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.

1. OCCUPATIONAL DERMATOSES
IN HEALTHCARE WORKERS
Dr. Dincy Peter
Department of Dermatology, DVL2
Christian Medical College, Vellore.

2. Outline
Introduction to OSD
Clinical presentation
Hand eczema
Contact dermatitis to glove, glutaraldehyde
Diagnosis and management

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?

9. Clinical presentation
Acute
– Itching
– Redness
– Scaling
– Vesiculation
– papulovesicles
Chronic
Fissuring
Hyperkeratosis
lichenification

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

12. ICD

13. Cumulative irritant dermatitis

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

23. Special allergens in nurses
 Cetrimide
 Chlorhexidine
 Chlorpromazine
 Chlorxylenol
 Formaldehyde
 Glutaraldehyde
 Penicillin
 Povidone-iodine

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.

27. Control of OSD
Elimination
Substitution
Engineering controls
Administrative control
Personal protective equipment

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