We see less and less tolerance in workplaces today for the full range of occupational hazards," says Jeffrey Stull, president, International Personnel Protection, a personal protection specialist within the industrial hygiene community and a member of the Kimberly-Clark Skin Wellness Institute. "Safety consciousness extends not only to serious accidents and acute diseases, but to chronic conditions, such as occupational dermatitis, that can have a lasting effect on a person's health and his ability to do his job."
Occupational skin diseases are common in industrial workplaces where heavy dirt and greases, contact with harsh chemicals or frequent handwashing are common. The U.S. Bureau of Labor Statistics notes that occupational skin diseases such as allergic and irritant (contact) dermatitis are the second most common occupational malady. In 1997, there were approximately 58,000 reported cases of occupational skin diseases, accounting for slightly more than 13 percent of all occupational diseases. That's more than cases of dust diseases of the lungs, respiratory conditions due to toxic agents, poisoning and disorders due to physical agents combined.
Stull says the prevalence of reported cases of contact dermatitis is due, in part, to the increased use of specialized chemicals in the workplace and workers' increased sensitization to them. He likens the trend to the increase in latex allergies reported when latex glove use became widespread in the 1980s to protect against bloodborne pathogens.
The National Institute for Occupational Safety and Health (NIOSH) has made contact dermatitis a top priority in the National Occupational Research Agenda (NORA). NIOSH notes that "occupational skin diseases are believed to be severely underreported, such that the true rate of new cases may be many fold higher than documented."
NIOSH/NORA observes, "Because the prognosis of occupational irritant and allergic dermatitis is poor, prevention is imperative. This fact is emphasized by one study showing that 75 percent of patients with occupational contact dermatitis developed chronic skin disease."
"One of the biggest issues is the lack of established exposure limits for skin protection," Stull says. "Those exposure limits are hard to quantify, due to the inherent differences in individuals' skin health and resistance to chemicals. Consequently, there are no accurate ways to measure or assess exposures."
In industries where the use of harsh chemicals is common, employers are working to control skin exposure by changing processes, substituting less-hazardous chemicals and encouraging the use of protective apparel, such as gloves. Stull cautions against relying solely on gloves to protect hands.
"Gloves can irritate skin or become damaged, allowing hazardous chemicals to permeate to the skin, and there are many work situations in which wearing gloves just isn't practical," he says.
To study the problem of skin diseases, NORA Allergic and Irritant Dermatitis Priority Research Area activities have been identified:
- Develop analyses for predicting the irritant contact dermatitis of chemicals and mixtures in the workplace.
- Sponsor scientific meetings focused on irritant and allergic contact dermatitis in the workplace.
- Develop a benchmark database for allergens and irritants.
- Develop alternative methods for identifying workplace irritants.
- Determine the genetic basis of workers' susceptibility to irritants.
- Increase knowledge of the pathophysiology of irritant contact dermatitis.
- Determine the genetic basis of workers' susceptibility to allergens.
- Determine the influence of environmental factors on initiation and elicitation of allergic contact dermatitis.
- Increase the knowledge of the basic pathophysiology of allergic contact dermatitis.
- Develop alternative methods for identifying workplace allergens.
Private industry and other research groups are focusing on issues relating to healthy skin and hands. For example, scientists in the Kimberly-Clark Skin Wellness Institute are researching the role of skin cleansers in contributing to or preventing contact dermatitis.
"Most people don't understand the subtle differences among various types of skin cleansers," Stull explains. "However, there is a growing appreciation for different types of skin health products, how they work together and how they are designed for different cleaning tasks and exposure situations."
Skin cleansers are expected to remove deep grime or kill bacteria and leave skin feeling and smelling good. Often, the nature of heavy-duty cleansing or killing bacteria calls for chemicals that can strip the skin of its natural oils, damaging, drying and cracking skin and decreasing its resistance to chemicals and substances that normally wouldn't affect healthy skin.
Gary Grove, Ph.D., director of the Skin Study Center in Broomall, Pa., and a member of the Kimberly-Clark Skin Wellness Institute, notes that traditional soaps and detergents clean skin well, but dry it by removing protective oils because they don't discriminate between dirt on the skin surface and the essential oils that protect skin.
Grove implemented a series of blind studies of the effectiveness of various cleansers and skin damage they cause. He washed with different cleansers, then measured the surface hydration state with an electrical conductance meter. In another test, he applied industrial oil-based ink and roofing tar to skin and used a chromameter to measure the amount of dirt before and after cleansing. He found most industrial skin cleansers cleaned skin effectively, but reduced its surface hydration, which can lead to contact dermatitis.
One cleanser tested did not reduce the skin's barrier function when removing dirt. It used liposome micro-encapsulation technology to incorporate a cleaning solvent within a skin conditioner for delivery to the skin. The result was less irritation to the skin.
"It's important to remember that the use of the wrong cleanser or the improper use of the right cleanser can have a detrimental effect on the skin. A holistic approach is needed," Grove says.
Barrier creams and post-cleansing moisturizers are key elements in a skin health program. Proper skin health behavior also is important. According to Kimberly-Clark's Skin Wellness Institute, here's how to clean hands properly:
1. Wet hands and forearms using a stream of warm running water. Excessively hot water is harder on the skin, dries the skin and is too uncomfortable to wash with for the recommended amount of time. Because cold water prevents soap from lathering properly, soil and germs may not be washed away.
2. Apply cleanser. Dispensers deliver the proper amount of cleanser, while protecting the rest from contamination. Use the right cleanser for the task. Use a nickel-size amount of general purpose cleanser or a quarter-size quantity of anti-microbial cleansers. Follow the instructions on the label.
3. Lather thoroughly. Scrub hands and forearms for at least 15 seconds. Use a nail brush, if necessary. Repeat until the skin is thoroughly clean.
4. Rinse thoroughly. Dry hands completely with a paper towel. Leaving soap residue on the skin and incomplete drying contribute to dermatitis.
5. Repeat steps 2-4 if hands are particularly dirty or greasy.
6. Use a paper towel to turn off the faucet without re-contaminating hands.
7. Use hand cream after washing and during the day to restore the skin's natural oils, keeping it resilient. Skin conditioning agents (emollients) soften and smooth skin. Moisturizers reduce shedding of dry skin flakes and inhibit the growth of microorganisms.
"Something as simple as using the right skin cleanser and the right handwashing technique can dramatically improve productivity," Stull concludes. "I encourage industrial hygienists and employers to conduct a cost/benefit analysis of skin care products and programs to determine the best and healthiest approach for their situation."
Ian Crassweller, skin care category manager, Kimberly-Clark Away From Home Sector, is executive director of the Kimberly-Clark Skin Wellness Institute in Roswell, Ga.