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.