Occupational Skin Diseases

By Delos D. Carrier, MD, MSPH

Occupational Skin Diseases are a major concern that can result in loss of work, costly medical expenses, and decreased quality of life. According to the October 2006 Bureau of Labor Statistics Survey of Occupational Injuries and Illness, skin diseases accounted for 16.5 percent of all reported private industry occupational injuries and illnesses (up from 15.6 percent in 2005).

Contact dermatitis, the most common occupational skin disease, has been blamed for an astounding $1.4 billion in direct medical expenses, with another estimated $500 million in productivity losses.2 Occupational skin diseases also pose a threat to public health. Given this, it is important to understand what occupational skin diseases are and how they can be avoided.

Understanding Occupational Skin Diseases

Contact dermatitis usually appears as a rash located at the point of exposure. Acute dermatitis may have a weepy, swollen, or blistered appearance, while skin suffering from chronic dermatitis may have more of a dry, cracked, and scaly appearance. More severe skin irritation may cause red blisters or burns, while weak irritant exposures can appear as very dry, itchy, thickened or scaly skin changes. Treatments for occupational skin disorders vary according to the disease.

Occupational skin diseases include:

  • Irritant contact dermatitis which develops slowly as a result of prolonged exposure to weak irritants such as water, solvents, or soaps. Heavy metals can cause an immediate and painful reaction, resulting in lesions when they come in contact with the skin.
  • Allergic contact dermatitis develops in response to even minimal exposure to substances like poison oak and poison ivy, epoxy resins, nickel, chromates, and acrylics. This rash, which usually appears at the point of contact, is likely to have redness, blistering, and severe swelling.
  • Oil acne and folliculitis (an inflammation at the base of hair follicles) develops due to regular exposure to solvents and lubricants. Rashes often appear in areas that have been exposed to oil-soaked clothing. Occupational acne may also appear on the face or neck further aggravating pre-existing acne.
  • Occupational skin neoplasm (skin cancer) can develop as a result of exposure to substances such as polycyclic hydrocarbons, inorganic metals, and arsenic containing compounds. Skin tumors and lesions common to this illness can also be caused by trauma, burns, or exposure to ultraviolet light or ionizing radiation. Signs and symptoms are often not seen until two or three decades after exposure.

Who Is at Risk?

According to American Family Physician (2002), workers spanning an array of industries are at risk of contracting skin diseases:

Exposure and examples of Workers at Risk

  • Sunlight: Outdoor workers, including landscapers, postal workers and construction workers
  • Heat: Outdoor and Foundry workers
  • Cold: Anglers, sailors and other outdoor workers
  • Moisture Dishwashers, food handlers and hairdressers
  • Plants like poison ivy, poison oak and poison sumac: Outdoor workers, including firefighters, park and highway maintenance workers, and farmers
  • Ionizing radiation: Welders, medical personnel and workers in the nuclear energy industry
  • Severe irritants (strong acids and alkalis, heavy metals, etc.) Factory workers and semiconductor workers
  • Weak irritants (soaps, detergents, solvents, synthetic oils, heat, sunlight, etc.) Dishwashers, physicians, nurses, waiters and food handlers

It is important to note skin that is washed and moisturized properly on a regular basis has a better chance of avoiding contact dermatitis. But as the number of reported occupational skin diseases proves, washing properly may be difficult.

Why Do Occupational Skin Problems Exist?

As the previous chart indicates, for many individuals who experience continuous exposure to the stated irritants, occupational skin disease may very well be inevitable.

Hand hygiene tends to be a problem because many people do not take the time to wash their hands correctly, nor do they do it frequently enough. Those who do wash their hands frequently do not wash as often enough and they spend less than half of the time required doing so.

In addition, if workers don't have convenient access to sinks, they may feel too pressed for time to find a washroom in which to wash their hands, or they simply may not make the effort.

Here are the key steps to good hand washing techniques:

Wash with soap and water for at least 20 seconds using warm water that is approximately 100 degrees Fahrenheit.

Scrub hands gently because harsh scrubbing can cause cracks and small cuts, giving pathogens a place to grow.

Dry hands thoroughly because wet hands are more likely to spread germs.

Use hand lotions to keep skin intact so that cuts and cracks do not occur.

The Role of Sanitizers

The most effective way to clean hands and prevent the spread of disease is through proper and frequent hand washing using pure, uncontaminated (containers not open to the air) soaps. However, there are times when this is not possible or practical. In these cases, sanitizers can be used. However, sanitizers should be viewed as a temporary measure until hands may be properly washed.

Select hand sanitizers that have a minimum of 60 percent ethyl alcohol. Some sanitizers may have only 40 percent; these are not effective at reducing and eliminating germs, microorganisms, and other contaminants on hands. However, because sanitizers can dry hands, always use lotions afterwards to moisturize hands.

Finally, when hand so rashes develop notify appropriate medical treatment personal for assistance. This is important to avoid the long term consequences of occupational exposure to irritants or causative agents.