Skin problems in professional cleaners

Introduction

Professional cleaning is a major source of employment and takes place in a wide variety of settings, including schools, hospitals and public and private buildings.

Dermatitis among professional cleaners is common, with potential to have a large impact on employment, economics and patient quality of life. In one study of workers, it was found that cleaners had a significantly higher rates of dermatitis and other skin conditions compared to other building workers.

Why are professional cleaners at risk of skin conditions?

Professional cleaners are at risk of skin conditions for the following reasons:

• They are exposed to a wide variety of chemicals, including window, floor and carpet cleaners, fragrances, preservatives, ammonia, solvents, degreasers, bleach and hydrochloric acid. These can act as contact irritants and are sensitising agents (potential allergens)
• Cleaners have responsibility for a wide variety of cleaning tasks, such as mopping and window-washing and more complex cleaning that requires training and use of highly toxic substances
• High rates of “wet work”, ie, work which requires repeated exposure to or immersion in water

A study of rates of dermatitis in the United Kingdom were around 28% for cleaners, versus 18% for the general population.

Understanding the causes of occupational skin disease

The epidermal barrier is important for protection against harmful agents such as bacteria, viruses, solar radiation and chemical toxins.

Repeated exposure to chemicals, work with a high risk for mechanical injuries like cuts or abrasions, and wet work can compromise this protective barrier and cause irritation, sensitivity and contact dermatitis. Those with a history of eczema are at greater risk than those without this history.

Skin conditions associated with cleaners

Professional cleaners are vulnerable to the following conditions.

Contact dermatitis

Contact dermatitis is common in professional cleaners.

• The rash can be contact irritant dermatitis and/or contact allergic dermatitis, due to exposure to allergens and irritants in the variety of cleaning agents
• Results in red hands, red and swollen fingertips, itch and scaling, or fissured skin
• Specific allergens are detected by patch tests

Yeast infections

Professional cleaners are also at risk for cutaneous yeast infection.

• This is most often due to Candida albicans
• The infection is associated with wet work
• Infection can occur within the nail plate (onychomyosis), around the nail bed (paronychia) and between the fingers (interdigital mycosis also called erosio interdigitalis blastomycetica and is a form of intertrigo)

Bacterial infections

Occupational bacterial infections in cleaners are generally caused by staphylococci or streptococci. They are associated with compromised skin integrity and work in an unclean environment.

Infections in cleaners include:

• Folliculitis
• Furuncles and carbuncles (boils)
• Impetigo and ecythma
• Acute bacterial paronychia

Contact urticaria

Contact urticaria is less common than contact dermatitis.

• Contact urticaria can be an immunological response to an allergen (a form of contact allergy)
• It can also be a non-immunological response, where the chemical directly stimulates histamine release on contact with the affected area (an irritant reaction)
• Contact urticaria may cause generalised urticaria within an hour of exposure
• It is sometimes accompanied by rhinitis, conjunctivitis or bronchospasm
• Contact urticaria can be difficult to treat, and in some cases results in need to change occupation

Occupational rashes in professional cleaners

Occupational extensive dermatitis 

Candida nail infection 

Infected hand 

Workplace risk assessment

If skin conditions are a problem, the workplace should be assessed. Improvements could possibly include the following:

• Changing or reducing the number of chemicals in use, or switching to less harsh chemical products
• Changing cleaning methods or methods of mixing or diluting products
• Educating workers on proper use of personal protective equipment, including gloves, goggles and aprons
• Providing employees with adequate washing facilities, safe means to remove oil or grease, and barrier creams to use as needed to protect the skin
• Change work methods to isolate dangerous processes and reduce employee exposure to toxins

Personal protective equipment

Use of personal protective equipment has been shown to help reduce worker exposure to irritants and sensitising agents. However, this is dependent on employees knowing which type of glove to choose for which job, how to don, remove and dispose of them safely and how many hours they should be worn. Also, there is also a chance of the gloves themselves causing contact dermatitis if a person become sensitised to their materials (such as latex or rubber accelerators), or sweats heavily under them.

Recommended hand/skin care for professional cleaners

For cleaners who are wanting to keep their skin healthy, the following guidelines are recommended:

• Wash hands with water and mild soap and dry thoroughly
• Use emollient hand creams as needed to moisturise
• Do not use solvents to clean hands
• Use oil-based cleaners to remove oils and greases that cannot be removed with soap and water
• Report and seek treatment promptly for skin breakdown

Treatment of occupational skin disease

Because skin conditions in professional cleaners are common, doctors should be aware of health risks associated with this occupation — keep in mind that skin conditions can sometimes go under-reported and underdiagnosed.

Treatment will naturally depend on the particular skin condition, but may include:

• Topical or systemic corticosteroids and antihistamines for dermatitis
• Topical antifungal agents for yeast infections
• Antibiotics for bacterial infection
• Elimination of allergens, if relevant and known, in contact allergic dermatitis and contact urticaria