Preventing Occupational Skin Diseases

• By Robert Kravitz
• Apr 01, 2009

Many people consider common skin rashes to be no more than an inconvenience. But to a staggering number of professionals in a variety of fields, they are a major concern that can result in loss of work, costly medical expenses, and decreased quality of life. In fact, according to the October 2006 Bureau of Labor Statistics Survey of Occupational Injuries and Illness, skin diseases continue to be the most widespread occupational illness. In 2006, skin diseases accounted for 16.5 percent of all reported private industry occupational injuries and illnesses (up from 15.6 percent in 2005).¹

Occupational skin diseases strike workers in a multitude of settings and cost employers billions of dollars every year. 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 serious threat to public health. In the face of such consequences, 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 become dry, cracked, and scaly. More severe skin irritation may cause red blisters or burns, while skin changes similar to those caused by eczema can appear over time due to exposure to weak irritants. Treatments for occupational skin disorders vary according to the disease.

Occupational skin diseases include:

• Irritant contact dermatitis. It develops slowly as a result of prolonged exposure to weak irritants such as water, solvents, or soaps. Exposure to more severe skin irritants is rare, but the reactions it causes are more serious. Heavy metals can cause an immediate and painful reaction, triggering lesions when they come in contact with the skin.
• Allergic contact dermatitis. It develops in response to even minimal exposure to antigenic substances (substances that evoke an immune response). This includes plants that are members of the Rhus genus (e.g., poison oak and poison ivy), epoxy resins, nickel, chromates, and acrylics. A rash, which usually appears at the point of contact, is likely to be characterized by redness, blistering, and severe swelling.
• Oil acne and folliculitis. This condition develops due to regular exposure to solvents and lubricants. Lesions often appear in areas that have been exposed to oil-soaked clothing. Occupational acne may also appear on the face or neck and can aggravate existing acne.
• Occupational skin neoplasm (skin cancer). It develops as a result of exposure to substances such as polycyclic hydrocarbons, inorganic metals, and arsenicals. The skin tumors and lesions common to this illness can also be caused by trauma, burns, or exposure to ultraviolet light or ionizing radiation. Symptoms often don't emerge 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:³

Exposure or Causal Agent, with Examples of Workers at Risk

• Sunlight Outdoor workers, including postal workers, landscapers, and construction workers
• Heat Foundry and outdoor workers
• Cold Sailors, anglers, and other outdoor workers
• Moisture Food handlers, dishwashers, and hairdressers
• Plants belonging to the Rhus genus (poison ivy, poison oak, etc.) Outdoor workers, including firefighters, park and highway maintenance workers, and farmers
• Ionizing radiation Medical personnel, welders, and workers in the nuclear energy industry
• Severe irritants (strong acids and alkalis, heavy metals, etc.) Factory and semiconductor workers
• Weak irritants (soaps, detergents, solvents, synthetic oils, heat, sunlight, etc.) Physicians, nurses, waiters, dishwashers, and food handlers

Why Do Occupational Skin Problems Exist?

As the previous chart indicates, people in many different occupations are exposed to causal agents that can trigger various skin diseases. And for many individuals who experience continuous exposure to those elements, occupational skin disease may very well be inevitable.

For instance, hairdressers and health care professionals, who must expose their hands to hot water many times throughout the day, almost always find themselves faced with dry, cracked skin. Once the skin is damaged, it loses the oils and moisture that help it to maintain its natural barrier function.⁴ Cracks in the skin present an ideal breeding environment for potentially harmful germs and bacteria, which can then be transferred to other people, as well as high-touch surfaces (such as door handles, light switches, railings, ledges, and countertops).

It is important to note healthy skin is less inclined to react when it comes in contact with irritants; this is why 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 more difficult than it seems.

The Hand Washing Compliance Challenge

Hand washing compliance is key to combating occupational skin diseases. Yet industries across the board--even health care--seem to struggle with it. In a field where hand washing and hygiene is of the utmost importance, studies indicate compliance among health care providers is, on average, well below 50 percent. And health care professionals who don't properly wash their hands risk passing germs and bacteria on to their patients.

Hand washing can help prevent the transfer of pathogens, but the key to disease prevention is performing hand washing properly. "Soap and water alone don't really remove germs from hands," said Mike Nelson, vice president of marketing for Pro-Link, a marketing and buying group for the professional cleaning industry. "They require agitation, rubbing the hands together, to mechanically remove unwanted material and disease-causing pathogens from hands, essentially pulling them off the skin, into the water, and down the drain."

While there are many reasons people don't meet hand washing standards, studies have revealed health care workers regularly fail to comply with the Centers for Disease Control and Prevention's "Guidelines for Hand Hygiene in Healthcare Settings" because frequent washing causes dry, cracked, painful skin.⁴ "As hands become overly dry, skin becomes chapped and can crack, and it hurts," said Nelson.

Hand hygiene also tends to be problematic because "many people simply do not take the time to wash their hands correctly, nor do they do it frequently enough," he said. "Those who do wash their hands frequently still do not wash as often as they should, and they spend less than half of the time required doing so."

Lack of convenience is a deterring factor in hand washing compliance. 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.

What does proper hand washing entail? Here are the key steps:

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

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

Dry hands thoroughly. Wet hands are more likely to spread germs.

Use hand lotions. These keep skin intact so that cuts and cracks do not develop.

Recently, it has been discovered that even if workers do wash their hands properly, they may be exposed to germs and bacteria during the hand washing process. The reason for this is that many industrial soap dispensers are "open": Soap is poured into them to refill them. Studies have found that, because they are open, the dispensers are exposed to airborne contaminants, which can contaminate the soap. "The way to prevent this is simple," Nelson said. "Using soap dispensers in which the contents are dispensed from factory-sealed, disposable refills essentially eliminates this problem."

Nelson advised that a successful hand hygiene program requires a committed manager. "If facility managers are not concerned about hand washing, employees will not be concerned. They must view the problem as a potentially serious but preventable health issue, which it is."

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 soaps. However, there are times when this is not possible. In these cases, sanitizers can be used. However, they should be viewed as an interim measure until hands may be properly washed.

Select hand sanitizers that have at least 60 percent ethyl alcohol. Some sanitizers may have only 40 percent and will not be effective at reducing and eliminating germs, microorganisms, and other contaminants on hands. A recently reported study revealed that if the alcohol content is below 60 percent, then it isn't killing the germs--just helping the germs move around the hand. In this study, a student's hand was cleaned using a hand sanitizer with less than 60 percent ethyl alcohol, and the other hand with a sanitizer with more than 60 percent. The hands were then placed on two different culture plates. Later, the culture plate revealed the hand cleaned with the hand sanitizer with less than 60 percent alcohol had an outline of his hand in bacteria. The other hand had virtually no evidence of bacteria.⁵

Because sanitizers can dry hands, always use lotions afterwards to moisturize hands.

References

1. "Eczema Treatment Breakthrough May Reduce Occupational Skin Disease." Business Wire, Dec. 12,, 2006.

2. James W. Arbogast. "Dry, Cracked Hands? Use Prevention to Combat Occupational Dermatitis." Industrial Safety & Hygiene News, June 1, 2006.

3. W. F. Peate. American Family Physician. American Academy of Family Physicians, 2002, 66:1025-32, 1039-40.

4. Susan Cantrell. "Hand-Care Products: The Gloves Are Off." Healthcare Purchasing News, Nov. 1, 2005.

5. Journal of Environmental Health, November 2006, Scott Reynolds, Foster Levy, Elaine Walker