Contact Dermatitis Medical - Epidemiology: Term Paper

Like other researchers, the CCOHS notes that allergic reactions including inflammation, redness and formation of blisters may only appear after prolonged exposure to possible allergens; for some this may mean exposure to a substance for a few days before symptoms arise, for others exposure throughout a lifetime may result in some minor dermatitis (CCOHS, 10007). Typically, as others have confirmed, exposure is first necessary, then a process referred to as sensitization, where a worker may become "sensitized" to a compound they work with, the penetration of the epidermal layer of the skin, following an allergic reaction, a process which can take up to four weeks (CCOHS, 1997).

This process results when allergenic compounds binds to proteins naturally occurring in the skin, and lymphocytes or protective agents within the body react to protect the skin from damage; tissue-damaging chemicals called "lymphokines" may be released, which ultimately result in the symptoms commonly associated with allergic contact dermatitis, including: "Pain, swelling, redness and the formation of blisters" (CCOHS, 1997, p. 1). Pre-existing irritant contact dermatitis may lead to an increased prevalence of allergic contact dermatitis as can cuts in the skin or other tears in the skin which may provide for faster penetration of allergenic compounds (McFadden & Basketter, 2000). Penetration of the epidermal layer of the skin is necessary for allergic contact dermatitis to incur symptoms in the affected individual, as penetration of the skin leads to binding of toxic substances to lymphocytes in the system contributing to the outbreak of redness, swelling or blisters (McFadden & Basketter, 2000).

Among those most at risk include cabinet makers, carpenters, construction and automobile workers, agricultural workers and any workers working with substances that require use of latex gloves or exposure to chromates, rubber, resins, cobalt, cement, chromium, formaldehyde or woods (CCOHS, 1997, p. 1).

The Royal College of Physicians (2005) and other international organizations including the EPA in Ireland are working to providing legislation that focuses on the potential causes for and risk factors for allergic contact dermatitis among construction workers and among manufacturers that may produce substances with toxic agents that may lead to sensitization (CCOHS, 1997, p. 1). Allergic contact dermatitis is more likely to occur in workers or other people who are chronically exposed to a known irritant, those who develop even a single case of ICD or irritant contact dermatitis and those with hereditary risk factors, including a high incidence of allergies within one's family history (Choi, Lee & Cho, 2000, p. 44). In the next section, a review of irritant contact dermatitis is presented along with its relationship to allergic contact dermatitis. The level of research conducted on irritant contact dermatitis is much more prevalent than that of allergic contact dermatitis. It is important to note however, that the research presented on irritant contact dermatitis often suggests that allergic contact dermatitis is more likely to manifest when an individual is exposed to a compound and develops a single case of irritant contact dermatitis. While irritant contact dermatitis typically manifests with quicker onset than allergic contact dermatitis, its symptoms are almost identical in many cases, and the manner in which it manifests in the body are also similar (Choi, Lee & Cho, 2000, p. 45).

Apart from allergic and irritant contact dermatitis there are other forms of dermatitis that may coincide with these diseases or occur separately from them; these include atopic dermatitis, or eczema, which more often results from hereditary causes, increasing the likelihood that an individual or construction worker may become sensitized to a chemical or compound agent resulting in allergic contact dermatitis (Choi, Lee & Choi, 2000, p. 45).

Irritant Contact Dermatitis

There is more literature available on contact dermatitis than on allergic dermatitis; however, one may correlate the research provided on irritant contact dermatitis with that of allergic contact dermatitis as irritant dermatitis may be a risk factor of or cause for the development of allergic dermatitis among affected people (McFadden & Basketter, 2000).

Contact dermatitis as mentioned comes in various forms including "chronic irritant contact dermatitis or ICD (Choi, Lee & Cho, 2000, p. 43). This form of contact dermatitis is associated by inflammation of the epidermal cells in the skin, resulting in redness or erythema, some swelling and at times scaling of the skin (Choi, Lee & Cho, 2000; McFadden & Basketter, 2000). Allergic contact dermatitis is much more common that irritant contact dermatitis (Sarkis, 2000). Much less is known about ICO than about allergic dermatitis in part because there are few exact diagnostic tests currently available for evaluating and properly diagnosing this form of contact dermatitis (Sarkis, 2000). Typically to diagnose ICD, a healthcare worker would have to rule out other "cutaneous diseases" including allergic contact dermatitis, and diagnose patients based on the clinical appearance of the dermatitis and one's exposure to a potential irritant known to cause skin reactions (Sarkis, 2000; Goldner, 1994).

The pathophysiology of ICD includes inflammation occurring from the release of "cytokines" from the cells of the epithelium, typically resulting from contact to a chemical agent (Sarkis, 2000). There are 3 primary changes noticed among patients with ICD: "skin barrier disruption," where the irritant penetrates the skin; cellular changes within the skin's epidermal level; and cytokine release (Sarkis, 2000, p.2). Some of the more common irritants include detergents; an example of ICD may include eczema arises from exposure to cleaning agents (Sarkis, 2000).

Prolonged exposure to any toxic chemical will result in sensitization and subsequent symptoms or disease manifestation, as is the case with ICD. Researchers also note that certain stimuli aside from chemical agents, including exposure to environmental hazards such as ultraviolet light (as in the case of workers working in the sun) may exacerbate the condition (Sarkis, 2000).

Hogan & May (2007) note that allergic contact dermatitis or ACD is a leading occupational hazard and illness, with most individuals affected demonstrating symptoms in their hands or from eye exposure (Lawley & Kubota, 1991, p. 265); this is one reason why prevent care and proper training is important for individuals who are at risk for developing dermatitis resulting from chronic exposure to chemical or other known irritants or allergens. Among the forms of contact dermatitis most prevalent among construction workers include the hands, eyes, lungs, head and neck; preservatives and formaldehydes are often to blame (Diepgen & Coenraads, 1999, p. 500).

Critical Evaluation Literature Related to Construction Industry and Dermatitis

This portion of the literature review includes an in-depth look at dermatitis in the construction or house building industry. Many health experts agree that contact dermatitis is more prevalent among construction workers than among workers in other industries, contributing to higher rates of work-related disease including skin diseases (Sarkis, 2000). Some research suggests that the risks associated with "wear and tear" as well as exposure to chemical irritants leading to allergic reactions are more to blame for deaths than serious injury or falls among this class of workers (Sarkis, p. 2).

Sarkis (2000) notes that construction workers are more at risk for allergic reactions and contact dermatitis that may contribute to multiple other skin diseases (p.2). To prevent the spread of disease, Sarkis recommends construction workers perform the following preventive measures: (1) identify allergens in the work environment so that workers are aware of potential hazards before exposure, (2) use substitute chemicals when available to decrease the risk of exposure, (3) provide personal protection equipment and (4) ensure educational programs and protocols are available to protect workers (p. 2).

Other researchers confirm the risks and consequences of contact allergy and irritancy associated with allergic reaction to chemicals and other hazards in the workplace. McFadden & Basketter (2000) note contact dermatitis presents a real danger to workers consistently exposed to hazardous material, with some workers becoming hypersensitive to products they come into contact with almost daily as part of their occupation (p. 124). Such rapid contagion is often referred to as sensitization (Kligman, 1966, p. 395). Still others note hat work-related irritant contact dermatitis will always present a risk to construction workers, making it more important than ever that workers in the construction business adopt safe job habits and policies and procedures that adequately train and protect employees from chronic illness associated with exposure to chemical agents (Goldner, 1994, p. 39).

Contact Dermatitis, Construction and the Irish

According to the Irish National Industrial Safety Organisation and multiple other health and safety agencies in Europe, case studies suggest in Ireland and related areas roughly 20% of construction accidents results from falls, but the largest number of accidents were related to reports of injury and illness from exposure to unsafe Irish building sites, which, according to the Minister for Labour, were among "the most dangerous places to work" through 1988 (McGarr, E., 2006).

Eireann (1991) notes that the Irish Office of the Attorney General and other agencies have been looking into Irish domestic law to define "damage" which under…