Summary
Occupational skin diseases are contracted from exposure in the workplace and are the second most common employer-reported occupational disorder. The most common manifestations include irritant contact dermatitis, occupational acne, and latex allergy. Other occupational diseases covered elsewhere include work-related musculoskeletal disorders (e.g., carpal tunnel syndrome, low back pain), asbestosis, mesothelioma, and silicosis.
Epidemiology
- Second most common cause of occupational disorders (15–20% of all reported occupational diseases) [1]
- 75% of patients with occupational contact dermatitis develop chronic skin disease. [1]
Epidemiological data refers to the US, unless otherwise specified.
Irritant contact dermatitis
- Occupational contact dermatitis is a localized inflammatory skin reaction resulting from exposure to substances at work [2][3]
-
Manifestations include: [2][3]
- Irritant contact dermatitis (most common)
- Allergic contact dermatitis
- See "Contact dermatitis" for details.
Occupational acne
Oil acne [4]
- Acne caused by clogging of pilosebaceous units by lubricants (e.g., oils, greases) and/or solvents
- Most common form of occupational acne
- Seen frequently in mechanics
- Lubricant or solvent exposure → reactive follicular hyperkeratosis → open comedones (blackheads) → folliculitis and microcystic lesions
- Clinical features
- Comedones, papules, and pustules affecting areas exposed to lubricants or solvents (e.g., hands, thighs)
- Commonly complicated by folliculitis
- Treatment [4]
- Avoid exposure to causative agents or use PPE.
- Recommend frequent cleansing of skin and work clothes.
- Persistent symptoms: Start pharmacotherapy for acne (e.g., topical benzoyl peroxide and retinoic acid).
Chloracne [5]
- Most serious form of occupational acne
- Caused by halogenated aromatic hydrocarbons penetrating the skin
- Clinical features
- Closed comedones, yellowish cysts, and scarring
- The nose is typically spared.
- May be associated with systemic disease
- Treatment is the same as for oil acne.
Mask acne [6][7]
- Acne affecting areas covered by a mask
- Caused by increased temperature and humidity beneath the mask
- First-line treatment is prevention, e.g.:
- Wash skin before and after mask use with a gentle noncomedogenic cleanser.
- Avoid wearing makeup if a mask will be worn all day.
- Take a 15-minute break from mask use every 2 hours.
- Change masks daily.
- If acne persists, consider topical acne treatment during mask-free intervals.
Latex allergy
A type I hypersensitivity or type IV hypersensitivity reaction to latex-based products (e.g., rubber gloves, condoms, balloons) [8]
Epidemiology
- Affects 1–2% of the general population [8]
- Increased risk of allergy in individuals who have:
- Atopy, eczema, and hand dermatitis
- Occupational exposure, e.g., healthcare workers, hairdressers
- Multiple surgeries (e.g., patients with spina bifida) [8]
Pathophysiology
- Immediate hypersensitivity (type I HSR): preformed IgE antibodies coating mast cells and basophils are crosslinked by contact with antigen (usually latex allergens) → cell degranulation → release of histamine and other inflammatory mediators.(e.g., leukotrienes, prostaglandins) → vasodilatation, increased capillary permeability, smooth muscle contraction, and inflammatory cell chemotaxis [9]
-
Delayed-type hypersensitivity (type IV HSR): contact of antigens (usually chemicals used during glove manufacturing such as benzothiazoles or amines) with presensitized T lymphocytes [10]
- Presensitized CD4+ T cells recognize antigens on antigen-presenting cells → release of inflammatory cytokines → activation of macrophages
- Presensitized CD8+ T cells recognize antigens on somatic cells → cell-mediated cytotoxicity
Clinical features
- Urticaria in the areas of contact
- Rhinitis, asthma [11]
- Anaphylactic shock (in sensitized individuals)
Diagnostics [8][12]
There is no standardized diagnostic algorithm to confirm latex allergy.
- Take a comprehensive history; consider screening questionnaires. [8]
- Confirm the diagnosis with laboratory studies or skin testing. [8][12]
- Suspected immediate hypersensitivity reaction
- Latex-specific serum Ig E testing
- Skin prick testing
- Suspected delayed-type hypersensitivity reaction : patch testing
- Suspected immediate hypersensitivity reaction
- For patients with a suggestive history but negative skin and antibody tests, consider a provocation test. [8][12]
Treatment [8][12]
- Treat the allergic reaction (e.g., see “Anaphylaxis,” “Allergic contact dermatitis,” and “Allergic rhinitis” as needed).
- Educate patients on allergen avoidance in the community.
- For hospitalized patients: Ensure latex-allergy status is documented on admission and the patient's environment remains latex-free.
Prevention [8][12]
For individuals at the highest risk (e.g., patients with spina bifida), maintain a latex-free environment from birth.
Skin infections
- Bacterial infections
- Fungal infections: tinea pedis
-
Viral infections: milker's nodules [13]
- Skin condition caused by the Cowpox virus from the family of Poxviridae that infects the teats of cows
- Individuals with occupational exposure to cows are at increased risk of developing the disease.
- Usually manifests on the fingers with raised, red spots that develop into red-blue, firm and slightly tender nodules.
- Resolves spontaneously
- Complications include lymphangitis and secondary bacterial infection.
Precancerous and cancerous skin diseases
Exposure to chemicals or UV radiation may lead to development of skin cancers, for more information see:
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