By Katelyn
Wood, MS, PAC, WorkPartners Occupational Health Specialists
Occupational skin disease is more common than one may think. It can strike an employee in a variety of settings from healthcare to housekeeping. The most common occupational skin disease is contact dermatitis.
Contact dermatitis is caused by contact with something that irritates the skin or causes an allergic response. Therefore, this further divides it into either irritant or allergic dermatitis, an example of each being exposed to the industrial cleaning solution and poison oak, respectively.
These two types can often be hard to distinguish. However, allergic dermatitis can occur in places on the body that did not come in direct contact with the offending agent due to the immune response, and irritant dermatitis typically develops slowly due to prolonged exposure. Contact dermatitis rash is red in appearance, often with swelling or scaling, associated with itching, and is clearly demarcated at the exposed sites.
Upon interview of the injured worker, questions should be asked about the exact time relationship between skin condition and work exposure, including effects of rash during time off and when returning to work. The clinician should cover general work conditions, specific work activities that involve skin contact with potential offending agents, material safety and data sheets if a specific product is involved, the presence of rash in colleagues, control measures or personal protective equipment in place, and routine work hygiene. Additionally, the provider should inquire about any other potential exposures outside of work including but not limited to lotions, soaps, detergents, household cleaning supplies, hobbies, gym use, medications, and any history of allergies or rashes in the past. If these questions are addressed it will allow the provider to determine if it is more probable than not that the rash is arising outside of the course of employment.
The first step in the treatment is removal from the offending agent. In the office, the provider will assess the severity of the rash and likely prescribe corticosteroids, such as hydrocortisone cream. Corticosteroids are used to reduce signs and symptoms of inflammation. Corticosteroids come in various strengths and routes, all of which will be determined based on severity and location. More often than not, the patient has already tried over-the-counter management without relief, so a prescription-strength topical corticosteroid would be the next course of treatment for a focal rash. When the rash is widespread, oral steroids or intramuscular injections are often indicated. Over-the-counter Benadryl, emollients or moisturizers, oatmeal baths, and calamine lotion are all helpful for healing and management of associated itching. As with all occupational injuries or illnesses, prevention remains the most important part of treatment. It is imperative employers equip their employees with the appropriate protection, such as gloves, masks, gowns, proper hand washing, etc.
About the Author
Katelyn Wood is a nationally certified physician assistant working in occupational medicine at WorkPartners Occupational Health Specialists in San Diego County. She graduated from San Diego State University with a Bachelor of Science degree in kinesiology athletic training, then went on to earn a Master of Science degree in physician assistant studies at AT Still University in Arizona. She has been practicing medicine since 2014 with experience in various settings including orthopedic surgery, emergency medicine, and occupational medicine.
