Health e-News from Affinity Occupational Health

By Brian Harrison, MD, medical director of Health and Productivity Management for Affinity Health System

Sometimes it takes a "thick skin" to work anywhere! How do you protect your skin from the following hazards?

Water - It may seem surprising to think of water as a skin hazard, but either too much OR too little water can affect your skin.

-- Some industrial jobs expose hands and feet to wet work. Soggy work boots or wet gloves cause the outer layer of the skin to become "water-logged." If this happens repeatedly, this outer layer of the skin can actually dissolve. Then the skin loses its ability to hold moisture within its deeper layers. That affects the softness and flexibility of skin, making it stiff and swollen. And, because the outer layer is the skin's main line of defense against chemicals, water-logged skin can be more easily penetrated by other chemicals and become irritated.

-- Frequent hand washing is required in many jobs. Excessive hot water and soap washes off the natural skin oils, causing dry, red, rough, "dish pan" hands.

-- This is particularly a problem for people with pre-existing skin problems, such as eczema and atopic dermatitis. Wet work is frequently not well tolerated by people with these conditions. That's especially true in winter months, when air humidity is reduced by heating furnaces. On the other hand, hot summer months with high humidity lead to impairment of the skin's ability to sweat normally, and the development of a rash called "prickly heat." This is a red, pin-point itchy rash especially under the arm pits and other skin folds.

-- Another way in which water can affect the skin is through live steam burns and hot water burns.

Alkalies (caustics) - Sodium hydroxide and potassium hydroxide are frequently used in cleaning pulp vats and pipelines that contain pulp slurries. While these do a good job cleaning your equipment, they can be highly dangerous to the skin. Caustics ruin the fat and oil (lipids) in the skin, damage skin proteins, and drive water out of skin tissues. This leads to chemical burns that often have a brown over-lying scab. Alkaline burns are more serious than acids burns. The alkalies penetrate more deeply and combine themselves with skin lipids and proteins, whereas acids tend to stay more external and wash off more easily. Calcium hydroxide, often added to cellulose pulp in paper mills, also has an alkaline characteristic and can cause burns of that type.

Acids - Sulfuric and hydrochloric (muriatic) acids are also used for line cleaning and deliming in paper mills. These are corrosive to the skin, although they do not penetrate as deeply as the alkalies.

Chlorine - The most serious risk from chlorine is inhalation burn of the lungs. It is also very irritating to the eyes. However, chlorine gas can also irritate the skin when it combines with surface moisture. Chlorine gas plus moisture on the skin results in hydrochloric acid, which "bathes" the skin. However, if someone has developed skin burns from chlorine, the greater risk is that they may also have had an inhalation injury.

Biocides - Various substances are used as anti-slime, anti-bacterial, and anti-fungal agents. The type known as isothiazolines are particularly common as they prevent mold and decay in paper and calcium oxide/calcium carbonate slurries. In most (although not all) people, biocides of that type can cause a skin rash called contact dermatitis. This is from a hypersensitivity or allergic mechanism. It looks exactly like poison ivy with redness, blisters, skin peeling and weeping. If someone has become sensitized to the biocides, even a very small amount of re-exposure can cause the same reaction. A similar type of allergic contact dermatitis can occur with other chemicals including glues, bonding agents (bisphenol A, epichlorohydrin, epoxy resins and acrylic monomers). Paper products that are treated with ink drying agents (colophony rosin) can also cause allergic skin reactions. Likewise, some individuals have allergies to metals (nickel and chromium) that cause similar contact dermatitis. Hardened metal objects such as tools can, in sensitive individuals, cause a skin rash.

Oils - Machinery oils, if in frequent contact with the skin, can cause a type of acne from plugging of skin oil glands.

To protect your skin on the job, following accepted safety measures is the most important thing. Read MSDS and follow the manufacturer's recommendations for personal protective equipment. Several different types of protective gloves are available, but it is important to choose a type that is recommended by the manufacturer for the product you will be handling. For example, latex gloves are easily penetrated and perforated by certain oils and solvents. Make sure that the insides of gloves are clean. Cotton glove liners are very useful for this purpose. Putting your hand inside of a glove that has been contaminated can be as bad as no glove at all; therefore, a clean glove with a clean liner is the best practice.

When your hands get dirty, wipe and wash them off immediately. However, when doing routine skin washing, don't use water that is hotter than needed or more soap than is necessary. Excessive hot water and soap robs the outer layer of the skin of its natural oils, leaving it red and irritated. This is particularly a problem in the winter when humidity levels are lower. For the same reason, moisturize your hands after washing. Use a non-fragranced hand cream. In general, the thicker the cream, the better it will protect the hands. Thin, white, "vanishing creams" are more likely to sting if the skin is red or cracked. Ointments such as petroleum jelly won't.

If your skin comes in contact with hazardous chemicals, immediately rinse them off, and continue rinsing while someone else gets you the help you need.

If you think you've had a rash develop in the course of your work, be sure to report it promptly to your occupational health nurse.