Skin surveillance

Key facts

Most workers are potentially at risk of skin disease. There is a misconception that only seriously hazardous chemicals present a risk, but one of the most common contributors to occupational irritant contact dermatitis is water. In Germany, a special regulation applies to all staff engaged in wet work for more than a quarter of their working shift.2 Even wearing chemical protective gloves can result in contact dermatitis, due to the occlusive effect.

To comply with the requirements of the Control of Substances Hazardous to Health regulations and the guidance note MS24,3 most employers should at least consider introducing some form of skin health surveillance programme.

In a study into dermatitis in the printing industry of just over 1,000 workers, funded by the Health and Safety Executive,1 41% reported that they had experienced a skin problem at some time, and 26% reported that they had a skin problem at the time of completing the questionnaire. Of those who reported a current skin problem, 45 were seen by a consultant dermatologist. All the skin problems were confirmed as such, with 58% diagnosed as occupation related.

What is particularly interesting is that a control group of 60 people was also seen by the dermatologist. They were selected from the respondents who had reported no current or previous skin problem. Of these, 35% were found to have a mild skin problem, and an occupational cause was considered likely in 28% of the control group.

In other words, 28% of those people who did not report a skin problem actually had what was probably an occupational skin disease, albeit mild.

Why conduct skin surveillance?

The danger for them and the employer is that had the condition been allowed to persist, it could have developed into a more severe skin disease, possibly requiring time off work, treatment and potentially leading to a claim for compensation.

What this shows is the need for a skin health surveillance programme for all staff who might be exposed to chemicals capable of causing damage to their skin. Early detection can facilitate early intervention, and identify areas of the workplace with unacceptable levels of skin exposure.

How to carry it out

Traditionally, skin health surveillance has taken the form of a visual inspection of the employees’ skin. Should symptoms such as cracking, redness or scaling be detected, then this would initiate a more detailed investigation and appropriate intervention. This type of examination is still an essential part of any skin health surveillance system. It is the only way to detect allergic reactions at an early stage, so that action can be taken to avoid a more serious skin problem.

However, most occupational skin problems will take the form of irritant contact dermatitis. This is mostly chronic in nature, meaning repeated contact – probably with a whole range of chemicals (including water) – results in the skin’s resistance slowly being broken down, ultimately resulting in the dermatitis.4 Unfortunately, this cumulative effect is undetectable by visual inspection. Thus the occupational health practitioner will be unaware of the impending skin problem until it actually manifests itself as the contact dermatitis. By then, it can then be difficult to resolve.

However, there is a method that can be used to detect this sub-clinical (invisible) damage. Skin bio-engineering techniques have evolved that can be used to safely and non-invasively, measure skin conditions, producing quantitative data.

Measurement of skin hydration in the stratum corneum has long been considered by dermatologists as a good indication of the overall skin condition.5 As the damage from contact with irritants accumulates, the ability of the cells in the outer part of the skin to bind water appears to diminish,6 so a reduction in skin moisture content is an indication of accumulated damage.

The body also loses moisture through the skin. This loss is controlled by a thin layer of lipids in the lower stratum corneum. If this layer is damaged, possibly due to contact with a solvent or even a detergent, then the trans-epidermal water loss (TEWL) will increase. Of course, such damage will also allow chemicals, bacteria and viruses to penetrate more easily, increasing the risk of damage to the health of the individual. Thus the measurement of TEWL is considered to be an indication of the condition of the skin barrier function.

Chris Packham is a partner at EnviroDerm Services. For more information, call 01386 832311 or e-mail info@enviroderm.co.uk

References
1 The prevalence of occupational dermatitis among printers in the Midlands (2000) HSE document CRR 307
2 Technische Regel fr Gefahrstoffe Nr. 531, Feuchtarbeit (Technical regulation for hazardous substances no. 531, Wet work)
3 Guidance Note MS24 (Second edition), Medical aspects of occupational skin disease
4 Malten K E, (1981) Thoughts on contact dermatitis, Contact Dermatitis, 7, p238-47
5 Ramsing D W, Agner T (1997) Effect of water on experimentally irritated human skin, British Journal of Dermatology p136, p364-7
6 Tagami H, Yoshikuni K (1985) Interrelationship between water-barrier and reservoir functions of pathologic stratum corneum, Archives of Dermatology, 121, p642-5


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