Skin Problems in Food Handlers

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OHA (Occupational Health Awareness) Health Talk for Catering Crews in Barges. 

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Food handlers may suffer from:

  • Irritant hand dermatitis.
  • Allergic contact dermatitis.
  • Contact urticaria.
  • Protein contact dermatitis.
  • Hand infections.

Why do food handlers have skin problems?     

Hand dermatitis in food handlers is caused by four main factors:

  • Exposure to irritants e.g. repeated contact with water and detergents; prolonged glove wearing; irritating food juices.
  • —Exposure to allergens: e.g. antimicrobial chemicals.
  • —Extreme changes of environmental and surface temperature.
  • —Pre-existing sensitive skin or atopic dermatitis (eczema).

Food Safety Standards require food handlers to wash their hands whenever handling food to avoid contamination of the food with harmful bacteria.

—A wet work occupation is one where the skin is wet for more than 2 hours a day in total, or the hands are washed more than 20 times a day.

Soaps and detergents strip the surface of the skin weakening its barrier properties.

Antimicrobial chemicals used in the food industry

The following chemicals can cause severe irritation or chemical burns to the skin when used in concentrated solutions or with repeated or prolonged exposure.

  • —Chlorine releasing (sodium hypochlorite)
  • —Iodine based (iodophor)
  • —Quaternary ammonium compounds (quat)
  • —Peroxyacetic acid (peracetic acid)
  • —Acid-anionic
  • —Alcohols (70% isopropyl alcohol)

Chemicals used for food preservation include:

  • —Organic acids
  • —Sorbic acid
  • —Benzoic acid
  • —Calcium propionate
  • —Nitrates
  • —Antibiotics
  • —Aldehydes

—Food irritants and allergens

Foods can be chemical or physical irritants. For example, they may be acidic, e.g. citrus fruit, or have sharp fibres, e.g. the skin of kiwifrit.

—Proteins in food may cause skin reactions in susceptible individuals, leading to allergic contact dermatitis or contact urticaria.

CHANGES IN TEMPERATURE

HEAT may result in:cover

  • —Thermal burn.
  • —Over hydration of the barrier layer of the skin through sweating
  • —Potentiating of irritant damage to the skin.

COLD may result in:

  • Cold injury (frostbite, chilblains)
  • Dry skin due to increased trans epidermal water loss when the skin warms up, and delayed barrier recovery.

SKIN CONDITIONS IN FOOD HANDLERS 

1. IRRITAN CONTACT DERMATITIS

Irritant contact dermatitis occurs when physical and/or chemical damage to the barrier layer of the skin exceeds the skin’s ability to repair the damage. Examples include : —repeated hand washing; and exposure to cold wet conditions in the fish-processing industry.

2. ALLERGIC CONTACT DERMATITIS 

 

—Allergic contact dermatitis is an immunological response to an allergen. Only people who are allergic to a specific agent (the allergen) will show symptoms.

  • —Nickel allergy is the most common form of allergic contact dermatitis in food handlers and others.
  • —Other common contact allergens that food handlers are exposed to include:
  • Rubber accelerators in rubber glove
  • Food preservatives
  • Fragrances and perfumes
  • Naturally occurring chemicals in foods such as mangoes and figs or garlic, onions and many other plants.

3. CONTACT URTICARIA

There are some specific features of contact urticaria :

  • —Rash occurs within a few minutes to one hour after exposure.
  • —Wheals may be localized to the site of contact, or occasionally, generalized over the whole body.
  • —Severe itchy can range from mild to severe.
  • —Usually symptoms disappear within one hour, and nearly always within 24 hours.
  • —Contact urticaria can be confirmed by prick testing, or variations on this such as scratch-patch testing, or by RAST testing if the response is immunological mediated, e.g. latex.

Many raw foods can cause contact urticaria, including:

Urticaria

Urticaria

  • —Vegetables:  carrots, onion, garlic, celery
  • —Fruits and Nuts: kiwifruit , bananas, tomatoes, berries and tree nuts (e.g. cashew)
  • —Legumes : peanuts
  • —Fish and shellfish: shrimp, lobster and crab
  • —Food preservatives, additives, emulsifiers, flavourings and fragrances
  • —Meat : commonly beef, pork and processed meats
  • —Dairy products: milk, cream and cheese
  • —Eggs
  • —Spices :  cinnamon , vanilla, paprika and mace
  • —Herbs : mint, parsley, chives and thyme
  • —Bakery products: wheat and soy.

4. HAND INFECTIONS

Bacterial infection (impetigo, boils and folliculitis) is usually caused by Staphylococcus aureus and/or Streptococcus pyogenes.

  • —Food handlers with bacterial skin infections should remain on leave until the infection has resolved, to avoid bacterial contamination of the food
  • —Hand dermatitis and wet work also predispose to yeast infection, usually presenting as chronic paronychia infected by Candida albicans, or as intertrigo between the fingers (also called erosio interdigitalis blastomycetica).
  • Workers in the meat, poultry and fish processing industries have an increased risk of warts, with human papilloma virus type 7 being responsible for the excess.

TREATMENT OF OCCUPATION SKIN DISEASES

If a food handler has developed hand dermatitis, they may be advised to:

  • —Minimise contact with irritants (water, detergents etc.)
  • —Avoid known allergens – identifying these will require a full history of the work and appropriate allergy tests
  • —Optimize skin barrier function with suitable emollients, barrier and moisturizing creams applied frequently during work and at home
  • —Apply potent topical corticosteroids to dermatitis flare-ups
  • —Take antibiotics for secondary infection.
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Food Handler Skin Problem

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