Eczema (dermatitis) is the name of a group of inflammatory skin conditions characterised by dry, red, scaling, itchy skin. For a significant number of people, eczema can make work uncomfortable, difficult and sometimes impossible.
There are various forms of eczema but one of the most significant for workers is contact dermatitis, caused by the skin coming into contact with chemicals, either natural or synthetic. Some nine per cent of the UK population suffer with contact dermatitis, but for workers in particular industries or professions, handling these causative substances on a regular basis can be the cause of ill health and lost working hours.
In the UK, the Health and Safety Executive (HSE), estimates that 84,000 employees have dermatitis caused or made worse by their work. Ten per cent of these people work in the catering and food industry. According to the HSE, occupational dermatitis also accounts for 10 per cent of all compensation cases under the Department for Work and Pensions’ Industrial Injuries Scheme and 13 per cent of cases of occupational diseases reported to the HSE under the rules of RIDDOR (the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations).
Furthermore, although the overall trend is for a fall in occurrences of contact dermatitis in the workplace since the 1990s, the HSE estimates that there are 7,000 new cases of work-related skin problems reported every year.
Types of contact dermatitis
Clinicians recognise two types of contact dermatitis, one caused by irritants in the environment and the other caused by allergens.
Irritant contact dermatitis is triggered by regular contact with everyday substances which damage the outer layer of the skin. These irritants could include water, soap, detergents or even just the cold, but the irritant substances could be essential to certain types of work, like cement to the building industry, or hair cosmetics to hairdressing. Other irritants are thought to include perfumes, solvents, machine oil, acids and alkalis and plants. As a result, chefs, hairdressers, nurses and carers, cleaners, mechanics and construction workers are all more likely to suffer with workplace contact dermatitis.
Symptoms can vary between mild redness and dryness to cracked and flaking skin or even bleeding. In the worst cases skin can look and feel like it has been burnt, with blisters and weeping sores.
There is evidence too that irritant contact dermatitis can develop when the skin on the hands has been weakened by regular or prolonged contact with water, called wet work. This condition can also be associated with other forms of eczema and experts believe people who suffer from a childhood form of eczema, known as atopic eczema, could be more vulnerable to mild irritants in the workplace.
Allergic contact dermatitis is much less common but potentially no less debilitating. This condition involves the body becoming allergic to a substance after exposure. The body’s immune system, when exposed to a substance, will attack the healthy cells and tissue around it.
The symptoms are similar to those of irritant dermatitis but the reaction can happen quite quickly.
The most common allergens include hair dye and cosmetic ingredients used by hairdressers and beauticians, metals, like nickel, used in jewellery making, latex used in rubber gloves for doctors, nurses and care workers, and plants like chrysanthemums used in floristry. A person who becomes sensitised to a substance on skin contact can also be at risk of more dangerous allergic responses to the substance, and can become unwell when exposed to other methods of contact (such as airborne latex).
Treatments for eczema
Prevention is easier than cure and identifying the offending irritant or allergen (and avoiding it) could be the first place to start in combating contact dermatitis. This could be done with a series of tests undertaken by the clinician.
Other practical steps may include:
- Cleaning skin carefully – with soap or an emollient.
- Wearing protective clothing (e.g. gloves) to avoid exposure.
- Wearing cotton gloves under rubber gloves.
- Changing the brand of product, like make-up or soap.
- Replacing soap with emollient or a soap that contains emollient.
- Using skin conditioning creams to help to maintain the skin’s natural defences (pre-work) and support the skin to self-repair (post-work or exposure).
Eczema and work
According to reports made during 2011-2013 by The Health and Occupation Research Network (THOR) GP scheme, skin diseases accounted for around 1% of all sick days caused by occupational illnesses. Employers have a general duty to protect the health of their staff and employers’ duties with regards to potential skin irritants are set out in the Control of Substances Hazardous to Health Regulations (COSHH). In addition, workplace exposure limits for a variety of substances commonly found in workplaces are listed in the EH40 document on the HSE website. All employers should be aware of EH40 and the limits for individual substances (although not all substances that can trigger occupational dermatitis are hazardous substances included in EH40).
For many industries and professions, eczema is a significant problem for the workforce, but there are steps that can be taken to combat the problem. For more detailed information on occupational skin problems, see our guidance on the Fit for Work website. Or, to find out more about eligibility and the benefits of Fit for Work referrals, call the free Fit for Work advice line 0800 032 6235, (English) or 0800 032 6233 (Welsh). You can also visit the Advice Hub or go to www.fitforwork.org. Those is Scotland can call 0800 019 2211 or visit fitforworkscotland.scot.