Contact Dermatitis • Original Article COD

Contact Dermatitis

Skin disease symptoms and related risk factors among young workers
in high-risk jobs
Emine Aktas and M. Nihal Esin
Istanbul University Florence Nightingale Faculty of Nursing, Public Health Nursing Department, 34381 Şişli/Istanbul, Turkey

doi:10.1111/cod.12606

Summary Background. Occupational skin diseases are the one of the most frequent diseases in
many industrialized countries. The studies about skin disease (SD) on young workers were
limited.
Objectives. In this study, we aim to evaluate the prevalence of SD symptoms and related
risk factors among young workers in high-risk occupations.
Methods. This cross-sectional study was undertaken between 2011 and 2012 in two
vocational training centres. We included 455 young workers who were working as hair-
dressers, jewellers, or car mechanics. Data were collected with the Nordic Occupational
Skin Questionnaire, which was adapted to Turkish for young workers.
Results. The average age of the young workers was 17.9 ± 1.7 years. Of the 455 young
workers, 52.7% were female and 47.3% were male. During the previous 12 months, the
prevalences of the total SD symptoms, hand/forearm eczema symptoms and urticaria
symptoms were 49.7%, 44.4%, and 13.4%, respectively. Those who worked as car
mechanics were 5.8 times more likely [odds ratio (OR) 5.81, 95%CI: 2.58–13.10) to have
a dry skin type, 2.9 times more likely (OR 2.86, 95%CI: 1.72–4.75) to work for >12 h
daily, 2.6 times more likely (OR 2.59, 95%CI: 1.25–5.35) to have worked for >5 years,
and 3.0 times more likely (OR 3.05, 95%CI: 1.14–8.14) to have SD symptoms.
Conclusion. The results indicate that young workers in high-risk jobs have a high
frequency of skin symptoms. These results could provide a basis for occupational health
professionals to plan prevention programmes for young workers.

Key words: eczema; hazardous jobs; NOSQ-2002; occupational skin disease; Turkey;
young workers.

Occupational skin diseases (SDs) have been observed to (2, 4, 5). Hand eczema has been reported to constitute
have the most significant risk of occurrence among work- 90–95% of all occupational SD symptoms (1, 5–7).
ers, owing to exposure to allergens or irritants in the SD symptoms, particularly hand eczema, are impor-
workplace (1–4). They are listed as the second most fre- tant health issues in occupations that involve mostly
quent work-related diseases in industrialized countries manual work, and such diseases are generally associ-
ated with prolonged or frequent contact with water,
other liquids, allergens, or irritants (2, 8). Furthermore,
exposure to certain heavy metals and contact with
Correspondence: Emine Aktas, Istanbul Universitesi Florence Nightin-
gale Hemsirelik Fakultesi, Halk Saglıgı Hemsireligi Anabilim Dalı, Abide-i dermatitis-causing chemicals such as acids, alkalis and
Hurriyet Caddesi, 34381 Şişli, Istanbul, Turkey. Tel: +90 212 440 00 solvents are known to be the most significant risk factors
00/27 108; Fax: +90 212 224 49 90. E-mail: emineaktas67@gmail.com,
for SD symptoms (2, 9–16). Workers with the highest
emineak@istanbul.edu.tr
risk of SD symptoms are those in the healthcare sector,
Conflicts of interest: None declared.
hairdressers, car mechanics, and those in industries such
Accepted for publication 29 March 2016 as food production, construction, car manufacturing,

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
96 Contact Dermatitis, 75, 96–105
 SKIN DISEASE SYMPTOMS OF YOUNG WORKERS • AKTAS & ESIN

printing, leather work, and engine servicing Materials and Methods

(2, 9–13).
According to the 138th Convention of the Inter- Settings of the study
national Labour Organization, a ‘child’ is defined as This descriptive cross-sectional study was undertaken
an individual who is aged <18 years. Global laws and between 2011 and 2012 in VTCs in Istanbul, which are
regulations on child labour prohibit the employment under the jurisdiction of the Ministry of Education. The
of children aged <15 years (17–19). The age range of VTCs train young workers and provide occupational edu-
the ‘young worker’ group is 15–24 years (18, 19). In cation according to their job interests. Young workers
Turkey, young workers must be enrolled in Vocational must attend lectures at the VTCs 1 day per week, and they
Training Centres (VTCs) for their formal education, must continue practising and working on the remaining
and are allowed to work as apprentices in hazardous 5 days of the working week in the occupations in which
jobs (16, 18). they are being trained. Young workers generally work
Young workers constitute one of the most important in establishments such as beauty centres, jewellers and
vulnerable risk groups, and prioritizing youth issues is car repair shops in the neighbourhoods where the VTCs
considered to be crucial in various developing countries are located. After 3 years of education, they graduate and
(3, 16, 20). In Turkey, according to the Child Labour receive an apprenticeship certificate.
Survey of 2012, youths aged between 6 and 17 years Young workers are exposed to many chemical, phys-
constituted 20.6% of the total population, and, of this ical, ergonomic and biological hazards in their work-
group, 5.8% were employed (21, 22). places, and they are not sufficiently trained in how to
SD affects workers of all ages in a wide range of avoid work-related risk factors and use personal protec-
occupations, but young workers have a higher risk tive equipment (PPE). We collected the data from young
than adults (20, 23). Young workers often choose to workers who attended VTCs once a week.
work as hairdressers, metal workers, jewellers, and
car mechanics – occupations that may easily cause
Sampling for the study
SD symptoms (2, 16, 24, 25). In a study performed
on young Turkish workers by Esin et al., the frequen- The total number of VTCs on the European side of Istan-
cies of skin-related symptoms were 58%, 23.9% and bul was 11, and the young workers were recruited from
8.2% among hairdressers, car mechanics, and jewellers, the two main VTCs near the industrial areas, which had
respectively (16). the highest student population. We chose the VTCs that
There have been studies on the occupational SD symp- had training programmes in three hazardous occupa-
toms of young workers in hazardous jobs, but the related tions, namely jewellers, hairdressers, and car mechanics,
literature is very limited. Generally, standardized and reli- because these three occupations were the most hazardous
able tools were not used in these studies. Therefore, there in terms of the development of SD symptoms in young
is a need to determine the prevalence of occupational workers.
SD symptoms among young workers by using reliable The total population of the two VTCs comprised 589
and standardized tools, such as the Nordic Occupational young workers, but our sample consisted of 455 young
Skin Questionnaire-2002 (NOSQ-2002). By the use of workers who completed a self-administered question-
this standardized tool, comparing the prevalence rates of naire.
occupational SD symptoms in countries all around the
world may be possible (6).
Data collection
We conducted this study particularly on young appren-
tices who were employed in high-risk occupations, such Data were collected from self-administered questionnaire
as in those in the sectors of jewellery-making, hairdress- forms completed by young workers in the classroom in
ing, or car repair. Our research focuses on the prevalence the presence of their teachers. The class size and days of
of SD symptoms among young workers in high-risk jobs. lectures were noted for each VCT. The average size of the
The aims of this descriptive and cross-sectional study were classes was between 20 and 25 students. The aim of this
as follows: study and the data collection tools were explained to the
students before they filled out the questionnaire.
1 To determine the prevalence of SD symptoms among
young workers who work as jewellers, hairdressers
or car mechanics by using NOSQ-2002. Ethical issues
2 To investigate the relationship between SD symp- The study was approved by the Ethics Board Commission
toms and general work characteristics. of the Istanbul University Cardiology Institute (Number:

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
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SKIN DISEASE SYMPTOMS OF YOUNG WORKERS • AKTAS & ESIN

B.30.2.IST.0510000/35), and separate written consent Data analysis

of the Ethical Committee of Istanbul Provincial Direc- The data were analysed with SPSS™ version 15. Descrip-
torate of National Education was also obtained (Number: tive statistics of the general and workplace characteristics
B.08.4.MEM.4.34.00.18.580/8781). The young work- and frequencies of SD symptoms in the population stud-
ers who refused to participate and those whose family ies were presented as numbers, percentages, mean and
members refused to let them participate in the study standard deviations. The 𝜒 2 -test was used for the cate-
were excluded, and both verbal and written consent were gorical data to assess the associations between variables
obtained. and SD symptoms. We estimated the association [odds
ratios (ORs) and 95% confidence intervals (CIs)] between
the factors and the prevalence of SD symptoms. A binary
Questionnaires
logistic regression analyses with a backward stepwise pro-
The data were obtained with two data collection tools: cedure was performed to identify the factors associated
a ‘young workers general characteristic form’, developed with the occurrence of skin symptoms. The dependent
by the researchers according to the literature, which variable of the regression analyses was having one of
included 21 questions related to the workplace character- the SD symptoms, such as eczema or urticaria symp-
istics of young workers (6, 16, 26); and the Turkish NOSQ toms, within the last 12 months. A total of 21 general
(T-NOSQ). characteristics, work characteristic and work activities
The NOSQ-2002 was developed by the Nordic Work- were determined as independent predictors. SD symp-
ing Group. According to the NOSQ-2002 Guideline toms were uniquely experienced by these young workers,
that was published by Flyvholm (2002), the ques- and they were evaluated according to the responses to
tionnaire was based on existing and well-established questions D1, D2, D3, D5, U1 and U4 of the NOSQ. In all
questionnaires/tools that were available in the literature. analyses, p-values of < 0.05 were regarded as statistically
The NOSQ-2002 was developed as a self-administered, significant.
standardized and reliable tool for the evaluation of occu-
pational SD symptoms (1, 6, 27–29). The new questions
related to exposure and urticaria sections were designed Results
for the NOSQ-2002, and included in the NOSQ-2002 as
very small number of literature examples regarding these General characteristics
subjects (6, 30, 31). The mean age of young workers was 17.9 ± 1.7 years
The long version of the NOSQ-2002 can be used in the (mean± standard deviation), and 67.7% of them were
general adult population to assess work-related SDs, and aged <18 years. Approximately 44.6% of them were in
it can be adapted to studies performed on specific popula- their first academic year at a VTC. Among the sample,
tions. The validity studies of NOSQ-2002 were carried out 52.7% were female, and 47.3% were male. A total of
by Aktas and Esin, in order to adapt the questionnaire to 52.8% of the young workers had a poor perception of their
Turkish and modify it for young workers (32). own health (reported as poor in 44.2%, and as very poor
The following questions were asked in order to in 8.6%) (Table 1).
define the SD symptoms: Question D1 – ‘Have you
ever had eczema-related skin symptoms on your
hands such as dryness/redness/cracking or cleav- Work characteristics
age/exfoliation/excessive itching?’; Question D2 – ‘Have It was found that 55.6% of the young workers worked as
you ever had eczema-related skin symptoms such as dry- hairdressers, 22.2% worked as jewellers, and 22.2% as
ness/redness/cracking or cleavage/exfoliation/excessive car mechanics. The mean number of working years
itching on your wrist or forearms but not on your elbows in the current occupations of young workers was
or elbow pits?’; Question D5 – ‘When was the last time 3.2 ± 2.2 years, and the mean number of total work
you felt eczema-related skin symptoms such as dryness, experience years was 3.6 ± 2.5 years. Additionally,
redness, cracking, scaling or excessive itching in your 76.2% of the young workers worked for ≥11 h per day,
hands, wrist or forearms?’; Question U1 – ‘Have you ever and 32.5% of the participants even worked for >12 h per
had itchy wheals or swollen red marks on your hands, day (Table 1).
wrists or forearms that appeared and disappeared rapidly The mean numbers of working hours per day and per
(within hours) in a day (urticaria or nettle rash)?’; and week were 11.8 ± 1.8 h and 68.4 ± 12.7 h, respectively.
Question U4 – ‘When did you last have these itchy wheals Moreover, 68.1% (n = 310) of the young workers were not
(urticaria) on your hands, wrists, or forearms?’ enrolled in an educational programme on occupational

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
98 Contact Dermatitis, 75, 96–105
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Table 1. General characteristics, work characteristics and their relationship to skin dissases symtoms n = 455

Skin disease symptoms

Yes No

Independent variables n n (226) % n (229) % p-Value

Age
≤18 308 159 51.6 149 48.4 0.23
≥19 147 67 45.6 80 54.4
Sex
Female 240 121 50.4 119 49.6 0.74
Male 215 105 48.8 110 51.2
Education class level
1 year 203 103 50.7 100 49.3
2 years 129 74 57.4 55 64.9 0.019∗
3 years 123 49 39.8 74 60.2
Household size
1–4 individuals 226 109 48.2 117 51.8
0.54
≥5 individuals 229 117 51.1 112 48.9
Medical history of systemic illness
Yes 82 45 54.9 37 45.1
0.30
No 373 181 48.5 192 51.5
Health perception
Very good 116 42 36.2 74 32.3 0.001∗
Good 99 49 21.7 50 21.8
Poor 201 108 53.7 93 46.3
Very poor 39 27 69.2 12 19.6
Occupations
Hairdressing 253 114 45.1 139 54.9 0.013∗
Car mechanics 101 63 62.4 38 37.6
Jewellery-making 101 49 48.5 52 51.5
Worked years in present occupations
≤1 year 82 33 40.2 49 59.8 0.018∗
1–5 year 312 169 54.2 143 45.8
≥6 year 61 24 39.3 37 60.7
Total working time years
≤1 year 35 15 42.9 20 57.1 0.67
1–5 year 348 176 50.6 172 49.4
≥6 year 72 35 48.6 37 51.4
The age of first starting work life
≤14 year old 205 94 45.9 111 54.1 0.14
≥15 year old 250 132 52.8 118 47.2
Employee numbers in the workplace
≤10 workers 334 164 49.1 170 50.9 0.69
≥10 workers 121 62 51.2 59 48.8
Weekly off days
≤1 days 341 171 50.1 170 49.9 0.73
≥2 days 114 55 48.2 59 51.8
Daily working hours
8–10 h 108 46 42.6 62 57.4 0.20
11–12 h 199 106 53.3 93 46.7
≥12 h 148 74 50.0 74 50.0
Receiving health education in workplace
Yes 145 57 39.3 88 60.7 0.003∗
No 310 169 54.5 141 45.5
Medical examination before attences at the work
Yes 115 47 40.9 68 59.1 0.029∗
No 340 179 52.6 161 47.4

Row percentages are indicated in the table values <0.05 were regarded as statistically significant differences.
Bold data shows that observed value is higher than the expected value.
∗ Significant difference, p<0.05.

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Table 2. Skin disease symptoms frequency of participants in the last webs of the fingers (45.5%), and the fingers (27.2%).
12 months (n = 455) Moreover, 80.2% of the young workers reported that their
Skin disease symptoms n % eczema started between the ages of 15 and 18 years.
The frequencies of allergy symptoms accompanying SD
Only eczema symptoms 165 36.3
symptoms were found to be 35.4% in young workers with
Only urticaria symptoms 24 5.3
Both eczema and urticaria symptoms 37 8.1
allergic conjunctivitis, 34.9% in those with allergic rhini-
No skin disease symptoms in the last 12 months 229 50.3 tis, 22.2% in those with atopic dermatitis, and 13.4%
Total 455 100 in those with asthma. Furthermore, 64.6% of the young
workers stated that they developed a rash when they came
into contact with metal objects (metal buttons, metal cos-
health and safety in the workplace, and 74.7% (n = 340) tume jewellery, etc.), 69.4% of them stated that they had
of them did not undergo a medical examination before dry skin, and 60.1% of them stated that they felt itchy
they started working life (Table 1). while sweating.
It was found that hairdressers mostly worked with However, hand eczema was not regarded as an occu-
water (washing, shampooing, etc.), frequently handled pational disease by 37.6% of the young workers, whereas
cleaning agents soaked in chemicals, and used hand 68.9% of them believed that their SD symptoms, especially
sanitizers, whereas car mechanics and jewellers mostly hand eczema, had worsened because of their occupation.
came into contact with solvents (diesel oil, fuel oil, paint
thinners, etc.) and used oils and liquids (sulfuric acid, Factors affecting SD symptoms. There was no signifi-
zinc sulfate, hydrochloric acid, ammonium chloride, etc.) cant association between SD symptoms and general
(p < 0.05). characteristics, such as sex and age group, of the young
It was found that 35.4% of young workers washed their workers.
hands >20 times in a typical working day. In addition, The following variables related to work characteristics,
47.5% of them noted that they used protective gloves at such as working as a car mechanic, working from 1 to
work, and 54.3% of these workers reported that using 5 years in the current job, not receiving any health edu-
natural rubber latex gloves led to skin symptoms. cation, and not undergoing a medical examination before
starting work, were found to be statistically significant
Prevalence of SD symptoms with regard to the SD symptoms of the young workers
In order to estimate the prevalence of SD symptoms, we (Table 1).
considered the young workers who had skin symptoms On analysis of the factors affecting the prevalence
such as eczema or urticaria on hands or forearms within of SD symptoms, it was found that having a history of
the last 12 months. Approximately half (49.7%; n = 226) atopic dermatitis (Question A1), having a history of aller-
of the them reported that they had SD symptoms, and gic rhinitis (Question A2), having a history of allergic
the other half (50.3%: n = 229) specified that they had conjunctivitis (Question A3), having a rash caused by
not had any SD symptoms within the last 12 months metal objects (Question S2), having a dry skin type (Ques-
(Table 2). tion S3) and feeling itchy while sweating (Question S4)
The frequency of eczema symptoms within the last were the factors significantly associated with SD symp-
12 months was reported by 202 (44.4%) young work- toms. While there was no statistically significant differ-
ers (‘at the time of study’ – 34.2%; ‘within the past ence between the prevalence of SD symptoms and hand
3 months’ – 38.1%; ‘3–12 months ago’ – 27.7%). Not washing >20 times a day, the use of gloves, the use of
having eczema symptoms within the last 12 months was oils/liquids/cutting fluids and contact with paints were
reported by 253 (55.6%) young workers, and 4% (n = 61) associated significantly with SD symptoms.
stated that they had urticaria symptoms during the last Hand washing, the use of hair products and contact
12 months (‘during the past 7 days’ – 37.5%; ‘7 days to with beauty and cleaning products were more frequent
3 months ago’ – 37.5%; ‘3–12 months ago’ – 25.1%). among hairdressers with eczema symptoms (n = 101)
According to type of occupation, SD symptoms were than among those with no SD symptoms. Moreover, being
observed in 45.1% of the hairdressers, in 62.4% of the car exposed to higher temperatures and motor oil while work-
mechanics, and in 48.5% of the jewellers (Table 3). ing and coming into contact with solvents were signif-
The most common three anatomical sites of eczema on icantly more frequent among the car mechanics with
the hands and forearms of young workers with eczema eczema symptoms (n = 58). Jewellers with eczema symp-
symptoms were the dorsum of the hands (68.8%), the toms were significantly more frequently exposed to acids

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Table 3. Skin disease symptoms in the last 12 months among young workers divided by occupational type (n = 455)

Having skin diseases symptoms

Yes No

n % n %
Occupation types 226 49.7 229 50.3 p

Hairdresser (n = 253) 114 45.1 139 54.9 0.013∗

Car mechanics (n = 101) 63 62.4a 38 37.6
Jeweller (n = 101) 49 48.5 52 51.5

Row percentages are indicated in the table.

a The observed value is higher than the expected value.
∗ significant difference (p < 0.05).

and alkaline-derived substances (n = 43) than those with workers in high-risk jobs. This study was based on the use
no symptoms. of the T-NOSQ, which is a rapid and reliable evaluation
tool adapted for the SD symptoms of young workers.
Relationship between the risk factors and SD symptoms. Having To our knowledge, our study is the first in which the
any of the SD symptoms was determined to be a dependent NOSQ-2002 has been adapted and modified for the
variable of the logistic regression model, and a total of 64 young worker population.
independent variables were employed. According to our study, the prevalence of SD symp-
Young workers who were car mechanics were more toms was very high among young workers as compared
likely (OR 5.81, 95%CI: 2.77–13.09) to have SD symp- with the studies performed previously (16, 26, 33, 34).
toms than those trained as hairdressers or jewellers, and Among both national and international studies, only
this was the strongest predictor (Table 4). a few studies have focused on the prevalence of SD or
Other statistically significant risk factors were as eczema symptoms in working adolescents. The studies
follows. Those having dry skin, those perceiving their were generally performed on schoolchildren in the early
health status as being ‘very poor’ and those working for grades, on working adults, and on adolescents who were
>12 h in a normal working day respectively, were more not active in the workforce.
likely to have SD symptoms than the others: OR 2.86, The results of this study show that young workers in
95%CI: 1.72–4.75, OR 2.79, 95%CI: 1.06–7.30 and high-risk jobs have a high percentage of SD symptoms and
OR 2.59, 95%CI: 1.25–5.35, respectively. The young related high occupational risks, owing to the characteris-
workers who had worked for >5 years were more likely to tics of their work.
suffer from SD symptoms than those who had worked for
<5 years (OR 3.05, 95%CI: 1.14–8.14). Those who did
not receive any health education in the workplace were SD symptoms
more likely to experience SD symptoms (OR 2.03, 95%CI: The frequencies of total SD symptoms, hand/forearm
1.23–3.36). Young workers whose work involved wet eczema symptoms and urticaria symptoms were found to
working (washing, cleaning, shampooing, etc.), those be 49.7%, 44.4%, and 13.4%, respectively.
who developed a rash after working with metal objects The frequencies of the total SDs reported by workers
and those who worked in places without restrooms in hazardous occupations were as follows: in a study per-
respectively, were more likely to have SD symptoms: OR formed by Esin et al., 58% of hairdressers, 23.9% of car
1.75, 95%CI: 1.05–2.93, OR 2.38, 95%CI: 1.09–5.23 mechanics, and 18.2% of jewellers; in a study performed
and OR 2.12, 95%CI: 1.27–3.53, respectively. Young by Yenigun et al., 54.9% of hairdressing apprentices; in a
workers who came into contact with paints were more study performed by Yenilmez, 59.7% of hairdressers and
likely to report having SD symptoms, as were those who 40.3% of jewellers; and, finally, in a study performed by
had contact with oils, liquids and cutting fluids (OR 2.04, Robert et al., 59.7% of hairdressers (16, 26, 33, 34). The
95%CI: 1.13–3.68). results of these studies were observed to be similar to those
in the related literature.
Although, in our study, the frequency of SD symptoms
Discussion in hairdressers was found to be 45.1%, this result was
This study was conducted in order to study the preva- not statistically significantly. The prevalence of SD symp-
lence of SD symptoms and related factors among young toms or hand/forearm eczema symptoms was generally

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Table 4. The main statistically significant predictors of skin disease symptoms: logistic regression analyses (n = 455)

Variables Categories p Odds ratio 95% Cl

Perceiveing overall health, as compared to others of young Good 0.008 2.55 1.28–5.11
workers own age (Ref: Very good) Bad 0.013 2.09 1.17–3.75
Very bad 0.037 2.79 1.06–7.30
Occupations (Ref: Hairdresser) Car mechanics < 0.001 5.81 2.58–13.09
Jeweller 0.033 2.28 1.07–4.84
Daily working hours (Ref: 8–10 h) 11–12 h 0.009 2.23 1.22–4.05
More than 12 h 0.010 2.59 1.25–5.35
The age of first starting work life (Ref:14 years and below) 15 years and above 0.028 1.74 1.06–2.85
Worked years in present occupations (Ref: less than 5 year) More than 5 years 0.029 0.31 0.11–0.89
Total working time (Ref: less than 5 year) More than 5 years 0.026 3.05 1.14–8.14
Receiving health education at workplace (Ref: Yes) No 0.006 2.03 1.23–3.36
Having rest room in workplace (Ref: Yes) No 0.004 2.12 1.27–3.53
Wet working (washing, cleaning,shampoing, etc.) (Ref: No) Yes 0.033 1.75 1.05–2.93
Contacting with oils, liquids, and cutting fluids (Ref: No) Yes 0.018 2.04 1.13–3.68
Contacting with paints (Ref: No) Yes 0.015 2.05 1.15–3.66
Having rash from metal objects (Ref: No) Yes 0.030 2.38 1.09–5.23
Having dry skin type (Ref: No) Yes < 0.001 2.86 1.72–4.75

Ref., reference answer category; CI, confidence interval.

p < 0.05; Nagelkerke R2 = 0.377.

observed to be significantly higher in the hairdresser Risk factors for SD symptoms

group, according to the results of some other studies (8, According to our results, the young workers work almost
15, 23, 28, 34). However, the prevalence of SD symptoms twice as long as they are supposed to work. Although
was found to be significantly higher in the car mechan- young apprentices are prohibited from working for >40 h
ics in this study. The percentage of car mechanics who a week in Turkey, the average working hours per week
suffered from eczema symptoms and had contact with were found to be 68.4 ± 12.7 h.
engine oil and chemical agents such as benzene was Although the age of the young workers was not found
found to be 95.3%. Moreover, car mechanics use mostly to be a significant factor in the prevalence of SD symp-
toms, 67.7% of them were found to be aged <18 years.
powerful solvents such as paint thinners to remove the
Owing to the exposure to multiple hazards, the use of
motor or engine oil residues from their hands. Various
dangerous equipment and agents, long working hours
studies have indicated that most metal workers are con-
per week, and starting working life at an early age, even
sidered to be among the highest-risk groups regarding though this is prohibited by the government, the high
SD symptoms (2, 14, 35) and at high risk for hand prevalence of SD symptoms among young workers is
eczema, with a prevalence of hand eczema during the last expected. We found that the young workers who had
12 months at 15% (36). worked for >5 years were 3.0 times more likely to suffer
Few research studies are available that have analysed from SD symptoms. In a previous study, it was stated that
the prevalence of SD symptoms in jewellers, and it has SDs developed in the first 2–4 years after the workers
been emphasized that jewellers are exposed to chemicals, had started working in a hazardous job (4). This may be
metals, acidic and basic compounds and to heavy metals attributable to the length of work time, and be obviously
such as copper and nickel that cause most SD symptoms, correlated with the duration of the exposure to the aller-
gens and irritants.
particularly eczema symptoms (14, 16, 37). Our study
In our study, the coexisting atopic symptoms, such as
gives a new clue that jewellery-making is also a hazardous
atopic dermatitis, allergic rhinitis, and allergic conjunc-
job that can lead to SD symptoms. tivitis, were significantly more frequent in young workers
The most common areas in which the SD symptoms with both SD and eczema symptoms. These findings are
were observed were the dorsum of the hands, the webs of similar to those of studies conducted on adolescents (34,
the fingers, and the fingers. Similarly, SD symptoms were 39, 40). A study conducted on electrical workers found
commonly found in these areas in a study conducted on that atopic dermatitis resulted in a 4.2-fold increased
an adolescent group (38). risk of them having SD symptoms (10). There is strong

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 SKIN DISEASE SYMPTOMS OF YOUNG WORKERS • AKTAS & ESIN

evidence that an atopic constitution, especially atopic der- phenomenon may affect their future. This study suggests
matitis, results in a highly increased risk for the develop- that a questionnaire survey of SD symptoms might be a
ment of eczema or SD symptoms. very effective initial method for planning strategies for
According to our results, young workers who perceived the prevention of SD symptoms among young workers in
their own health status as ‘very bad’ were 2.7 times more high-risk jobs.
likely to have SD symptoms. Recently, it has been found
that hand eczema in young adults is substantially asso- Strengths and limitations
ciated with possibly severe social consequences, such as
The strengths of this study are the use of a standardized
sick leave, pension, or rehabilitation (38). In a previous
and reliable tool, namely T-NOSQ, for young workers, and
study, >80% of individuals with eczema reported that
the fact that the study was carried out among those who
hand eczema symptoms negatively affected their mood
were working in hazardous occupations. The limitations
and daily activities (41).
of this study are that the results seem primarily descriptive
Receiving health education in the workplace is one of
of the study sample, and that the data were collected with
the important factors that can prevent the development of
a self-reporting method, which is more likely to result
SD symptoms. In studies performed by Runyan et al., the
in bias (e.g., over-reporting). Furthermore, the study did
young workers who were provided education on how to
not include a comparison group composed of unexposed
use PPE were observed to use gloves more frequently than
workers with similar demographic characteristics.
those who were not. Furthermore, apprentices generally
do not receive any training, and rarely receive any type
of education (42, 43). In this context, the appearance of Conclusion
SD symptoms in young workers who have not had any In conclusion, the study has provided evidence that
training is to be expected. Education could be effective in work characteristics have a strong influence on the skin
increasing the level of knowledge about SD and how to health of young workers who are frequently exposed
avoid it. to skin-damaging substances in their workplaces.
It has been found that wet work increases the risk of A high frequency of SD symptoms was observed among
SD symptoms, as does contact with paints and contact young workers. SD symptoms were more prevalent in
with oils/liquids similar to (44). In a study conducted on car mechanics than in hairdressers or jewellers. SD
young Turkish hairdressers, it was shown that working symptoms can be a major burden on young apprentices,
with liquids and having contact with solvents, hair sprays and are becoming a serious challenge for healthcare
and hair dyes increased the frequency of hand eczema providers, and for developing countries where youth
symptoms (34). It is obvious that constantly working with labour is widespread.
liquids and specific chemicals causes SD symptoms in It is believed that this study can serve as an impor-
young workers, similar to sensitive skin and regular con- tant example for other countries, especially for developing
tact with metal objects and having dry skin. Furthermore, countries, because it facilitates the international compre-
the young workers who were itchy while sweating had a hension of research results for SD and eczema prevalence
higher frequency of SD symptoms. Shiao et al. found that in young workers worldwide. Many vocational schools
allergy to metal resulted in a 2.3-fold increase in the risk do not have access to occupational health services, and
of having eczema symptoms (10). young workers constitute a substantial risk group in the
The use of protective gloves was significantly more fre- workplace. Our results can provide the basic data for occu-
quent among individuals who were suffering from SD pational health professionals, especially occupational or
symptoms. Similarly, workers with hand eczema symp- school health nurses, to plan SD prevention programmes
toms were shown to use protective gloves more frequently for young workers in high-risk jobs.
than those without such symptoms (45). The apprentices
who worked as jewellers, hairdressers and car mechanics Acknowledgements
generally preferred to not use gloves, because it reduced
the speed of work, because the gloves became wet inside This study was financially supported by Istanbul Uni-
versity Scientific Research Projects (Project Number:
easily, owing to their poor quality, and because the gloves
15039). The authors thank all of the young workers and
usually did not fit the young workers’ hands, because they the parents who agreed to participate in this study, and
were ergonomically designed for adults (43). all school staff and teachers for their support. The data
Young workers clearly constitute a high-risk group reported here were included in a poster presented at the
for the development of SD symptoms. SD symptoms are 5th International FOHNEU Congress on Occupational
frequently observed among young workers, and this Health in Tarragona, Spain, 19–21 September 2012.

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Contact Dermatitis, 75, 96–105 103
SKIN DISEASE SYMPTOMS OF YOUNG WORKERS • AKTAS & ESIN

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