numbers are expected to increase with the increasing number
of chemicals in use. Skin and inhalation are the two most common occupational routes of chemical exposure. Historically,
efforts have been aimed at regulating respiratory exposures;
however, the contribution of skin exposure in the development
of systemic disease is gaining increased recognition. In particular, studies are beginning to demonstrate the contribution
of skin exposure to the development of respiratory sensitization and altered pulmonary function. The skin is the largest
organ of the body, and while less volatile chemicals are known
to directly penetrate the skin to induce toxicity, there is also
evidence of a contribution from vapors or aerosolized chemicals that should not be overlooked. While contact dermatitis
is one of the most common and well-understood occupational
diseases, increasing the awareness about potential systemic
effects following skin exposure to chemicals is also of occupational importance. Not only does skin exposure have the
potential to contribute to total body burden of a chemical but
also the skin is a highly biologically active organ capable of
chemical metabolism and the initiation of a cascade of immunological events, potentially leading to adverse outcomes in
other organ systems.
Workers should be aware not only of the hazards associated with the chemicals in their environment but also of conditions that are likely to enhance the systemic absorption of
these chemicals. Factors such as excessive hand washing, use
of hand sanitizers, high frequency of wet work, exposure to
chemical mixtures, or wearing occlusive gloves can change the
integrity or function of the skin and play a role in enhancing
chemical penetration or sensitization by influencing additional
biological responses.
Author contributions
Wrote the first draft of the manuscript: SEA. Contributed
to the writing of the manuscript: SEA, BJM. Made critical
revisions and approved final version: SEA, BJM. Both authors
reviewed and approved of the final manuscript. SEA, BJM.