Dermatitis is a form of eczema, an inflammatory skin condition caused by contact with something that irritates the skin or causes an allergic reaction. It usually occurs where the skin is touched by the substance, commonly through splashing or by touching a contaminated surface. It is a common condition affecting staff in the social care sector, such as care home and domiciliary care staff. Martin Hodgson outlines its causes and treatments, along with employers’ duties.
Symptoms of dermatitis
Dermatitis can take many forms but in most cases someone with dermatitis will display one or all of the following signs on their skin:
Dermatitis is most frequently seen on the hands, as they are more likely to have contact with substances than other parts of the body. Itching and pain are common. It tends to affect women more than men. One in five women experience it on their hands at some point and it can develop at any age.
When dermatitis occurs at work and is caused by a work process or substance it is referred to as an occupational disease.
Two types of dermatitis are commonly described.
The more common form, irritant dermatitis, is caused by contact with a substance that has irritant qualities. A strong irritant can cause an almost immediate reaction while a weaker substance may cause dermatitis after a number of exposures.
Another form, contact dermatitis, occurs where someone develops an allergy to a certain substance that does not produce a reaction in others. People who develop such a reaction are said to be “sensitised” and even a brief contact with the substance, which does not have to be an irritant, can cause symptoms.
Common irritants linked by the Health and Safety Executive (HSE) to dermatitis include:
soaps, shampoos and detergents
some food (eg onions)
oils and greases
acids and alkalis
The HSE links the following substances to allergic contact dermatitis:
some hair dyes
ultraviolet cured printing inks
some food (eg shellfish, flour)
Many people do not realise it, but repeated and prolonged contact with water can also cause dermatitis. This is often a problem for kitchen staff, who have to do a lot of washing up, and for cleaners. Repeated or prolonged exposure is described by the HSE as more than 20 hand washes or having wet hands for more than two hours per shift.
Irritant or sensitising substances can best be identified during procurement and by managers and staff inspecting labels for hazard details and for symbols indicating that the substance is an irritant or a skin sensitiser. Data sheets supplied with substances will also contain additional important safety and handling information. Lists of irritant products and allergenic sensitisers are available from the HSE.
Most cases of dermatitis will be treated by a GP. Some will be referred to a dermatologist. In some cases, an occupational health service can also provide support.
Where the symptoms are mild, the dermatitis will often clear up of its own accord, if the affected person can identify the substance that caused or exacerbated the condition and avoid contact with it.
In some cases an emollient cream (a form of moisturiser that reduces the loss of water from the skin) will be required to soothe the skin and prevent cracking. Emollients come in various forms and a pharmacist or GP can advise on the right type for a particular person.
In more serious cases, where the skin is very red and inflamed, topical corticosteroid medicines may be prescribed. These contain hormones called steroids and should be applied carefully according to the instructions given. They are rarely prescribed for any length of time as prolonged use can cause a thinning of the skin.
Occasionally dermatitis will resist treatment and may affect a person’s quality of life. Some people have suffered from depression linked to their condition and have been unable to continue in their job role.
Other occupational skin conditions
Dermatitis accounts for about 80% of work-related skin disease but other conditions also occur.
For instance, urticaria is another skin condition caused by contact with an irritant or allergen. However, unlike dermatitis, it usually appears soon after skin contact and fades away quickly. Common causes include the latex protein in single-use latex gloves, some foods (eg potatoes, fish and meat) and even cold or heat.
Latex allergies are relatively common in the health and social care sectors where managers should take proactive steps to control risks.
Employers have a legal duty under the Health and Safety at Work, etc Act 1974 to ensure the health of their staff, where practicable, and prevent work-related conditions such as dermatitis.
In addition, the Control of Substances Hazardous to Health Regulations 2002 (COSHH) require employers to identify the hazards associated with substances in the workplace, such as chemical agents, and to assess the extent of likely exposure when these substances are used. They must respond to assessments by controlling such risks that exist.
Although skin problems at work are common there is much that can be done to prevent them. The HSE recommends an “Avoid, Protect and Check” approach.
Avoiding direct contact with substances associated with dermatitis or skin allergies is the most effective approach. This involves removing irritant substances or products altogether from the workplace or replacing them with safer non-irritant products.
Wet work should be avoided wherever possible and replaced by alternatives.
However, avoiding contact with certain products or avoiding wet work is not always possible, so managers should provide adequate personal protective equipment and ensure it is used correctly. Protective gloves are probably the most commonly used personal protective equipment (PPE) and it is important that the right type of glove is chosen for the job to be completed.
Selecting suitable gloves and protective clothing can be a complex process. When selecting gloves, managers should involve the workforce and seek advice from manufacturers or suppliers where necessary. Single-use products should never be reused.
Before using a chemical, staff should always read the label on the container.
In addition to wearing gloves:
staff should be required to wash their hands before eating and drinking, before wearing gloves and after any contamination of the hands, particularly from substances that might be irritants
washing facilities with hot and cold water should be provided, with a mild skin cleaning cream
where suitable washing facilities are not available, for instance in some domiciliary care settings, then suitable hand cleaning gels should be provided
disposable paper towels should be provided for staff to dry their hands thoroughly
suitable pre-work creams and moisturisers should be provided to help staff keep their hands in good condition.
The HSE states that staff should also be encouraged to check their hands regularly for any sign of dermatitis or any other skin condition. If signs are spotted they should take action, such as seeing their GP or occupational health advisor.
Information for staff
Managers can help their staff by including skin conditions in any training for staff, particularly training in implementing COSHH and in using PPE such as gloves. Staff should be instructed in how to wash their hands properly and in hand care.
The HSE publishes resources about dermatitis, including a poster which shows the signs and symptoms to look for.
Last reviewed 13 March 2014