Occupational Illnesses Major, Under-reported Problem

Tinker Ready

June 18, 2019

MILAN — Occupational health hazards are common and can result in job loss and even cancer, but are under-reported around the world, specialists warned here at the World Congress of Dermatology 2019.

People need to be made aware of the magnitude of the problem and its impact on quality of life, explained Swen Malte John, MD, PhD, from Osnabrück University in Germany.

It is estimated that more than 13 million workers in the United States are potentially exposed to chemicals that can be absorbed through the skin. Contact dermatitis is one of the most common types of occupational illness, with estimated annual costs exceeding $1 billion, according to the Centers for Disease Control and Prevention.

In most European countries, skin diseases make up about 40% of all occupational diseases reported, a position paper on the topic that John coauthored reports (J Eur Acad Dermatol Venereol. 2017;31[Suppl 4):31-43). The conditions range in severity and scope from raw hands in healthcare workers and cooks to skin problems related to sun exposure in farm and construction workers.

However, if you look at the official statistics from other countries, cases are rarely reported. In a survey of Eastern European countries that John was involved in, for example, only 10 cases of occupational skin diseases were reported in 2014 in Romania (J Eur Acad Dermatol Venereol. 2017;31[Suppl 4]:5-11).

When politicians review these under-reported statistics, they suggest there is no problem, John explained. But if you ask dermatologists in some of these countries, many report they see 10 cases a day, he added.

"Most people who have not had skin problems may not think it's important," John told Medscape Medical News. "But if you have skin that bleeds whenever you touch anything, you can't button your shirt without difficulty, and no one wants to be touched by you, it is a problem."

In Germany, there is an incentive program for doctors who report cases and effective prevention programs, he explained.

Skin Cancer and Contact Dermatitis

Skin cancer is just one of the occupational skin diseases faced by workers employed as farmers or field hands in the agricultural industry in India, said Kaushal Verma, MD, from the Institute of Medical Sciences in New Delhi.

In addition, contact dermatitis can affect construction workers who handle concrete and field workers who apply pesticides and herbicides without proper protective gear, he reported. Dermatitis can also develop after airborne exposure to pollen from parthenium, a common invasive weed in India.

Many times, these conditions go undiagnosed in India, said Verma. But even when people are treated, they are exposed again as soon as they return to work.

Fathima Hasmiya, MD, a dermatologist in Columbo, Sri Lanka, said she sees many patients with dermatitis related to parthenium exposure.

These patients are difficult to treat and facilities in Sri Lanka are limited, she told Medscape Medical News. Many affected people do not come forward and the ones who do are often afraid that their condition will be reported and they will lose their jobs.

The need for reporting and awareness is understandable, said Rosella Gallo, MD, from the University of Genoa in Italy. However, she pointed out, the reporting process, which requires the completion of multiple forms that have to be sent different institutions is too time-consuming.

"I'm focused on the patient's diagnosis, and if I report, the patients don't benefit," she explained.

A possible "game changer" is the upcoming ICD-11 revision, which will give clinicians more coding options for occupational ski diseases, said John, who added that he understands patient fears about reporting and being overwhelmed by paperwork.

Anonymous reporting could protect workers but still get data to the authorities, he suggested.

In the end, he pointed out, reporting will help patients on a wider scale, "not just individuals."

John, Verma, Hasmiya, and Gallo have disclosed no relevant financial relationships.

World Congress of Dermatology (WCD) 2019. Presented June 12, 2019.

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