Occupational Contact Dermatitis: Health Personnel

  • Ana M. Giménez-ArnauEmail author
  • Christoph Skudlik
Living reference work entry


Healthcare personnel show high occupational risks suffering mainly from irritant and/or allergic contact dermatitis and less frequently contact urticaria. The spectrum of occupations involved is broad. The specialized nature of the tasks developed by some of these workers makes it difficult to relocate or substitute them. Although atopic condition and wet work increases the risk of hand eczema in healthcare workers, the hazard of sensitization is also very high. The agents capable to induce contact allergy show different chemical structures including proteins and low molecular weight molecules. This updated chapter reviews the causes of occupational contact dermatitis and urticaria in nurses, clinical assistants and cleaners, surgeons, laboratory personnel, other therapists, veterinarians, and laboratory animal handlers. Skin complains should be assessed habitually with both prick and patch testing. The identification of the responsible agents is always necessary being fundamental for developing effective preventive measures, some of which have been already demonstrated to be effective.


Allergy Contact Dermatitis Health personnel occupation 


  1. 1.
    Stingeni L, Lapomarda V, Lisi P (1995) Occupational hand dermatitis in hospital environments. Contact Dermatitis 33:172–176PubMedCrossRefGoogle Scholar
  2. 2.
    Mahler V (2007) Skin protection in health care setting. Curr Probl Dermatol 34:120–132PubMedCrossRefGoogle Scholar
  3. 3.
    Camarasa JG, Conde Salazar L (1988) Occupational dermatoses in sanitary workers. In: Orfanos CE, Stadler R, Gollnick H (eds) Dermatology in five continents. Proceedings of the XVIIth world congress of dermatology, Berlin, 24–29 May 1987. Springer, Berlin/Heidelberg/New York, pp 1045–1048Google Scholar
  4. 4.
    Holness DL, Mace SR (2001) Results of evaluating health care workers with Prick and Patch testing. Am J Contact Dermatitis 12:88–92PubMedGoogle Scholar
  5. 5.
    Nettis E, Colanardi MC, Soccio AL, Ferrannini A, Tursi A (2002) Occupational irritant and allergic contact dermatitis among healthcare workers. Contact Dermatitis 46:101–107PubMedCrossRefGoogle Scholar
  6. 6.
    Higgins CL, Palmer AM, Cahill JL, Nixon RL (2016) Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993–2014. Contact Dermatitis 75:213–222PubMedCrossRefGoogle Scholar
  7. 7.
    Akan A, Toyran M, Erkoçohlu KA, Kocabas C (2012) The prevalence of allergic contact sensitization of practicing and student nurses. Int J Occup Environ Med 3:10–18PubMedGoogle Scholar
  8. 8.
    Suneja T, Belsito DV (2008) Occupational dermatosis in health care workers evaluated for suspected allergic contact dermatitis. Contact Dermatitis 58:285–290PubMedCrossRefGoogle Scholar
  9. 9.
    Kikuchi-Numagami K, Saishu T, Fukaya M, Kanazawa E, Tagami H (1999) Irritancy of scrubbing up for surgery with or without a brush. Acta Derm Venereol 79:230–232PubMedCrossRefGoogle Scholar
  10. 10.
    Hachem JP, De Paepe K, Sterckx G, Kaufman L, Rogiers V, Roseeuw D (2002) Evaluation of biophysical and clinical parameters of skin barrier function among hospital workers. Contact Dermatitis 46:220–223PubMedCrossRefGoogle Scholar
  11. 11.
    Callahan A, Baron E, Fekedulegn D, Kashon M, Yucesoy B, Johnson VJ, Domingo DS, Kirkland B, Luster MI, Nedorost S (2013) Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers. Dermatitis 24:170–175PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Weber DJ, Consoli SA, Rutala WA (2016) Occupational health risks associated with the use of germicides in health care. Am J Infect Control 44(5 Suppl):e85–e89PubMedCrossRefGoogle Scholar
  13. 13.
    Pedersen LK, Held E, Johansen JD, Agner T (2005) Short-term effects of alcohol-based disinfectant and detergent on skin irritation. Contact Dermatitis 52:82–87PubMedCrossRefGoogle Scholar
  14. 14.
    Slotosch CM, Kampf G, Löffler H (2007) Effects of disinfectants and detergents on skin irritation. Contact Dermatitis 57:235–241PubMedCrossRefGoogle Scholar
  15. 15.
    Stutz N, Becker D, Jappe U, John SM, Ladwig A, Spornraft-Ragaller P, Uter W, Löffler H (2009) Nurses’ perceptions of the benefits and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing by the German Contact Dermatitis Research Group. Br J Dermatol 160:565–572PubMedCrossRefGoogle Scholar
  16. 16.
    Valsecchi R, Leghissa P, Cortinovis R, Cologni L, Pomesano A (2000) Contact urticaria from latex in healthcare workers. Dermatology 201:127–131PubMedCrossRefGoogle Scholar
  17. 17.
    Lammintausta K, Kalimo K (1981) Atopy and hand dermatitis in hospital wet work. Contact Dermatitis 7:301–308PubMedCrossRefGoogle Scholar
  18. 18.
    Nilson E, Mikaelsson B, Andersson S (1985) Atopy, occupation and domestic work as risk factors for hand eczema in hospital workers. Contact Dermatitis 13:216–223CrossRefGoogle Scholar
  19. 19.
    Gupta SB, Gupta A, Shah B, Kothari P, Darall S, Boghara D, Sonkar S, Deo K (2018) Hand Eczema in nurses, nursing auxiliaries and cleaners- A cross-sectional study from tertiary hospital in western India. Contact Dermatitis 79:20–25PubMedCrossRefGoogle Scholar
  20. 20.
    Visser MJ, Verberk MM, Campbell LE, McLean WH, Calkoen F, Bakker JG, van Dijk FJH, Bos JD, Kezic S (2013) Filaggrin loss-of-function mutations and atopic dermatitis as risk factors for hand eczema in apprentice nurses: part II of a prospective cohort study. Contact Dermatitis 70:139–150PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Lammintausta K, Kalimo K, Havu VK (1982) Occurrence of contact allergy and hand eczemas in hospital wet work. Contact Dermatitis 8:84–90PubMedCrossRefGoogle Scholar
  22. 22.
    Flyvholm MA, Bach B, Rose M, Jepsen KF (2007) Self-reported hand eczema in hospital population. Contact Dermatitis 57:110–115PubMedCrossRefGoogle Scholar
  23. 23.
    Lan CC, Feng WW, Lu YW, Wu CS, Hung ST, Hsu HY, Yu HS, Ko YC, Lee CH, Yang YH, Chen GS (2008) Hand eczema among University Hospital nursing staff: identification of high-risk sector and impact in quality of life. Contact Dermatitis 59:301–306PubMedCrossRefGoogle Scholar
  24. 24.
    Skudlik C, Dulon M, Wendeler D, John SM, Nienhaus A (2009) Hand Eczema in Geriatric Nurses in Germany. Prevalence and Risk Factors. Contact Derm 60:136–143PubMedCrossRefGoogle Scholar
  25. 25.
    Hansen KS (1983) Occupational dermatoses in hospital cleaning women. Contact Dermatitis 9:343–351PubMedCrossRefGoogle Scholar
  26. 26.
    Singgih SI, Lantinga H, Nater JP, Woest TE, Kruyt-Gaspersz JA (1986) Occupational hand dermatoses in hospital cleaning personnel. Contact Dermatitis 14:14–19PubMedCrossRefGoogle Scholar
  27. 27.
    Gawkrodger DJ, Lloyd MH, Hunter JAA (1986) Occupational skin disease in hospital cleaning and kitchen workers. Contact Dermatitis 15:132–135PubMedCrossRefGoogle Scholar
  28. 28.
    Gibbon KL, McFadden JPM, Rycroft RJG, Ross JS, Chinn S, White IR (2001) Changing frequency of thiuram allergy in healthcare workers with hand dermatitis. Br J Dermatol 144:347–350PubMedCrossRefGoogle Scholar
  29. 29.
    Aalto-Korte K, Jolanki R, Estlander T, Alanko K, Kanerva L (1996) Occupational allergic contact dermatitis caused by Euxyl K 400. Contact Dermatitis 35:193–194PubMedCrossRefGoogle Scholar
  30. 30.
    Weisshaar E, Radulescu M, Bock M, Albrecht U, Diepgen TL (2006) Educational and dermatological aspects of secondary individual prevention in healthcare workers. Contact Dermatitis 54:254–260PubMedCrossRefGoogle Scholar
  31. 31.
    Crippa M, Balbiani L, Baruffini A, Belleri L, Draicchio F, Feltrin G, Larese F, MAaggio GM, Marcer G, Micheloni GP, Montomoli L, Moscato G, Previdi M, Sartorelli P, Sossai D, Spatari G, Zanetti C (2008) Consensus document. Update on latex exposure and use of gloves in Italian health care settings. Med Lav 99:387–399PubMedGoogle Scholar
  32. 32.
    Allmers H, Schmengler J, John SM (2004) Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol 114:347–351PubMedCrossRefGoogle Scholar
  33. 33.
    Bensefa-Colas L, Telle-Lamberton M, Faye S, Bourrain JL, Crepy MN, Lasfargues G, Choudat D, Members RP, Momas I (2015) Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Br J Dermatol 173:1453–1461PubMedCrossRefGoogle Scholar
  34. 34.
    Molin S, Bauer A, Schnuch A, Geier J (2014) Occupational contact allergy in nurses: results from the Information Network of Departments of Dermatology 2003–2012. Contact Dermatitis 72:164–171PubMedCrossRefGoogle Scholar
  35. 35.
    Schubert S, Bauer A, Molin S, Skudlik C, Geier J (2017) Occupational contact sensitization in female geriatric nurses: data of the Information Network of Departments of Dermatology (IVDK) 2005–2014. JEADV 31:469–476PubMedGoogle Scholar
  36. 36.
    Gielen K, Goossens A (2001) Occupational allergic contact dermatitis from drugs in healthcare workers. Contact Dermatitis 45:273–279PubMedCrossRefGoogle Scholar
  37. 37.
    Pinheiro V, Pestana C, Pinho A, Antunes I, Gonçalo M (2018) Occupational allergic contact dermatitis caused by antibiotics in healthcare workers- relationship with non-immediate drug eruptions. Contact Dermatitis 78:281–286PubMedCrossRefGoogle Scholar
  38. 38.
    Lyon TC (1971) Allergic contact dermatitis due to Cidex. Oral Surg 32:895PubMedCrossRefGoogle Scholar
  39. 39.
    Schnuch A, Geier J, Uter W, Frosch PJ (1998) Patch testing with preservatives, antimicrobials and industrial biocides. Results from a multicenter study. Br J Dermatol 138:467–476PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Shaffer MP, Belsito DV (2000) Allergic contact dermatitis from glutaraldehyde in health-care workers. Contact Dermatitis 43:150–156PubMedCrossRefGoogle Scholar
  41. 41.
    Neering H, van Ketel WG (1974) Glutaraldehyde and formaldehyde allergy. Contact Dermatitis Newslett 16:518Google Scholar
  42. 42.
    Maibach HI (1975) Glutaraldehyde: cross reaction to formaldehyde. Contact Dermatitis 1:326PubMedCrossRefGoogle Scholar
  43. 43.
    Nethercott JR, Holness DL, Page E (1988) Occupational contact dermatitis due to glutaraldehyde in health care workers. Contact Dermatitis 18:193–197PubMedCrossRefGoogle Scholar
  44. 44.
    Hansen KS (1983) Glutaraldehyde occupational dermatitis. Contact Dermatitis 9:81–82PubMedCrossRefGoogle Scholar
  45. 45.
    Hansen EM, Menné T (1990) Glutaraldehyde: patch test, vehicle and concentration. Contact Dermatitis 23:369–370PubMedCrossRefGoogle Scholar
  46. 46.
    Waters A, Beach J, Abramson M (2003) Symptoms and lung function in health care personnel exposed to glutaraldehyde. Am J Ind Med 43:196–203PubMedCrossRefGoogle Scholar
  47. 47.
    Lehman PA, Franz TJ, Guin JD (1994) Penetration of glutaraldehyde through glove material: tactylon versus natural rubber latex. Contact Dermatitis 30:176–177PubMedCrossRefGoogle Scholar
  48. 48.
    Foussereau J, Samsoen M, Hecht MT (1983) Occupational dermatitis to Ampholyt G in hospital personnel. Contact Dermatitis 9:233–234PubMedCrossRefGoogle Scholar
  49. 49.
    Suhonen R (1980) Contact allergy to dodecyl-di-(aminoethyl) glycine (Desimex i). Contact Dermatitis 6:290–291PubMedCrossRefGoogle Scholar
  50. 50.
    Dejobert Y, Martin P, Piette F, Thomas P, Bergoend H (1997) Contact dermatitis from didecyldimethylammonium chloride and bis-(aminopropyl)-laurylamine in a detergent-disinfectant used in hospital. Contact Dermatitis 37:95–96PubMedCrossRefGoogle Scholar
  51. 51.
    Dibo M, Brasch J (2001) Occupational allergic contact dermatitis from N,N-bis(3-aminopropyl)dodecylamine and dimethyldidecylammonium chloride in 2 hospital staff. Contact Dermatitis 45:40PubMedCrossRefGoogle Scholar
  52. 52.
    Lombardi P, Gola M, Acciai MC, Sertoli A (1984) Unusual occupational allergic contact dermatitis in a nurse. Contact Dermatitis 20:302CrossRefGoogle Scholar
  53. 53.
    Cristersson S, Wrangsjö K (1991) Contact allergy to undecylenamide diethanolamide in a liquid soap. Contact Dermatitis 27:191–192CrossRefGoogle Scholar
  54. 54.
    Diba VC, Chowdhury MM, Adisesh A, Statham BN (2003) Occupational allergic contact dermatitis in hospital workers caused by methyldibromoglutaronitrile in a work soap. Contact Dermatitis 48:118–119PubMedCrossRefGoogle Scholar
  55. 55.
    Larsen TH, Gregersen P, Jemec GB (2001) Skin irritation and exposure to diisocyanates in orthopedic nurses working with soft casts. Am J Contact Dermatitis 12:211–214PubMedGoogle Scholar
  56. 56.
    Kiec-Swierczynska M, Krecisz B, Swierczynska-Machura D (2003) Occupational allergic contact dermatitis due to thimerosal. Contact Dermatitis 48:337–338PubMedCrossRefGoogle Scholar
  57. 57.
    Suzuki K, Matsunaga K, Umemura Y, Ueda H, Sasaki K (2000) 2 cases of occupational dermatitis due to mercury vapor from a broken sphygmomanometer. Contact Dermatitis 43:175–177PubMedGoogle Scholar
  58. 58.
    Pegum J, Medhurst FA (1971) Contact dermatitis from penetration of rubber gloves by acrylic monomer. Br Med J 2:141PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Fries JB, Fisher AA, Salvati EA (1975) Contact dermatitis in surgeons from methylmethacrylate bone cement. J Bone Joint Surg Am 57:547PubMedCrossRefGoogle Scholar
  60. 60.
    Fisher AA (1979) Paresthesia of the fingers accompanying dermatitis due to methylmethacrylate bone cement. Contact Dermatitis 5:56PubMedGoogle Scholar
  61. 61.
    Bergh M, Menné T, Karlberg AT (1994) Colophony in paper-based surgical clothing. Contact Dermatitis 31:332–333PubMedCrossRefGoogle Scholar
  62. 62.
    Knudsen BB, Avnstorp C (1991) Chlorhexidine gluconate and acetate in patch testing. Contact Dermatitis 24:45–49PubMedCrossRefGoogle Scholar
  63. 63.
    Foti C, Vena GA, Angelini G (1992) Occupational contact allergy to benzydamine hydrochloride. Contact Dermatitis 27:328–329PubMedCrossRefGoogle Scholar
  64. 64.
    Ophaswongse S, Maibach HI (1994) Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome, a review. Contact Dermatitis 30:1–6PubMedCrossRefGoogle Scholar
  65. 65.
    Steinkraus V, Hansen BM (1994) Contact allergy to propylene oxide. Contact Dermatitis 31:120PubMedCrossRefGoogle Scholar
  66. 66.
    Wakelin SH, McFadden JP, Leonard JN, Rycroft RJG (1998) Allergic contact dermatitis from d-limonene in a laboratory technician. Contact Dermatitis 38:164–165PubMedCrossRefGoogle Scholar
  67. 67.
    Sommer S, Wilkinson SM, Wilson CL (1998) Airborne contact dermatitis caused by microscopy immersion fluid containing epoxy resin. Contact Dermatitis 39:141–142PubMedCrossRefGoogle Scholar
  68. 68.
    Le Coz C, Goossens A (1998) Contact dermatitis from an immersion oil for microscopy. N Engl J Med 339:406–407PubMedGoogle Scholar
  69. 69.
    Hughes R, Taylor JS (2002) Surveillance of allergic contact dermatitis: epoxy resin and microscopic immersion oil. J Am Acad Dermatol 47:965–966PubMedCrossRefGoogle Scholar
  70. 70.
    Rademaker M (1994) Allergic contact dermatitis from lavender fragrance in Difflam® gel. Contact Dermatitis 31:58–59PubMedCrossRefGoogle Scholar
  71. 71.
    Pazzaglia M, Vincenzi C, Gasparri F, Tosti A (1996) Occupational hypersensitivity to isothiazolinone derivatives in a radiology technician. Contact Dermatitis 34:143PubMedCrossRefGoogle Scholar
  72. 72.
    Fung MA, Geisse JK, Maibach HI (1996) Airborne contact dermatitis from metaproterenol in a respiratory therapist. Contact Dermatitis 35:317–318PubMedCrossRefGoogle Scholar
  73. 73.
    Forschner K, Zuberbier T, Worm M (2002) Benzoyl peroxide as a cause of airborne contact dermatitis in an orthopaedic technician. Contact Dermatitis 47:241PubMedCrossRefGoogle Scholar
  74. 74.
    Camarasa JG (1986) Contact eczema from cow saliva. Contact Dermatitis 2:117CrossRefGoogle Scholar
  75. 75.
    Prahl P, Roed-Petersen J (1979) Type I allergy from cows in veterinary surgeons. Contact Dermatitis 5:33–36PubMedCrossRefGoogle Scholar
  76. 76.
    Hjorth N (1967) Occupational dermatitis among veterinary surgeons caused by penethamate. Berufsdermatosen 15:163PubMedGoogle Scholar
  77. 77.
    Melhorn HC, Beetz D (1971) Das Antioxydans Aethoxyquin als berufliches Ekzematogen bei einem Futtermitteldosierer. Berufsdermatosen 19:84Google Scholar
  78. 78.
    Burrows D (1975) Contact dermatitis in animal feed mill workers. Br J Dermatol 92:167PubMedCrossRefGoogle Scholar
  79. 79.
    Caplan RM (1973) Contact dermatitis from animal feed additives (letter to editor). Arch Dermatol 107:918PubMedCrossRefGoogle Scholar
  80. 80.
    Shauder S, Schröder W, Geier J (1996) Olaquindox-induced airborne photoallergic contact dermatitis followed by transient or persistent light reactors in 15 pig breeders. Contact Dermatitis 35:344–354CrossRefGoogle Scholar
  81. 81.
    Bleumink E, Nater JP (1973) Allergic contact dermatitis to dinitolmide (letter to editor). Arch Dermatol 108:423–424PubMedCrossRefGoogle Scholar
  82. 82.
    Nelder KM (1972) Contact dermatitis from animal feed additives. Arch Dermatol 106:722–723CrossRefGoogle Scholar
  83. 83.
    Agrup G, Sjöstedt L (1985) Contact urticaria in laboratory technicians working with animals. Acta Derm Venereol 65:111–115PubMedGoogle Scholar
  84. 84.
    Davies GE, McArdle LA (1981) Allergy to laboratory animals: a survey by questionnaire. Int Arch Allergy Appl Immunol 64:302–307PubMedCrossRefGoogle Scholar
  85. 85.
    Aoyama K, Ueda A, Manda F, Matsushita T, Ueda T (1992) Allergy to laboratory animals: an epidemiological study. Br J Ind Med 49:41–47PubMedPubMedCentralGoogle Scholar
  86. 86.
    Alfonso JH, Bauer A, Bensefa-Colas L, Boman A, Bubas M, Constandt L, Crepy MN, Gonçalo M, Macan J, Mahler V, Mijakoski D, Ramada Rodilla JM, Rustemeyer T, Spring P, John SM, Uter W, Wilkinson M, Giménez-Arnau AM (2017) Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe- position paper of COST Action StanDerm (TD 1206). J Eur Acad Dermatol Venereol 31(Suppl 4):31–43PubMedCrossRefGoogle Scholar
  87. 87.
    Papadatou Z, Williams H, Cooper K (2018) Effectiveness of interventions for preventing occupational irritant hand dermatitis: a quantitative systemic review. JBI Database System Rev Implement Rep 16:1398–1417PubMedCrossRefGoogle Scholar
  88. 88.
    Madan I, Parsons V, Cookson B, English J, Lavender T, McCrone P, Murphy C, Ntani G, Rushton L, Smedley J, Williams H, Wright A, Coggon D (2016) A behavioural change package to prevent hand dermatitis in nurses working in national health service (the SCIN trial): study protocol for cluster randomised controlled trial. Trials 17:145PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Soltanipoor M, Kezic S, Sluiter JK, Rustemeyer T (2017) The effectiveness of a skin care program for prevention of contact dermatitis in health care workers (the Healthy Hands Project): study protocol for a cluster randomized controlled trial. Trials 18:92PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Ibler KSI, Jemec GB, Diepgen TL, Gluud C, Lindschou Hansen J, Winkel P, Thomsen SF, Agner T (2012) Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial. BMJ 345:e7822PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Wilke A, Gediga K, Weinhöppel U, John SM, Wulfhorst B (2012) Long-term effectiveness of secondary prevention in geriatric nurses with occupational hand eczema: the challenge of a controlled study design. Contact Dermatitis 66:79–86PubMedCrossRefGoogle Scholar
  92. 92.
    Chen J, Gomez P, Kudla I, DeKoven J, Holness DL, Skotnicki S (2016) Return to work for nurses with hand dermatitis. Dermatitis 27:308–312PubMedCrossRefGoogle Scholar
  93. 93.
    Brans R, Skudlik C, Weisshaar E, Scheidt R, Ofenloch R, Elsner P, Wulfhorst B, Schönfeld M, John SM, Diepgen TL, ROQ Study Group (2016 Oct) Multicentre cohort study ‘Rehabilitation of Occupational Skin Diseases – Optimization and Quality Assurance of Inpatient Management (ROQ)’: results from a 3-year follow-up. Contact Dermatitis 75(4):205–212PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of DermatologyHospital del Mar, Institut Mar d’Investigacions Mèdiques IMIM, Universitat AutònomaBarcelonaSpain
  2. 2.Department of Dermatology, Environmental Medicine, Health Theory Faculty of Human Sciences University of OsnabrueckInstitute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Lower-Saxonian Institute of Occupational Dermatology (NIB)OsnabrückGermany

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