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Author: Brian Wu PhD. MD Candidate, Keck School of Medicine, Los Angeles, USA; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, January 2016. DermNet NZ Update April 2021
Healthcare is a major employer worldwide. It has strong employment growth, as demand increases for doctors, nurses and other medical personnel. However, it is also considered to be an environment at high risk for the development of occupation-related skin dermatoses. For instance, one study surveying 706 nurses found that 47.3% of them had some form of occupational skin disease, allergic contact dermatitis and irritant contact dermatitis are the most commonly reported.
There are many factors which increase the risk of developing an occupational skin disorder, including:
The skin has evolved as a protective barrier against invasion by pathogens and contact with irritants or sensitisers [see Skin barrier function]. However, the nature of some professions compromises this barrier, including dental and medical personnel, construction workers, cleaners, hairdressers, food handlers and farmers/agricultural workers. Healthcare workers are considered to be at high risk of developing skin problems.
Latex allergy is a Type 1 hypersensitivity reaction to latex proteins (contact urticaria) and in extreme cases can be fatal. Diagnosis is based on the medical history of immediate redness and swelling on exposure to the gloves. Latex reactions can be severe, but generally resolve within an hour or so.
Contact dermatitis can be due to either allergens (eg, rubber accelerants) or irritants (eg, water, harsh soaps, friction), with irritant dermatitis being the more common. Long work hours and prolonged exposure can also be causative factors. The most common signs and symptoms of dermatitis include redness and itching, but swelling, pain, burning sensations and scaling also occur.
Exposure to needles and other sharps means medical personnel are at high risk of needlestick injuries, cuts, or skin punctures. In the United States, the Occupational Health and Safety Administration (OSHA) estimates that 5.6 million healthcare workers annually suffer from mechanical injuries. This puts doctors and nurses at high risk for transmission of blood-borne diseases such as human immunodeficiency virus (HIV), or hepatitis C. Secondary bacterial infection can follow breaks in the skin.
The medical profession is highly regulated and thorough workplace risk assessments are mandated by most governing bodies. Assessment should include:
Workplace safety must be a priority for both administration and workers.
Due to the risk for infective disease transmission between patients and medical personnel, gloves are mandated for workers performing direct personal care, handling bodily fluids, or other potentially infectious material. Gloves should also be worn when coming into contact with disinfectants, cleaners and other chemicals. However, if gloves are made of rubber, they may cause latex sensitivity or dermatitis; the increased use of non-latex gloves in the medical profession has helped to reduce this risk.
Prolonged wearing of gloves, face masks, protective goggles, and fullbody suits during the COVID-19 pandemic is resulting in healthcare personnel presenting with skin dryness and flaking, itch, irritant contact hand dermatitis, acne, folliculitis, and eczema flares, with subsequent effects on quality of life. Face mask-related skin problems particularly affect the cheek, chin, behind the ear, and nose. Goggles affect the periocular skin and bridge of nose. Excessive sweating, poorly fitted PPE, occlusion and friction are believed to be contributing factors to the development of skin symptoms and dermatoses.
Proper hand care reduces the chances of occupational dermatoses and includes:
Diagnosis of occupational skin disorders should include:
Treatment of occupational skin disorders can include:
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