Dermatitis: The nurse’s allergy

Does the skin on your hands frequently feel dry and irritated? You’re not alone. Nursing has long been recognized as a profession at high risk for allergic contact dermatitis.

According to a 2007 study published by the American Contact Dermatitis Society, more than 50 percent of inpatient nurses at U.S. hospitals suffer from hand dermatitis. Symptoms range from mild redness, irritation and itching to swelling, scaling, blistering and fissuring of the skin.

Why Does Hand Dermatitis Target Nurses?
There are three main environmental factors that play a role in making nursing so hard on your hands:

1. Frequent hand washing is mandatory in hospitals to limit infection. Constant wetting tends to disrupt the protective barrier of the skin. This porosity allows allergens and irritants to penetrate below the skin’s surface, triggering an autoimmune response.

2. Soaps used in hand washing as well as alcohol-based hand sanitizing agents both greatly increase skin dryness. They may also put skin pH out of balance.

3. Chemical additives used in the production of latex gloves often cause a “Type IV” chemical sensitivity reaction (a rash that is not as severe as the allergic response to latex itself). As many as one in four healthcare professionals have this Type IV response to latex products.

You’ve Got a Real Problem on Your Hands
Hand dermatitis is troubling for a number of reasons. First, as a nursing professional, you are expected to work with your hands throughout your shift. Cracked skin can make hand movement painful. Second, you are working in an occupation where bacterial infection is a significant risk—having a compromised skin barrier is bad news. Finally, once you become sensitized to an allergen or chemical irritant, this problem is likely to last a lifetime. If there’s no way to avoid a particular substance in your work environment, you may end up having to treat symptoms without really eliminating the root problem of your hand rash.

Basic Skin Care
There’s no getting around the need for frequent hand cleansing if you work around sick people all day. Data about which cleanser is more likely to cause a dermatitis reaction—S&W (soap and water) or ABC (alcohol-based cleansers)—is unclear. But if you find that one method tends to cause less irritation than the other, you can adjust your hand sanitation routine accordingly. Use warm water rather than hot water for hand washing and pat your hands dry gently.

Keep a small tube of fragrance-free hand moisturizer in your scrubs pocket and use a little every time you wash your hands. If you experience severe or chronic hand dermatitis, consider adding a topical corticosteroid cream to your hand care routine. According to a recent Australian study, daily use of mild topical steroids in sufficient quantities to fully control eczema symptoms is safe over the long term—even for kids. Use these products as directed by your physician and you should be fine.

Making the Switch
What about latex? Obviously, if you’re having a reaction to latex gloves, you’ll want to use non-latex ones from now on. Just remember: Even if you’re not wearing latex, powdered latex gloves can distribute potentially harmful chemicals throughout the workplace. The latex leaches into the cornstarch and becomes airborne in those little puffs of powder that are released whenever disposable gloves are donned or removed. Airborne latex molecules can increase your daily exposure and make your systemic reaction worse over time.

You need to talk with your hospital administrator about what your coworkers are wearing so you can share your concerns. Ideally, this will prompt the entire facility to make the switch to non-latex gloves. We assure you, other nurses with latex allergies will be grateful!

You may also be interested in:

• The Scrubs Allergy Tool: Do you know all the allergens you’re exposed to every day?
• The Scrubs Allergy Quiz: Challenge yourself: can you identify these allergy symptoms?