Understanding occupational skin disorders

Reviewing nearly half a million injury and illness cases involving active members of the U.S. Navy and Marine Corps, Chris Rennix discovered something unexpected: Skin disorders were one of the most prevalent occupational conditions for which military members were being treated.

“I was surprised it was so high,” said Rennix, head of the EpiData Center at the Navy and Marine Corps Public Health Center in Portsmouth, VA, and chair of the American Industrial Hygiene Association’s Occupational Epidemiology Committee. “It’s overlooked from a corporate level because it’s so easy to treat. It’s inexpensive to treat, except for rare allergic reactions. It doesn’t bump the budget that much.”

In fact, skin diseases are the second most common type of occupational illness, according to NIOSH. More than 13 million U.S. workers are estimated to be potentially exposed to chemicals that are absorbed through the skin.

On-the-job exposure

Irritant contact dermatitis, allergic contact dermatitis, skin cancer, infections and injuries are among the types of occupational skin diseases. According to NIOSH, causes of these diseases include:

Chemical agents: Irritants effect the skin through chemical reactions. Repeat exposure to sensitizers can lead to allergic reactions.
Physical agents: High or low temperatures and radiation
Biological agents: Parasites, plants and animal materials
Mechanical trauma: Bruises, cuts and friction

Exposure can occur through splashes, immersion, inhalation or contact with a contaminated surface. Workers in industries such as health care, construction, food service and cosmetology are at risk.

“Essentially, any workplace that involves excessive handwashing, hand hygiene wet work, as well as those who are in contact with chemicals, can lead to occupational skin disorders, so essentially everyone is at risk for it,” said Tallar Chouljian, occupational health and safety specialist with the Canadian Center for Occupational Health and Safety.

Contact allergens include pesticides, herbicides, formaldehyde and nickel. Products such as medicines, preservatives, oils and dyes also may play a part. The chemicals can be absorbed through the skin without the worker realizing it, and could lead to systemic toxicity if they go through the skin and enter the bloodstream, NIOSH states.

About 90 to 95 percent of occupational skin disease cases in the United States are contact dermatitis, and the hand is the most common area affected, according to Fred Frasch, research physical scientist in the Health Effect Laboratory Division at NIOSH. The two types of occupational contact dermatitis are:

Irritant: Accounts for about 80 percent of all cases of occupational contact dermatitis. The skin is exposed to a hazardous agent, resulting in damage and skin inflammation, which typically occurs at the site of contact.
Allergic: The worker is sensitized to an allergen, resulting in an immunological reaction that involves skin inflammation on repeat exposures.

“The allergic ones are the hardest to control, because once you’re allergic, it doesn’t take much to have that response again,” Rennix said.

A high frequency of allergic contact dermatitis occurs as a result of occupational exposure to metals, as 10 percent to 15 percent of people are estimated to have allergies to at least one kind of metal, Frasch said.

The two types of contact dermatitis have similar symptoms, so telling the two apart is difficult without clinical testing, NIOSH notes. Severity depends on factors such as the concentration of the hazardous agent, duration of exposure and condition of the skin.

“People lose their jobs over it,” Rennix said. “Once you become sensitized, your reactions can actually debilitate you. I’ve seen people who work in the aircraft industry when they get these hydraulic fluids on their fingers and they swell up like sausages. They can’t work in that field anymore.”

Diagnosis of skin diseases also is a challenge because many patients see a doctor and never return, so no investigation occurs to determine the cause of the disorder, Rennix said, adding that determining the agent then can be difficult.

“Everybody is exposed to chemicals. The soap that’s in your house could cause this reaction,” Rennix said. “Such a high percentage of these are the allergic type. We don’t know what sets them off, if it’s a work-related exposure or a home exposure. If you’re in an industry that only uses certain chemicals, you can do testing to see which. Most people work with a whole variety of chemicals, and it’s kind of hard to figure that out.”

Respiratory and dermal effects

Skin exposure typically occurs when the skin comes in contact with a contaminated surface or a chemical is splashed on the skin. This frequently happens at irregular intervals and unpredictable locations, so measuring exposures can be challenging in terms of knowing what, when, where and how to measure, Frasch said.

Exposure through inhalation has been the most apparent workplace hazard, Frasch said. Measuring these exposures – such as vapor and dust – is both practical and standard, but standardized methods for measuring and assessing skin exposures are “currently lacking,” NIOSH states. However, Frasch noted, “I’ve been in this business for close to 20 years, and in that 20 years, there’s definitely been an increased focus on assessing and measuring dermal exposures.”

Prevention methods

To prevent and control work-related skin diseases, OSHA recommends substituting chemicals with safer alternatives, redesigning work processes to prevent splashes and immersions – or using personal protective equipment if impossible – good housekeeping, and enclosure and isolation.

Frasch shared the standard occupational hygiene Hierarchy of Controls for protecting workers from skin diseases:

1. Elimination of the hazard
2. Substitution of the substance with a less hazardous alternative
3. Engineering controls, such as ventilation systems
4. Administrative controls through education and changing the way of work
5. Personal protective equipment, such as gloves and lab coats

In addition to the Hierarchy of Controls, Chouljian recommends employers conduct a hazard identification or a risk assessment with a safety committee or a safety representative on all types of skin allergens or irritants used in the workplace.

“The employees would also play [an] important part in preventing occupational skin disorders, so they should also be aware [of] personal hygiene, how to do proper hand hygiene techniques, how to dry their skin and use skin moisturizers if needed, how to wear that personal protective equipment properly so they don’t have skin exposed to the elements, how to report their concerns to supervisors,” Chouljian added. “They should also be assessed by a health care professional if they suspect they might have an occupational skin disorder.”