MOJ ISSN: 2379-6383MOJPH

Public Health
Research Article
Volume 2 Issue 2 - 2015
Occupational Dermatitis among the Hair Dressers of Selected Area of Dhaka City
MD Saiful Islam1, Mesbah Uddin Ahmed2*, Abu MD Ahsan Firoz3, Muhammad Foyez Ullah4, Rubaiyat-E- Mortaz5 and M H Faruquee6
1Medical Officer, Clinical Pathology Department, BSMMU
2MS in Microbiology, Bangladesh University of Health Sciences (BUHS)
3,4Medical Officer, Dermatology & Venereology Department, BSMMU
5Research Assistant, Clinical Pathology Department, BSMMU
6Assistant Professor, Department of Public Health, State University of Bangladesh
Received: March 03, 2015 | Published: March 26, 2015
*Corresponding author: Mesbah Uddin Ahmed, MS in Microbiology, Bangladesh University of Health Sciences (BUHS), Bangladesh, Tel: +8801712191479; Email: @
Citation: Islam MDS, Ahmed UM, Firoz AMDA, Ullah FM, Mortaz ER, et al. (2015) Occupational Dermatitis among the Hair Dressers of Selected Area of Dhaka City. MOJ Public Health 2(2): 00018. DOI: 10.15406/mojph.2015.02.00018

Abstract

Background: Dermatitis among hairdressers has been recognized as a significant occupational health problem.
Objective: To assess occupational dermatitis among the hair dressers of selected area of Dhaka city was aim of this study.
Methodology: This was a cross sectional observational study conducted among randomly selected 116 hair dressers.
Results: Mean age was 26.69±8.565 years. Among them 65.5% had primary level of education. About 62.1% had BDT within 10000 and rest had more than BDT 20000. Mean working duration was 10.53±7.47 years. It was reported that majority 42.2% of the respondents had to serve up to ten clients per day, 26.8% served 11-15 clients and 31% had to serve more than 15 clients per day. Result found 76.7% had dermatitis lesions in their hands. Dry scaly plaque was found among 43.8% cases followed by hyper pigmentation (39.3%), erythematous plaque (11.2%) and vesicle & patch (5.6%). Lesions appeared mostly on lateral side of middle finger (71.9%), index finger (18%) and index & middle finger (10.1%). Significant association was found between dermatitis and duration of work (p<0.05).
Conclusion: Promotion of use of protective gloves among the hair dressers and further research is needed to explore the specific etiological factors of hairdresser's dermatitis.

Keywords: Dermatitis; Hair dresser

Introduction

Occupational hand dermatitis among hairdressers has been recognized as a significant health concern [1]. Hairdressers belong to an occupational group that is commonly affected by occupational skin disease, specifically contact dermatitis, which may be allergic or irritant and, less commonly, contact urticaria. Occupational contact dermatitis predominantly affects apprentices, and atrophy is a recognized risk factor associated with a poor prognosis. Repetitive wet work leading to irritant contact dermatitis, followed by exposure to allergens and the development of allergic contact dermatitis, are the main factors contributing to occupational contact dermatitis. Once developed, it is often difficult to manage and is a cause of significant morbidity [2]. Numerous data from the medical literature show that working as a hairdresser is associated with the highest risk of occupational contact dermatitis. In Europe, hairdressers rank first of all occupation groups with the highest prevalence of occupational dermatitis. It is estimated that 10-20% and even 50% of hairdressers are affected with skin disorders. Skin problems occur soon after commencing hairdressing, in the first 2 years of work, sometimes during vocational training. The most common factors contributing to skin damage include water, shampoos, detergents, conditioners, hair dyes, bleaches, permanent wave solutions and components of gloves [3]. Occupational dermatitis is a well-known problem among hairdressers, as either irritant contact dermatitis or allergic contact dermatitis, or often a combination of both. Hairdressers are exposed to extensive wet work that can cause irritant contact dermatitis, and they have daily skin contact with innumerable cosmetic products containing compounds that are known to cause contact allergy. In Britain, hairdressers and barbers are in the top three occupational groups in terms of prevalence of dermatitis [4]. Traditional and low-income hair dresser/Barbers in Bangladesh carry on their existence by providing shaving and hairdressing service in the bazaar and in the street-side, commonly known as Saloon. Most of them have to use shaving cream/foam/gel and hair dressing instruments. Most of the time they keep their hand wet which may help in developing dermatitis. No such information related to occupational dermatitis among hairdressers in Bangladesh available.

Methodology

This was a cross-sectional observational study. Study was conducted among 116 hair dressers in Dhaka city. Simple random sampling technique was adopted in the study. The Following steps were taken to obtain the sample:
  1. 1st step: Dhaka North City Corporation has 36 wards, Ward-9 (Shewrapara) was selected by lottery system
  2. 2nd step: A list of hair dressing salons of the ward was made by road-to road survey
  3. 3rd step: All (a total 39) hair dressing salons of the ward were include in the study
  4. In each salon, there was 2-4 hair dresser
All were included in this study. Data were collected from the respondents through face-to-face interview. After data collection, data were sent to the researcher, which was sorted, scrutinized by the researcher himself by the selection criteria and then data were analyzed by personal computer by SPSS version 12.0 program. Data were analyzed by descriptive statistics and inferential statistics.

Results

Variables

Number

Percentage

Age Group in Years

 <20

33

28.4

21 - 30

55

47.4

31 - 40

20

17.2

≥ 40

8

6.9

Mean ± SD age

26.69 ± 8.565

Education

Primary level

76

65.5

Secondary level

40

34.5

Marital Status

Unmarried

56

48.3

Married

60

51.7

Monthly Income (BDT)

<10000

72

62.1

≥10000

44

37.9

Mean ± SD income

10180 ± 3944

Table 1: Socio-demographic characteristics (n=116).

Results are expressed as number (%) and M ± SD Mean ± SD age of respondents was 26.69 ± 8.565 years. Two third of respondents (65.5%) had primary level of education. Married and unmarried was nearly equal. Mean ± SD monthly income of respondents was 10180 ± 3944 BDT.

Duration in years

Frequency

Percentage

<5

36

31.0

6 - 10

34

29.3

11- 15

24

20.7

≥15

22

19.0

Total

116

100.0

Table 2: Distribution of the respondents by duration of work in occupation (n=116). About 31% were found working in this occupation for up to five years, followed by 29.3% for 6-10 years, 20.7% for 11–15 years and rest 19% for more than 15 years.

Clients

Frequency

Percentage

<10

49

42.2

11-15

31

26.8

≥15

36

31.0

Total

116

100.0

Table 3: Distribution of the respondents by number of clients per day (n=116).

It was reported that majority (42.2%) had to serve up to ten clients and 31% had to serve more than 15 clients per day.

Dermatitis Lesion

Frequency

Percentage

No

27

23.3

Yes

89

76.7

Total

116

100.0

Table 4: Distribution of the respondents by dermatitis lesion (n=116). Result found that 76.7% had dermatitis lesions in their hands.

Clinical Manifestations

Frequency

Percentage

Dry scaly plaque

39

43.8

Erythematous plaque

10

11.2

Hyper pigmentation

35

39.3

Vesicle & patch

5

5.6

Total

89

100.0

Table 5: Distribution of the respondents by clinical manifestation (n=89).
Dry scaly plaque was found among 43.8% cases followed by hyper pigmentation 39.3%, erythematous plaque 11.2% and vesicle & patch 5.6%.

Site of lesion

Frequency

Percentage

Index Finger

16

18.0

Middle Finger

64

71.9

Index & Middle Finger

9

10.1

Total

89

100.0

Table 6: Distribution of the respondents by site of lesion (n=89).
Lesions appeared mostly on lateral side of middle finger (71.9%).

Occupation in Years

Dermatitis Lesion

Total

No

Yes

<5

22(81.5%)

14(15.7%)

36(31.0%)

6-10

5(18.5%)

29(32.6%)

34(29.3%)

11-15

0(0.0%)

24(27.0%)

24(20.7%)

≥15

0(0.0%)

22(24.7%)

22(19.0%)

Total

27(100.0%)

89(100.0%)

116(100.0%)

Table 7:Association between years in occupation and development of dermatitis lesion (n=116). χ2 =44.211; p=0.000

Statistical significant association was found between increase of age in this occupation and development of dermatitis lesion (p<0.05).

Discussion

As previously mentioned, Cynthia’s cognitive ability had been reported as being on the borderline range of normal functioning; her IQ on the standardized tests like the Wechsler Intelligence Scale for Children (WISC), was lower than the range expected for kids her age, but the reason for the lower than expected IQ on such tests are not indicated. Both anecdotal information and the results from studies have demonstrated that this prenatal exposure to alcohol greatly affects memory and learning abilities in childhood and observations of children with ARND support this observation. Some studies [2], show that children exposed to alcohol in utero demonstrated deficits in memorizing verbal information; this deficit resulted from difficulties with the acquisition of the information rather than the ability to remember the information over time.

Connor and Mahurin [3] found that learning deficits occurred in both verbal and nonverbal areas of information acquisition. For parents and teachers, this means that children whose brains were damaged due to teratogens like alcohol have an uphill battle when it comes to learning. These abnormalities are recognized as behaviors that are viewed as negative or disruptive. The behavior further impedes learning and participation in the classroom, the social environment and home-life. Children with ARND appear to be at increased risk for psychiatric disorders, alcohol abuse, drug abuse and other maladaptation [2]. Children suffering from ARND are also more likely to be hyperactive, disruptive and impulsive. When these behaviors are combined with a diminished capacity for cognitive acquisition, these children are at a great disadvantage in the classroom. Teachers and parents often do not understand that the child is merely using the limited tools they have to try to fit in. Having a learning disability is tough. Having a behavioral disability is tough. Having both makes it nearly impossible to excel in today’s ‘one-size-fits-all’ classrooms. In these surroundings, planning, organizing and forming strategies are all aspects of social grouping that require a group of higher-level cognitive abilities called executive functioning.

Executive functioning is critical to the success of problem-solving, abstract thinking, planning and a flexible thought process. Cognitive abilities can be thought of as tools that the child uses to interpret their world; executive functioning refers to the ability to use these cognitive tools. Children with heavy prenatal alcohol exposure are at risk of impairments on executive functioning tasks. More importantly, a child’s deficits in executive functioning are often unrelated to their overall intellectual level, as indicated by studies among adults with ARND [4]. Moreover, deficits in executive functioning have real-life implications for people exposed to alcohol in utero. They may act without first considering the consequences of their behavior or they may have difficulties linking behavior and consequence. These types of deficits help explain why children with heavy prenatal alcohol exposure, even those with average IQ scores, often have difficulty in school and in society in general.

The neuropsychological and behavioral issues described above manifest themselves in real life effects of prenatal alcohol exposure. The effect of alcohol on brain development has been noted in articles on FAS dating back to the 1970s. With the advent of structural imaging techniques such as MRIs and EEGs as well as imaging scanning devices for example PET and the Single Photon Emission Computed Tomography, researchers can now study the brains of alcohol affected children in non-invasive fashions [2]. What they’re finding strengthens the argument against drinking while pregnant; longitudinal studies now show many complications, both psychological and physiological resulting not only with FAS, but also ARND.

ARND and following on from the example given in the above case study of Cynthia, the child that suffers with behavioral, emotional and educational difficulties resulting from neurological injury in utero are often forced to adopt somewhat antisocial defense mechanisms. This can result in anger becoming a predominant response to others. Children like Cynthia often become vulnerable to the verbal aggression of their peers and respond aggressively. Intellectually they may experience anxiety over the inability to perform educationally compared to peers. This anxiety can manifest as unwanted behaviors and they can be extensive; Cynthia often used anger in communicating with her peers and even some adults. She would attempt to draw attention to herself, for example falling off her chair during class to illicit laughter from her peers. This drew the ire of her teacher and in the long term, such behavior often resulted in consistent rejection that reinforced her feelings of worthlessness. Children like Cynthia may also have greater difficulties in coping with themselves.

Children suffering from ARND are often ill equipped to understand their behavior and may be prone to criticism for behaving in ways that are not deemed socially acceptable or ‘normal’. The impact of the child’s neurological injury often manifests in struggles with memory or comprehension, which if not handled expertly can result in feelings of low self-esteem, internal anger or overt anger and high levels of anxiety. Feelings of isolation, confusion, frustration and anxiety are too often the result of failed interactions and depending on the level of emotions involved may lead to serious self-harm as a way to deal with the frustration as these children progress to adulthood as a way to control the emotional chaos. This anxiety and need for control may be placed onto food that can result in Bulimia or Anorexia.

These feelings of rejection often turn inward through the child’s experiences with rejection from peers or adults from unwanted behavior or being ‘slow’ educationally or internally by the inability to feel understood or accepted. Anxiety can also manifest in social situations creating a self-perception of being odd or abnormal. The reactions of peers and many adults often result in children like Cynthia feeling rejected, without understanding why, often leading to an extensive self-criticism and further rejection of themselves. Cynthia was referred from one therapist to another creating the perception that she was the problem, one that could not be fixed. As she was referred again and again, Cynthia’s feelings of rejection were further reinforced as each person who failed her was seen as a rejection.

In the case of Cynthia, the attachment style to her primary caregiver in infancy was extremely unhealthy. Developmental psychologists considered the first 12 to 18 months of a child’s life to be crucial in regards to the child’s primary caregiver and that this earliest relationship is foundational for all future relationships [5].

The first 12 months of Cynthia’s life were spent with her birth mother before she was removed from custody and placed in the care of a relative. From the age of one, Cynthia’s childhood could be described as average, at least concerning her home life. However, the factors of her negative early attachment combined with ARND led to an avoidance of equal relationships: Cynthia attempted to control her friends and her siblings and once commented to me that a person can only have one friend at a time. On several occasions, I witnessed her becoming very jealous and aggressive toward anyone approaching the person she deemed as her one friend. This controlling behavior will often lead to problems with intimacy and for children born with ARND, these perceptions, both internal and external, often result in avoidance of closeness for fear of rejection. As young adults, these can be manifested in relationships that are unhealthy or destructive, due to a lack of self-esteem or an inability to commit for fear of rejection.

What does seem clear is that children like Cynthia are different. With this recognition comes a type of grieving process where the child must try to come to terms with his or her inability to be like everyone else. In children with ARND, the grieving process may be unconscious, reflective of the perceived inability to have emotional stability or security. This often results in further frustration, anger and aggression, which may lead to depression as the child enters adulthood. The angry and frustrated child becomes the depressed teen and we often see an increase in eating disorders, tendencies towards violence or withdrawal and isolation. The neurological, psychological and social effects of ARND can be extensive. Unlike many similar fetal defects, prevention is simple: limit or cease alcohol consumption when pregnant. This can only come through a better awareness of drinking in pregnancy. If you are pregnant do not use alcohol. Check with your pharmacist about prescriptions that may be detrimental to your unborn child. The bottom line is simply this: what you put into your body you are putting it into your unborn child.

Conclusion

The current study concludes that three fourth of respondents had dermatitis lesions in their hands. Dry scaly plaque was common. Development of dermatitis lesion was statistically significant with duration of working age.Personal protective equipment should be used.

References

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