Eczema is a general term for a kind of inflammation of the skin. In 2010, it was estimated that approx. 3.5% of the total world population is affected by eczema. Atopic dermatitis, considered as a hereditary, frequently severe form of eczema, often starts in early infancy. Every 5th child in Northern Europe nowadays is affected by atopic dermatitis, frequency has been increasing through the last decades. In many countries in Europe – and in the US, eczema is the most common work-related health problem and accounts for over 35% of occupational illnesses, like in Denmark or Germany.
The most frequent kind of eczema is contact dermatitis and atopic individuals are more prone to developing this kind of dermatitis, which accounts for almost 90% of skin disorders acquired in the workplace. Contact dermatitis can be divided into irritant contact dermatitis that involves a non-immunologic response to a skin irritant such as water, acids, alkalis and others. In contrast, allergic contact dermatitis is caused by a skin inflammation driven by an immunologic cell mediated reaction to an antigenic substance (e.g. epoxy resin, potassium dichromate, hair dyes). Both can result in skin inflammation with clinically characteristic signs of redness, swelling, blistering, flaking, cracking and itching.
Unfortunately, work-related eczemas are often underreported because their association with the working environment is frequently not recognised. Contact dermatitis affects individuals from all ages, both sexes and a large variety of occupations. High risk industries for occupational eczema include healthcare, hairdressing/beauticians, metal work, construction, manufacturing, food production, agriculture, printing, and janitorial services. The most affected body sites are the hands; the single most relevant occupational risk factor is wet work, followed by occupational exposure to multiple irritants and allergens. The permanent increase of allergens to which people are exposed at home and at their workplaces also adds to the complexity of the challenge. Within the European Union the costs of occupational eczema-related medical treatment, sick leave and loss of productivity vastly exceeds €5bn annually. In the US, total annual costs for work-related eczema amounts to more than $1bn. For affected individuals, the chronic course of dermatitis may result in detrimental socioeconomic and psychological consequences, including social exclusion, job loss and long-term unemployment.
The good news is that most forms of eczema can be successfully prevented if detected early and appropriate dermatological interventions are being applied. Prevention measures include specific teaching of affected individuals on proper personal skin protection and care. Lack of information is one of the greatest risks at home and the workplace. Unfortunately, the effectiveness of targeted prevention measures is as yet not entirely recognised by patients, workers and employers. Concerning workers, one uniform finding common to various European intervention studies is the lack of knowledge pertaining to the causes of eczema and the proper means of personal skin protection: Using crude brushes and abrasives or even organic solvents to clean the skin is completely obsolete but still common. To-date, there are effective ways of cleaning which are much less harmful. Using protective creams beforehand reduces the amount of soiling. There are furthermore various minimal contact techniques including avoiding contamination to hazards, and there is a tremendous variety of gloves, which have to be carefully and individually chosen. Before the detailed advice on improved skin protection is given there should be dermatological consultations and meticulous patch testing of affected individuals. Good experiences have been made by providing patients as well as workers at risk with individually tailored instructions on the use of gloves, protective creams and skin care in the framework of multidisciplinary seminars.
The following 2 figures show by way of example that prevention pays: In Germany, rehabilitation and compensation costs in the hairdressing trade have been reduced by 77% cent from €32m per year to less than €8m per year over the last 15 years due to systematic and early preventive intervention strategies. In Switzerland, the numbers of registered work-related skin diseases have dropped by approximately 45% from 1,100 to 600 between 2000 and 2008 due to the multiple prevention efforts undertaken at different levels. Furthermore, the pan European EADV campaign “healthy skin@work” emphasises that prevention does not stop outside work but needs to be equally applied at home and leisure. Dermatologists – in cooperation with other disciplines – can save patients’ health and jobs, and thus reduce costs for tax-payers and insurance systems.
If you need further information, please consult the websites of the national dermatological societies, or of the EADV and the European Society of Contact Dermatitis (ESCD), which will provide useful information and contacts, or consult a local dermatologist. For specific knowledge how to protect your skin against eczema in hairdressing find exemplarily the web-based skin& beauty toolbox: www.safehair.eu.
Prof. Dr. Swen Malte John, University of Osnabrück, Germany, Chair of the Media & PR Committee, EADV and Chair of the EU Horizon2020 COST Action “Development and Implementation of European Standards on Prevention of Occupational Skin Diseases (StanDerm)”.
This article was originally published on the website of Adjacent Government - link.