Work-related skin diseases

You might think that hand eczema is not a very serious condition, but for certain groups of workers having the condition might result in them having to stop their jobs.

Health effects

Skin diseases are very common in developed countries. In industrialized nations, up to 30 percent of all occupational diseases involve the skin. However, due to a lack of studies, the prevalence of work-related skin diseases in developing countries is not known.

As much as 90-95 % of all work-related dermatoses are contact eczema. Work-related contact eczema usually affects the hands and forearms while areas of skin covered by clothing are seldom primary sites. The disease can arise at any time during employment, but workers seem to have a greater risk for developing contact eczema during the first 3-12 months of a new job.

Contact eczema is caused when a substance or chemical is able to penetrate the superficial layers of the epidermis, known as the barrier layer of the skin.

A chemical must be able to penetrate the superficial layers of the epidermis, the so-called barrier layer of the skin, to cause contact eczema. ^{© Colourbox}

Contact eczema develops through two different mechanisms, irritant or allergic. The two are morphologically indistinguishable, but the distinction between them is important in terms of providing advice to a worker who has work-related eczema.

A typical example of contact eczema. ^{© Hilde Kristin Vindenes}

Hand eczema can present as dry, flaking, and fissuring; or erythematous, swollen, blistering, weeping and eroded. Broken skin increases the risk of secondary skin infections that can lead to red, painful, swollen skin with ulceration, discharge or pustules.

For workers who are dependent upon fine mechanical skills, the condition can make it almost impossible for them to do their job.

Irritant contact eczema

Irritant contact eczema is caused by repeated, prolonged or chronic skin exposure to water and/or (usually) weak/mild irritants. Such exposure damages the barrier layer of the skin, which makes the skin even more susceptible to irritants. Eczema develops when the exposure to physical or chemical injury exceeds the skin’s ability to repair the damage resulting from the exposure.

In general, the degree of damage following irritant exposure depends on the potency of the irritant, the duration of application, the frequency of exposure, occlusion, temperature, anatomical site, and individual susceptibility. Workers with a history of childhood eczema are at greater risk of developing irritant contact eczema.

Black or oriental skin is generally more resistant to irritation compared to white skin. About 80 % of contact eczemas are caused by an irritant mechanism.

Reducing exposure to skin irritants and water decreases the risk of developing irritant contact eczema. Eczema can be aggravated when the irritating chemicals are trapped on the skin, for example by gloves, rings or a wristwatch.

Allergic contact eczema

Allergic contact eczema depends upon a previous sensitization to a contact allergen. The allergen may have been previously tolerated for years without causing dermatitis. In the first stage of this process, a contact allergen penetrates through the barrier layer of the skin and provokes a delayed, cell-mediated or type IV allergy.

Further skin contact with the same allergen at a later stage may result in allergic contact eczema. Once sensitized the reaction may then occur with only minimal exposure to the allergen. Approximately 20 % of contact eczemas are of the allergic type. Allergic contact eczema is a lifelong condition.