Dermatitis & other skin conditions

Our skin is an amazing organ: when assaulted from the outside by irritants, or from the inside by disease, skin raises a red danger flag in the form of a rash. The rash could be irritation, a virus, a bacterial infection or an allergy. Dermatitis is the general term for any inflammation of the skin and is a common work-related condition. It is not infectious – it cannot be passed from one person to another.

There are three types of dermatitis:

• Contact dermatitis describes conditions which result from direct contact of the skin with external agents
• Irritant contact dermatitis defines conditions where the inflammation is only to the part of the skin which has come into contact with the external agent
• Allergic contact dermatitis results from skin contact with a sensitising agent which stimulates an allergic response.

Health experts estimate that allergic and irritant contact dermatitis are on the rise in the workplace. The most recent Safe Work Australia paper (March 2012), which summarises two new reports on chemical exposure and dermatitis, and a report on wet work released in 2011, says there were 10,730 workers' compensation claims for occupational contact dermatitis (OCD) and similar conditions in Australia in the nine years to 2009. Of these, 3760 involved absences from work of one week or more, and, in 2008/09, a "typical" payment for a serious claim was about $3000. But the paper says this data is likely to underestimate the problem.  (Australian workers' dermal exposures to wet work and chemicals and the causes and characteristics of occupational skin disease: A summary of the findings and policy implications of three research reports [pdf] )

Further, Canadian researchers found in a June 2009 study that cleaners who develop dermatitis are more likely than those who don't to develop work-related asthma symptoms, suggesting employers should use safety and skin-care training as a preventative measure. [Cutaneous and respiratory symptoms among professional cleaners. Lynde, Carrie et al, Canada. Occupational Medicine, Volume 59, Number 4, June 2009.]

Advice for OHS Reps

The first step is to identify any substances or other agents that may cause dermatitis, and then seek to control the hazard at the source. Remember that under Part 4 - Duty to Consult of the Victorian Occupational Health and Safety Act (2004) the employer must consult with the OHS rep prior to changes in the workplace, the plant or substances used at the workplace or the systems of work - so your employer should be consulting with you.

Prevention is the smartest way of minimizing contact dermatitis. Recommended action is to eliminate, or if this is not practicable, minimise skin contact with irritants.

• Ensure that all substances have an up-to-date SDS (Safety Data Sheet). If they don't, either ask your employer to provide one, or ring the manufacturers or suppliers of the products directly.
• Check the SDSs to identify any possible problem substances - look for the words 'may cause sensitisation by skin contact', 'irritating to skin', 'avoid contact with skin' or 'Wear suitable protective clothing and gloves'. Consider whether:
  • the substance can be eliminated
  • if cannot be eliminated, whether it can be replaced with safer substances;
  • if this is not possible, whether the work can be done differently to isolate the process, to stop workers coming into contact with the substance
  • finally if the substance must still be used, whether appropriate, carefully chosen and properly maintained PPE (personal protective equipment) has been provided; and
  • workers have been adequately trained in the potential effects of the substances, how to use them correctly and also on the PPE provided.
• Ensure that the work area is kept clean; spills, splashes and sprays are avoided and cleaned up promptly if they occur
• Hands should be washed with a mild soap and water, and thoroughly dried. The employer should provide adequate washing facilities (see the Compliance Code for Workplace Amenities and Work Environment - in particular the FAQ Change rooms and other facilities) . The employer should provide a vegetable oil based cleanser to remove grease or other substances that cannot be removed with soap and water. The employer should provide also barrier creams to apply before work. Solvents should never be used to clean hands.
• Cuts and abrasions, even minor ones, should be treated promptly.
• Ensure that information about dermatitis, and its link to asthma, is included in all training programs. Note that the most recent report from Safe Work Australia (March 2012) found that up to 40 per cent of the thousands of workers regularly exposed to chemicals or wet work have not been provided with proper safety training.

More information on Dermatitis

Dermatitis can affect many workers in all sectors, including those working in:

• manufacturing
• printing
• catering and food processing
• health care
• cleaning
• teaching
• construction
• agriculture/horticulture
• hairdressing/beauty care

In addition, dermatitis which is not work-related may be aggravated by irritants in the workplace.

The symptoms of dermatitis

Areas of irritated skin may be red, swollen, tender, hot, painful or itchy. If the reaction is severe, the skin may blister or weep and can become crusty. Skin affected over a period of time tends to thicken and change to a deeper colour. If exposure occurs to a sensitising agent, the reaction may spread to other areas of the body. As noted above, research has confirmed a strong link between work-related symptoms of asthma and dermatitis among cleaners. Sufferers of dermatitis may not be able to continue with normal duties at work.

Possible causes of dermatitis

Chemical, physical and biological agents can cause dermatitis and other occupational skin diseases. How quickly dermatitis develops depends on the substance itself, the strength or potency and how long and how often it touches the skin.

Chemical agents include strong irritants and corrosives; organic solvents; oils and related liquids; chemical sensiters (such as metal salts, dyes, formaldehyde, glutaraldehyde, isocyanates, rubbers, etc); fibreglass products; carcinogens (such as tar, pitch, mineral oils, etc); cement and chlorinated hydrocarbons. These will variously burn the skin or irritate it, remove its protective oils, block the pores, cause allergic contact dermatitis, lead to sensitisation, cause skin cancers, or cause chloracne.

Physical agents include abrasions and cuts; heat, cold and humidity; water; sunlight and radiation; photosensitivity. They can lead to excessive dryness, irritation and burns.

Biological agents include bacteria and viruses; fungi (eg: tinea, ringworm); insect bites; and plants and plant products (eg resins, wood dust).

Other work-related skin conditions

Occupational acne
These are comedos (pinheads), papules and pustules caused mostly by industrial oils and greases. Unlike common acne, these eruptions manifest at the site of skin contact. Tar derivatives and halogen-containing compounds (polychlorinated naphtalenes, polychlorinated phenoxy phenols, 3 4-dichloroaniline and similar herbicides, iodides and bromides) may cause acne, just like certain pharmaceuticals. Car mechanics, maintenance workers are most at risk. Personal and work hygiene is of utmost importance in the prevention of oil acne. Frequent change and centralised washing of dirty work wear is necessary

Skin cancers due to chemical exposure
Pitch, tar, soot, anthracene and compounds thereof, mineral and other oils, raw parafin, carbazole and their compounds, coal tar distillation products may cause a disturbance in the epidermis. This can trigger the development of basal cell and squamous cell carcinomas, or conditions (keratotic papilloma, keratoacanthoma) that may lead to these cancers. Arsenic causes brownish pigmentation and rough, scaly patches (keratosis). Bowen's disease, squamous cell carcinoma and multiple basalioma may develop.

Bacterial infections
Occupational pyodermas (folliculitis, furuncle, carbuncle, impetigo, ecthyma, paronychia, etc.) can be caused by the Streptococcus and Staphylococcus bacteria which generate pus. These infections are common among those working in dirty environments (e.g., car mechanics, sewerage cleaners) where microtrauma (bruises, cuts) of the skin are common (e.g., butchers, slaughterhouse workers, machining of metals), or who may be in contact with infected persons (e.g., nurses, hairdressers, manicurists). Colonisation, which is the presence of microorganisms on the worker without apparent disease, and manifest infection with antibiotic resistant bacteria (e.g., MRSA) among health care workers is an emerging issue with implications for patient safety.

Erysipeloid is caused by Erysipelothrix rhusiopathiae. The infection presents in the form of marked skin inflammation that accompanies the inflammation of the underlying connective tissue (cellulitis). It is almost exclusively occupational, among butchers and workers in contact with fish and poultry.

There are other forms of bacterial infections that are work-related

Fungal infections
Yeast infections - mainly caused by Candida albicans, occurs usually on the hands: onychomycosis (nail), paronychia (around the nail bed), interdigital mycosis (between the fingers or toes). Workers in canneries and confectioneries, and health care workers are at risk. Wearing rubber gloves and boots (wet work) and handling of sweets can be contributing factors to the development of these infections.

Dermatophyte infections (ringworm) Trichophytia profunda is caused by Trichophytia verrucosum and looks like a deep bacterial skin infection. Farmers, milkers, animal handlers, and veterinarians may acquire it from infected cattle. Microsporiasis is an infection of Microsporum canis that is common among pets (dogs, cats, guinea pigs) and may cause ringworm among pet traders and breeders, vets, laboratory workers. Microsporum gypseum lives in soil and may also infect agriculture workers.

Viral skin diseases
Milker's nodules (Nodus mulgentium) are caused by the Paravaccinia virus. The source is the udder of the cow, (less frequently the udder of sheep or goats), where it presents as a quickly healing wound. Milkers and other animal handlers may develop the skin lesion which heals spontaneously without scarring within weeks.

Orf (Ecthyma contagiosum) is caused by a Parapox virus, which is common in sheep and goats. The tender skin lesion may be accompanied by regional inflammation of the lymph vessels and nodes. The disease may be contracted by shepherds, goatherds, veterinarians and it may heal spontaneously without scarring within weeks unless the wound is superinfected.

Parasitic skin lesions
Although frequently unrecognised, parasitic skin diseases may have an occupational origin. Arthropod bites from animal parasites or granary mites are common in agricultural workers. Bee and wasp stings are important, because their venom may cause serious and even life-threatening allergic complications. Scabies is caused by Sarcoptes scabiei. This tiny mite digs itself into the skin around the wrists, elbows, hands, feet, back, buttocks, and external genitals causing itching and superficial burrows. The infection is transmitted by direct contact, e.g. during care activities. Treatment should involve contact persons without symptoms too. Control of infection is challenging for the health and social care institutions, which are most at risk.

See Also:

• A report released in March 2011 from the National Hazard Exposure Worker Surveillance survey (2008): Wet work exposure and the provision of wet work control measures in Australian workplaces. Occupational skin diseases (e.g. contact dermatitis of the hands) are one of the most common work-related problems seen by Australian general practitioners, with an important risk factor being 'wet work' - exposure of the hands to liquids, either through frequent hand washing or through immersion of the hands in liquids.

• SafeWork Australia summary report issued in March 2012: Australian workers' dermal exposures to wet work and chemicals and the causes and characteristics of occupational skin disease: A summary of the findings and policy implications of three research reports
• Also on the Safe Work website, some older publications:  Occupational Contact Dermatitis [pdf] and Guidance for the Prevention of Dermatitis caused by wet work [pdf].
• The Occupational Dermatology Research and Education Centre (ODREC) website. The ODREC, which is situated in Melbourne, undertakes research on occupational skin disease and there are a number of factsheets downloadable from the site. Interesting information includes a series of pamphlets for school leavers, new workers and workers in particular industries on their Skin @ Work page. From this page a number of Skin@Work brochures can be downloaded.
• From the UK union UNISON Dermatitis at work [pdf] - a booklet giving reps advice on what can be done to avoid workers suffering from skin problems caused, or made worse by work
• UK's HSE has a great deal of information on Occupational Skin Disease:
  • The Skin at Work  website, with information on the different types of common work related skin diseases and a plan of action for controlling skin diseases. There are a number of leaflets, including:
  • There is also a new inspection pack for awareness raising and enforcement activity in industry sectors where contact dermatitis is a problem: Topic Inspection Pack - Work Related Contact Dematitis [pdf]
  • information on Hairdressing and dermatitis. The HSE says that up to 70% of hairdressers suffer from skin damage. Let's Cut Out Dermatitis!
  • Information for medical and health and safety professionals and trainers  page that deals with work-related skin diseases (WRSDs) in more technical depth.
  • and many more pages on skin disease.
• Work Related Skin Diseases - basically an online chapter on a range of skin from OSH WIKI - a resource put together by the European Agency for Safety and Health at Work

Last updated, August 2021

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