Skin problems in chefs and restaurant workers

Introduction

The food/catering industry is a major employer worldwide and takes place in a variety of settings, including restaurants, resorts, hotels, spas and bistros. Statistically, restaurant workers have twice as many cases of dermatitis as employees in other sectors. These skin complaints can become serious enough to warrant time off from work or even a change of career.

Why do chefs and food handlers have skin disorders?

Chefs, food handlers and other restaurant workers are at risk for skin disorders due to:

• Wet work, or prolonged exposure to water
• Exposure to food
• Exposure to chemicals used in cleaning or sanitising
• A wide range of tasks that must often be performed quickly.

The nature of the restaurant industry itself also carries many risk factors, such as:

• Irregular and long working hours
• Small businesses with few resources to spend on employee safety
• A preponderance of young, poorly paid, unskilled, transient workers.

Understanding the nature of occupational skin disorders

The skin barrier is an important part of the body's immune system and acts as a natural barrier to a wide variety of substances that can cause irritation, allergic reactions and infections. The risk of skin disorders increases when the skin barrier is compromised by injury or disease.

Chefs and food handlers are at high risk for skin disease due to the nature of their work. The main occupational risk for chefs and food handlers is contact dermatitis.

Contact dermatitis

Contact dermatitis stems from wet work as well as repeated/prolonged contact with food, kitchen cleaners/sanitisers and other chemicals. Dermatitis causes redness, swelling and itchiness, most often of the hands, face and forearms.

Mechanical injury

The most frequent mechanical injuries include cuts, scrapes and knife or blade injuries secondary to cutting or preparing food. The most common sites for these injuries are the hands, forearms and fingers. These injuries can also lead to secondary infections, especially from staphylococci or streptococcal bacteria.

Thermal burns

Due to contact with ovens, grills, deep fryers and other sources of heat, thermal burns are frequent among chefs and restaurant workers. These burns result in pain, redness, swelling, blistering and when severe, loss of epidermis or dermis. Thermal burns also put workers at risk for secondary bacterial infections.

Workplace risk assessment

In order to be truly effective, a workplace risk assessment must cover all aspects of restaurants work, including:

• Food storage, preparation, handling
• Cleaning
• Equipment, such as cutting machines and knives.

Additionally, employers and employees must be committed to safety.

Employee education in the workplace is key to reducing risk, and should include:

• Understanding the use and disposal of personal protective equipment
• Knowing how to identify signs and symptoms of skin breakdown — and seeking early treatment
• Practising principles of knife safety, including how to use and sharpen knives properly, choose the right knife for the job, store them safely, and carry them vertically with the blade pointing downwards.

Personal protective equipment

Gloves are required for workers when handling food and also during “wet work”, like the washing of dishes; dishwashers are advisable rather than washing items by hand. Gloves are used to reduce exposure to potential allergens or irritants, including food, cleaning or sanitising products.

Hand care advice for restaurant workers

To protect their hands at work, those employed in the restaurant business should:

• Use gloves when coming into contact with potential allergens or irritants including wet work
• Use hand creams (emollients) frequently
• Know how to identify early signs and symptoms of dermatitis and other skin disorders
• Seek early treatment if problems are detected.

Diagnosis and treatment of skin disorders

Diagnosis of occupational skin disorders should be based on:

• A thorough occupational assessment of the patient, including the nature of their work, any chemicals or other substances they are in frequent contact with, safety protocols in place at the worksite and the presence of similar skin problems in co-workers.
• Knowledge of both classic and atypical signs and symptoms of dermatitis.
• Patch testing and other tests to determine the presence of patient allergies.

Treatment of occupational skin disorders can include:

• Reduction of worker exposure to potential allergens and irritants
• Use of appropriate personal protective equipment
• Appropriate applications of moisturisers and barrier creams as needed
• Use of oral or topical steroids
• Use of second-line treatments like phototherapy, methotrexate, ciclosporin and azathioprine.