Nurse Occupational Contact Dermatitis and Urticaria

BOHRF
BOHRF
BOHRF
BOHRFOccupational Contact
BOHRF
Dermatitis and Urticaria
A Guide for General Practitioners
BOHRF and Practice Nurses
BOHRF
BOHRF
March 2010
BOHRF
British Occupational Health Research Foundat ion
This leaflet summarises the key evidence based advice for policy and
practice on the risk management of occupational contact dermatitis and
urticaria.
The full guidelines, report, and analysis of relevant research is available

from the British Occupational Health Research Foundation. It can also
be accessed on the BOHRF website at www.bohrf.org.uk.
BOHRF is an award-winning, innovative niche charity specialising in the

provision of evidence based solutions to practical questions asked by
employers and their advisers in both private and public sectors.
Our mission is:
'Bringing employers and researchers together to produce research that

will contribute to good employee health and performance at work'.
Registered Charity No: 1077273
The cost of producing the summary leaflets for the evidence review on
occupational contact dermatitis has been generously provided by Pfizer
Ltd. Neither Pfizer nor any of their employees has been involved in
deciding which research is within scope of the review, nor have they
been involved in the analysis or presentation of either the review or the
summary leaflets.
OCCUPATIONAL CONTACT DERMATITIS AND URTICARIA
A Guide for General Practitioners and Practice Nurses
British Occupational Health Research Foundation
This guide helps you to:
• Summarize the key recommendations of the systematic evidence review of the

prevention, identification and management of occupational contact dermatitis and
urticaria. The full guidelines are available from the British Occupational Health
Research Foundation (BOHRF).
• Increase understanding of occupational contact dermatitis and urticaria and their
significance, in addition to the management of these conditions in a primary
setting.
• Understand the importance of early referral as this affords patients the best
chance of improvement
About this guide
This guide was created through funding by the British Occupational Health
Research Foundation (BOHRF) which is a non-profit, grant awarding charity
established in 1991 to contribute to the best possible physical and mental well-
being of workers.
Epidemiology of occupational dermatitis and urticaria
Skin disease is the second commonest occupational health problem in the European
Union after musculoskeletal disorders. Contact dermatitis accounts for 70-90% of all
occupational skin disease, while contact urticaria accounts for less than 10%. Up to
half of workers with occupational contact dermatitis experience adverse effects on
quality of life, daily function and relationships at home. It is because occupational
skin disease is so common and the impact is so severe that this evidence review was
undertaken.
This guide will assist you in your clinical practice to manage these conditions. It
provides a brief summary of the 2010 occupational contact dermatitis and urticaria
evidence based guidelines.
What are occupational contact dermatitis and urticaria?
This guide is focused on the following three skin conditions caused by exposure to
substances in the course of work:
1. Occupational irritant occupational contact dermatitis
This is the commonest type of occupational contact dermatitis where agents have
a direct toxic effect on the skin e.g. wet work, detergents, alkalis, solvents, friction
2. Occupational allergic occupational contact dermatitis

which involves a delayed or type IV hypersensitivity T cell mediated immune
reaction to skin sensitizers such as epoxy resins, preservatives, etc. Allergic
contact dermatitis often carries a worse prognosis than irritant contact dermatitis.
3. Occupational contact urticaria

which can be divided into 2 broad categories: non-immunologic contact urticaria
and immunologic contact urticaria that involves an immediate or type I
hypersensitivity reaction, associated with the presence of specific immunoglobulin
E. Contact urticaria is associated with proteins in food and latex gloves,
especially in health care workers and with some low molecular weight agents.
The outlook for these conditions may be improved in individual cases by earlier
identification and improved case management.
Who is at risk?
Different jobs carry different levels of risk for occupational contact dermatitis. Those
at the highest risk include hairdressers, health care workers, cleaners, construction
workers, cooks and caterers, mechanics, metalworkers and vehicle assemblers,
chemical/petroleum plant operatives and agricultural workers. Those at greatest risk
of developing occupational contact urticaria include bakers, farmers, health care
workers and those in food preparation occupations.
Practice Point: If a patient asks advice about the risk of dermatitis in association with
a proposed job, be aware of the jobs at increased risk, especially if that patient has
previously experienced dermatitis.
Practice Point: Take a full occupational history whenever someone of working age
presents with a skin rash, asking them about their job, the materials with which they
work, the location of the rash and any temporal relationship with work
Practice Point: Occupational contact urticaria is more likely in someone with a history
of atopy.
What can health professionals do?
Occupational contact dermatitis and urticaria can be prevented in the workplace by

applying the normal hierarchy of controls as required under the Control of
Substances Hazardous to Health, namely:
• hazard elimination
• hazard substitution
• engineering controls such as ventilation
• safe work practices with appropriate training, and, where this is not possible,
• personal protective equipment.
Gloves have only been shown to help reduce the incidence of irritant occupational
contact dermatitis when coupled with other preventive measures. They must be
selected according to their chemical and physical resistance properties and their
general suitability for the job tasks. The employer is responsible for arranging the
choice of glove following an adequate risk assessment.
Wet work is a significant risk factor for irritant contact dermatitis and occurs when the
hands are in contact with water (including water-diluted detergents) or where the
prolonged wearing of gloves causes the hands to become moist from perspiration.
Thin cotton gloves that absorb sweat may be worn inside occlusive gloves and this
may be beneficial for this condition.
Pre-work creams are of questionable value. They are often referred to as barrier
creams, but this term gives rise to a false perception that they form a physical barrier
to protect the skin. Pre-work creams are not generally effective as a preventative
measure. Their use should not be overly promoted as this may confer on workers a
false sense of security and encourage them to be complacent in implementing more
appropriate preventative measures. After-work or conditioning creams help to
prevent the development of occupational irritant contact dermatitis. They should be
encouraged and made readily available in the workplace.
Medical management of occupational contact dermatitis and urticaria
Care must be taken to distinguish between occupational and non-occupational

disease and between irritant and allergic occupational contact dermatitis, since the
occupational management of the individual patient will differ. The diagnosis of
occupational contact dermatitis and urticaria is an iterative process that involves
fastidious history taking, clinical examination, patch testing and prick testing. A
temporal relationship with work (for example improvements noted at weekend or on
holiday) and/or the presence of a rash on the hands only raises suspicion of an
occupational cause, and does not confirm occupational causation. The identification
of any offending allergen by patch or prick tests is a major objective, since exclusion
of an offending allergen from the environment can contribute to clinical recovery in
the individual worker and avoidance of new cases of disease.
Practice Point: If an occupational cause for contact dermatitis is suspected, a referral

for patch testing (or prick testing in the case of urticaria) should be made. This is
extremely important as accurate diagnosis is paramount especially if it influences
advice regarding implications for future employment,
Practice Point: It will be helpful in the referral to list the possible agents to which the
patient is exposed.
The pharmacological treatments for dermatitis and urticaria do not differ irrespective
of whether the cause is occupational or non-occupational. This review therefore only
addresses the occupational management of affected individuals.
Occupational management of occupational contact dermatitis and urticaria
Redeployment to a low exposure area or the introduction of exposure controls may

lead to improvement or resolution of occupational contact dermatitis and urticaria in
some workers (especially if the problem is picked up early and adequately reviewed
while working in the new area), but is not always effective. Likewise, the enhanced
use of gloves or protective clothing may improve or prevent symptoms in some but
not all workers who continue to be exposed to the causative agent. Difficulties in
managing occupational contact dermatitis, once caused, emphasise further the
importance of prevention. Improvements are more likely to be seen when the
problem is non-immune i.e. irritant contact dermatitis.
The prognosis of occupational contact dermatitis varies widely and, in some

occupational settings, reasonable control of symptoms and job retention is possible.
Similar proportions of patients report either improvement or ongoing symptoms. As
many as about one in ten patients continue to have persistent or post-occupational
contact dermatitis in the very long term, even after exposure to the original offending
agent has ceased.
Loss of job or complete change of employment is common among workers with

occupational contact dermatitis; however, most manage to continue working in some
capacity. There is little if any evidence related to the prognosis of occupational
contact urticaria.
BOHRF BOHRF
BOHRF
BOHRF
BOHRF is an award-winning, innovative niche charity

specialising in the provision of evidence based solutions to
BOHRF
practical questions asked by employers and their advisers in
both private and public sectors.
Our mission is:
'Bringing employers and researchers together to produce

research that will contribute to good employee health and
BOHRF
performance at work'.
BOHRF
BOHRF
6 St Andrews Place
Regent’s Park
London NW1 4LB
020 7034 3420
BOHRF
www.bohrf.org.uk
Registered Charity No: 1077273

Nurse Occupational Contact Dermatitis and Urticaria

Uploaded by

Copyright:

Available Formats

Nurse Occupational Contact Dermatitis and Urticaria

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nurse Occupational Contact Dermatitis and Urticaria

Uploaded by

Copyright:

Available Formats

BOHRF

A Guide for General Practitioners

BOHRF and Practice Nurses

The full guidelines, report, and analysis of relevant research is available

BOHRF is an award-winning, innovative niche charity specialising in the

Our mission is:

'Bringing employers and researchers together to produce research that

Registered Charity No: 1077273

A Guide for General Practitioners and Practice Nurses

British Occupational Health Research Foundation

This guide helps you to:

• Summarize the key recommendations of the systematic evidence review of the

About this guide

Epidemiology of occupational dermatitis and urticaria

What are occupational contact dermatitis and urticaria?

2. Occupational allergic occupational contact dermatitis

3. Occupational contact urticaria

What can health professionals do?

Occupational contact dermatitis and urticaria can be prevented in the workplace by

Medical management of occupational contact dermatitis and urticaria

Care must be taken to distinguish between occupational and non-occupational

Practice Point: If an occupational cause for contact dermatitis is suspected, a referral

Redeployment to a low exposure area or the introduction of exposure controls may

The prognosis of occupational contact dermatitis varies widely and, in some

Loss of job or complete change of employment is common among workers with

BOHRF is an award-winning, innovative niche charity

Our mission is:

'Bringing employers and researchers together to produce

020 7034 3420

Registered Charity No: 1077273

You might also like