Allergic Skin Reactions on the Job: Occupational Allergic Contact Dermatitis
Updated: Aug 16, 2020
I've been performing patch testing for close to 20 years, and during that time I've seen many cases of allergies related to the workplace. For example, I've seen multiple cases of allergies to medical gloves. This has impacted surgeons, physicians, and nurses, all of whom have had difficulties completing their important work due to the red, flaking, itching, and sometimes painful, rashes that they've developed on their hands.
Substances in the workplace can trigger allergic reactions of the skin.
This is known as occupational contact dermatitis. It's not limited to those in the medical profession, of course. I've treated many professionals who have become allergic to the tools, equipment, or supplies that are used in the course of their job. From dentists to hairdressers to mechanics to nail technicians, these types of allergic reactions can sharply limit a person's ability to do their job. In some cases, these reactions can even be career ending.
What is occupational contact dermatitis?
These types of skin reactions can be either due to irritation, or due to allergy.
If the reactions are due to allergy, they're usually due to allergic contact dermatitis.
Allergic contact dermatitis (ACD) is one specific type of allergic skin reaction. It's also known as delayed-type hypersensitivity, because it usually develops 2 to 3 days after exposure to a substance.
That delay is what makes it so hard to figure out. You may have worn your sparkly eyeshadow on Saturday night, but the resulting rash shows up on Monday. That makes it especially hard to pinpoint the cause. (And definitely makes it more likely that you're going to unfairly blame something in your workplace on Monday morning. It's important to remember that while some reactions are due to workplace exposures, many others are due to home or personal exposures.)
There are a large number of substances and chemicals that can trigger allergic reactions, and some of these are in our work environment. The term occupational contact dermatitis means that the reaction is related to some exposure that's specific to your job.
Here are some examples of substances, tools, and equipment that can trigger occupational skin allergies:
1. Machinists and mechanics contact a number of tools. They also come into contact with different cooling fluids or other mechanical lubricants and fluids.
Machinists and mechanics may react to their tools, to mechanical lubricants and fluids, or to industrial hand soaps.
I've treated machinists and mechanics who have become allergic to the metal in their tools. I've also seen multiple reactions to the preservatives used in cooling fluids and lubricants. One of the most common triggers often goes unsuspected, though: hand soap. The fragrances and preservatives used in industrial hand soaps, such as GoJo cleanser, are frequent triggers of allergic skin reactions on the hands.
2. One of the occupations with the highest rate of allergic skin reactions is hairdressing.
Hairdressers may react to the nickel in scissors, to hair dye or perming chemicals, or to the ingredients in hair care products themselves.
Allergic contact dermatitis is a large potential problem for hairdressers. Hairdressers use their hands constantly during the course of their workday. Some have become allergic to the nickel in their metal scissors. Others have become allergic to the chemicals in hair dye or hair perming solutions. Some of the most common triggers are the ingredients in shampoos, conditioners, and styling gels. These chemicals are common triggers in the general population, but because hairdressers contact them so frequently during a workday, they're an even bigger concern for this occupation.
3. Nail technicians
Some of the most dramatic reactions I've seen have been in nail technicians. Nail technicians frequently contact acrylates. These chemicals are used to make acrylic nails. Many people don't realize that they're also frequently used to create gel nails or shellac nails.
The acrylates in acrylic nails, gel nails, and shellac nails are a potential trigger for nail technicians, as well as customers.
Acrylates may come in powder, liquid, or gel form, and when they're exposed to UV light [or sometimes heat or just time] they polymerize. That means they form cross-links that create the final, hardened object. They're not a problem when they polymerize, but in their original chemical form [acrylate monomers] they're a notable trigger of allergic reactions. These chemicals also go right through most rubber gloves, which is how nail technicians may become sensitized. This allergy can be a real problem, since these same chemicals are frequently used in dentistry, in crowns and fillings.
4. Physicians and nurses
There are many potential triggers for health care professionals.
Health care professionals may develop reactions to rubber chemicals in gloves, to ingredients in soaps and cleansers, and other substances.
One of the most common are the ingredients in soaps and cleansers. The fragrance additives and preservatives, as well as the anti-bacterial ingredients, that are so commonly used in hospital cleansers are a frequent trigger of allergic skin reactions. This is a real problem for physicians and nurses, because they wash their hands so frequently during the course of a single workday.
The rubber chemicals in latex gloves, and those same rubber chemicals in non-latex gloves, are also an important cause of allergic reactions. I've also seen some nurses and physicians become allergic to the dyes in their scrubs, or to the rubber in the stethoscopes that they wear around their neck.
5. Office workers
You wouldn't think that office workers would have many workplace exposures, but there are so many everyday exposures in our environment that can trigger allergic reactions. I've seen office workers react to their metal scissors at work. Nickel is a frequent cause of allergic skin reactions, and it's used in all types of metal objects. There have, in fact, been multiple reports of people reacting to nickel in their cellphone cases or laptop exterior. Some patients have developed allergic reactions to the neoprene rubber chemicals in their computer mousepad. I've also seen a handful of patients with eyelid rashes, possibly from the air freshener used in their office.
Even office workers can develop allergic reactions, such as to the neoprene used in some computer mouse pads.
There are many other workplace exposures, from the many, many plants that can trigger reactions in chefs, farmworkers, and grocery store workers, to the acrylate chemicals used by dentists.
Treatment of occupational ACD focuses on treating the skin inflammation and, importantly, identifying any potential triggers. For many of these substances, it is possible to create a plan to successfully avoid contact.
Dr. Rajani Katta is the author of Glow: The Dermatologist's Guide to a Whole Foods Younger Skin Diet. To receive future updates on preventive dermatology and the role of diet, sign up here.