Occupational Skin Disease

What is occupational skin disease?

Occupational skin disease is any skin problem that is caused, or made worse, by something you come into contact with at work. Dermatitis, also known as eczema, is by far the most common form, though skin cancer and urticaria (hives) can also be linked to work.

are the symptoms of occupational skin disease?

Dermatitis can cause:

• redness
• scaling or flaking
• blistering
• weeping
• cracking
• swelling.

It can also feel itchy or painful, and in severe cases the symptoms can be bad enough to stop you working.

Urticaria looks and behaves differently. It appears quickly as a raised, red, itchy rash, known as a wheal and flare, and usually disappears again within hours.

Work-related skin cancer can show up as:

• a scaly patch of hard skin
• a red lump or spot
• an ulcer
• a new mole
• a patch of skin that bleeds, oozes or has a crust.

What causes occupational skin disease, and who is at risk?

Occupational skin disease can follow exposure to chemical, biological or physical agents at work. Chemical causes include soaps, detergents, solvents, oils, greases, dusts, acids and alkalis, and wet cement. Some substances, such as nickel, certain hair dyes, adhesives and some plants, cause an allergic reaction rather than direct irritation.

'Wet work’ meaning long-lasting or repeated contact with water, is also a common cause. This means having wet hands for two or more hours a day, or washing your hands more than 20 to 25 times a day.

The following occupations account for around 80% of reported occupational skin disease in Europe, mostly because they involve wet working conditions:

• hairdressing and beauty therapy
• food handling and catering
• healthcare, including dental and veterinary work
• laboratory work
• agriculture, gardening and floristry
• cleaning
• painting and decorating
• motor vehicle repair
• construction, printing and metalworking.

Your individual risk also depends on factors such as an existing skin condition like atopic dermatitis, your personal hygiene, and the exact circumstances of your exposure. Younger workers have a slightly higher risk than older workers.

Work-related skin cancer is mainly caused by ultraviolet light, from either natural sunlight or sunbeds. Less common causes include certain chemicals, such as polycyclic aromatic hydrocarbons found in coal tar, pitch and unrefined mineral oils, and ionising radiation.

Are there different types of occupational skin disease?

There are three broad groups:

• Irritant contact dermatitis: This is the most common type, making up around 80% of cases. It happens when a chemical or physical substance damages your skin faster than it can repair itself, and can affect anyone with enough exposure
• Allergic contact dermatitis: This makes up more than 10% of cases. It only affects people who have become sensitised, or allergic, to a specific substance. Once sensitised, even a small amount of contact can trigger a reaction, and this tends to be permanent
• Other occupational skin disease: This makes up less than 10% of cases, and includes skin cancer, certain skin infections, and other skin and nail conditions.

How is occupational skin disease diagnosed?

An occupational cause is often suspected when a rash appears on skin that has been in contact with a particular substance at work, such as the hands. A useful clue is whether your symptoms improve when you are away from work, such as at weekends or on holiday, and flare up again when you return.

Allergic contact dermatitis can usually be confirmed with a patch test, carried out by a dermatologist. This involves applying a small amount of a suspected substance to your skin to see whether a reaction develops.

Many workplaces also carry out skin health surveillance for employees who are regularly exposed to known irritants or allergens. This involves a questionnaire and a visual skin check, so that early signs of a problem can be picked up and followed up quickly.

How is occupational skin disease treated?

Treatment usually focuses on avoiding the substance causing the problem and protecting your skin, alongside any medical treatment you need. Practical steps include:

• avoiding or reducing contact with the substance causing the problem, where possible
• using personal protective equipment, such as gloves chosen for the specific task and substance involved
• using emollients (moisturisers) and barrier creams to help protect and repair your skin
• keeping any wounds clean and covered, and drying your skin properly after wet work.

Medical treatment can include:

• topical steroid creams, or oral steroids in more severe cases
• antibiotics, if the skin has become infected.

If you have developed an allergy to a substance at work, avoiding it permanently is the only way to prevent further reactions, since the sensitisation will not go away. Your employer may need to look at moving you to a different role or task where you will not be exposed to it.

If a work-related skin cancer is suspected, for example because of a new mole or a sore that will not heal, you will need a specialist assessment to confirm the diagnosis and agree on the right treatment for you.

When should I see a doctor?

Report any changes in your skin to your manager or occupational health team as soon as you notice them, especially if they seem linked to something at work.

See a GP if your skin symptoms are severe, are not improving, or are affecting your ability to work. Get checked promptly if you notice a scaly patch, a new mole, or a sore that bleeds, oozes or will not heal.