Wet-work Exposure: A Main Risk Factor for Occupational Hand Dermatitis

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Abstract

Wet-work can be defined as activities where workers have to immerse their hands in liquids for >2 hours per shift, or wear waterproof (occlusive) gloves for a corresponding amount of time, or wash their hands >20 times per shift. This review considers the recent literature on wet-work exposure, and examines wet-work as a main risk factor for developing irritant contact dermatitis of the hands. The aim of this paper is to provide a detailed description of wet-work exposure among specific occupational groups who extensively deal with water and other liquids in their occupations. Furthermore, it highlights the extent and importance of the subsequent adverse health effects caused by exposure to wet-work.

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Most cited references 69

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The epidemiology of occupational contact dermatitis.

T Diepgen, P-J Coenraads (1999)

Occupational contact dermatitis (OCD) ranks first of all occupational diseases in many countries. The incidence rate is believed to be around 0.5-1.9 cases per 1000 full-time workers per year. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. In this review article the lack of truly epidemiologic data on OCD and the difficulties of those studies are illustrated. The following issues are highlighted: case ascertainment and bias, the distribution of allergic and irritant contact dermatitis in the working population, the interrelationship between exogenous (allergens, irritants) and endogenous factors, the prognosis, the social and economic impact, and the need for intervention studies.

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Hydration disrupts human stratum corneum ultrastructure.

Y Boissy, Joshua Stone, Robert R. Warner (2003)

Using transmission and cryo-scanning electron microscopy, we confirm that extended water exposure leads to extensive disruption of stratum corneum intercellular lipid lamellae. We define the in vivo swelling behavior of the stratum corneum: exposure to water for 4 or 24 h results in a 3- or 4-fold expansion of the stratum corneum thickness, respectively. Corneocytes swell uniformly with the exception of the outermost and inner two to four corneocyte layers, which swell less. We show that hydration induces large pools of water in the intercellular space, pools that can exceed the size of water-swollen corneocytes. By 4 h of water exposure there are numerous small and large intercellular pools of water ("cisternae") present throughout the stratum corneum, and at 24 h these cisternae substantially increase in size. Within cisternae the lipid structure is disrupted by lamellar delamination ("roll-up"). Cisternae appear to be disk-shaped structures that do not obviously communicate. Cisternae appear to contain considerable lipidic and other material and to contain a substantial fluid volume that can rival the volume of the dry stratum corneum. Similar results are obtained following urine exposure. With urine exposure, cisternae communicate with salts in the external solution. This study illustrates the disruptive effect of overhydration on the stratum corneum intercellular space, identifies large and numerous unanticipated intercellular cisternal structures, defines the magnitude of stratum corneum swelling, and identifies stratum corneum cell layers that swell less. The study suggests the stratum corneum is a more chaotic structure than previously envisioned, and provides a framework for better understanding desquamation, irritancy, and percutaneous transport.

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Atopy, occupation and domestic work as risk factors for hand eczema in hospital workers.

E. Nilsson, B Mikaelsson, S. Andersson (1985)

By means of a multivariate regression analysis, we have studied the importance of atopy, "wet" and "dry" occupations, and domestic work as risk factors for hand eczema. Hand eczema was identified by questionnaire. The studied cohort consisted of 2452 newly employed hospital workers with a median follow-up time of 20 months. Of the total cohort studied, 86% were female. The total occurrence of hand eczema in the 4 occupational groups studied were: nursing staff 41%, kitchen workers/cleaners 37%, office workers 25% and caretakers/craftsmen 17%. Atopic dermatitis increased the odds of developing hand eczema by 3 times in wet as well as in dry work. Subjects with atopic dermatitis developed a more severe hand eczema than subjects with atopic mucosal symptoms and non-atopics. Wet hospital work increased the odds by a factor of 2 compared to dry office work. 2 anamnestically available parameters of domestic work, namely "nursing of children younger than 4 years" and "absence of dish-washing machine" were found to significantly increase the risk of developing hand eczema. Wet work in combination with unfavourable domestic factors increased the odds by a factor of 4. The caretakers/craftsmen group, which was dominated by men, showed the lowest figure for hand eczema.

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Author and article information

Contributors

Ali Behroozy

Journal

Journal ID (nlm-ta): Saf Health Work

Title: Safety and Health at Work

ISSN (Print): 2093-7911

ISSN (Electronic): 2093-7997

Publication date PMC-release: 23 August 2014

Publication date (Electronic): 23 August 2014

Publication date (Print): December 2014

Volume: 5

Issue: 4

Pages: 175-180

Affiliations

[1 ]Department of Occupational Hygiene, School of Paramedicine and Public Health, Zanjan University of Medical Sciences, Zanjan, Iran

[2 ]Centre for Ergonomics and Human Factors, Public Health and Human Biosciences, La Trobe University, Melbourne, Australia

[3 ]Monash Centre for Occupational and Environmental Health (MonCOEH), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Author notes

[∗ ]Corresponding author. Department of Occupational Hygiene, School of Paramedicine and Public Health, Zanjan University of Medical Sciences, Parvin E'tesamee Avenue, Zanjan, 45157-86349, Iran. abehroozy@ 123456zums.ac.ir

Article

Publisher ID: S2093-7911(14)00056-0

DOI: 10.1016/j.shaw.2014.08.001

PMC ID: 4266809

PubMed ID: 25516808

SO-VID: 44e14ea0-7007-45f0-ac43-2b1eee4be394

License:

This is an Open Access article distributed under the terms of the CC-BY-NC License (http://creativecommons.org/licenses/by-nc/3.0).

History

Date received : 25 February 2014

Date revision received : 3 August 2014

Date accepted : 3 August 2014

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Wet-work Exposure: A Main Risk Factor for Occupational Hand Dermatitis

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China Occupational Medicine

Most cited references 69

The epidemiology of occupational contact dermatitis.

Hydration disrupts human stratum corneum ultrastructure.

Atopy, occupation and domestic work as risk factors for hand eczema in hospital workers.

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Cited by 29

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