Occupational Dermatitis

Most of us usually associated occupational hazards with things like lower back pain, carpal tunnel syndrome, or perhaps hearing loss in noisy workplace environments. We tend not to think of skin problems as being that serious and often ignore it. In reality, however, occupational skin problems account for nearly 50% of occupational illness and account for up to 25% of lost workdays1 making it one of the most common workplace hazards.

What is occupational dermatitis, and what's the big deal?

Occupational dermatitis is a general term that describes rashing, inflammation, and itching, and thickening of the skin that is triggered by an allergen or irritant that the skin is exposed to at the workplace. Minor cuts, abrasions, and friction to the skin is common in many workplaces, as is frequent exposure to various chemicals. There are numerous practical challenges for a patient with occupational dermatitis. The first challenge is identifying the problem in the first place. It will often be unclear what is causing the dermatitis, and second, if the problem is in the workplace, it's not always practical or feasible to completely avoid contact. Given that a typical full-time employee spends almost a quarter of their lives at the workplace (a third of their waking hours), it's no surprise that exposure to an allergy or sensitivity at work can wreak havoc on the patient's quality of life. If you have eczema that is persistent and the source is occupational, the problem is unlikely to go away on its own, and it may become worse over time. Some problems are significant due to their immediate impact or effect, and others due to how frequently they occur. With occupational dermatitis, it is often both chronic, and high impact, deteriorating the patient's quality of life in significant ways.

Which occupations are at risk?

Anyone can be a potential candidate for occupational dermatitis. Even "common" workplaces are frequently unique environments that are distinct from a typical or public space environments. There may be one or more substances that are irritants to the skin that. Some professions are higher risk, however. The most common occupations at risk for dermatitis are:

  • Healthcare workers
  • Food service industry
  • Printing
  • Construction
  • Cosmetology
  • Agriculture
  • Cleaning

One of the most common sources of dermatitis or rash is irritant contact dermatitis, caused by chronic and constant exposure to an irritant. In most cases, it isn't a rare chemical that your skin is reacting to. It may sound surprising, but overexposure to water is actually one of the most common causes of irritant contact dermatitis, as many professions like health care workers or food industry workers are required to wash their hands very frequently. Another common problem are true allergens: Rubber gloves, metals like nickel and cobalt, as well as formaldehyde, perfumes, and various foods can all cause allergies in the workplace2.

How to Identify and Manage

Dermatitis can occur anywhere on the body, but the hands are one of the most commonly affected sites, as we primarily use our hands to work. Perhaps because dryness of the hands is so common, hand eczema isn't treated as seriously as it should. Hand eczema can affect up to about 10% of the general population, and it can have a serious impact on the patient's quality of life3.

If you develop a rash or patch of dry or irritated skin, you can start with moisturizers to provide some added protection for the skin. For mild symptoms like dry patches on the fingers, using a moisturizer helps to keep the skin's barrier function strong, and helps it recover faster from damage. There are also some very mild corticosteroids that are available over the counter which may help control some mild rashes. Common sense protection should not be underestimated. Occupational dermatitis is frequently caused by repeated insults to the skin, such as hand washing, and an accumulation of small efforts can counteract a lot of this. A simple procedural change such as always wearing gloves before handling dirt, weak solvents and other chemicals common in factories, or simply applying a moisturizer before and after work, can make a big difference.

While recognizing and identifying the problem, and making some lifestyle adjustments can help, in some cases you will need to take more drastic action. It's important to understand that chronic occupational dermatitis presents numerous unique challenges:

  • Identifying the source of the problem is often challenging. Your skin may be reacting negatively to any number of things.
  • Hand dermatitis is one of the most common types of occupational dermatitis, and treating the hands presents additional challenges: The skin is thick, requiring stronger topical medications in order to take effect, and the hand is constantly touching other objects (and the source of the sensitivity/allergy).
  • Avoiding contact with the offending substance is not always possible or practical. For example, a nurse may not be able to limit hand washing as the job requires it (for good reason), and similar things could be said of a factory worker.

Talk to a Doctor

Most people are reluctant to visit a doctor and prefer to manage it themselves if possible. While it can certainly be a pain to visit a doctor, depending on how accessible they are in your area, it will often be worth the visit. They can help you identify common causes, or sometimes a patch test will be performed to identify the offending substance. If you identify the problem, you may be able to exercise caution or avoid it altogether (realistically though, sometimes not--that's the nature of occupational dermatitis). Doctors can prescribe more potent topical treatments to control dryness, itch, and inflammation, and if warranted, provide other treatment options like light therapy or oral drugs if the symptoms are severe. As a rule of thumb, see a doctor if:

  • The symptoms are becoming more severe and affecting your quality of life
  • The problem becomes chronic (persists over the weekend)
  • If you can't identify the cause of the problem

What to expect: For most cases of occupational dermatitis, topical treatments will likely be the first line of treatment. Identifying the cause of the dermatitis may be part of the process. Usually this involves patch testing, or other methods to identify sensitivities or allergies may be involved. If the symptoms are severe, or if the triggers aren't practical to avoid (this is unfortunately common in the workplace), more powerful systemic medications or light therapies may be recommended.

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1Occupational injuries and illnesses counts, rates, and characteristics, 1995. Washington, D.C.: U.S. Dept. of Labor, Bureau of Labor Statistics, 1998.
2https://www.ccohs.ca/oshanswers/diseases/allergic_derm.html
3https://www.ncbi.nlm.nih.gov/pubmed/17868211?dopt=Abstract