Hand Eczema is a common problem for healthcare workers with two key risk factors for eczema identified in a recent study. In Denmark, where the study took place, a fifth of those with skin eczema were found to work in the healthcare professions with immediate suspicion of the connection between frequent hand washing and eczema development.
The relationship between eczema and healthcare workers is a little more complex however, as the Danish researchers observe in their paper published this month in Contact Dermatitis.
Connecting Eczema with Hand Washing
Looking at the hand washing habits of 2269 healthcare workers, researchers at the Department of Dermatology, Roskilde University Hospital, and the Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark, examined the incidence of eczema and the possible eczema triggers for these patients.
They were particularly interested in how hand washing behaviours changed between the workplace and the home, as well as looking at the use of disinfectants, gloves, and exposure to rubber, plastic, food, detergents, plaster, laboratory reagents, and medications.
Risk Factors for Eczema
The healthcare workers also answered questions on hand washing practices at home as well as their involvement with gardening, childcare, decorating, laundry, cleaning, cooking, and engine repair. The time spent on each activity, and the frequency of hand washing, was included in the questionnaire, as well as information on how often (if at all) the eczema patients used moisturisers.
Information on physical activity, smoking, and the severity of their eczema, using photos of eczema to guide their self-assessment, also formed part of the study.
Hand Washing Increases Eczema Risk
The analysis showed that those with eczema washed their hands more often than those without the skin condition, and that most respondents washed their hands 6-10 times a day at work. More than half of those with hand eczema washed their hands ten times or more a day, with 43% without hand eczema washing their hands a similar amount.
Outside of work, those with eczema also washed their hands more frequently (23% vs 16% more than ten times a day).
Rubber Gloves and Eczema
The researchers also found that those with hand eczema wore synthetic rubber gloves more often than those without hand eczema with the difference in incidence statistically significant (34% vs 27%). Cotton gloves were worn by 2% of those with eczema but less than 1% of those without, and those without eczema were slightly more likely to wear natural rubber gloves, although the difference between eczema sufferers and non-sufferers was not significant.
Eczema and Moisturisers
Those with hand eczema reported wearing protective gloves more frequently when collecting blood and handling drugs and the eczema sufferers also used moisturisers more frequently than those without the skin problem. The use of moisturisers outside the workplace correlated with the severity of the hand eczema, and the incidence of eczema increased for those involved in childcare of children under four, as well as those frequently cooking, cleaning, washing dishes and clothing while wearing gloves.
Psychology of Eczema
Potential risk factors for eczema that did not appear significant in this study included gardening, engine repair, decorating, smoking, and physical activity. The dermatology researchers recommended that healthcare workers are consistently reminded to disinfect rather than wash the hands when their hands are visibly clean in order to reduce the frequency of hand washing.
However, the study’s self-evaluative nature means that the reasons behind the more frequent hand washing in eczema sufferers has not been explained, with the possibility of psychological reasons predisposing healthcare workers to eczema by increasing hand washing.
This study does not necessarily highlight the causes of eczema in the general population but could help reduce the incidence of eczema in healthcare workers by influencing hand washing practices. Paying special attention to those working in healthcare who also have children at home and who are responsible for the majority of the domestic work in the home could help target those more likely to develop hand eczema.
While the results are not able to be generalized to other groups it may be that others whose professions involve frequent hand washing or immersion of their hands in liquids, along with those working in childcare or domestic spheres are also at increased risk of hand eczema.
Ibler, K.S., Jemec, G.B.E., Agner, T., Exposures related to hand eczema: a study of healthcare workers, Contact Dermatitis, Volume 66, Issue 5, pages 247–253, May 2012. https://www.ncbi.nlm.nih.gov/pubmed/22486567