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Author: Susan Ford BSc (Hons), Occupational Health, 2012.
Occupational hand dermatitis in motor vehicle repair workers is common. Workers in the motor vehicle repair industry may suffer from:
Occupational skin problems in motor vehicle repair workers are mainly caused by:
The outermost layer of the skin (the horny cell layer of the epidermis) acts as a barrier to prevent infection and to prevent potential allergens from penetrating the skin. Its pH is slightly acidic which can help to neutralize the degreasing agents that are in soaps, which are alkaline. Excessive use of soaps and some detergents can destroy the acidity and de-fat the surface skin and therefore the protection it offers.
If the moisture content of the skin is too high (overhydrated skin) or too low (dry skin), the skin’s barrier function may be impaired. Air-conditioned environments with low humidity will cause the skin to dry out, becoming rough, thickened and flakey. This eventually leads to cracking of the skin because of loss of elasticity. Over-hydration of the barrier layer from prolonged contact with water, or from sweating inside gloves also results in dry skin, since impaired barrier function allows moisture in the skin to evaporate away.
Occupational skin disease may occur in the following circumstances:
Irritant contact dermatitis is the name given to inflammation of the skin resulting from direct contact with a chemical or physical agent that damages the skin. Examples of irritants include:
The features of irritant contact dermatitis are varied.
Allergic contact dermatitis is an immunological response (allergy) to a contact allergen, such as nickel in tool handles such as spanners and wrenches, or epoxy hardeners found in body fillers and sealants. Only people who are allergic to a specific agent (the allergen) will show symptoms. The appearance can be exactly the same as irritant contact dermatitis and often co-exists with irritant contact dermatitis. There are some specific features of allergic contact dermatitis.
Exposure to industrial oils, grease or cooling agents can cause oil folliculitis (inflamed hair follicles) and comedones (blackheads and whiteheads). These conditions appear on any area of the body where there is excessive oil on the skin or clothing, commonly the forearms and thighs.
Hand dermatitis, wet work and trauma causing a break in the epidermis, predispose to yeast infection, usually presenting as chronic paronychia infected by Candida albicans or as intertrigo between the fingers also called erosio interdigitalis; whereas bacterial infection (impetigo, boils and folliculitis are usually caused by Staphylococcus aureus and/or Streptococcus pyogenes.
Skin cancer is sometimes associated with the motor vehicle repair industry.
Contact leukoderma (sometimes spelt leucoderma), or white skin, occurs when the melanocytes (the pigment-producing cells) are selectively destroyed. Although it may look similar to vitiligo, leukoderma is due to toxic effects on the melanocytes, whereas vitiligo is an autoimmune process. Leukoderma may follow skin contact with chemicals such as phenol, and phenolic resins may be found in brake pads, brake shoes and clutch disks.
Vibration white finger, also known as hand-arm vibration syndrome, is one cause of Raynaud phenomenon. Vibration white finger is caused by repetitive injury from handheld vibrating tools such as sanders, polishers and air chisels. The length of exposure before symptoms develop varies from months to years, and the risk of symptoms increases with the intensity and duration of exposure. If exposure to vibration is not reduced at an early stage in the disease, permanent damage may arise. Specific features and symptoms of vibration white finger include:
Specific features and symptoms of vibration white finger include:
Workplace risk assessments identify ‘hazards’ (anything that has the potential to cause harm) and ‘risk’ (the likelihood of an event occurring). The aim should be to reduce these, as sickness absence from work can be prolonged and costly. Ill health can adversely affect the quality of life; the ability to work in a chosen industry; insurance costs and litigation claims. A generic risk assessment in any motor vehicle repair establishment should include a specific section on skin exposure and should cover:
Staff education and training should include:
Results of workplace risk assessments must be recorded and kept.
Health surveillance should be carried out when a workplace hazard is minimised rather than eliminated. Staff should be encouraged to report any signs of skin problems and all reasonable steps should be taken to resolve the problem and prevent recurrences. This may involve a referral for medical advice.
Management of hand dermatitis in a motor vehicle repair worker may include the following:
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