Phototherapy, or the use of ultraviolet A or B light waves alone or combined, may be an effective treatment for mild to moderate dermatitis. Soaking in a lukewarm bath with a mild bar soap or non-soap cleanser may help relieve symptoms.

Perioral dermatitis is treated with an oral antibiotic. Treatment may last several months.

The long-term goal for stasis dermatitis is to reduce the pooling of fluid (edema) in the legs. Treatment may include support hose or compression stockings. Ulcers are treated with zinc oxide paste and corticosteroid creams. Individuals may need treatment with an Unna boot (a cast-like dressing containing a zinc paste). The boot protects the skin, and the paste helps heal it.

Source: Medical Disability Advisor



Prognosis

The outcome of dermatitis depends on the underlying cause. If the agent causing contact dermatitis can be identified and avoided, the skin inflammation will usually resolve itself within a few weeks. Occupational contact dermatitis clears in 25% of individuals, improves with periodic recurrence in 50% of individuals, and is persistent and severe in 25% of individuals. Seborrheic dermatitis has periods of worsening and periods of remission. Allergic photodermatitis may persist for weeks or years. There is no cure for eczema (atopic dermatitis), but it can be controlled with treatment. Properly treated, perioral dermatitis can be resolved but may recur. Individuals with stasis dermatitis often have recurring problems, particularly if measures to counteract persistent edema and tissue changes are not conscientiously adhered to throughout life.

Source: Medical Disability Advisor



Complications

Because of poor skin barrier function, bacterial (staphylococcal or streptococcal), viral, and fungal infections are common complications of dermatitis. In severe cases, the skin may become reddened and fall off in layers (exfoliative erythroderma). Poor hygiene and poor general health can also complicate dermatitis.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations may be related to the location of rash, type of work, or clothing that must be worn. If the rash is located on the fingers or hands, working with food or in direct contact with other individuals would not be appropriate. Work uniforms, gloves, or equipment made of certain fabrics can further irritate the rash. Contact dermatitis may be avoided by removal (or replacement) of the offending substance or by wearing personal protective equipment (cotton liners inside rubber gloves) and using barrier creams. Individuals with photodermatitis need to avoid sun exposure. Changes to the individual's position or duties may be required. For individuals with stasis dermatitis, heavy lifting or prolonged standing may need to be limited. Such individuals would benefit from periods of leg elevation throughout the work day.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have contact dermatitis, seborrheic dermatitis, photodermatitis, eczema (atopic dermatitis), or stasis dermatitis?
  • Does individual complain of overly dry or moist skin?
  • Does individual complain of redness of the skin; severe swelling; blisters; dry or greasy scales on the scalp; peeling skin; thickened scaly patches; itching of apparently healthy skin; or itchy, red, scaly patches on the lower legs?
  • Does individual complain of itching, burning and stinging?
  • Does individual report a recent change in detergent, soap, cosmetics, jewelry, or topical medication?
  • Does individual report that he or she had been working or recreating outdoors?
  • Does individual have a family history of atopic dermatitis?
  • Did individual have a total skin examination?
  • Has individual had skin patch testing? Photo patch tests?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Is individual able to avoid the agent causing the inflammation?
  • Has individual tried soaking in cool water, Calamine lotion, antihistamines, topical or oral corticosteroids, or an oral antibiotic?
  • Has individual used a medicated shampoo when indicated?
  • Does individual keep the skin well hydrated?
  • For stasis dermatitis, has individual tried support hose, compression stockings, zinc oxide paste, corticosteroid creams or an Unna boot?

Regarding prognosis:

  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that may affect the ability to recover?
  • Does individual have any complications such as infections or exfoliative erythroderma?
  • Does individual have poor hygiene or poor general health?

Source: Medical Disability Advisor



References

Cited

"Atopic Dermatitis." National Institute of Arthritis and Musculoskeletal and Skin Diseases. National Institutes of Health (NIH). 4 Oct. 2004 <http://www.niams.nih.gov/hi/topics/dermatitis/index.html#link_a>.

"Perioral Dermatitis." American Academy of Dermatology. 4 Oct. 2004 <http://www.aad.org/pamphlets/Perioral.html>.

"Seborrheic Dermatitis: What It Is and How to Treat It." familydoctor.org. American Academy of Family Physicians (AAFP). 4 Oct. 2004 <http://familydoctor.org/157.xml>.

Michael, John A. "Dermatitis, Contact." eMedicine. Eds. Mark Louden, et al. 9 Jan. 2004. Medscape. 4 Oct. 2004 <http://emedicine.com/emerg/topic131.htm>.

Source: Medical Disability Advisor






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