Contact dermatitis is a common work-related disease. It is an itchy or painful inflammatory skin reaction that looks like a rash or burn. It can present in mild forms, such as dryness with reddening, chapping and scaling, as well as in more severe forms, such as eczema-like dermatitis with swelling, blisters or fissures. It typically affects the hands, making it painful to continue work.
The Centre for Research Expertise in Occupational Disease (CREOD) reports that only 62% of contact dermatitis patients at their occupational disease clinic in Toronto returned to work 6 months after skin assessment. Of those who had returned to work, about one-third had changed jobs due to their skin problem.
Occupational risk factors
*Wet work is the main risk factor for occupational contact dermatitis. It involves extensive hand washing (more than 20 times per shift), immersing the hands in water for more than 2 hours per shift, or wearing gloves for extended periods. Prolonged exposure to wet work disrupts the natural barrier in the skin, allowing sensitizing agents to pass through the skin more easily and cause skin allergies.
The greatest risk of contact dermatitis was observed among barbers and hairdressers, and workers in metal machining occupations.
Hairdressers are particularly vulnerable to developing dermatitis because they are regularly exposed to both wet work and chemicals (e.g., soaps, shampoos, hair dye, cleaning agents).
Nursing and relating occupations in the ODSS had consistently decreased risks of dermatitis despite being recognized as a high-risk group with a high prevalence of dermatitis. This may be explained by the prevention measures put in place to reduce exposure to, and effects of, natural rubber latex in Western industrialized countries. Prevention measures, such as use of gloves or skin barrier creams in wet activities and hand alcohol instead of soap and water as disinfectant have been promoted in healthcare [4,5]. Additionally, healthcare workers may not seek treatment for dermatitis, opting instead to self-manage until their skin condition resolves and are therefore not captured in health outcome data in the ODSS [6]. Only workers in ‘Other occupations in medicine and health, nec’ had an increased risk of dermatitis in the ODSS.
*This group includes occupations, not elsewhere classified, concerned with activities in medicine and health, such as: designing, making, assembling and fitting prosthetic devices; operating inhalation therapy, electroencephalographic, orthoptic, electrocardiographic and other hospital, equipment; controlling infection and assisting professional staff in clinics, pharmacies, morgues and animal hospitals; sterilizing and packaging hospital supplies and assisting in preparation of special diet menus.
Food-handlers are required to wash their hands frequently and may wear gloves to prevent the spread of foodborne illness. They also clean food preparation equipment and surfaces using various cleaning agents and detergents that could increase their risk of contact dermatitis. Workers in food and beverage industries and laboring occupations may also be at increased risk of contact dermatitis due to exposure to chronic mechanical and frictional stress combined with wet work exposure.
Painters can be exposed to a variety of paints and coatings which may be risk factors for contact dermatitis. Isothiazolinones, which are used as biocides in paints, can cause allergic contact dermatitis [3].
Chronic mechanical and frictional stress and exposure to solvents, oils, metal working fluids, and chlorinated agents are important exposures for contact dermatitis for metal machining and product fabricating occupations [7,8].
Figure 1. Risk of dermatitis diagnosis among workers employed in each industry group relative to all others, Occupational Disease Surveillance System (ODSS), 1999-2016
The hazard ratio is an estimate of the average time to diagnosis among workers in each industry/occupation group divided by that in all others during the study period. Hazard ratios above 1.00 indicate a greater risk of disease in a given group compared to all others. Estimates are adjusted for birth year and sex. The width of the 95% Confidence Interval (CI) is based on the number of cases in each group (more cases narrows the interval).
Figure 2. Risk of dermatitis diagnosis among workers employed in each occupation group relative to all others, Occupational Disease Surveillance System (ODSS), 1999-2016
