Occupational Skin Disease in Physicians: A Review of the Literature

Abstract

Objectives Occupational skin disease (OSD) arises from work-related activity. However, there is a paucity of literature on OSD in physicians. The aim of the this review was therefore to examine and summarize what types of symptomatic OSD physicians experience. Methods We conducted a systematic literature search on Cochrane Library, Embase, and Pubmed. Results Contact dermatitis from formaldehyde and glutaraldehyde were found in 11.5 and 13.5% of cases, respectively. In total 2.4–14.9% had latex allergy. The reported standardized incidence ratio of squamous cell carcinoma and melanoma was up to 2.15 [95% confidence interval (CI) 1.57–1.95] and 3.2 (95% CI 1.38–6.31). Transmission of human papilloma virus (HPV) particles during carbon dioxide laser wart ablation were found in 70% of samples collected from protective gloves and in 52% of samples from vapors. Conclusions The most frequently reported OSD in physicians is contact dermatitis from allergens in disinfectants and rubber gloves. There is also a risk of cutaneous reactions to latex. The incidence of skin cancer was higher in physicians than in the general population, and the reason for this remains unexplained and potentially biased. There are no reports of transmission of patient HPV to surgeons during wart ablation, possibly because of proper use of protective equipment.

Characteristics of hand eczema in final‐year apprentice nurses during the COVID‐19 pandemic

“…In a study from Denmark, NRL allergy was diagnosed in 2.5% of HCWs with hand eczema, 37 but in a similar Australian population the prevalence of NRL allergy was as much as 13% 36 . A recent systematic review on OSDs in physicians showed the prevalence of NRL allergy within 2.4% to 14.9% 39 . Such differences in the prevalence of NRL allergy in HCWs are probably due to the varying extent of implemented preventive measures regarding NRL allergy in different countries.…”

“…The most frequently found occupational contact allergy in HCWs with OSDs was to rubber additives in medical gloves (thiurams, diphenylguanidine), preservatives (formaldehyde, isothiazolinones), and disinfectants (glutaraldehyde). 36 , 38 , 39 It seems that the development of allergic contact dermatitis due to occupational allergens during apprenticeship is not common in nurses. In contrast to this, the development of irritative contact dermatitis seems common in this population, keeping in mind high proportions of self‐reported hand eczema in this population in our study and studies from Germany and the Netherlands (31%‐46%), 26 , 27 in contrast to HCWs who reported hand eczema prevalence at around 20%.…”

“… 36 A recent systematic review on OSDs in physicians showed the prevalence of NRL allergy within 2.4% to 14.9%. 39 Such differences in the prevalence of NRL allergy in HCWs are probably due to the varying extent of implemented preventive measures regarding NRL allergy in different countries. Prevention measures are implemented mostly in high‐income countries, with indications of good effects in reducing NRL allergy.…”

“…Studies performed in samples of HCWs confirm the domination of irritative contact dermatitis in HCWs with OSDs, 36 particularly in women, 17 but contact sensitization or allergic contact dermatitis was found at a higher proportion of around 50% in HCWs with hand eczema 36,37 compared with our results in apprentice nurses with hand eczema (26%). The most frequently found occupational contact allergy in HCWs with OSDs was to rubber additives in medical gloves (thiurams, diphenylguanidine), preservatives (formaldehyde, isothiazolinones), and disinfectants (glutaraldehyde) 36,38,39 . It seems that the development of allergic contact dermatitis due to occupational allergens during apprenticeship is not common in nurses.…”

Contact allergy to and allergic contact dermatitis from formaldehyde and formaldehyde releasers: A clinical review and update

“…FA contact allergy may also be the result of exposure to FRs that are widely used, not only in cosmetics, but also in occupational products, such as metalworking fluids, 16,30 cleaning agents, and disinfectants. Occupations at risk for occupational ACD from FA/FRs comprise, among others, metalworkers, health care workers (eg, hemodialysis nurses, laboratory technicians, embalmers), hairdressers and beauticians, painters, veterinary and dental students, and laborers in the food‐processing industry 3,24,30‐33 …”