Occupational skin problems in construction workers.

BACKGROUND: Construction workers handle cement which has constituents to produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients, such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients, such as chromium). AIM: The present study has been carried out among unorganized construction workers to find the prevalence of skin problems.
MATERIALS AND METHODS: The present cross-sectional study was conducted in 92 construction workers of Ahmedabad and Vadodara. RESULTS AND DISCUSSION: All the workers were subjected to clinical examination after collection of information regarding demographic characteristics, occupational characteristics and clinical history on a predesigned proforma. Of them, 47.8% had morbid skin conditions. Frictional callosities in palm were observed in 18 (19.6%) subjects while 4 (4.3%) subjects had contact dermatitis. Other conditions included dry, fissured and scaly skin, infectious skin lesion, tinea cruris, lesion and ulcers on hands and/or soles.
CONCLUSION: The skin conditions were common in the age group of 20-25 years, males, those having ≥1 year exposure and those working for longer hours. Half of the workers not using personal protective equipment had reported skin-related symptoms.

Introduction

Construction industry is one of the stable growing industries world over, including India. It is basically a labor-intensive industry. It employs a considerable proportion of population. The construction workers usually belong to poor socioeconomic strata and thus lack the basic amenities. Apart from this, most of the construction projects or sites where these workers are employed are unorganized in nature. Thus, these sites are often not guided by the legislations made for the health and welfare of the workers.

Construction workers perform a large variety of duties concerned with building, repairing and wrecking buildings, bridges, dams, roads, railways, and so on. The work may include mixing, pouring and spreading concrete, asphalt, gravel and other materials. Despite the increasing mechanization of construction and the more frequent use of pre-cast concrete sections, contact with wet cement still occurs, particularly in small jobs. The work is hard physical labor, often under difficult conditions, including hot, cold, and wet weather. Occupational diseases of the skin in the construction have paralleled industrial development.[1]

Cement and concrete are products used widely in the construction sector, with a traditional perception that any hazards that they have are limited to dermatitis in a small number of workers. In some cases, employers and builders do not think that concrete is a chemical. However, contact dermatitis is one of the most frequently reported health problems among the construction workers. A review of the available literature suggests that cement has constituents that produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients such as chromium).[2]

Though a number of studies have been carried out to find the respiratory health problems among these workers,[3-5] very few studies, particularly from India, have been reported on the different skin problems among these workers. These skin conditions usually include contact dermatitis, friction callosity, cement burns, etc. With this background, the present study has been carried out among unorganized construction workers to find the prevalence of skin problems.

Materials and Methods

The present cross-sectional study was conducted on the workers employed at different construction sites in Ahmedabad and Vadodara. After approval from Institutional Ethics Committee, the project was started with obtaining an informed consent from the participants. Randomly selected 92 study subjects were included in the study during the study period 20-31 May 2005. Using the interview technique for data collection, the information regarding demographic characteristics, occupational characteristics and clinical history was recorded on a predesigned proforma. This was followed by detailed clinical examination of each subject with particular emphasis on the skin examination.

The questionnaire for assessment of skin problems included questions on pain/itching at the site of lesion, its relation with the work process, use of any personal protective device during work, use of any medication for the lesion and detailed features of the skin lesions. Standard diagnostic definitions were used to diagnose different skin conditions. The following definitions were used for the present study:

Frictional callosity

It is thickened reactionary growth in skin, caused due to friction. Skin of palms had become thick and dry. It was near knuckles over palmar aspects.[6]

Contact dermatitis

The subjects complaining of redness, itching, pain at the site of the contact with the cement or the subjects complaining of itching due to rubber gloves were involved.[7]

Fissured skin

Presence of cracks in the continuity of skin leading to fissure formation.[6]

Infectious skin diseases

Based on the clinical features.[8]

Ulcer

Subjects with the loss of full thickness of epidermis.[8]

Statistical analysis included calculation of percentages and proportions using statistical software package SPSS version 15.0.

Results

The present study included 56 (60.9%) male and 36 (39.1%) female construction workers. Majority of the subjects were in the age group 20-25 years, which included 27 (29.3%) of the subjects while only 6 (6.5%) subjects were in the age group 30-35 years. The mean age of the male subjects was 26.48±11.15 years while that for females was 24.81±7.57 years. The overall mean age of the study subjects was found to be 25.83±9.89 years.

It was found that 36 (39.1%) of the workers were involved in this occupation for more than 6 years while only 10 (10.9%) had joined this occupation recently and had work experience of less than 1 year. The mean duration of exposure was 6.58±0.73 years. Most of the workers were working for 8-10 hours per day and the mean daily working hours was found to be 8.18±0.65 hours.

Only 42 (45.7%) of the subjects were using one or the other personal protective devices. Majority of them [42 (83.3%)] were using gloves as the hands were the most common body part coming in contact with the sand and cement mixture. Other personal protective devices used by the workers included boots, gloves along with boots, cap and finger toti.

Table 1 shows the distribution of study subjects according to the skin-related symptoms. The skin-related symptoms were present in 44 (47.8%) of the subjects while 48 (52.2%) subjects were free from any skin-related symptom. Only two subjects had itching and pain at the site of lesion. The lesions were commonly present on the upper extremity where it involved the hands and forearms the most. Lesions on other body parts like neck, chest and abdomen were also noticed in one subject each. When asked about the relation of the symptoms to work, 86.4% of the subjects having symptoms related it to their work while 84.1% also mentioned that these symptoms got aggravated by work.

Table 1

Distribution of skin symptoms and its relation to work

Table 2 describes the morbid skin conditions among the study subjects. Eighteen (19.6%) of the subjects had frictional callosities in their palm. Contact dermatitis was observed in 4 (4.3%) subjects. Dry, fissured and scaly skin was observed in 10 (10.9%) of the subjects while 2 (2.2%) of the subjects were having skin disease of infectious origin, which included tinea cruris infection. Other conditions like ulcers on hands and/or soles, molluscum etc. were observed in 10 (10.9%) of the subjects. Forty-eight (52.2%) of the subjects were free from any skin disorder.

Table 2

Distribution of study subjects according to morbid skin conditions

Table 3 depicts the distribution of presence of morbid skin conditions according to different epidemiologic factors. Two-thirds of the subjects in the age group 25-30, 30-35 and ≥40 years were having symptoms. Also, 62.5% of the males were having symptoms while only 25% females had symptoms. Only one-third of the subjects having <1 year exposure had symptoms, while about half of the subjects who had ≥1 year exposure reported skin-related symptoms. It was also seen that 43.7% of the subjects working for 8-10 hours had symptoms, while 75% of those working for more than 10 hours daily had symptoms. The symptoms were present in 45.2% of those using Personal Protective Equipments (PPE) while in those who were not using PPE, 50% had reported skin-related symptoms.

Table 3

Distribution of morbid skin conditions according to epidemiologic factors

Discussion

The present cross-sectional study includes 56 (60.9%) males and 36 (39.1%) females. The mean age of the male subjects was 26.48 11.15 years while that for females was 24.81±7.57 years. The overall mean age of the study subjects was found to be 25.83±9.89 years. This suggests that the subjects are quiet young and if they suffer from skin conditions at this young age they have to live life with it, which results in cosmetic, social and health problems.

Almost all the subjects belonged to upper lower and lower socioeconomic strata of modified Kuppuswamy's scale.[9] This affects their capacity to go for the treatment of their conditions and thus often they neglect their lesion and leave it as it is. This results in further progress of the conditions to a stage where prognosis can be poor. High level of illiteracy affects their knowledge regarding the usefulness of personal protective devices for the prevention of skin conditions and their proper care, once the lesions develop. It was found that majority of those who had some education were using PPE as compared to those who were illiterate.

The mean duration of exposure was 6.58±0.73 years while the mean daily working hours were found to be 8.18±0.65. This suggests that the workers have sufficient exposure to develop the skin conditions.

The use of PPE was also present in only 45.7% of the subjects who were using one or the other personal protective devices and, among these, majority were using gloves as the hands were the most common body part coming in contact with the sand and cement mixture.

The lesions were commonly present on the upper extremity where it involved the hands and forearms the most. Lesions on other body parts like neck, chest and abdomen were also noticed. Majority of the subjects having lesion mentioned that it was work related and also aggravated by work.

In the present study, the common skin disorders reported include friction callosities in the palm in 19.6%, contact dermatitis in 4.3% and dry, fissured and scaly skin in 10.9% of the subjects. Contact dermatitis is more likely to be irritant contact dermatitis as none of the workers reported positive past or family history of atopy. Other studies have also reported the cases of contact dermatitis in construction workers.[10-13] Two-thirds of the subjects in the age group 25–30, 30–35 and ΃40 years were having symptoms. This may be attributed to their long duration of exposure. Also, 58.9% of the males and only 22.2% females had symptoms. This can be due to the reason that firstly there were less number of females involved, secondly females are usually employed in the operations like load lifting rather than mixing of cements and sands which are mostly done by males and thirdly due to the social norms like the dress of females, usually saris, act as a protective clothing, whereas in males most of the body parts are exposed to the ill effects of cement and its mixture. Both the increased duration of work and more daily working hours were found to be associated with more morbid skin conditions. Similarly, less number of PPE users was affected than those not using PPE.

Thus, it is recommended that these workers should be should be provided some social security schemes with good occupational health services. Properly maintained and correctly used gloves are very effective means to prevent occupational skin diseases. Health education should be provided to practice good personal hygiene. It should also give emphasis on the regular use and maintenance of personal protective devices.

The small sample size is the major limitation of the study. Therefore, generalization of the results should be with caution. Also, diagnosis of the diseased conditions is purely based on clinical examination. However, this study was done only to know the pattern of morbid skin conditions. Further studies with detailed investigations are recommended.