Module 4: Occupational Skin Disease - Summary

TO SUMMARISE:

In summary, one first has to make the diagnosis of the skin condition and having decided what it is, one has to link it to work. Did work cause or aggravate the condition?

Having decided that there was a work relationship, a full work assessment and evaluation of tasks in the work place is needed. Only then can appropriate and cost-effective use be made of special investigations to help identify a particular product so specific management can be instituted.

Prevention should be the basis of all occupational health programmes, whether related to skin or any other system of the body. Knowing the hazards and preventing exposure should be the aim of all occupational health management programmes.

Investigations are particularly controversial in contact dermatitis as only 10-20% of all occupational contact dermatitis is immune mediated, requiring specific immune based testing such as RAST, skin prick tests and patch tests.

The mere presence of skin disease does not mean that these expensive tests are necessary or even indicated. Interpretation of the results is important. Many people have positive reactions that may have little bearing on their clinical presentations.

RAST and skin prick tests are only of relevance if an urticarial element is present.

Patch testing is of importance if an allergic condition is suspected. Patch testing with irritants will always produce positive patch test results irrespective if who is tested. Because of this, patch testing should only be undertaken by specialists using products that are known and appropriately diluted in the correct vehicle.

Specialist interpretation of test results and their relevance to the clinical presentation is desirable. A positive test does not necessarily signify causality. The person undertaking patch testing must inform the patient fully of the results. The following advice should be given to the person tested.

• Discuss the relevance of the result to their condition.
• Offer advice on alternative replacement products.
• Offer help with identifying potential exposures and cross-reactions.
• Offer advice of on how to avoid exposure in all aspects of daily living.
• Offer advice on compounding hazards modifiers such as dry air and/or irritant exposure.

Personal Protective Equipment:

The law states that so far as is reasonably practical the prevention or adequate control of exposure of employees to a substance hazardous to health shall be by means other than the provision of personal protective equipment. This is because of the hazards and the failure of personal protective equipment.

Personal protective equipment should only be used as a last resort.

The points below summarise the essential knowledge needed before issuing personal protective equipment. The points will be discussed in greater detail in the lecture on gloves.

The worker and management need:

• to have a thorough knowledge of substance/product chemistry;
• to have a thorough knowledge of skin function;
• to have a thorough knowledge of personal protective equipment characteristics;
• to choose the personal protective equipment according to risk and task;
• to choose the personal protective equipment that is user friendly;
• to ensure that every effort has been made to ensure the correct use of personal protective equipment.

Remember that if personal protective equipment is used and fails, management has failed the worker.

In most work environments personal protective equipment for the skin offers a false sense of security. Workers do not know why they are using the equipment and what they are being protected against.

Personal hygiene:

A good skin care plan for the workplace must include personal hygiene and the provision of facilities to ensure personal hygiene.

Soiling should be removed from the skin frequently using a cleanser that will not itself cause damage to the barrier function. Soiling should be removed with running water at the correct temperature (approximately 37ºC) and not in a communal basin as this compounds exposure. The regular use of an emollient cream will help to maintain skin barrier function and prevent it drying out. The cream also adds a thin layer of oil, facilitating easy removal of soiling provided it does not act as an added reservoir for concentration of the products to which the worker is exposed.

Some simple rules for occupational skin management are as follows:

• Has everything been done to eliminate contact with potential hazards? In other words has every effort been made to engineer out or replace potential hazards with other chemicals so that the use of personal protective equipment is limited to splash protection only?
• Has there been adequate training of the workers in skin care and hygiene?
• Have adequate and appropriate ablution facilities been made available.

Where unavoidable, has correct personal protective equipment been identified and the staff received training in the use of the equipment, its limitations, cleaning and maintenance.

The best rule for both prevention and management of occupational skin disease is to keep it simple! This ensures that contact with irritants and allergens in the work, home and play environments is minimised.