Allergic Contact Dermatitis (ACD) is a frequent dermatological condition encountered in clinical practice. It is characterized by symptoms such as erythema, edema, vesiculation, and, in chronic cases, lichenification and fissuring [1,2]. Among the affected sites, the hands are particularly vulnerable due to their constant exposure to external agents [3,4]. The prevalence of ACD has been reported to range from 1.7% to 6% in various studies [5]. In India, approximately 21.72% of the population is engaged in agricultural activities, either directly or indirectly [6]. Agriculture, despite being a vital sector, is recognized by the International Labour Organization as one of the most hazardous occupations due to limited safety regulations and frequent exposure to allergens and irritants. Prolonged or repeated exposure to sensitizing agents can result in chronic dermatitis, manifesting with scaling, hyperkeratosis, and persistent discomfort, which can negatively impact an individual’s physical health, mental well-being, and economic productivity [7]. Occupational contact dermatitis is a major contributor to work-related skin disorders and accounts for up to 30% of occupational health compensation claims in some countries [8]. Prevention is a cornerstone in the management of ACD and relies heavily on the identification and avoidance of causative allergens. Patch testing serves as a vital diagnostic tool, enabling clinicians to distinguish allergic from irritant contact dermatitis and to identify specific allergens responsible for the condition. This test involves the application of standardized allergens under occlusion on the skin, with responses evaluated at intervals using the International Contact Dermatitis Research Group (ICDRG) grading system [9].

Understanding the clinical patterns of ACD and identifying common allergens in specific populations, such as agricultural workers, is essential for guiding preventive strategies. This study aims to explore the clinical and etiological profile of hand ACD among agricultural workers in Western Odisha using patch testing, to support targeted interventions and promote occupational skin health.

A hospital-based, observational, cross-sectional study was conducted at the Department of Skin and Venereal Diseases, VIMSAR, Burla. The study included 52 agricultural workers who were clinically diagnosed with Allergic Contact Dermatitis (ACD) of the hands. The study period spanned two years, from November 2017 to October 2019.

Informed written consent was obtained from all participants prior to enrolment. Data were collected using a pre-structured questionnaire that captured demographic details, disease onset and duration, frequency of symptoms, exposure to potential allergens, and personal or family history of dermatological disorders or atopy.

All participants underwent a detailed dermatological examination. This included assessment of lesion morphology, location, and estimation of the affected surface area of the hands. Patch testing was performed using the Indian Standard Series, which includes 20 allergens.

The upper back was used as the standard site for patch application in all cases, except for one participant where the lateral aspects of both thighs were used due to anatomical constraints. Patch test readings were taken 30 minutes after patch removal to minimize false-positive results. The first reading was taken at 48 hours. If a reaction was doubtful or weak, follow-up readings were taken at 72 hours and again on day 7 [10]. Reactions were documented using digital photography under consistent ambient lighting conditions. A diagnosis of allergic contact dermatitis was confirmed only if there was a positive reaction to one or more allergens. All responses were graded according to the criteria recommended by the International Contact Dermatitis Research Group (ICDRG), which provides standardized interpretations for patch test results [11].

This institution-based, cross-sectional study was conducted from November 2017 to October 2019 and included 52 patients with clinically diagnosed allergic contact dermatitis (ACD) of the hands. All patients underwent thorough clinical evaluation followed by patch testing using the Indian Standard Series of antigens. The majority of patients belonged to the 31–40 years age group (48.1%), followed by the 41–50 years group (30.8%). The youngest participant was 19 years old and the oldest was 50 years. Males outnumbered females (33 vs 19), resulting in a male-to-female ratio of 1.73:1. Regarding occupational classification, perennial farmers constituted the largest group (42.3%), followed by agricultural labourers (28.9%) and seasonal farmers (15.4%). Other occupations such as animal herding were also reported (Figure 1).

A significant proportion of participants (32.7%) had been exposed to occupational allergens for 1–5 years, while 23.1% reported 5–10 years of exposure. In terms of disease duration, 38.5% had been suffering from ACD for 6–12 months, 23.1% for over a year, and 19.2% for 3–6 months. Only three patients (5.8%) reported symptoms for less than one month.

Seasonal variation was reported by 56% of participants, all of whom experienced worsening of symptoms in the winter and relative improvement in the summer months. The most commonly affected sites were the dorsa of the hands (63.5%) and the dorsal surfaces of the fingers (53.8%). Other frequently involved sites included the palms (30.8%), palmar surfaces of fingers (21.1%), and webspaces (25.0%). Wrists were the least commonly affected (5.7%).

Table 1: Sites of hands involved

Patch testing with the Indian Standard Series of 20 allergens was conducted for all 52 participants. No ambiguous or severe irritant reactions were recorded. Of the 52 patients, 33 (63%) showed a positive response to at least one antigen, yielding a total of 51 positive reactions.

Twenty participants were sensitive to a single antigen, 9 showed sensitivity to two antigens, 3 to three antigens, and 1 participant reacted to more than three antigens.

Table 2: Number of allergens with positive patch test response

According to ICDRG grading, most reactions (72.5%) were mild (+1), while 23.5% were moderate (+2), and only 4% were strong reactions (+3).

Table 3: Positive patch test response grading as per ICDRG

Among the 20 allergens tested, Parthenium emerged as the most common sensitizer, eliciting a positive response in 21 out of 33 positive cases (40.4%). This was followed by Nickel sulphate (15.4%) and Cobalt sulphate (11.5%). Notably, 9 allergens did not elicit any positive reaction.

Table 4: Positive patch test response to individual allergens

This study examined the clinico-etiological profile of allergic contact dermatitis (ACD) of the hands among agricultural workers in Western Odisha, with an emphasis on patch test reactivity to common allergens. The findings reveal patterns in demographics, occupational exposure, clinical presentation, and allergen sensitivity that are consistent with and add to the existing body of literature on occupational ACD.

A male predominance was noted in our study, with 33 of 52 participants being male, yielding a male-to-female ratio of 1.73:1. This gender distribution is consistent with earlier findings by Hogade et al., Lakshmi et al., and Handa et al. [12–14]. In contrast, some studies such as those by Singh et al. and Minocha et al. have shown a female predominance [15,16]. This difference could be attributed to variations in gender roles across different regions. In rural Odisha, although both genders are involved in farming, men often engage in more labor-intensive tasks that involve direct handling of soil, tools, and chemicals, potentially increasing their risk of exposure. Additionally, women from rural backgrounds may be less likely to seek early medical attention due to sociocultural or economic factors.

The majority of patients (48.1%) were aged between 31 and 40 years, followed by those in the 41–50 age group (30.8%). This age range aligns with the peak productive years in agricultural occupations, a finding echoed in other Indian studies [12,14]. The duration of agricultural exposure varied widely among the participants; however, 32.7% reported working for 1–5 years, and 23.1% for 5–10 years. Interestingly, nine patients developed dermatitis within the first year of occupational exposure, highlighting the possibility of early sensitization in some individuals.

Our study found that 38.5% of participants had been symptomatic for 6–12 months, while 23.1% had symptoms persisting for over a year. These findings indicate a chronic and recurrent course, particularly in a population with limited access to specialized care. Similar chronicity has been reported in previous studies. For instance, Hogade et al. documented 46% of their cases with a disease duration of 3–6 months [12], while Bajaj et al. reported more than 60% of patients with symptoms lasting over six months [17].

Seasonal variation was a notable observation, with 56% of patients reporting worsening symptoms during the winter. This finding aligns with studies reporting up to 70% seasonal exacerbation [18]. Dry winter air can compromise the skin barrier function, increasing susceptibility to allergens. Moreover, the post-harvest season coinciding with winter may increase exposure to crop residues and environmental allergens like Parthenium.

Regarding site involvement, the dorsum of the hands (63.5%) and dorsal fingers (53.8%) were most commonly affected, while the wrists were least involved (5.7%). These results are consistent with Bhatia et al., who also reported a higher incidence of lesions on the dorsal aspects of the hands and fingers [19]. These areas are typically more exposed and less protected during manual work. Patch testing remains the gold standard for diagnosing ACD. In our study, 63% of participants showed a positive response to one or more allergens, which falls within the reported range of 30–85% observed across various studies [20–25]. The higher sensitivity rate in our cohort could be attributed to the intensive nature of agricultural work and continuous exposure to a wide variety of allergens.

Among the 33 patients who tested positive, 20 reacted to a single allergen, 9 to two allergens, and 3 to three allergens. One patient was sensitive to more than three allergens. This frequency of multiple sensitivities is slightly higher than previous studies by Hogade et al. and Lakshmi et al., who reported 16% and 4.5% multi-allergen sensitivity, respectively [12,14]. The broad range of exposures in agriculture—ranging from plant allergens to metals and rubber—could explain the increased rate of polysensitization. Grading of patch test responses revealed that the majority (72.5%) were weak positive (+1), followed by moderate (+2) in 23.5% and strong (+3) in 4%. These findings are comparable to the results reported by Lakshmi et al., where 69.7% of reactions were +1, 27.3% were +2, and only 3% were +3 [14]. One of our participants exhibited both +1 and +2 reactions to different allergens, indicating variable degrees of hypersensitivity.

Parthenium hysterophorus emerged as the most prevalent sensitizer, responsible for 40.3% of positive responses. Among the 33 patients who tested positive, 21 (63.6%) reacted to Parthenium. This aligns with studies by Lakshmi et al. and Bhatia et al., who found Parthenium sensitivity in 41.5% and 90% of their study populations, respectively [14,19]. Its widespread growth in rural India and high allergenic potential make Parthenium a major public health concern. Notably, both severe (+3) reactions in our study were attributed to Parthenium, reinforcing its clinical relevance.

Nickel sulphate and cobalt sulphate were the second and third most common sensitizers in our study, with positivity rates of 15.4% and 11.5%, respectively. Among agricultural labourers, 40% tested positive for nickel, and 33.3% for cobalt. These metals are commonly found in agricultural tools and equipment, providing a plausible source of exposure. Similar co-sensitization has been reported by Lakshmi et al., where all multi-allergen reactive patients showed sensitivity to both nickel and cobalt [14]. Potassium dichromate was another significant allergen, with five patients testing positive—four of whom were agricultural labourers. The migratory nature of their work and use of various farming implements and chemicals may account for their increased exposure.

This study highlights that allergic contact dermatitis (ACD) of the hands is a significant occupational health issue among agricultural workers in Western Odisha. The condition predominantly affects individuals in their most productive years, with a higher prevalence in males engaged in perennial or labor-intensive farming. The dorsum of the hands and fingers are the most commonly involved areas, and symptoms often worsen during winter.

These findings emphasize the need for routine screening, early diagnosis through patch testing, and preventive strategies such as education on allergen avoidance and the use of protective gear. Incorporating occupational health awareness into agricultural practices could play a crucial role in reducing the burden of ACD and improving the quality of life and productivity of the farming community.

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