Common skin disorders that may arise from housework are:
Irritant contact dermatitis
This is the commonest skin disorder that can arise from housework. It commonly affects the hands. The condition usually begins with mild dryness, redness, peeling and scaliness on the hands. Later cracks and crusts develop (Fig 1).
Causes of irritant contact dermatitis due to housework commonly include detergents, cleansing agents, foodstuff, disinfectants, water and bleaches.
Individuals with sensitive skin and pre-existing skin diseases e.g. atopic eczema are more prone to developing irritant contact dermatitis. Affected individuals should be encouraged to wear cotton gloves inside loose-fitting rubber gloves if wet work cannot be avoided. It is not advisable to wear rubber gloves for more than 30 minutes at a stretch, as perspiration may cause discomfort and maceration. If the patient is allergic to rubber gloves, vinyl gloves may be used as an alternative. Treatment includes use of topical steroid creams, moisturizers and oral antihistamines.
Allergic contact dermatitis
This occurs less frequently than irritant contact dermatitis. It is often difficult to differentiate between an allergic from an irritant contact dermatitis by the appearance of the rash alone (Fig 2).
Substances known to cause skin allergy include rubber gloves, food stuff (onions, garlic, fruits), spices, flavouring agents, certain hand creams, fragrances, nickel, chromate (in bleaches), flowers, polishes and disinfectants. Skin allergies can be confirmed by a skin patch test. Once the patient is found to be allergic to a particular substance, he/she should make special efforts to avoid direct skin contact with the substance, in order to avoid worsening or relapse of the dermatitis.
This is an immediate but transient wheal response (localised swelling with redness) at the site of direct contact with the substance causing an allergic reaction (Fig 3.1, 3.2). It usually resolves within a few hours, leaving normal skin. Contact urticaria can be confirmed by doing a skin prick test. Causes of contact urticaria include foodstuff, fragrances, flavouring agents, animal and plant products, preservatives, disinfectants and rubber latex. Avoidance of the causative agent is important to avoid recurrance of the rash.
a. Candida intertrigo
refers to itchy red rash with white flakes, that is commonly seen at the fingerwebs (Fig 4). It is caused by yeast -infection. Moisture promotes candida infection.
b. Fungal nail infections
may affect the fingers and toenails. The infection originates from the free margin and sides of the nails and eventually involves the nail plate, causing it to become brittle, thickened or completely destroyed (Fig 5). Skin fungal infections can be treated with antifungal creams and/ or tablets. Fungal nail infections may require prolonged treatment for up to one year. The affected nails may take up to a few months after the treatment has been stopped, to return to near normal appearance.
This refers to inflammation with/without infection of the nail folds (Fig 5). It is commonly caused by constant wet work. Secondary infection by bacteria or fungus will cause painful swelling of the nail fold. The nail plate may become deformed with chronic infection of the nail fold. Patients with paronychia should avoid prolonged wet work or wear impervious gloves during wet work.
Viral warts commonly infect the hands, fingers, nail folds and nail beds. It may be further exacerbated by the mild repetitive trauma experienced during housework. Warts on the fingers and hands can be destroyed with liquid nitrogen or laser surgery. Wart infection around the nails (Fig 6), however, is very difficult to eradicate. The best treatment so far is laser surgery.
DEDICATED TO EXCELLENCE IN DERMATOLOGY
By National Skin Centre (Singapore)
Copyright (C) 1995 - National Skin Centre (Singapore)