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What Happens When Our Skin Fails Us?

Barry Michaels
July 15, 2014

occupational skin disease

One would think that taking care of our skin should be no big deal, that our skin will undergo a never-ending series of rebirths no matter how we treat it. In fact we replace our skin at the rate of one complete outer skin every 27 days.  This means that we will go through about 1,000 new skins in a lifetime.


Our skin is renewable but just like a bank account; if withdrawals exceed the rate of replacement we will quickly find there is a finite limit. Treat your skin wrong and you can come up more than a few skin lifetimes short. 


And now that the stage is set and you see what's at stake, you'll see that learning how our largest organ works, and how to protect it, goes hand in hand with proper hand hygiene.


How does our skin protect us?


As our body’s protector, the skin is the first line of defense against foreign substances entering the body and protecting us from the impact of numerous types of  environmental exposure.  However, despite the complexity of the skin we are not all equally suited for the challenges of our environment and  the things that we come into contact within it.  A good example is the melanin in our skin protecting against the harmful UV-B rays when out in the sun; some skin types are far more susceptible to burning, and the potential consequences of this, that others Also, the condition of the skin can impact on its ability to function correctly; this may not just be a matter of genetics, but also how individuals treat their skin in their daily lives, particularly whilst at work.


What kind of protection does the skin provide?


epidermasWhen healthy and intact, our skin has numerous other mechanisms that help protect us from physical, chemical and microbiological  impact.    Fortunately, our skin is formed such that the outer epidermal layers are thickest where we have the most abrasion,  such as our palms. Here they are over 25 layers thick but there are other locations that are dangerously thin.  At its best, the skin is equipped with around 100 sebaceous (oil) glands and 650 sweat glands per square inch; these are important for maintaining our body’s moisture content and suppleness, but under certain conditions they too can fail to function correctly. In addition to the cooling effect of sweat, these secretions have antimicrobial properties allowing our skin symbionts (passenger microbes) free rein and healthy pastures.   These are a not so small contingent of the 100-plus trillion or so microbes that outnumber human cells in our body 10 to 1. It is up to these secretions and the bacteria that comfortably bathe in them to ride range over thousands of microbial species (benign and pathogenic)  looking to invade. Fortunately these species part of our microbiome are skillful actors both on and off stage, as with healthy skin they bounce back quickly from hand washing or sanitizer use, taking up station generation after generation as they have so done for hundreds of millennia. These beneficial commensal species in addition to favorably out-competing  their pathogenic cousins, appear to have a role in priming or educating the billions of T cells that in concert help maintain skin health and the delicate balance against infections, cell survival and wound repair function.


What happens when our skin is colonized by transient microbes?


We are fortunate that most occupational skin diseases (OSD) are usually confined only to the hands and forearms, as allergens and irritants have an average of approximately 22 square feet of body surface to choose from and to make their  impact known. Allergens and chemical irritants seem to begrudgingly find a way into our immune system and hovering anxiously are the various resident and transient bacteria, fungi and viruses that live in our skin. It is on this landscape  that skin disorders, from irrational rashes to ringworm, warts (human papillomavirus), cold sores, shingles (herpes simplex virus), impetigo, vitiligo, psoriasis and infections, can  become real health issues.


What happens when our skin fails us?


Like using UV sunscreen, each of our skin’s  natural functions may need augmentation at one time or other. However, damage any one of  these functions, or take  the skin beyond what its functions are able to perform, and there is potential for serious skin disorders. Although the skin has  a remarkable power  for self-regeneration, once its functions are impaired and the damaging impact continues, some form of injury will almost inevitably occur and [what should be] routine skin protection and hand hygiene measures will no longer be enough.


When skin dries out, nerve fibers and blood vessels are exposed with skin conditions activated, then pain signals are sent at the rapid rate of around 250 miles per second to the brain.  In one square inch of skin, we have an average of  4-80 yards of nerve fibers and 1300 nerve cells, each with skin receptors producing at least 5 different sensations. Overall, the skin has 200,000 nerve endings for temperature, 500,000 nerve endings for touch and pressure and 3 million for pain. Therefore, it’s no surprise that hot water hurts and friction against the skin from operating machinery, equipment, handling food or washing hands too often, has a lasting effect.  Here, little by little, these actions can scrape away the skin, reducing its protective action against irritants and sensitizers. These often microscopic cuts or skin injuries can enable irritant substances to penetrate the skin more readily and create potentially more serious skin problems that only well formulated moisturizers can be used to help alleviate that the pain and sensitivity that often occurs.


How do we protect our skin at work?


Some known high-risk trades for occupational skin disease are the butchers, bakers, cooks and bartenders. It is also known that wet work and glove use seems to lead in all occupational groups, but these are not at all pre-requisites. Hospital workers, dentists and dental techs along with hairdressers and beauticians and vets are all well known for being high risk environments.  The cleaning trades, mechanics,metal workers and construction work also yield high rates of occupational skin disease, as do painters, with their use of solvents, adhesives, thinners and a heavy reliance on the use of aggressive hand cleaners.   


With 3 million cells and the three yards of blood vessels per square inch, it is better to plan ahead when protecting the skin.  Chemical exposure can cause toxic chemical to quickly and efficiently be transported to immune system network. In some cases this can lead toallergic contact dermatitis which in extreme cases could be the result of limited exposure, or more often is results from regular unhindered exposure. 


And now we see what the ritual of skin protection and hand hygiene is all about; without adequate hand health practices we are exposing ourselves to the spectre of occupational skin disease.


What are the costs of occupational skin disease?


occupational skin diseaseVarious numbers can be ascribed to the cost of OSD with best figure being that skin diseases accounted for around 2 per cent of total days sickness absence certified due to all occupational illnesses.  According to some US statistics, skin disorders consist of more than 35 percent of all occupationally related diseases.  As such, within each of the higher risk occupations these rates are  likely to be significantly higher.  This can start to make a big difference on a company’s bottom line and prevention measures can both provide an economic benefit as well demonstrating corporate and social responsibility.


And it doesn't come down to just a simple matter of money, as those in healthcare industry know all too well. So serious are the implications with our medical institutions hovering dangerously close to the tipping point into the post-antibiotic age, that minor skin infections could take on a much greater significance and skin health actually meaning the difference between life and death. At the end of the day, it is not so much a matter of our skin failing
us, but us failing our skin.


How do you establish a good skin care plan?


Prevention is always the best cure and implementing proper work-flow based skin risk assessments is key to implementing the appropriate skin protection and hand hygiene regimens to help prevent OSDs. The anatomy of the skin is clear,  without these preventative regimens, contact dermatitis and skin damage is most likely only treatable with compresses and specialist creams, ointments, antibiotics and skin cleansers. Or of course, in more extreme cases of allergic dermatitis, a worker may in fact need to be completely removed from the risk of exposure the substances causing the allergic reaction.


In general, people should protect their skin from physical trauma, chemical irritation, excessive sunlight, wind, and rapid temperature changes. This becomes even more acute if they have active dermatitis. The most common agents cited by dermatologists and occupational physicians as causes of skin disease are "soaps and cleaners", “wet work” as discussed before, and "rubber chemicals and materials" (e.g. gloves). This is a clear indication that whilst there should be great  importance placed on the selection of soap and sanitizer an an overall skin care plan must also include the provision of pre-work protective creams, after-work moisturising creams, plus simple and effective education & training to motivate compliance, ensuring we can make hands matter in the workplace and in the process protect a company’s most valuable asset, its people.


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