Occupational Skin Disease

very few industries where there are not at least one or two of these causes.

So first of all, and maybe most simply, water exposure.

I'm Lynn Holness. I'm a professor at the Dalla Lana School of Public Health in the Department of Medicine at the University of Toronto.

And I'm also the chief of occupational health at St. Michael's Hospital.

And I'm also the director of the Center for Research Expertise in Occupational Disease, which is focused on the non-malignant occupational disease.

Occupational skin disease is one of the most common occupational diseases.

It depends a little on the jurisdiction you're in, but typically it's either the first or second most common occupational disease.

So again, I think we often think of lung disease and other and noise and just hearing loss, but in fact, occupational skin disease is often the most common workplace disease.

There are two kinds of occupational skin disease, that caused by irritant exposure and that caused by actually developing an allergic reaction to the chemicals at work.

And when we think about irritants, water is actually an irritant.

So individuals that have their hands in water a lot, in other words, who do wet work, are certainly at increased risk for developing occupational skin disease.

In the studies that have been done actually looking at populations in workplaces where there is exposure to wet work.

So that would be individuals say in health care, in a variety of food services industries.

It's not uncommon to find that between 10 and 15% of workers actually have some degree of occupational skin disease.

So that gives you a sense of how common it is, and as I say, although we don't tend to think about water as kind of a really serious hazard.

The reality is that frequent exposure to water is one of the big risk factors, particularly for irritant contact dermatitis.

There's definitely some variation by sector.

In many jurisdictions, actually agriculture is the sector that has the most the frequent occurrence, often related to plant and crop exposures.

But other sectors where we see a fair bit of occupational skin disease is in the manufacturing sector, the automotive sector is a subset of manufacturing.

And also in some of the service sector, particularly health care and hospitality.

One of the challenges about occupational skin disease is the fact that we often think that it is just a rash.

So a person has a rash, it may not look very pretty, but we don't actually understand it how it actually impairs their hand function, how they may not be able to return to work.

So I think one of the key challenges we have is really raising awareness that it's not just that superficial rash that maybe doesn't look very nice, but it also means that they potentially can't use their hands to the same degree that they usually can, their grip strength may be diminished, their range of motion may be diminished.

And therefore that impacts their ability to actually do a variety of both work and daily functions.

actual problems that the worker has.

So that's kind of one of the inputs.

The first one is basically getting to a diagnosis of occupational skin disease can take a long time and many doctor visits.

You have to make the link between the workplace exposure and the clinical disease, the dermatitis or the asthma.

And to do that, you have to ask about the workplace.

So one of the things that we're taught in medical school is that you need to take an occupational history.

Um, but I think when we actually survey workers and even physicians, we find that they don't always take an occupational history.

And so I think one of the challenges because family physicians, primary care providers have to be concerned about kind of every possible thing that the patient comes in with.

Um, so I think the challenge is how can we create a very simple history that actually can be done quite easily by the primary care provider, that will at least have them recognize that there might be an association between the dermatitis and the workplace exposure.

Um, I think it's unrealistic to think that most primary care providers are going to be able to do the entire diagnostic process, but what's key is that they recognize that the possibility is there, so the worker can be referred to the appropriate dermatologist or occupational medicine physician so that can be further investigated.

So it's really asking just one or two key questions around work that would cause the potential link to be made.

If there are exposures to irritants or allergens, you need to reduce those exposures by the traditional ways of reducing exposure.

You may be able to engineer the exposure out from a this is a skin contact, so ventilation may not have as much of a role in this context.

There's certainly work practices that one might think about, but the importance of protective equipment, the appropriate gloves for instance, and also the appropriate skin care.

So very simple things.

Um, workers in some trades where you have exposure to a lot of oily or greasy materials often use solvents as their hand cleanser because the solvents are very good at removing the grease or oil.

The problem is solvents are irritants to the hands, so in fact, in cleansing the skin, you're actually irritating them.

So understanding appropriate skin care, appropriately skin cleansing, and also the use of moisturizing creams is really important in prevention.

So it's really a combination of kind of traditional control measures for the exposure, appropriate protective equipment, good skin care, and obviously, all of that needs a good educational program so one knows the appropriate gloves to use, the appropriate skin care products to use.

So I think one of the challenges with occupational disease in general is that the the key thing is you have to recognize both the clinical problem, so whether it's the dermatitis or the asthma.

And then the fact that there's been a workplace exposure that is potentially the cause of that rash or the asthma.

And I think as physicians, we, although we kind of in theory know that we're supposed to take an occupational history, often that doesn't happen.

And if that possibility isn't raised, often the person is continued to be treated for their problem, and the actual cause isn't identified.

In the case of skin disease caused by work, if we don't address the workplace issues, whether it's removal from the offending chemical, whether it's better protective equipment, no matter how much kind of medical treatment we give, we're not really going to have a successful outcome and really improvement in the person's dermatitis.