Healthcare Workers

  • Rasika ReddyEmail author
  • Howard I. Maibach
  • Donald V. Belsito
Reference work entry


The generic term “healthcare worker” (HCW) has been applied to professions as diverse as physicians, laboratory technicians, cleaning personnel, dieticians/food handlers, and even hairdressers. This chapter focuses on the occupational dermatoses that plague the varying medicosurgical specialties, their nursing staffs, and their technical support staff (respiratory technicians, physical/occupational therapists, orthotics, etc.). Problems unique to other groups that work within the healthcare system (dentists, laboratory technicians, veterinarians, food handlers, cleaning personnel) are discussed elsewhere. The types of dermatoses and the incidence with which they affect HCWs vary with each specialty. While the orthopedic surgeon has significant exposure to antiseptic soaps, methyl methacrylate, and rubber allergens, the radiologist has much more limited exposure to these materials while having increased exposure to electromagnetic and ionizing radiation. Furthermore, even within a given specialty, the types of products used can vary dramatically not only from country to country but also from hospital to hospital. Thus, the reported incidence rates of occupational dermatoses (primarily dermatitis) among HCWs vary considerably. Not surprisingly, however, as a profession, HCWs have a significantly higher incidence of occupational dermatoses than most other occupational groups (Skoet et al. 2004; Kucenic and Belsito 2002; Meyer et al. 2000; Sertoli et al. 1999; Halkier-Sørensen 1996; Stingeni et al. 1995; Rustemeyer et al. 1994; Smit et al. 1993; Kavli et al. 1987; Kiec-Swierczynska 1996). Furthermore, nurses and aides constitute the group at highest risk in most studies of HCWs (Lammintausta et al. 1982; Nilsson et al. 1985; Rudzki et al. 1989; Smit et al. 1993, 1994; Rustemeyer et al. 1994; Stingeni et al. 1995; Halkier-Sørensen 1996). While irritant contact dermatitis (ICD) accounts for the vast majority of occupational dermatoses, allergic contact dermatitis (ACD), contact urticaria (CU), infections, accidental exposure to electromagnetic energy, friction, and other disease processes also significantly contribute to occupational morbidity (Lammintausta et al. 1982; Nilsson et al. 1985; Fisher 1987; Kavli et al. 1987; Rudzki et al. 1989; Smit et al. 1993, 1994; Hirschowitz 1994; Rustemeyer et al. 1994; Stingeni et al. 1995; Halkier-Sørensen 1996; Kiec-Swierczynska 1996; Holness and Mace 2001; Nettis et al. 2002; Suneja and Belsito 2008; Warshaw et al. 2008).


Healthcare workers Irritant contact dermatitis Allergic contact dermatitis Contact urticaria Infectious diseases Occupational dermatoses Photosensitivity Photoallergic contact dermatitis 


  1. Allmers H, Schmengler J, John S (2004) Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol 11:347–351CrossRefGoogle Scholar
  2. Belsito DV (1990) Contact urticaria caused by rubber: analysis of seven cases. Dermatol Clin 8:61–66PubMedCrossRefGoogle Scholar
  3. Belsito DV (1993) Contact urticaria from pentamidine isethionate. Contact Dermatitis 29:158–159CrossRefGoogle Scholar
  4. Belsito DV (1995) Rubber. In: Guin JD (ed) Practical contact dermatitis. McGraw-Hill, New York, pp 373–396Google Scholar
  5. Benyoussef K, Bottlaender A, Pfister HR et al (1996) Allergic contact dermatitis from mesna. Contact Dermatitis 34:228–229PubMedPubMedCentralCrossRefGoogle Scholar
  6. Bergh M, Menné T, Karlberg AT (1994) Colophony in paper-based surgical clothing. Contact Dermatitis 31:332–333PubMedPubMedCentralCrossRefGoogle Scholar
  7. Berky ZT, Lucianc WJ, James WD (1992) Latex glove allergy: a survey of the US army dental corps. JAMA 268:2695–2697PubMedCrossRefGoogle Scholar
  8. Bernedo N, Garcia M, Gastaminza G et al (2008) Allergy to laxative compound (Plantago ovata seed) among health care professionals. J Investig Allergol Clin Immunol 18:181–189PubMedGoogle Scholar
  9. Bhargava K, White IR, White JM (2009) Thiuram patch test positivity1980–2006: incidence is now falling. Contact Dermatitis 60:222–223PubMedGoogle Scholar
  10. Brans R, Kolomanski K, Mentzel F et al (2016a) Colonisation with methicillin-resistant Staphylococcus aureus and associated factors among nurses with occupational skin diseases. Occup Environ Med 73:670–675CrossRefGoogle Scholar
  11. Brans R, Skudlik C, Weisshaar E et al (2016b) Multicentre cohort study ‘Rehabilitation of Occupational Skin Diseases – Optimization and Quality Assurance of Inpatient Management (ROQ)’: results from a 3-year follow-up. Contact Dermatitis 75:205–2012CrossRefGoogle Scholar
  12. Bruinewoud A, van der Meer E et al (2015) Role models in a preventive program for hand eczema among healthcare workers: a qualitative exploration of their main tasks and associated barriers and facilitators. BMC Dermatol 15:14PubMedPubMedCentralCrossRefGoogle Scholar
  13. Clayton TN, Wilkinson SM (2005) Contact dermatoses in health care workers: reduction in type I latex allergy in a UK Center. Clin Exp Dermatol 30:221–225PubMedCrossRefPubMedCentralGoogle Scholar
  14. Comaish JS, Cunliffe WJ (1967) Absorption of drugs from varicose ulcers. A cause of anaphylaxis. Br J Clin Pract 21:97–98PubMedGoogle Scholar
  15. Conde-Salazar L, Guimaraens D, Romero LV (1988) Dermatosis profesionales en personal sanitario. Graphia, MadridGoogle Scholar
  16. Corazza M, Mantovani L, Trimurti S et al (1994) Occupational contact sensitization to ethylenediamine in a nurse. Contact Dermatitis 31:328–329PubMedPubMedCentralCrossRefGoogle Scholar
  17. Daman L, Lieberman P, Ganier M et al (1978) Localized heat urticaria. J Allergy Clin Immunol 61:273–278PubMedCrossRefGoogle Scholar
  18. Das M, Tandon A (1988) Occupational vitiligo. Contact Dermatitis 18:184–185PubMedCrossRefGoogle Scholar
  19. Daughters D, Zackheim H, Maibach HI (1973) Urticaria and anaphylactoid reactions after topical application of mechlorethamine. Arch Dermatol 107:429–430PubMedCrossRefGoogle Scholar
  20. de Groot AC (1994) Patch testing: test concentration and vehicles for 3700 chemicals. Elsevier Science, AmsterdamGoogle Scholar
  21. Dooms-Goossens A, Gevers D, Mertens A et al (1983) Allergic contact urticaria due to chloramine. Contact Dermatitis 9:319–320PubMedPubMedCentralCrossRefGoogle Scholar
  22. Ebner H, Kraft D (1991) Formaldehyde induced anaphylaxis after dental treatment. Contact Dermatitis 24:307–309PubMedCrossRefGoogle Scholar
  23. Edwards EK (1976) Allergic reactions to benzyl alcohol in a sunscreen. Cutis 28:332–333Google Scholar
  24. Filipe P, Soares-Almeida SL, Guerra-Rodrigo F (1996) Occupational allergic contact dermatitis from cephalosporins. Contact Dermatitis 34:226CrossRefGoogle Scholar
  25. Filon FL, Radman G (2006) Latex allergy: a follow up study of 1040 healthcare workers. Occup Environ Med 63:121–125PubMedPubMedCentralCrossRefGoogle Scholar
  26. Fisher AA (1982) Contact dermatitis from topical medicaments. Semin Dermatol 1:49–57Google Scholar
  27. Fisher AA (1986) Contact urticaria due to cornstarch surgical glove powder. Cutis 38:307–308PubMedGoogle Scholar
  28. Fisher AA (1987) Contact dermatitis in medical and surgical personnel. In: Maibach HI (ed) Occupational and industrial dermatology, 2nd edn. Yearbook Medical Publishers, Chicago, pp 271–281Google Scholar
  29. Foo CC, Goon AT, Leow Y et al (2006) Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome – a descriptive study in Singapore. Contact Dermatitis 55:291–294PubMedCrossRefGoogle Scholar
  30. Fowler JF (1990) Immediate hypersensitivity to acrylic acid. Dermatol Clin 8:193–195PubMedCrossRefGoogle Scholar
  31. Gardner MJ, Coggon D, Pannett B et al (1989) Workers exposed to ethylene oxide: a follow up study. Br J Ind Med 46:860–865PubMedPubMedCentralGoogle Scholar
  32. Gastelain PY, Piriou A (1980) Contact dermatitis due to propanidid in an anesthetist. Contact Dermatitis 6:360CrossRefGoogle Scholar
  33. Gibbon K, McFadden J, Rycroft R et al (2001) Changing frequency of thiuram allergy in healthcare workers with hand dermatitis. Br J Dermatol 144:347–350PubMedCrossRefGoogle Scholar
  34. Gielen K, Goossens A (2001) Occupational allergic contact dermatitis from drugs in healthcare workers. Contact Dermatitis 45:273–279PubMedCrossRefGoogle Scholar
  35. Goday-Buján JJ, Yanguas-Bayona I, Soloeta-Arechavala R (1994) Allergic contact dermatitis from cyanamide: report of 3 cases. Contact Dermatitis 31:331–332PubMedCrossRefGoogle Scholar
  36. Guldager H (1987) Halothane allergy as cause of acne. Lancet 1:1211–1212PubMedCrossRefGoogle Scholar
  37. Halkier-Sørensen L (1996) Occupational skin diseases. Contact Dermatitis 35(Suppl 1):5–43Google Scholar
  38. Hashem CJ, Christina B, Sheretz EF (1997) Is cryotherapy an occupational “contact” hazard for physicians with Raynaud’s disease? Am J Contact Dermat 8:56–57PubMedGoogle Scholar
  39. Haustein UF (1976) Anaphylactic shock and contact urticaria after the patch test with professional allergens. Allerg Immunol 22:349Google Scholar
  40. Hirschowitz BI (1994) The cost of doing business: occupational hazards for endoscopists. Endoscopy 26:559–561PubMedCrossRefGoogle Scholar
  41. Holness DL, Mace SR (2001) Results of evaluating health care workers with prick and patch testing. Am J Contact Dermat 12:88–92PubMedGoogle Scholar
  42. Horio T (1975) Chlorpromazine photoallergy: coexistence of immediate and delayed type. Arch Dermatol 111:1469–1471PubMedCrossRefGoogle Scholar
  43. Ibler K, Jemec G, Diepgen T et al (2012) Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema: randomised clinical trial. Br Med J 345:e7822CrossRefGoogle Scholar
  44. Kampf G, Loffler H (2003) Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection. J Hosp Infect 55:1–7CrossRefGoogle Scholar
  45. Kanerva L, Jolanki R, Estlander T (1987) Organic pigment as a cause of plastic glove dermatitis. Contact Dermatitis 134:95–97Google Scholar
  46. Kavli G, Angell E, Moseng D (1987) Hospital employees and skin problems. Contact Dermatitis 17:156–158PubMedCrossRefGoogle Scholar
  47. Key MM (1961) Some unusual allergic reactions in industry. Arch Dermatol 83:3–6PubMedCrossRefGoogle Scholar
  48. Kiec-Swierczynska M (1996) Occupational allergic contact dermatitis in Lodz: 1990–1994. Occup Med (Oxf) 46:205–208CrossRefGoogle Scholar
  49. Kosákavá M (1977) Sub-Schock bei der epikutanprobe mit chloramphenicol. Berufsdermatosen 25:134–135Google Scholar
  50. Kucenic M, Belsito D (2002) Occupational allergic contact dermatitis is more prevalent than irritant contact dermatitis: a 5-year study. J Am Acad Dermatol 46:698–699CrossRefGoogle Scholar
  51. Lachapelle JM, Reginster JP (1977) Occupational contact dermatitis from an ampholytic soap (TEGO). Contact Dermatitis 3:211–212PubMedCrossRefGoogle Scholar
  52. Lagier F, Vervloet D, Lhermet I et al (1992) Prevalence of latex allergy in operating room nurses. J Allergy Clin Immunol 90:319–322PubMedCrossRefGoogle Scholar
  53. Lahti A (1980) Nonimmunologic contact urticaria. Thesis, Universities of Oulu and HelsinkiGoogle Scholar
  54. Lammintausta K, Kalimo K, Havu VK (1982) Occurrence of contact allergy and hand eczemas in hospital wet work. Contact Dermatitis 8:84–90PubMedCrossRefGoogle Scholar
  55. Levene GM, Withers AF (1969) Anaphylaxis to streptomycin and hyposensitization (parasentitization). Trans St Johns Hosp Dermatol Soc 55:184PubMedGoogle Scholar
  56. Lombardi P, Gola M, Acciai MC et al (1989) Unusual occupational allergic contact dermatitis in a nurse. Contact Dermatitis 20:302–316CrossRefGoogle Scholar
  57. Mahler V (2007) Skin protection in the healthcare setting. Curr Probl Dermatol 34:120–132PubMedCrossRefGoogle Scholar
  58. Malik M, English J (2015) Irritant hand dermatitis among health care workers. Occup Med 65:474–476CrossRefGoogle Scholar
  59. Marks JG (1982) Allergic contact dermatitis to povidone-iodine. J Am Acad Dermatol 6:473–475PubMedCrossRefGoogle Scholar
  60. Martin-Pascual A (1987) Dermatoses de las profesiones sanitarias. In: Garcia-Perez A, Conde-Salazar L, Gimenez-Camaraso JM (eds) Tratado de Dermatosis Profesionales. Euderma, Madrid, pp 365–370Google Scholar
  61. Mathelier-Fusade P, Leynadier F (1994) Occupational allergic contact reaction to disulfiram. Contact Dermatitis 31:121–122CrossRefGoogle Scholar
  62. Maucher OM (1972) Anaphylaktische reaktionen biem epicutan-test. Hautarzt 23:139–140PubMedGoogle Scholar
  63. McCormick R, Buchman TL, Maki D (2000) Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers. Am J Infect Control 28:302–310PubMedPubMedCentralCrossRefGoogle Scholar
  64. Meseguer J, Sastre A, Malek T et al (1993) Systemic contact dermatitis from isoniazid. Contact Dermatitis 28:110–111PubMedCrossRefGoogle Scholar
  65. Meyer JD, Chen Y, Holt DL et al (2000) Occupational contact dermatitis in the UK: a surveillance report from EPIDERM and OPRA. Occup Med 50:265–273CrossRefGoogle Scholar
  66. Morelli R, Piancastelli E, Lanzarini M et al (1989) Occupational contact dermatitis from pyrocatechol. Contact Dermatitis 21:201–202PubMedCrossRefGoogle Scholar
  67. Nagendran V, Wicking J, Ekbote A et al (2009) IgE-mediated chlorhexidine allergy: a new occupational hazard. Occup Med 59:270–272CrossRefGoogle Scholar
  68. Nater JP, de Groot AC (1985) Unwanted effects of cosmetics and drugs used in dermatology, 2nd edn. Elsevier, AmsterdamGoogle Scholar
  69. Nettis E, Colonardi M, Soccio A et al (2002) Occupational irritant and allergic contact dermatitis among healthcare workers. Contact Dermatitis 46:101–107PubMedCrossRefGoogle Scholar
  70. Nilsson E, Mikaelsson B, Andersson S (1985) Atopy, occupational and domestic work as risk factors for hand eczema in hospital workers. Contact Dermatitis 13:216–223CrossRefGoogle Scholar
  71. Nutter AF (1979) Contact urticaria to rubber. Br J Dermatol 101:597–598PubMedCrossRefGoogle Scholar
  72. Okamoto H, Kawai S (1991) Allergic contact sensitivity to mydriatic agents on a nurse’s finger. Cutis 47:357–358PubMedGoogle Scholar
  73. Ophaswongse S, Maibach HI (1994) Alcohol dermatitis: allergic contact dermatitis and contact urticaria syndrome: a review. Contact Dermatitis 30:1–6CrossRefGoogle Scholar
  74. Pabst R (1987) Exposure to formaldehyde in anatomy: an occupational health hazard? Anat Rec 219:109–112PubMedCrossRefGoogle Scholar
  75. Papa CM, Shelley WB (1964) Menthol hypersensitivity. Diagnostic basophil response in a patient with chronic urticaria, flushing and headaches. JAMA 189:546–550PubMedCrossRefGoogle Scholar
  76. Reunala T, Alenius H, Turjanmaa K et al (2004) Latex allergy and skin. Curr Opin Allergy Clin Immunol 4:397–401PubMedCrossRefGoogle Scholar
  77. Rose RF, Lyons P, Horne H et al (2009) A review of the materials and allergens in protective gloves. Contact Dermatitis 61:129–137PubMedCrossRefGoogle Scholar
  78. Rothe A, Yousif SH, Zschunke E (1977) Allergic contact eczema from sodium amidotrizoate – a radiopaque substance in angiography and renography. Contact Dermatitis 3:284–286PubMedCrossRefGoogle Scholar
  79. Rudzki E, Rebandel P, Grzywa Z (1989) Patch tests with occupational contactants in nurses, doctors and dentists. Contact Dermatitis 20:247–250CrossRefGoogle Scholar
  80. Rustemeyer T, Pilz B, Frosch PJ (1994) Contact allergies in medical occupations. Hautarzt 45:834–844CrossRefGoogle Scholar
  81. Ryan ME, Davis BM, Marks JG (1980) Contact urticaria and allergic contact dermatitis to benzocaine gel. J Am Acad Dermatol 2:221–223PubMedCrossRefGoogle Scholar
  82. Schnuch A, Uter W, Geier J et al (1998) Contact allergies in healthcare workers. Results from the IVDK. Acta Derm Venereol 78:358–363PubMedCrossRefGoogle Scholar
  83. Schwensen J, Menne T et al (2016) Contact allergy in Danish healthcare workers: a retrospective matched case-control study. Acta Derm Venereol 96:237–240PubMedPubMedCentralCrossRefGoogle Scholar
  84. Sertoli A, Francalanci S, Acciai MC et al (1999) Epidemiological survey of contact dermatitis in Italy (1984–1993) by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). Am J Contact Dermat 101:18–30Google Scholar
  85. Skoet R, Olsen J, Mathiesen B et al (2004) A survey of occupational hand eczema in Denmark. Contact Dermatitis 51:159–166CrossRefGoogle Scholar
  86. Slotosch C, Kampf G, Löffler H (2007) Effects of disinfectants and detergents on skin irritation. Contact Dermatitis 57:235–241PubMedPubMedCentralCrossRefGoogle Scholar
  87. Smit HA, Burdorf A, Coenraads PJ (1993) Prevalence of hand dermatitis in different occupations. Int J Epidemiol 22:288–293PubMedCrossRefGoogle Scholar
  88. Smit HA, van-Rijssen A, Vandenbroucke JP et al (1994) Susceptibility to and incidence of hand dermatitis in a cohort of apprentice hairdressers and nurses. Scand J Work Environ Health 20:113–121PubMedCrossRefGoogle Scholar
  89. Smith JD, Odom RB, Maibach HI (1975) Contact urticaria from cobalt chloride. Arch Dermatol 111:1610–1611PubMedCrossRefGoogle Scholar
  90. Soper LE, Vitez TS, Weinberg D (1973) Metabolism of halogenated anesthetic agents as a possible cause of acneiform eruptions. Anesth Analg 52:125–127PubMedCrossRefGoogle Scholar
  91. Stingeni L, Lapomarda V, Lisi P (1995) Occupational hand dermatitis in hospital environments. Contact Dermatitis 33:172–176PubMedCrossRefGoogle Scholar
  92. Suneja T, Belsito D (2008) Occupational dermatoses in health care workers evaluated for suspected allergic contact dermatitis. Contact Dermatitis 58:285–290PubMedCrossRefGoogle Scholar
  93. Szczurko C, Dompmartin A, Michel M et al (1996) Occupational contact dermatitis from propacetamol. Contact Dermatitis 35:299–301CrossRefGoogle Scholar
  94. Temesvári E, vonSoos G, Podányi B et al (1978) Contact urticaria provoked by balsam of Peru. Contact Dermatitis 4:65–68PubMedCrossRefGoogle Scholar
  95. Tuft L (1975) Contact urticaria from cephalosporins. Arch Dermatol 111:1609–1611PubMedCrossRefGoogle Scholar
  96. Turjanmaa K (1987) Incidence of immediate allergy to latex gloves in hospital personnel. Contact Dermatitis 17:270–275PubMedCrossRefGoogle Scholar
  97. Valsecchi R, Leghissa P, Cortinovis R et al (2000) Contact urticaria from latex in healthcare workers. Dermatology 201:127–131PubMedCrossRefGoogle Scholar
  98. van der Meer E, van der Gulden J et al (2015) Barriers and facilitators in the implementation of recommendations for hand eczema prevention among healthcare workers. Contact Dermatitis 72:325–336PubMedPubMedCentralCrossRefGoogle Scholar
  99. van Ketel WG, Tan-Lim KN (1975) Contact dermatitis from ethanol. Contact Dermatitis 1:7–10PubMedCrossRefGoogle Scholar
  100. Warshaw E, Schram S, Maibach HI et al (2008) Occupation-related contact dermatitis in North American health care workers referred for patch testing: cross sectional data, 1998–2004. Dermatitis 191:261–274CrossRefGoogle Scholar
  101. Wasilewski C (1968) Allergic contact dermatitis from isopropyl alcohol. Arch Dermatol 98:502–504PubMedCrossRefGoogle Scholar
  102. Weisshaar E, Radulescu M, Bock M et al (2006) Educational and dermatological aspects of secondary individual prevention in health care workers. Contact Dermatitis 54:254–260CrossRefGoogle Scholar
  103. Williams J, Lee AY, Matheson MC et al (2008) Occupational contact urticaria: Australian data. Br J Dermatol 159:125–131CrossRefGoogle Scholar
  104. Wilson HTH, Cronin E (1971) Dermatitis from dyed uniform. Br J Dermatol 85:67–69CrossRefGoogle Scholar
  105. Zabala R, Aguirre A, Eizaguirre X et al (1993) Contact dermatitis from potassium chloride. Contact Dermatitis 29:218–219PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rasika Reddy
    • 1
    • 4
    Email author
  • Howard I. Maibach
    • 2
  • Donald V. Belsito
    • 3
  1. 1.Department of DermatologyVeterans Affairs Medical CenterSan FranciscoUSA
  2. 2.Department of DermatologyUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of DermatologyColumbia University College of Physicians and SurgeonsNew YorkUSA
  4. 4.UT Southwestern Medical Center in DallasTexasUSA

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