Health care workers are at high risk for developing irritation contact dermatitis

As I said in a previous blog post, I have had an annoying, painful, red, and itchy rash on my right hand for over a year since I started doing full time clinical dentistry. I ruled out latex allergy, poison ivy, and 3^rd year dental student syndrome. I finally got an appointment with my dermatologist who called the problem hand eczema. I have made some important changes by being much more selective about the products I buy that come in contact with my skin but the problem still has not gone away. Yesterday I realized why...

I was studying the Dental Decks for part II of the National Board Dental Exam, when I read a card that hit me like a Mack Truck on its way to a NASCAR race:

“The most common form of an adverse epithelial reaction noted for health-care professionals is: Irritation dermatitis. A number of published reports have cited data suggesting that between 20-30% of health care workers suffer from occasional or chronic dermatitis on their hands. The most common manifestation of the condition is irritation dermatitis, a non-specific immune reaction often caused by contact with a substance that physically or chemically damages the skin. The condition can be aggravated by frequent hand washing, residual glove powder left on hands, and the harshness of repeated use of some antiseptic hand wash agents. Health care workers located in colder climates may also experience chapping during the winter months.”

Wow! Finally after a year of searching, something tells me what the specific name of my problem is! I have had this problem for more than a year! All my dermatologist did was prescribe a topical steroid, say it was eczema, and throw a pamphlet about “Hand Eczema” at me as I was kicked out the door. “That will be $80 please.”

Irritant contact dermatitis is a form of eczema that occurs from frequent irritation by harsh chemicals, water, dry air, or chronic physical trauma. I googled “Irritation Contact Dermatitis and Health Care” and found the following article on the American Academy of Dermatology Website.

I don’t know but Dr. Nedorost may be getting some of her information from this article on Pub Med:

Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review.

Dr. Nedorost explained that irritant contact dermatitis is more highly associated with the number of times you wash your hands every day than any other factor; the best way to prevent it is to reduce the amount of times you wash your hands. Does this mean that we should stop washing our hands? Absolutely Not! Clean hands are essential for preventing the spread of infection from patient to patient and to you and your family. However, we can take the following precautions while still maintaining very clean hands as health care providers:

• Use a good alcohol hand sanitizer rather than soap and water whenever possible. (If you have visibly soiled hands then soap and water is necessary.) A great hand sanitizer that is fragrance free and includes moisturizers is Nexcare 3M Moisturizing Hand Sanitizer or the EO brand hand sanitizers.Don’t use the cheap stuff from the Dollar store or Wal-Mart!
• Use good quality, fragrance free moisturizers/emollients right after hand-washing
• Irritant contact dermatitis is a form of eczema that occurs from frequent irritation by harsh chemicals, water, dry air, or chronic physical trauma.
• Topical steroids may provide temporary relief of the symptoms but will not likely solve the problem. Long term use of topical steroids may actually weaken the skin making it more susceptible to further damage.
• Use cotton under gloves if possible; this may not be feasible in dentistry due to the fine amount of tactile sense required but if you have a bad case it may be helpful.
• Look up your hand soaps, moisturizers, and other cosmetic products that come in contact with your skin on http://www.cosmeticsdatabase.com and try to choose those products that have less harsh chemicals for your skin

I encourage anyone who has to wash their hands frequently to be aware of the damage it can cause to your hands. Even if you use the best hypoallergenic, mild soaps available, the water and drying effect on your hands can cause dermatitis. Especially those of us who work in health care, we need to use a good hand sanitizer as the rule not the exception. When your hands are visibly dirty then wash with soap and water, if not then use the hand sanitizer. Our dental school needs to improve by having hand sanitizer available to our students and to educate them on this topic; for now, I am going to bring my own Nexcare hand sanitizer from home.

Public Service Announcement #2: Replace Your Worn Out Tires!

This sounds obvious but I have friends whose family members were killed because they had tires that exploded. We recently replaced our tires on our one car that had very worn out tire treads. I watched this video on the Tirerack.com website that scared me quite a bit because I have almost crashed a few times on wet roads. Watch this video on the testing they did as to how long it takes you to stop with worn tires on a wet road you will be amazed! http://www.tirerack.com/videos/index.jsp?video=5

I know its biased propaganda from a tire company trying to scare you into buying new tires but why take the risk? The old rule: “replace your tires when the tread does not pass Lincoln's head on a penny” is just not safe at all. Even tires which only have tread as deep as Washington’s head on a quarter are not as safe. Rule: If the tire tread does not pass Washington’s head on a quarter you need new tires yesterday!

Even new tires vary as to their stopping ability. Some tires stop faster than others which may be the difference between life and death or an expensive crash and a close call. The Tirerack.com website has excellent reviews and ratings and fairly good prices. I ended up buying my tires from a local tire company but you can order through tirerack.com and they will send the tires to the auto shop where they install your tires.

Another good resource for information on tires in consumersearch.com which gives you a good review of the reviews and details on why performance tires are good for heat dissipation and handling which may be good when you are in a potentially scary situation on the highway. http://www.consumersearch.com/www/automotive/tires/

Again having a baby inspired me to do all this research too. I come from a long line of people who worry about things, just ask my mom.

Today's Public Service Announcement: Eat More Fruit

I was very long winded on the last post so this will be short and sweet. Fruit helps prevent various types of cancer including oral cancer and provides essential nutrients. I took this photo of a strawberry I picked from a local farm where they let you pick (and pay for) your own fresh, organic strawberries. Fruit is good for you and tastes good too!

Even if it's not organic fruit is still good, and we should all eat more of it. A multivitamin can never take the place of a healthy diet. While studies show that fruit helps prevent cancer, studies also show that you do not get the same benefit from taking a multivitamin. That's all I have to say; just eat more fruit!

How to protect your skin from toxic chemicals

This topic really chaps my hide. About a year ago when I first started treating patients in the clinic I noticed a red, painful, itchy sore on my right hand. I originally thought it was from Poison Ivy which is plentiful where I live. It does not look like much but it is annoyingly itchy to the point of being painful.

The differential diagnosis

When it still had not gone away about 4 months later I realized something else was wrong. To give you some background, at the same time I had been using the cheapest shampoo available in a huge container from the dollar store, the cheap antibacterial soap from Wal-Mart, the cheap dollar store hand sanitizer, dental student budget, you get the idea. I was also wearing latex gloves all day at school and washing my hands a lot, and using gallons of hand sanitizer because I was covering the emergency oral surgery (extractions) clinic for people who came in off the street with toothaches. I was not sure if it was a latex allergy or just dried out and chronically irritated skin. I decided to try to see a dermatologist. It’s now nearly 10 months later and I still have not been able to get an appointment because of my hectic schedule and the lack of available dermatologists.

I started to realize that the soap, hand sanitizer, shampoo, lotion, cavicide used to clean the clinic, and other chemicals may have caused an allergic or other type of inflammatory reaction. The problem does not get worse when wearing latex and it is isolated to one spot on my right hand so I don’t think it is a latex allergy.

I stumbled upon this awesome website called Environmental Working Group which collects a lot of research about chemicals, the environment, and practical advice on how to protect your family from these harmful substances.

Check out there Every Day Pollution Solutions for basic ways to de-toxify your life. You can also look at the Skin Safety Database of cosmetic products and what they contain. The database ranks the products from the best (least amount of cancer causing and allergenic substances) to the worst and even gives you a level of evidence for being toxic in the form of a percent data gap. You can then choose to show 500 results and you can click control-F to “Find” your product. I discovered that I was dumping all kinds of cancer causing and allergenic chemicals on my skin every day without even knowing it. The government does a poor job regulating the safety of cosmetics while these companies make a lot of money poisoning the public.

One quick tangent: Are all chemicals bad?

Just to clarify, I am not an extremest or an alarmist when it comes to “toxins” that people blame for everything like vaccinations or amalgam fillings and Autism. Many good studies have shown no association of Autism with vaccinations or Amalgam fillings. Vaccinations serve a very useful purpose protecting you, your children, and society from lethal and debilitating diseases.

Amalgam fillings also do not pose any danger other than the danger of uglyness. Sometimes amalgam serves better as a restorative material in situations where composite would not work well. I personally would rather use composite (the tooth colored filling material) in most situations if the area where the filling is being done can be kept dry enough to make a suitable, long-lasting filling but my reason for using composite is because it looks better not because it is less toxic. Some studies have shown amalgam fillings to last longer than composite fillings and even composite has some minor toxicity concerns.

Fluoride in drinking water is one of the safest and most effective and economical ways to prevent tooth decay. Many activists would have no fluoride in drinking water or toothpaste which would then lead to a huge increase in tooth decay. Untreated tooth decay is the number one chronic illness in children. Parents who constantly feed their children soda or even juice place their kids at a high risk of developing cavities. Please give young children mostly water to drink with the occasional juice or milk at meal times. Children who then develop severe tooth decay do not gain weight like they should, may have social problems, pain, and sometimes require extensive treatment under general anesthesia which carries the risk of death. So in the name of safety, fluoride in the water is the safe alternative. And fluoride in toothpaste does not pose any problems and unless ingested in large quantities. Just keep the toothpaste locked up so your kids don't eat it. Fluoride serves the practical purpose of preventing cavities which people can actually die from or at the very least have to pay to have it restored or the tooth extracted. A cavity can be deadly if it develops into an abscess which infects their brain or closes off the airway due to swelling. I have seen someone in the hospital operating room who was near death because she started out with a simple cavity which was never treated leading to a deep space infection which nearly closed off her airway. There was also a young boy in Maryland who died about a year ago due to a brain infection he developed as a result of a cavity not being treated.

There are many chemicals that serve a genuine and useful purpose that should not be omitted from our daily lives just because they contain a small and often unfounded concern of toxicity that is not substantiated by any good science. While some substances do both good and bad, sometimes if the good outweighs the bad you have to take that chance. The antibacterial triclosan in Colgate Total toothpaste helps prevent gingivitis although I think it is unnecessary if you already have very good oral hygiene and is also unnecessary in hand soaps.

Along this same line of thinking is the whole concept of “antibacterial” soap. My good friend’s dad is a microbiologist who laughs at the idea of an “antibacterial” soap. He says it is completely unnecessarily except in hospitals or in the homes of people who are immunocompromized because soap without the triclosan antibacterial will wash away all of the bacteria without the need for any “antibacterial” substances which are nothing more than a sales gimmick and an extra irritant to your skin. Here is a good article on antibacterial soap. Some chemicals are fine to use even if there is some slight toxicity concern but if you can get something that works equally well with less harsh chemicals than why not do it.

Another important concept to understand it that fetuses and young children are more susceptible to toxins than adults are which is my whole reason for doing all of this research; to protect my son.

How to eliminate hazardous chemicals from your daily life

The EWG cosmetic safety website also has a tips section and suggestions of specific chemicals to avoid such as “fragrance” when you are at the store but in my experience it is impossible to remember the complex chemical names while shopping on a busy Saturday with a stressed out wife and a one year old son screaming to be able to accomplish anything this way. I would do your research ahead of time and buy online even if it means paying a shipping fee. However some of these things are readily available as you will see below.

The skin safety database has thousands of products which work as good or better than the cheap ones you can buy at Wal-Mart or the dollar store or it can help you know which products at Wal-Mart are less toxic. I have found that these safer products are usually more expensive with a few exceptions. I have a few recommendations of products I have tried. Again, I am not being paid by any of these companies although they should pay me for telling you about these things on my blog.

Mother always knows best

After doing hours and hours of searching the database on the environmental working group website and then checking the prices and availability of the products nearly every product that had a very good (low toxin) score was made of pure saponified olive oil or something to that affect and was very expensive. Then I realized that my mother has had the solution all worked out for years without doing any Internet research or getting a doctorate level degree in biochemistry. She had been using pure olive oil as a lotion and even told me about it but I had never tried it. Now I only use two skin "lotions" olive oil and 100% pure petroleum jelly. I guess I need to listen to her more; some things it takes years to learn. In short, using pure olive oil accomplishes two goals:

1) a safe, effective, and inexpensive lotion or makeup remover

2) a good way to stick it to the MAN who in this case happens to be the cosmetics industry. They don’t make a dime from my olive oil purchases.

So here is a list of products that are not too expensive but are also safe and effective alternatives to the toxic cosmetics we usually use: If you have a whole household of bad chemicals you want to replace with “healthy alternatives” start with the chemicals your children are exposed too. Babies are much more sensitive to chemicals than adults are. I would also start with what you use the most of. Here are a few suggestions:

A few suggestions of safe alternatives

Lotion:

Use 100% pure olive oil (Much cheaper and much safer than the normal lotions; use it for my one year old after he takes a bath; dermatologists recommend moisturizing your skin within 3 minutes after bathing)

OR

Use 100% pure petroleum jelly with no fragrance (equate at Wal-Mart or Vaseline; also very safe and effective; more viscous than olive oil too) Also works well for chap stick.

Makeup remover:

Use pure olive oil (according to my wife and my mom this is the best way to do it) (very inexpensive and moisturizes your skin at the same time)

Bar hand soap:

Try Kiss My Face 100% pure saponified olive oil fragrance free. (It’s a green bar of olive oil soap; works great; I bought it on Amazon.com)

Shampoo:

I am still working on finding a good, inexpensive alternative for me. For my 1 year old son I use California Baby brand shampoo and body wash which you can purchase at Target, healthfood stores or online.

Liquid Soap:

I have tried a few alternatives but most of them are very watery and can work fine but you have a compromise as to ease of use. I am still working on this one too.

Deodorant:

This is a tricky one because you will likely want to use something that actually works. I have found the Tom's of Maine fragrance free deodorant to work well.

Baby wipes:

I had to make a compromise as to what was affordable and what actually worked while factoring in the chemicals also. I would just see what you have at your local stores and buy the least toxic one according to the database.

Hand sanitizer:

Nexcare 3M Moisturizing Hand Sanitizer or any of the other least toxic sanitizers on the list at ewg.org.

Sunscreen:

Plain old Rite Aid Zinc Oxide Ointment can be used as a very effective sunscreen! The active ingredient in one of the most effective broad spectrum sunscreens is Zinc Oxide. There are some good "natural" sunscreens that are safe and effective but they are also very expensive! The top ones on the list on the EWG website will cost about $16 for 2 oz. or you can buy the Rite Aid Zinc Oxide Ointment for $5.

The sunscreen section is an excellent part of the database because it not only rates its effectiveness against blocking UVA and UVB rays but also its chemical safety. Here is the EWG guide to sunscreens. I recently purchased California Baby’s SPF 30+ fragrance free sunblock stick which was #1 on the list. I was really concerned with getting the best stuff for my 1.5 year old who will be spending some time in the sun this summer.

While I am on this topic of skin protection a few other notes/ tips to be aware of:

Wear an effective sunscreen, sun proof shirts, and broad rimmed hats that cover your ears, a good way to prevent melanoma, squamous cell carcinoma of the lip, basal cell carcinoma on the ears and face, etc. They sell cool sun proof swim shirts for kids/babies or adults which I highly recommend along with a good hat that covers your child's ears, face and neck. You don’t need to sunbathe for vitamin D; Take a multivitamin!

Wear gloves when dealing with chemicals used for automotive, gardening, construction, health care, etc. Motor oil is a carcinogen, most chemicals are not good for you or your skin. Buy a cheap pair of rubber coated gloves or latex exam gloves at the very least when doing these things. I would also wear gloves when doing housework with chemicals. There are also good alternatives to some chemicals used around the house for cleaners but I don’t feel like writing an article about that topic just Google it.

Use a safe moisturizer following your shower such as olive oil or petroleum jelly (Vaseline).

These are only a few examples but you get the idea; when I have time to finish this project, I want to replace all of my household cosmetics with a healthy alternative that is affordable and effective thus reducing my family’s exposure to these chemicals. I think as time goes on and this subject gets more attention, companies will realize it is not profitable to put crap in cosmetics that have questionable safety and the safe alternatives will become more readily available and less expensive.

Is Cancer Preventable?

One end note on cancer. Cancer is the 2^nd leading cause of death in the USA after heart disease. When I tell people about things I have learned on how to prevent cancer they usually say something like “Everything causes cancer!” which to some extent is true but that just reflects peoples frustration as to the overwhelming amount of information and studies which show a lot of things to be cancer causing. I hope this blog will show you that there are some specific, simple things you can do to prevent cancer. Don’t get overwhelmed and don’t be careless either. Not everything causes cancer. Just because there are a lot of ways to get cancer does not mean you can’t make a few changes in your life to do something about it.

Check out this quote from Wikipedia on cancer prevention: (I know there are better sources than this but they quoted a study by Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M (2005). "Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors". Lancet 366 (9499): 1784–93. doi:10.1016/S0140-6736(05)67725-2. PMID 16298215.)

“About a third of the twelve most common cancers worldwide are due to nine potentially modifiable risk factors. Men with cancer are twice as likely as women to have a modifiable risk factor for their disease. The nine risk factors are tobacco smoking, excessive alcohol use, diet low in fruit and vegetables, limited physical exercise, human papillomavirus infection (unsafe sex), urban air pollution, domestic use of solid fuels, and contaminated injections (hepatitis B and C).^”

So there you have it 9 things that can be “modified” to prevent cancer. I hope you find this information interesting and helpful. I still don't quite know what the problem is with my hand but I plan on going to the dermatologist soon; hopefully I will get some answers. For now I am self medicating it with over the counter topical hydrocortizone cream which does provide some relief. It may just be eczema but its still a good excuse to use less harsh chemicals that could potentially endanger my family.