OCCUPATIONAL DERMATITIS

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Occupational Dermatitis

Occupational dermatitis is a skin inflammation that affects an individual in the line of duty or when they contact a hazardous substance. The disease occurs when a worker gets in contact with any biological, physical, or chemical substance associated with the disease. Most of the workers affected include caterers, cleaners, gardeners, florists, medical personnel, mechanics, and other industrial workers (Canadian Centre for Occupational Health & Safety, 2008). Occupational dermatitis is often associated with type IV cell-mediated allergy.

Rubber gloves, food products, coins, alcohol-based sanitizers, cleaning agents, and other chemical compounds cause an inflammation of the skin of the worker. Prolonged exposure to cleaning agents such as water, soaps, detergents, and disinfectants causes irritation and inflammation of the skin. Preparing and handling selected foods such as sugars, citrus fruits, flour, spices, meat, vegetables, and fish causes skin inflammation. The biological substances, mainly include insects, animals, plants, bacteria, fungi, and arthropods. Chemical agents include aldehydes, acids, alcohols, salts, solvents, heavy metals, and esters (Stellma, 1998).

Occupational dermatitis is the most common occupational disease in many countries, including the United States. Every year, the incidence rate of occupational dermatitis is 0.5–1.9 cases per 1000 full-time workers with about 3200 infected individuals. 55% of the cases are caused by cleaning agents while 40% of dermatitis incidences occur due to food irritants. Most of the infections are not fatal since they are treatable and manageable at an early diagnosis. Statistics indicate that the number of dermatitis has reduced drastically over the years, for example, the numbers dropped from the 400s in the 1990s to the 100s between 2004 and 2005. The incidence rate also reduced significantly between 1996 and 2009. The workers at the highest risk of contracting the disease include barbers, hairdressers, beauticians, glass cutters, chemical manufacturers, and ceramic workers (Rycroft, 2001).

Occupational dermatitis occurs when the skin is damaged or external agents diminish its protective capacity. The external agents damage the skin by removing water and essential oils and fats from the dermis, making the skin prone to the penetration of the harmful substances. Once the substances penetrate the skin, they mix with the skin proteins in the body and the formed combination is transported to other body parts by the white blood cells. The white blood cells protect the body against foreign substances. Thus, when the external agents penetrate the body, they fight them through the immune system (Kanerva, 2000). The white blood cells recognize the agents as foreign substances and trigger the release of chemicals called lymphokines that damage the tissues. The lymphokines cause swelling, itching, redness, pain and the formation of blisters on the skin. The inflammation often occurs in the area of contact with an agent, but it could spread to other body parts of the sensitized individual (Rom and Markowitz, 2007). The incubation period is twelve hours and severe symptoms appear three to four days after contact.

The disease mainly affects the hands because they are the most active organs at the workplaces. However, other body parts could be affected. The feet, groin, and axillae are affected when an individual wears clothes contaminated with chemicals. Dust irritants will cause inflammation in areas of the body where dust collects, such as sock line, collar line, flexural areas, and belt line. The neck and face are affected by vapor or mist contaminants that may splash or settle in these areas. Occupational dermatitis manifests itself through various symptoms (Johansen, Frosch, and Lepoittevin, 2010). The inflammation is manifested through reddening of the area of contact, scaling of the skin, hyperpigmentation, itching, fissures, burning sensation and vesicles on the affected part, and pain.

Several contributing factors predispose an individual to the disease. Hot working environments cause excessive sweating that causes hazardous chemicals to dissolve into the skin. Dry air also causes the skin to chap, exposing it to allergens. Cuts and scratches on the skin create an avenue for the hazardous substances to penetrate the body causing the disease. Operating grinding machines and other sharp machineries could cause friction and cuts that compromise the skin’s protection against the substances. Preexisting skin conditions may also contribute to the development of the disease. Age and other hereditary factors that vary among individuals could pose as risk factors to occupational dermatitis.

Diagnostic techniques of occupational dermatitis include a historical examination of an individual’s occupation, the working environment, and the substances involved in the workplace. Other confirmatory tests include a patch test where an allergen or irritant is applied on the skin; inflammation of the contact area indicates sensitivity to the test agent. However, the tests should be carried out meticulously to avoid false positives since excessive application of the agents could yield false results (Sickness Absence Recording Tool, 2014).

Occupational dermatitis can be prevented by observing some precautionary measures. Employers should identify potential skin irritants and sensitizers and replace them with safer products that have low skin reactivity. Employers should also provide appropriate personal protective equipment at the workplace depending on the nature of the job. For example, gardeners and florists handling harsh chemicals should be provided with gloves and gas masks, mechanics and construction workers should have coveralls and gas masks to protect them from hazardous fumes and chemicals. Employees should undergo regular health surveillance to establish potential risks when an individual is exposed to a hazardous agent. Employees should also undergo training in skin care and hygiene procedures, usage and maintenance of PPE, and reporting procedures during emergencies. Employers, in conjunction with representatives of the workers’ unions, should encourage employees to have minimal exposure to hazardous chemicals, carry out regular skin checkups, and promote good personal hygiene and housekeeping procedures (Health and Safety Executive, 2014).

Both drug and non-drug approaches can manage occupational dermatitis. Affected people should be encouraged to wash their hands regularly with non-perfumed products and dry them thoroughly. The patient should remove rings and other ornaments, clean them thoroughly, and not wear them until the condition has resolved completely. Complete avoidance of the irritant is the most effective management technique of the disease. Drug management includes the use of topical corticosteroid creams to treat severe cases of the disease. In the case of itching on the affected areas, antihistamines are effective in relieving the discomfort. Chronic and steroid resistant cases can be treated using second line agents such as psoralen combined with ultraviolet A, azathioprine and cyclosporine (Fisher, 2008).

Occupational dermatitis is a skin condition associated with various workplaces that expose the workers to harsh chemicals and substances. The most hazardous substances include cleaning agents, rubber chemicals, and food irritants. Working in wet and moist areas is also a major predisposing factor to the disease. Workers handling the above mentioned agents are at the highest risk, but the duration of exposure determines the severity of the disease. Avoiding the agents and proper skin care are the main ways of preventing and managing the disease. Severe cases are managed using drugs such as corticosteroid creams (Draper, 2011). Workers should avoid exposure to irritants and hazardous agents at the workplace and observe personal hygiene techniques in order to avoid contracting dermatitis. Constant exposure sans proper hygiene and PPE makes the workers vulnerable to the disease.

References

Canadian Centre for Occupational Health & Safety, 2008. Dermatitis, irritant contact. [Online] (updated 15 Oct. 2008) Available at: <http://www.ccohs.ca/oshanswers/diseases/dermatitis.html> [Accessed 6 May 2014].

Draper, R., 2011. Contact and occupational dermatitis. [Online] (updated 22 Jun. 2011) Available at: <http://www.patient.co.uk/doctor/Contact-and-Occupational-Dermatitis.htm> [Accessed 6 May 2014].

Fisher, A., 2008. Fisher’s contact dermatitis. Shelton: PMPH-USA.

Health and Safety Executive, 2014. Dermatitis. [Online] Available at: <http://www.hse.gov.uk/food/dermatitis.htm> [Accessed 6 May 2014].

Johansen, J, Frosch, P. J, and Lepoittevin, J., 2010. Contact Dermatitis. New York: Springer.

Kanerva, L., 2000. Handbook of occupational dermatology. New York: Springer.

Rom, W. N, and Markowitz, S. B., 2007. Environmental and occupational medicine. New York: Lippincott Williams & Wilkins.

Rycroft, R., 2001. Textbook of contact dermatitis. New York: Springer.

Sickness Absence Recording Tool, 2014. Information on occupational dermatitis. [Online] Available at: <http://www.iom-world.org/sicknessabsence/occderm.htm#> [Accessed 6 May 2014].

Stellma, J. M.,1998. Encyclopaedia of occupational health and safety. Brussels: International Labour Organization.