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Skin…Exposed!

Posted on by Scott Dotson, PhD, and Garrett Burnett, MS, MBA

illustration of a hair folicleTake a postage stamp. Stick it to your arm. You’ve just covered 16 million cells, 55 hairs, 8 meters of nerves, 17,000 nerve endings, 5 meters of blood vessels, 500 sweat glands, and 83 oil glands. You’ve also just wasted 44 cents. Your skin is marvelously complex. It is your largest organ, accounting for 10% of your body’s mass. And it is the site of 15 to 20 percent of all reported work-related illnesses according to the US Bureau of Labor Statistics.

Skin can suffer direct, sensitizing, or systemic effects when exposed to hazardous chemicals. Direct exposure can corrode, irritate, bleach, or stain skin. Dermal exposure to chemicals such as nickel, glutaraldehyde, and chromium may sensitize the skin, causing or contributing to the onset of allergic contact dermatitis (ACD) or other immune-mediated responses, such as airway hyper reactivity (asthma). Many commonly used chemicals in the workplace—pesticides, organic solvents—can be absorbed through the skin and potentially result in systemic toxicity. These agents enter the blood stream and cause health problems away from the site of entry. While our skin is marvelous, clearly it’s no suit of armor.

But dermal exposures in occupational settings are frequently overlooked. Traditionally inhalation has been perceived as the most “important” route of entry when addressing chemical exposures within the workplace. Inhalation exposures—fumes, noxious gases—tend to be more obvious threats than their dermal counterparts. As a result, sampling methods have been developed, personal protective equipment has improved, and occupational exposure limits have been established for numerous chemicals. These, however, are almost exclusively intended to protect workers from inhalation hazards, while skin contact is often seen as a secondary exposure route. In reality, occupational skin diseases are among the most frequently reported workplace maladies, more so even than respiratory cases, both in the United States and Europe.

Occupational skin diseases cause employee impairment, lost time and productivity, medical diagnoses and treatment, and administrative costs that impact the economy to the tune of $1 billion annually in the United States. This estimate doesn’t even include the costs of systemic diseases related to skin because those become too difficult to untangle from toxicity caused by inhalation or ingestion.

Research in this area is progressing. NIOSH has proposed a new strategy for the assignment of more effective skin notations. (Notations provide a system for identifying and documenting any ill effects of skin contact with a given chemical). However, because of the breadth of the problem, more research needs to be done. Workers, managers, and occupational safety and health professionals need to be aware of the significance of dermal risks. We need to fill data gaps, improve chemical protective clothing, and focus on performing comprehensive exposure and risk assessments that evaluate chemical exposures beyond what a worker may potentially inhale. Please share your thoughts or questions on dermal exposures, skin notation, use of engineering controls, or control banding. This is an emerging area with a lot of work to be done.

Dr. Dotson is an Industrial Hygienist in the NIOSH Education and Information Division.

Mr. Burnett is a health communications specialist in the NIOSH Education and Information Division.

You may also be interested in the blog 1-BP: A Potential Occupational Hazard by Scott Dotson and Charles Geraci.

Posted on by Scott Dotson, PhD, and Garrett Burnett, MS, MBA

19 comments on “Skin…Exposed!”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Yes I agree more research needs to be done in this area. People laugh at me and say your skin reacts to everything and I can never explain. We need to look into this more because I know of other people as well that have suffered. Creams do not work we need to make people more aware.

    Hopefully you can make the #AIHce tweet-up Monday at 4pm during the expo mixer. Great opportunity for networking and meeting new friends. Meeting in front of booth 1211. See you there!

    i have recently endured a second degree burn on my lower left arm via mercury exposure, i cant seem to find what problems may occur internally, the physician treated the burn but did not explore the symptoms i am experiencing. always nauseated, muscle pain, weakness workers comp doc released me to duty. please help.

    We advocate that you seek additional medical attention if you are still experiencing adverse health effects. If you are not already seeing a physician specializing in occupational medicine, you may want to seek one out. The American College of Occupational and Environmental Medicine (ACOEM) Doctor Finder Service may be of use to you. In addition, please direct your attending physician to the following information to aid in your treatment.

    NIOSH has a mercury topic page. The Agency for Toxic Substances & Disease Registry (ATSDR) Toxicology Profile for mercury lists health effects and other information.

    Did you know that washing with soap and water does not effectively remove lead and other toxic metals from skin?

    Most OH&S professionals are not aware of this fact. NIOSH studies have confirmed that soap and water does not effectively (>90% removal)dislodge and remove lead and other toxic metal particulate from skin. Why not? It has to do with aspects of pH, mechanical removal, appropriate chelation (not using EDTA) and an appropriate surfactant. What to do? If you, your employees, or those you advise have risks for skin exposures to toxic metals such as lead, Cd, As, etc., and you’ve not evaluated how effective your skin decontamination practices are, consider testing. Collect 30 second handwipe samples from workers after workers wash their hands and have the wipes analyzed. With one wipe, you’ll likely be getting about 50-60% of the dermal load on the wipe, with two wipes it may approach 70%. Still seeing metals after washing? Through the Research-to-Practice Program NIOSH has invented and patented highly effective, award-winning methods to detect and remove Pb and other metals from skin. The detection method is licensed and commercially available under the brand name “Full Disclosure”, the removal methods are licensed and commercially available under the brand names “LeadTech Wipes” and “Hygenall”. All can be found with a quick web search.

    Keith…look up symptoms of mercury poisoning. Sounds like some of the symptoms. Bring in a description of the symptoms to the worker’s comp doctor and ask for a toxic metal blood work up. There are some great natural things that will detox your body. Try some health food stores. But contact that doctor! Good luck.

    Your symptoms may be related to your exposure. They may not be. Whether or not you can gain Workers’ Compensation for them depends on even more factors.

    However, this can be said: There are resources available on the internet which can tell you whether or not your exposure is known to cause symptoms of the type you are experiencing. Without knowing what kind of mercury(elemental? a comound form? which one?) or the duration of your dermal exposure, it is hard (especially without expertise) to say.

    For a basic resource regarding checmical exposure, see this website: http://hazmap.nlm.nih.gov/index.html. You can find some information regarding your issue there. If you find that in fact your exposure does constitute a potential cause for your symptoms, then, armed with this knowledge, you can try to find support for furthering your claim. Legal clinics may be available, but they are generally underresourced and lack workers’ comp specific departments. Returning to your treating physician with further questions may bear out results.

    HOWEVER, the hard truth is that these types of issues are not easily solved, that many workers face injuries and illnesses for which they ought to receive compensation—yet they never do. Additionally, you may face workplace retaliation as a result of your endeavors. Being motivated and willing to pursue your claim helps, but the truth is that it’s not usually enough. Your best chance comes with expert legal assistance; however, this can be difficult or impossible to find or too costly to be useful.

    Good luck.

    yeah, skin exposure to chemicals is very important in the assessment of exposure. We need do much not only in the mechanism of skin toxiology but also in the surface sampling strategy.

    Wow fantastic blog! I love the fact about the postage stamp, it really highlights just how powerful and complex our skin is. So interestin what you mentioned about the harmful chemicals in te work place. I really think that is is an important point to stress because i bet many people over look the dangers harmful checmicals can do to thier skin. They can do some much more damages then just cause acne on chin and blemishes. They can really cause severe irritation.

    Very insightful post, thank you.

    Very informative article on exposure of skin to hazardous chemicals.Some good points have been mentioned about its consequences such as employee impairment, lost time and productivity, treatment costs. I especially found it useful where the example of postage stamp has been used. However, the harmful effects can be reduced to certain extent if one take serious care of skin.

    I found this very interesting as I was once in charge of a departments health and safety and with some people the only way you could make them use the protection provided was “use it or find a new job”.
    Also there are a great number of people working outdoors in the sun without protecting the skin.

    I am glad to see that people are begining to consider the effects of exposure to the skin. There is no reason why this should not be considered. Many people that have psoriasis and are looking for >remedies for psoriasis have found that the work place can be frustrating, because of a lack of understanding among employers to there skin problem.

    I wish my employers read that, in fact i’ll probably print it out and put on the reception, i work in the care home, and because of my duties contact quite a lot with a chemicals and my skin often gets flaky and i do get intermittent skin rash even though i always wear PPE, mentioned it to the managers but they seem to think i’m making an issue out of nothing.

    I used a chemical fabric glue all last summer. I now have a breaking down of the skin on two fingers. My doc. prescribed Triamcinolone Acetonide. But, all it does is take off the top layer of skin leaving the second layer red. Then it drys and splits continuing with the same old thing over and over. My fingers are very painful. Thanks, Sharren

    Great article, both informative and enlightening. I came across this while searching online for psoriasis pictures. I don’t think the general public realize that the skin is indeed and organ, or the roll it plays in their health. Keep up the good work.

    I strongly agree that Dermal exposure is very dangerous. I think we are more exposed to high concentration chemicals due to skin pores rather than inhaling fumes because at work masks are provided and no skin protection is there. If I talk ayurvedically applying almond oil can protect 60-70% of chemical to reach our body. I have found it very informative and happy to see medicines directory or post to get protected from skin problems. Keep that posts going.

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