Occupational dermatoses, especially contact dermatitis, are common among healthcare workers due to frequent exposure to irritants and allergens. The most frequent types are irritant contact dermatitis caused by chemicals like detergents, disinfectants, and gloves, and allergic contact dermatitis triggered by substances like latex, glutaraldehyde, and antibiotics. Proper diagnosis involves a detailed history of workplace exposures and patch testing. Management focuses on eliminating exposures, using protective equipment, and treating flares with topical steroids and immunosuppressants to prevent chronicity.
3. Introduction
workplace exposure to some physical, chemical or
biologic hazard has been a causal or a major
contributing factor
high index of suspicion and a knowledge of the
worker’s environment
4. Impact of OSD
Change of occupation
prolonged sick leave
limiting leisure activities
interfere with the ability to perform household
chores
time-consuming treatment
5. OCD- health personnel
Fifth high risk occupational category
Annual incidence of 7.3 OSD per 10,000 workers
Highest incidence in younger people
Health personnel- 3 groups
6. OCD- health personnel
First group- physicians, surgeons, medical specialists,
dental personnel
Second group- nurses, laboratory and radiology
technicians, biologists, pharmacists, physiotherapists
and dialysis workers
Third group- office personnel, technical service workers,
Kitchen and laundry workers, cleaners and disinfection
and sterilization area workers
Contact dermatitis.fifth ed. Johansen DJ, Frosch PJ, Lepoittevin JP editors.
7. OSD
Contact dermatitis is reported to comprise 90–95%
of cases of occupational dermatoses:
irritant contact dermatitis (70–80%)
allergic contact dermatitis (20–25%)
contact urticaria (<5% , latex allergy)
8. History
Is the worker exposed to irritant or allergen?
Is there a temporal relationship between dermatitis
and the work?
Is the dermatitis associated with particular tasks?
Does it resolve/improve when the worker is away
from work for a week or more?
10. Irritant contact dermatitis
irritant - induce dermatitis in anyone if applied to the
skin
acids,alkalis, solvents, detergents/soaps, abrasives,
enzymes
only affects the site of primary contact (forearm,hands)
Occasionally the face - an irritant dust, vapour or
aerosol
cleaners, sterilisation area, kitchen and laundry workers
11. Irritant contact dermatitis
Acute
Chronic – cumulative irritant dermatitis
result of multiple subthreshold insults induced by
weak irritants
Frequent use of disinfectant solutions, detergents
and soaps – epidermal barrier defect
Nurses, surgeons, laboratory personnel
14. Management
Treat with steroids, emollients, antibiotics, etc.
Reduce the exposure to irritant
Reduce frequency or duration of exposure
Substitute less irritating chemical(s)
Avoid occlusion
Avoid excessive heat and humidity
15. Prevention - hand dermatitis
Wash with warm, not hot water
Use the least harsh soap or lowest concentration of
antibacterial soaps
Use alcohol sanitizing emulsion gels if feasible
(Avant, Sterillium, Desderman and Allsept S)
Use water-based moisturizers liberally
Use non-latex gloves
Protect and treat the hands when away from the work
environment
16. CASE
32 year old surgeon
presented with itchy
skin lesions over the
hands for 1 month
duration. What is your
diagnosis?
17. Allergic contact dermatitis
delayed hypersensitivity reaction
chemical spills/exposure often initiate sensitisation
sensitisation takes about 7–21 days
dermatitis develop within 24 hours after the next
exposure
at any time of a person's career
18. Sites- ACD
not only the site of primary contact, but also distant
sites where small amounts have been accidentally
transferred, e.g. by the fingertips
Thick skin (such as the palms) is relatively resistant to
contact dermatitis
thin skin (face, genitals) is much more susceptible
19. Contact urticaria
Erythema and wheals occurring at the site of
contact ,within an hour of exposure, and resolving
within 24 hours
Immunogenic (Type 1, IgE-mediated) - rubber
latex, formaldehyde
20. Rubber gloves
irritant dermatitis (by making the hands hot and sweaty)
allergic dermatitis to rubber additives(thiurams,
carbamates, thioureas and mercaptobenzothiazoles)
Site- flexor wrist, dorsa of the hand
contact urticaria to latex
Glove powder not incriminated in cutaneous reactions
adsorb chemicals in the glove , airborne vehicle of
allergens — provoking respiratory reactions
21. Management
Avoid contact
Medical alert bracelet – latex allergy
Use vinyl or totally synthetic rubber gloves
Nitrile gloves- latex free, but may contain
additives
22. Glutaraldehyde
Skin contact – cold disinfection of equipment, fixing
specimens for microscopy, Processing of X-ray films
Strong irritant and sensitizer
Skin irritation, contact dermatitis , chronic dermatitis
Substituition- hydrogen peroxide, peracetic acid-
hydrogen peroxide (PAHP) or orthophthaldehyde
Minimization of contact
24. Diagnosis of OCD
Detailed history
In-depth information on workplace
Results of careful patch testing
Observation of the course of the disease
Complex cases – follow up
25. Management
Topical corticosteroids of medium to strong potency
Tacrolimus ointment
Systemic steroids
Ciclosporin
Azathioprine
Acitretin/ alitretinoin
Phototherapy
26. Patch test
A small 0.5 cm strip of
allergens are placed on
the patient’s clean back.
The strips are removed
in 48 hours and a
preliminary reading
done.
Late reading is done at
72, 96 or 120 hours.
28. Learning points
OCD most frequent cause of occupational skin
disease
Treatment goal is to avoid chronicity
All work place contact allergens and irritants must
be evaluated as the cause or contributory factors
29. References
Fischer's Text book of contact dermatitis
Contact dermatitis, JD Jeann, FJ Peter. 5Th ed
Occupational skin diseases.ENVIS-NIOH news
letter. Vol 5, No.2 Apr-Jun 2010.
A guide to occupational skin disease. Oct 1995.
Dept of Labour, New Zealand.
Occupational dermatoses. Australian Family
Physician Vol 34; May 2005