For job-related skin problems, best prevention unclear

 It’s hard to say whether creams, moisturizers or other preventive measures might help protect workers in many industries from skin damage on their hands that can lead to painful blisters, cracks and infections, a research review suggests.

The analysis focused on so-called occupational irritant hand dermatitis, which can affect employees who regularly come in contact with water, detergents, chemicals and other irritants or who wear gloves during their work day. People at risk include nurses, construction workers, hairdressers, farm workers, restaurant employees and individuals who work in dye, printing and metal industries.

Researchers examined data from nine previous studies with a total of 2,888 workers. The studies lasted anywhere from four weeks to three years; all of them examined the effectiveness of preventive measures like protective gloves, employee education, moisturizers and creams.

Moisturizers, and to a lesser extent barrier creams, were both associated with fewer people getting dermatitis but the quality of this evidence was low, the analysis found.

“We come into contact with lots of different chemicals and other factors every day that will either physically disrupt the natural barrier of the skin or deplete the natural moisturizing factors which then causes disruption to the skin barrier function,” said Dr. Saxon Smith, author of an editorial accompanying the study and a dermatologist at the University of Sydney in Australia.

“The body reacts to these changes and develops inflammation which presents as red, dry, scaley skin on the hands,” Smith said by email.

Topical moisturizers can help replenish moisture lost when the skin is exposed to harsh chemicals, detergents or other things that can damage skin, Smith said. Topical corticosteroids and other immunosuppressive drugs known as calcineurin inhibitors can help ease inflammation in the skin caused by certain types of work.

Gloves and barrier creams can help to diminish the impact and direct contact of the irritating chemicals on the skin, Smith added. But chemicals can sometimes penetrate gloves and barrier creams, and this may explain why the study found this approach less effective than moisturizers for preventing dermatitis - a result Smith said was surprising.

Four studies in the analysis that focused on barrier creams found 29 percent of people who used this method for preventing hand skin irritation developed this problem, compared with 33 percent of workers who didn’t use barrier creams.

Three studies focused on moisturizers found 13 percent of people who used this method for preventing skin issues developed these problems on their hands, compared with 19 percent who didn’t use moisturizers.

Two of the smaller studies in the analysis examined the combination of both barrier creams and moisturizers. Eight percent of people using both methods of prevention developed dermatitis on their hands, compared to 13 percent who didn’t.

It’s not clear based on the study results whether skin protection education is associated with a lower risk of skin irritation on the hands, the analysis found.

Only a few people in the studies reported side effects from moisturizers or barrier creams, and these were generally mild reactions like itching or reddening of the skin.

One limitation of the analysis is that the smaller studies used a variety of methods to assess the effectiveness of approaches to skin irritation and examined a number of different prevention options, Dr. Andrea Bauer of Technical University Dresden in Germany and colleagues write in the Cochrane Database of Systematic Reviews. Dr. Bauer didn’t respond to emails seeking comment.

Still, the results highlight a need for workers in a wide range of industries to educate themselves about the best ways to prevent skin problems that may be associated with their specific job, Smith said.

“If you work in a job that is known to have a high rate of irritant and allergic contact dermatitis, educate yourself about the best workplace practices and look after the care of your hands with soap-free wash, regular moisturizer, and minimal wet work with your hands where possible,” Smith advised.