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GBZ 20-2019: PDF in English

GBZ 20-2019
ICS 13.100
C 60
Replacing GBZ 20-2002
Diagnosis of occupational contact dermatitis
Issued by: National Health Commission of the PRC
Table of Contents
Foreword ... 3 
1 Scope ... 4 
2 Normative references ... 4 
3 Diagnostic principles ... 4 
4 Diagnosis ... 4 
5 Treatment principles ... 5 
6 Instructions for the correct use of this Standard ... 6 
7 Common pathogenic substances of occupational contact dermatitis ... 6 
Appendix A (Informative) Instructions for the correct use of this Standard ... 7 
Appendix B (Informative) Common pathogenic substances of occupational
contact dermatitis ... 10 
Diagnosis of occupational contact dermatitis
1 Scope
This Standard specifies the principles of diagnosis and treatment of
occupational contact dermatitis.
This Standard applies to the diagnosis and treatment of occupational contact
2 Normative references
The following documents are indispensable for the application of this document.
For the dated references, only the editions with the dates indicated are
applicable to this document. For the undated references, the latest edition
(including all the amendments) are applicable to this document.
GBZ 18 Diagnosis of occupational skin diseases - General guideline
GB/T 16180 Standard for identify work ability - Gradation of disability caused
by work-related injuries and occupational diseases
3 Diagnostic principles
According to the clear history of occupational contact, skin lesion diseased
parts, clinical manifestations, and dynamic observation results, refer to the
working environment survey and the onset situations of the same type of work;
if necessary, combine with skin patch test for comprehensive analysis, to
eliminate contact dermatitis caused by non-occupational factors; and perform
the diagnosis.
4 Diagnosis
4.1 Occupational irritant contact dermatitis
Acute dermatitis presents erythema, edema, papules; or dense papules,
blisters, or bullae on the basis of edematous erythema. After blisters breaking,
it shows erosion, exudate, and scabbing. Self-conscious burning pain or itch.
Chronic changers present varying degrees of infiltration, thickening,
desquamation, or chap. It can be diagnosed if:
A chronic skin
inflammation which
develops on the basis of
It often distributes in parts
with many sebaceous
glands, such as the scalp,
face, chest, back,
armpits, etc.
The skin lesions are
slightly-yellowish mild
erythema, with greasy
scales and scabbing.
Skin inflammation
reaction caused by
contact with
substances and exposure
to sunlight in occupational
It is confined to the light-
irradiated part or begins
at the contact position;
and then spreads to the
surrounding area; may
spread to the whole body.
Flushing, swelling with
burning, pricking, and
itching appear at the light-
irradiated parts. In severe
cases, on the above basis,
bullae, erosion, and
scabbing appear.
A.2 Occupational contact dermatitis currently lacks specific auxiliary
examination indicators. The diagnosis is mainly based on clinical data. When
the occupational history is clear; there is a close causal relationship between
occupational contact and the occurrence and development of skin lesions; and
contact dermatitis and other diseases caused by non-occupational factors can
be eliminated, diagnosis shall be performed.
A.3 When inquiring about occupational history and conducting on-site
investigations, attention shall be paid to the effect OF changes in contactant,
contact dose and contact mode, workplace environmental health (including
production facilities and layout, ventilation and exhaust, dust removal,
workshop temperature and humidity, etc.), occupational protection, personal
hygiene, individual specificity, and seasonal factors, etc. ON the occurrence
and development of this disease.
A.4 The skin patch test is currently one of the most important methods for
detecting sensitizers of allergic contact dermatitis. It is suitable for occupational
allergic contact dermatitis and not for occupational irritant contact dermatitis.
During the operation, attention shall be paid to the concentration of the patch
material. Appropriate excipients shall be selected. The results of the patch test
shall be correctly evaluated (see GBZ 18).
A.5 Occupational contact dermatitis is classified into irritant and allergic types.
During diagnosis, they shall be separated as much as possible, to facilitate the
identification of work ability. However, some pathogenic substances have both
irritating and sensitizing effects. When it is clinically difficult to distinguish or
both effects exist, it can be diagnosed as occupational contact dermatitis and
treated according to occupational allergic contact dermatitis.
A.6 If the occupational allergic contact dermatitis repeatedly occurs, has no
improvement in the long term so that work is affected, the job can be changed,
to get rid of the environment containing sensitizers.
Appendix B
Common pathogenic substances of occupational contact dermatitis
B.1 Irritating effect-based pathogenic substances
B.1.1 Inorganic primary irritants: acids such as sulfuric acid, nitric acid,
hydrochloric acid, hydrofluoric acid, chlorosulfonic acid, hypochlorous acid,
chromic acid, etc. Alkalis such as potassium hydroxide, sodium hydroxide,
ammonium hydroxide, sodium carbonate, etc. Certain metals and their salts
such as antimony and antimony salts, arsenic and arsenic salts, dichromate,
zinc chloride, gallium chloride, beryllium fluoride, etc.
B.1.2 Organic primary irritants: organic acids such as acetic acid, formic acid,
salicylic acid, phenol, etc. Organic alkalis such as ethylenediamine,
propylamine, butylamine, etc. Organic solvents such as turpentine, carbon
disulfide, etc.
B.1.3 Petroleum and its products, including asphalt, tar, various lubricating oils,
B.1.4 Organohalogen compounds, such as polychlorinated biphenyls,
chlorophenols, and chloronaphthalenes, which have special irritating effects.
B.1.5 Animals: pine caterpillars, mulberry caterpillars, rove beetles, bees, mites,
ticks, leeches, jellyfish, etc.
B.1.6 Plants: figs, Centipeda minima, lavender, mint, ivy, ailanthus, safflower
(saffron), etc.
B.1.7 Pesticides: insecticides (dichlorvos, trichlorfon, isocarbophos,
methamidophos, dimehypo, benzofuranone, etc.), acaricides, fungicides, and
herbicides (paraquat), etc.
B.1.8 Other: glass fiber, asbestos, soap, synthetic detergent, flux, depilatory
agent, disinfectant, hair dye, etc.
B.2 Allergic reaction-based pathogenic substances
B.2.1 Dyes (pigments) and their intermediates: dark reddish purple, Lithol Red,
basic red, disperse blue 106, disperse blue 124, naphthylamine yellow,
fluorescent dyes, dyes in modern beauty products, p-phenylenediamine, m-
Source: Above contents are excerpted from the PDF -- translated/reviewed by: www.chinesestandard.net / Wayne Zheng et al.