Work-related skin diseases

Healthcare workers are often in contact with water and certain chemicals, such as cleaning agents or latex gloves. This exposure can cause skin irritation, allergic reactions, and eczema. Prolonged or repeated exposure can lead to chronic skin conditions.

You might think that hand eczema is not a very serious condition, but for workers who depend on fine mechanical skills, it can make it almost impossible for them to do their job. 90-95% of all work-related skin diseases are contact eczema. Work-related contact eczema usually affects the hands and forearms, while areas of skin covered by clothing are seldom primary sites.

Contact eczema occurs when a substance or chemical penetrates the superficial layers of the skin, known as the barrier layer. Eczema develops through two different mechanisms: irritant or allergic. Although the two are morphologically indistinguishable, distinguishing between them is important for providing advice to a worker with work-related eczema.

Irritant contact eczema

Irritant contact eczema is caused by repeated, prolonged, or chronic skin exposure to water and/or mild irritants. This exposure damages the barrier layer, making the skin even more susceptible to irritants. Eczema develops when exposure to physical or chemical injury exceeds the skin’s ability to repair the resulting damage. Workers with a history of childhood eczema are at greater risk of developing irritant contact eczema. 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. The condition can be aggravated when 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 skin disease. In the first stage of this process, a contact allergen penetrates through the barrier layer and induce a primary immune response. Further skin contact with the same allergen at a later stage may result in allergic contact eczema with only a minimal exposure to the allergen. Approximately 20 % of contact eczemas are of the allergic type. Allergic contact eczema is a lifelong condition.

No diagnostic test can confirm irritant contact eczema. Allergic contact eczema, however, can be confirmed by a patch test, a specialized test performed by dermatologists. The test involves application of small amounts of allergens under occlusion onto the skin of the upper back for two days.
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The relevance of a positive patch test has to be established for suspected occupational allergens, preferably identified by safety data sheets (SDSs). It is important to keep in mind that a positive patch test only tells us that the patient has, at some point, been sensitized to a specific chemical. A diagnosis of allergic contact eczema has to be confirmed by clinical manifestations and relevant work exposure.

Some examples of exposures that cause contact eczema

Usually contact eczemas are caused by skin exposure to different chemicals. Such exposure is often combined with exposure to water.

All types of cleaning work can involve prolonged contact with water and soap. On intact skin, extended exposure to water increases skin permeability and susceptibility to both irritants and allergy-provoking agents.
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Acrylates, such as “super glues”, are a group of strong, fast-acting adhesives with industrial, medical/dental, and household uses. Here “super glue” is used to mend a shoe, but it is also used to close open wounds instead of a surgical procedure. Acrylates may act as skin irritants, but can also cause allergic contact eczema. ^{© G. Tjalvin}

Construction workers are exposed to a range of different allergy provoking agents. Cement, for instance, can cause allergic contact eczema due to its chromate content, but it can also cause irritant eczema. Work-related contact eczema usually affects the hands and forearms. In this situation, however, workers are also at risk of developing contact eczema on their feet and legs.
^{© G. Tjalvin}

Organic solvents are used in many different industries. They dissolve the natural layer of fat that forms a skin barrier and make the skin more vulnerable to other chemicals.
^{© G. Tjalvin}

All industries that cut, grind, or machine metals use large quantities of metalworking fluids/cutting oils. Cutting oils act as skin irritants, but also contain potential sensitizers. Once sensitized, a person may experience a reaction with minimal exposure to the allergen. ^{© Colourbox}

Hairdressers are at great risk of developing occupational eczema, both irritant and allergic, since they, in addition to much wet work, use many highly sensitizing chemicals in their work. They are even at risk of being sensitized to the metals nickel and chromium. The use of appropriate gloves may help to protect the hands of such workers from harmful chemicals.
^{© G. Tjalvin}