Occupational irritant and allergic contact dermatitis among healthcare workers

TLDR

Contact dermatitis is the most common occupational skin disease, caused by non‑specific irritants such as soaps, solvents, and gloves, as well as specific Type IV sensitizers, and its management relies on avoidance or reduced exposure, especially for atopic individuals. The study retrospectively reviewed 360 consecutive healthcare workers from 1994–1998 who presented with hand, wrist, or forearm contact dermatitis. Work‑related allergic contact dermatitis accounted for 16.5 % and irritant contact dermatitis for 44.4 % of cases, with nickel sulfate, disinfectants (glutaraldehyde, benzalkonium chloride), and rubber chemicals (thiuram mix, carba mix, tetramethylthiuram monosulphide) identified as the main allergens.

Abstract

Contact dermatitis is the most frequent occupational dermatosis and non-specific irritants in addition to specific Type IV sensitization are involved. We reviewed our database for data from 1994 to 1998 and selected 360 consecutive patients working in healthcare environments and experiencing contact dermatitis at their hands, wrists and forearms. We found that allergic contact dermatitis and irritant contact dermatitis were considered to be work-related in 16.5% (72/436) and 44.4% (194/436) of diagnoses, respectively. Occupational irritant contact dermatitis is due to exposure to a wide range of irritants in the workplace, such as soaps, solvents, cleansers and protective gloves, which conspire to remove the surface lipid layer and/or produce cellular damage. In this study the major relevant aetiological agents that induced occupational allergic contact dermatitis were: nickel sulphate (41 patch positivities), components of disinfectants [glutaraldehyde (5) and benzalkonium chloride (7)] and rubber chemicals [thiuram mix (15), carba mix (9) and tetramethylthiuram monosulphide (6)]. The best treatment for allergic contact dermatitis is to avoid those allergens causing the rash. Whenever this is not possible, contact with them needs to be reduced using properly selected protective gloves. Finally, subjects with atopic dermatitis should avoid 'wet work' and contact with irritants, because atopic dermatitis is significantly associated with irritant contact dermatitis.