Eczema: an occupational hazard for dentists
The detrimental impact of eczema in the workplace is the focus of this year’s National Eczema Week (11-18 September).
Six million people in the UK suffer from eczema, which can be a huge cause of economic loss to employers and employees. It is one of the most common occupational skin diseases and 80% of newly diagnosed work-related skin problems are eczema caused by exposure to irritant substances.
High risk jobs include those working in the dental industry, due to repeated exposure to chemicals and irritants, and the need for continual hand washing. Work-related contact eczema is the most common skin condition in dentistry. It is nearly 10 times greater in dental nurses and seven times greater in dentists than the all-profession average. 14.8% of 3080 dentists questioned had experienced hand eczema during the previous year.
Themed ‘6 million reasons to support’, National Eczema Week aims to raise awareness amongst sufferers and employers of the issues surrounding eczema at work. The campaign will offer advice for both employers and employees about best practice in the workplace, as well as tips on how to manage eczema at work.
As part of the week, the National Eczema Society has developed new literature on contact dermatitis and eczema at work. ‘Working with eczema’ for people with eczema, as well as a guide for employers and occupational health workers entitled ‘Contact dermatitis at work’. Copies will be available free of charge from September on the society’s Helpline 0800 089 1122 or by ordering online at www.eczema.org.
What is contact eczema or contact dermatitis?
Contact dermatitis, or contact eczema (or hand eczema) is the name given to those types of eczema that occur as a result of contact with irritants or allergens. There are two main types:
• Irritant contact dermatitis where the eczema develops as a result of contact with substances that directly damage or irritate the skin
• Allergic contact dermatitis which develops when an individual becomes sensitised or allergic to something in the environment. If ACD is thought to be a possibility then you are likely to be referred to a dermatologist for possible patch-testing.
Is it possible to prevent contact eczema?
Most irritant and allergic contact dermatitis is preventable:
• If possible, use machinery and tools to clean equipment, rather than your hands
• Wear non-latex gloves where possible, especially when cleaning (care needs to be taken when selecting gloves if you are allergic to any materials used in gloves)
• Do not use abrasive skin cleaners and keep the use of disinfectants to a minimum
• Dry your hands thoroughly with a soft, disposable paper towel
• Protect your hands by moisturising them regularly with an emollient (soothing and softening skin product). Use a product that is free from fragrances and preservatives
• Avoid sensitisers that you are allergic to (investigation by your dermatologist will help identify these)
Management and treatment of contact dermatitis
Once contact dermatitis has occurred, management of the skin is very important. Apart from the avoidance of irritants and sensitisers you are allergic to, there are the following treatment options:
• Emollients (medical moisturisers): these soothe and relieve dry skin, producing an oily layer which traps water beneath it. The aim is to restore the skin’s barrier and rehydrate the skin
• Topical steroids: these help to reduce inflammation, make the skin less red, hot and itchy or sore and speed up the healing of the skin
• A good skin care routine: Good general skin care measures are essential. It can take several months for the skin to recover completely from an attack of contact dermatitis so even when it looks apparently normal it is still vulnerable
• Additional treatments: In very severe cases of hand eczema that is not responding to treatment with topical steroids and emollients, other treatments may be needed such as light treatment or immunosuppressants. There is also a relatively new oral treatment now available called Alitretinoin (Toctino). Toctino has been developed specifically and is licensed for use in adults with severe chronic hand eczema which has not responded to treatment with potent topical steroids. Toctino is a capsule which is taken orally once a day with a meal. The treatment period is normally 12-24 weeks, depending on how your eczema responds.
One last word….
If you suspect you may be suffering from contact eczema/contact dermatitis, it is vital you seek specialist help from either a dermatologist or skin specialist as soon as possible – the earlier you get help, the less risk there is of the condition becoming long-term and chronic.
There are a variety of different treatment options available, some of which can only be prescribed by a dermatologist. If treatments are not working, you should return to your GP and ask to be referred to a specialist as soon as possible.
For further information, go to:
• www.eczema.org – National Eczema Society
• www.myhandeczema.co.uk – website that gives information about the causes, management and treatment options for hand eczema, with a dedicated section on high-risk jobs including dentistry.