Occupational contact dermatitis

Occupational contact dermatitis is a skin condition caused by work-related exposures. It occurs in workers who are exposed to irritating or allergenic substances or specific physical factors in the workplace. Eliminating or preventing exposure to these agents or conditions can largely prevent the occurrence, and if already present, the severity of OCD. The disease is most common amongst nurses, food handlers, hairdressers and beauty therapists, motor mechanics, cleaners, construction workers and specialized epoxy workers, printers and those within the health care and manufacturing industries.

In most western industrialized countries, OCD is one of the most commonly reported and underestimated occupational disease with international estimates of incidence varying between 50-190 cases per 100, 000 full-time workers per year. Specific OCD prevention activities derived from the literature and analysis of the data suggest that the largest gains are likely to be made by targeting the following seven areas:

1. cement dermatitis – guidance and consideration of regulating the addition of ferrous sulphate to cement;
2. latex – awareness and elimination of powdered latex gloves;
3. national OCD audits in specific industries;
4. education and skills – inclusion of information on OCD in vocational training competency packages and appropriate career counseling for at-risk individuals;
5. wet work – awareness and development of risk management approaches to wet work;
6. hairdressing - promote the substitution of glyceryl monothioglycolate and the substitution, or reduced use, of powdered bleach products; and
7. surveillance – consider OCD in the national strategy for the surveillance of disease hazards and exposures.

Severity of OCD

The severity of OCD may be measured in terms of medical, pharmaceutical and workers’ compensation costs, employment prospects, retraining costs and effects on quality of life. Occupational contact dermatitis often has a poor prognosis or outcome, and, of particular importance, is the condition persistent post-occupational dermatitis. In this condition, a worker may be incorrectly re-classified as having non-work-related eczema sometime after an original diagnosis of OCD. Workers’ compensation payments may be terminated. This is different from many other countries, where once work-related causation has been established, a worker is not re-assessed and is not in danger of losing financial support.

Risk factors

There are a number of risk factors that are common to high-risk occupations. 
These include:

• atopy;

• wet work; and

• use of gloves.

1   Atopy- Workers who are atopic are at a higher risk of developing OCD in occupations with frequent exposure to irritants. Education for people with atopy about avoidance of exposure to skin irritants in high-risk careers is an important preventative measure. Ideally, this would occur at the time of choosing a career or before the commencement of work experience, apprenticeships or part-time employment. Career counsellors and general practitioners may potentially be key individuals in the delivery of this message.

      Wet work- ‘Wet work’, according to the German regulation of hazardous substances at the workplace, is defined as occupational duties where “individuals have their skin exposed to liquids for longer than two hours per day, or use occlusive gloves for longer than two hours per day, or clean their hands very often (e.g. 20 times per day), or fewer times if the cleaning procedure is more aggressive.”

Preventative measures aimed at reducing the risk associated with wet work may include:

• trial of waterless hand cleansers for nurses;
• recommendations regarding the amount of wet work to be carried out by a worker per day;
• supply, by the employer at the workplace, of barrier creams, moisturizing creams and lined gloves

Gloves- Gloves are a form of personal protective equipment (PPE), with different types of gloves providing protection for different irritants and allergens. The supply of PPE is distinct from upstream control measures such as substitution of hazardous substances. Whilst the use of gloves may provide a degree of protection against workplace exposures, gloves also present a level of associated risk for workers. To be effective in the control of work-related exposures, appropriate gloves for the specific task must be supplied by the employer. Also, the worker needs to use the gloves, and use them correctly when carrying out the task. A worker who uses damaged gloves or re-uses disposable gloves may falsely think they are protected against hazardous substances. Many gloves that are appropriate for protection against hazardous substances are occlusive, i.e. they form a non-permeable barrier. Occlusive gloves, whilst necessary for protection, have the potential to cause sweating, which can irritate the skin. Latex gloves, which are widely used in the healthcare industry, are a particular risk. Synthetic gloves that do not contain latex include those made of vinyl, nitrile, neoprene or polyurethane. Vinyl gloves, whilst suitable for food handlers, do not offer appropriate protection against infectious agents found in bodily fluids. Nitrile gloves are suitable for this purpose.

4       
      Prevention Activity

The issue of OCD has been of concern to most jurisdictions for several years. As a result, many have already produced a range of advice and guidance material for those occupations where this condition is acknowledged to be a problem.19 In addition, all stakeholders have been active participants in ongoing projects (such as the review of hazardous substances), which will ultimately contribute to the prevention of OCD.

For more information on jurisdiction and other prevention activities, readers are directed to the following web sites:

NSW Work Cover Authority http://www.workcover.nsw.gov.au/default.html

Victorian Work Cover Authority http://www.workcover.vic.gov.au/dir090/vwa/home.nsf

OCD is a largely preventable and under-recognized condition. Based on empirical research and good OHS practice, this report proposes a range of OCD preventative actions. Raising overall awareness of this issue, appropriate targeted education, introducing the issue of wet work as a risk factor for OCD to industry, and cessation of the use of powdered disposable latex gloves are the most important recommendations for prevention arising from this report.

Dr. P. K. Tiwari

MBBS, MD

Dermatology, V.D