Health: Dermatitis

GP Alice Fitzgibbon explores another work-related condition

This month we cover another condition that can be work-related – dermatitis. Dermatitis means inflammation of the skin and is a condition that presents similarly to eczema. Occupational dermatitis is one of the most widespread causes of ill health and affects workers in many industries. The Health and Safety Executive estimates that 84,000 people in England have dermatitis caused or made worse by their work. This condition is seen in many industries as there are many potential causes: contact with foods, rubber/latex gloves, water, chemicals and cleaners to name a few, may all cause skin reactions.

In this condition, the skin becomes red and itchy and develop blisters and cracks. Over time, it can become thickened, just like in eczema. So how do we know its work-related dermatitis and not eczema? Often people with eczema have a history of skin problems starting in childhood. It may be present all the time – regardless of being at work or not – and can occur on the body and areas of skin that would not be exposed to chemicals at work. With work-related dermatitis, it is mainly seen on the hands where the skin has been exposed to chemicals. It often flares up during a period of work, but then may improve if the person was away on holiday, for example, before coming back when work restarted. It is also a clue if more than one person in a workplace has the same thing happening to them.

Work-related dermatitis is known as a contact dermatitis. That means the skin must be in contact with the cause for it to happen. It is a significant problem and can have long term consequences for affected people. Dermatitis can be very painful, require considerable treatment and take a long time to settle down. In some cases, it may never fully resolve.

There are two types of contact dermatitis: irritant and allergic. Irritant contact dermatitis makes up most cases (80%). This is when the skin is directly damaged by contact with a substance; this can happen in various ways. It may be that the skins protective layers get damaged by repeated exposure to solvents, detergents or soap in handwashing, or that there is physical damage, such as repeated friction or minor cuts from something eg. fibreglass, which breaks down the protective layer of the skin. Exposure to acids or alkalis can cause chemical burns.

In the construction industry, common irritants seen are cutting oils, solvents and degreasing agents which remove the skins outer oily barrier layer and allow easy penetration of hazardous substances. Wet cement coming into contact with exposed hands is a particular example of a skin irritant.

The less common type of contact dermatitis is allergic contact dermatitis. This is when a person develops an allergy over time to the product they have been exposed to on multiple occasions. This can happen over a time period of days to months to years! There are some known chemical products that have a higher likelihood to cause allergy – these can be things like latex in gloves, adhesives used for floor coverings, wood dust or chromates in wet cement. When someone develops allergic dermatitis, even a tiny exposure may cause a big reaction; it may occur in areas of skin that have not been directly in contact with the culprit substance. Once someone has developed the allergy, it is likely to be present for life.

You may have noticed that wet cement featured in both types of contact dermatitis. It is possible to develop both types together. It is not uncommon for people to be working in an environment where they are exposed to multiple agents that may be harmful at the same time.

So how to avoid dermatitis at work? Avoidance or minimising skin contact with potentially harmful agents is the key. If a specific chemical product is identified, it can perhaps be removed and replaced with a less hazardous alternative. Excess chemical products should be removed safely using drainage vacuuming or local exhaust ventilation. If contact occurs, washing the agent off the skin as soon as possible is important, using hand cleaners that are appropriate for removing the product but will not damage the skin. And lastly, as with many things, prevention is better than cure: using appropriate PPE – gloves, face masks, overalls- to avoid any contact with hazardous materials is essential.

If you think you have dermatitis then it is important to identify it, treat it and make changes to the workplace to prevent it becoming a chronic problem. Sometimes it is not straightforward to know the cause so if you have concerns about your skin, report it and seek a review from a healthcare professional for advice.

For more information on dermatitis from the NHS visit Contact dermatitis – Causes – NHS (www.nhs.uk).