Summary
In short
- Wet work is the main risk factor for occupational contact dermatitis, ahead of chemical exposure. It is also the exposure least likely to be assessed, because water does not look like a hazardous substance.
- Occlusive gloves worn for more than two hours per shift count as wet work. The glove is simultaneously a control for chemical contact and a cause of irritant damage.
- HSE guidance G403 recommends a baseline skin assessment within six weeks of someone starting a role with relevant chemical or wet work exposure.
- The symptoms to look for are specific: itching, scaling or flaking, dry or cracking skin, colour changes, blistering, weeping and soreness.
- A single reported case should trigger a check of everyone doing the same task. Dermatitis is usually an exposure problem rather than an individual susceptibility.
- Intervention works. Following German wet work guidance, reported dermatitis incidence among hairdressers fell from 194 to 18 cases per 10,000 workers across the 1990s.
What it is
What it is
What is occupational dermatitis?
Inflammation of the skin caused by contact with substances or physical agents at work. It divides into irritant contact dermatitis, caused by direct damage to the skin barrier from repeated exposure, and allergic contact dermatitis, caused by sensitisation to a specific substance. Many cases are mixed, and the practical question is which exposures contribute rather than which category applies.
What counts as wet work?
The thresholds most widely used, from Germany's TRGS 401, are hands wet for more than two hours per shift, wearing occlusive gloves for more than two hours per shift, or hand washing more than twenty times per shift. Any one of these triggers preventive measures including health surveillance in that framework, and they are a reasonable screening basis anywhere.
When to use it
When to use it, and when not to
This assessment covers skin exposure. It sits alongside the chemical assessment rather than inside it, because the dominant exposure is frequently water.
Use it for
- Roles involving frequent hand washing, immersion, or prolonged glove wear
- Work with known skin sensitisers: epoxy resins, isocyanates, rubber accelerators, cutting fluids, hairdressing chemicals
- Food handling and preparation, where hand hygiene requirements create wet work by design
- Cleaning and sanitation roles, which combine wet work with detergents and disinfectants
- Following any reported skin symptom, for the affected person and everyone doing the same task
Not for
- The general COSHH assessment, which addresses inhalation and systemic effects and frequently omits skin
- Health surveillance itself, which is a clinical activity with its own record and confidentiality
- Patch testing, which is a diagnostic procedure conducted by a clinician
- The glove selection record, which specifies material and breakthrough time for chemical protection
- Personal medical records, which stay with occupational health and are not part of this assessment
Standards
What it is built against
Skin exposure is regulated under general chemical control duties rather than a dedicated standard, which is part of why it is under-assessed.
| Clause | Requirement | Where it lands |
|---|---|---|
| COSHH reg.6 | Assessment of risk to health from substances, including exposure by skin contact and absorption | Chemical contact |
| COSHH reg.7 | Prevention or adequate control of exposure, with PPE only after other measures | Controls |
| COSHH reg.11 | Health surveillance where exposure may cause identifiable disease and valid detection techniques exist | Outcome |
| HSE G403 | Baseline skin assessment within six weeks of starting relevant work, with defined symptoms to detect | Outcome |
| OSHA 1910.1200 | Hazard communication including skin hazards, with safety data sheet section 8 exposure controls | Chemical contact |
| EU Directive 98/24/EC | Protection from risks related to chemical agents, including dermal exposure | Header |
| TRGS 401 (Germany) | Wet work thresholds triggering preventive measures: two hours wet, two hours occlusive gloves, twenty washes | Wet work |
| RIDDOR / 29 CFR 1904 | Diagnosed occupational dermatitis reportable or recordable depending on jurisdiction | Outcome |
What it does not cover
- Health surveillance, which is a clinical activity with confidentiality requirements and its own records.
- Patch testing, a diagnostic procedure performed by a clinician where allergic dermatitis is suspected.
- The general COSHH assessment, which addresses inhalation and systemic routes and typically treats skin briefly.
- Glove specification, which selects material and breakthrough time against the chemicals handled.
- Individual medical records, which remain with occupational health and are not part of this assessment.
Filling it in
Filling it in well
Four things determine whether this assessment finds anything: whether wet work is measured, whether glove time is counted as exposure, whether the symptom list is specific, and what happens when one person reports.
Count hand washes in a shift, time hands in water, and time in occlusive gloves. The thresholds are two hours wet, two hours in occlusive gloves, or twenty washes per shift. Most food handling, cleaning and healthcare roles exceed at least one of these and are assessed as though the only exposure is the detergent.
Record how long gloves are worn continuously and whether breaks or liners are used. Where glove wear is long, the response is to reduce it: task rotation, cotton liners, shorter periods, or eliminating the contact that made gloves necessary. Specifying a better glove addresses the chemical and worsens the occlusion.
Itching, scaling or flaking, dry or cracking skin, colour changes, blistering, weeping and soreness. Asking whether anyone has skin problems produces almost no reports, because people do not classify dry cracked hands in winter as a work issue. Asking about the specific signs produces early detection, which is the point of surveillance.
When someone reports symptoms, remove them from the specific exposure, refer for assessment, review the task assessment, and check everyone else doing that task. A single case is frequently the first presentation of an exposure affecting a group, and treating it as individual susceptibility is how the next four cases arrive.
Audit findings
Common audit findings
Dermatitis findings concentrate on what was never assessed rather than on controls that failed.
| Finding | Clause | What fixes it |
|---|---|---|
| Wet work not assessed because water was not treated as an exposure. | COSHH reg.6 | Assess wet work explicitly against the two hour and twenty wash thresholds. |
| Glove wear time not recorded as an exposure. | TRGS 401 | Count occlusive glove time; over two hours per shift is a wet work exposure in its own right. |
| No baseline skin assessment for workers in relevant roles. | HSE G403 | Baseline within six weeks of starting; later surveillance has nothing to compare against. |
| Health surveillance limited to a general question about skin problems. | COSHH reg.11 | Use the specific symptom list; general questions produce almost no reports. |
| A reported case treated as individual susceptibility. | ISO 45001 cl.10.2 | Check everyone doing the same task; one case usually indicates a group exposure. |
| Rubber accelerators in gloves not considered as a sensitiser. | COSHH reg.6 | Assess the glove material itself; it is a recognised cause of allergic contact dermatitis. |
| Skin creams provided in place of exposure control. | COSHH reg.7 | After-work creams support barrier recovery; they are not a control and do not replace one. |
| Diagnosed occupational dermatitis not reported or recorded. | RIDDOR / 1904 | Report or record per jurisdiction; occupational skin disease is frequently missed in reporting. |
| Assessment not reviewed after a change of cleaning chemical or glove supplier. | COSHH reg.6 | Trigger review on any change to substances or PPE materials in contact with skin. |
| Hand hygiene requirements creating wet work with no compensating control. | COSHH reg.7 | Hygiene requirements are non-negotiable; the response is drying, emollients and glove time reduction. |
Worked case
Case in point: the sanitation crew and the better glove
A food plant recorded four cases of hand dermatitis in its sanitation crew over one winter. The assessment on file covered the cleaning chemicals in use, correctly identified two as irritants, and specified a heavy-duty nitrile gauntlet. When cases appeared, the response was to upgrade to a thicker gauntlet with a longer breakthrough time.
Cases continued. An occupational health review found the crew wore the gauntlets continuously for six to seven hours per shift, with hands wet inside them throughout. The chemical exposure had been well controlled from the start. The exposure causing the dermatitis was the glove.
The controls that worked were cotton liners changed at break, rotation so no one spent a full shift in gauntlets, and a change in the cleaning schedule that reduced total glove hours. None of them involved a better glove.
Definitions
Definitions and key terms
- Irritant contact dermatitis
- Skin damage from direct barrier disruption through repeated exposure, most commonly wet work. The larger share of occupational cases.
- Allergic contact dermatitis
- Dermatitis following sensitisation to a specific substance, after which very small exposures provoke a reaction.
- Wet work
- Hands wet for over two hours per shift, occlusive gloves for over two hours, or more than twenty hand washes per shift.
- Occlusion
- The effect of non-breathable gloves preventing sweat evaporation, macerating the skin and degrading its barrier function.
- Sensitisation
- The immune response after which a person reacts to a substance at exposures previously tolerated, and which is not reversible.
- Baseline assessment
- The initial skin check, recommended within six weeks of starting relevant work, providing the comparison for later surveillance.
- Rubber accelerator
- A chemical used in glove manufacture, and a recognised cause of allergic contact dermatitis from the glove itself.
- Emollient
- A moisturiser supporting barrier recovery, useful after work and not a substitute for exposure control.
FAQ
Frequently asked questions
Is water really the main risk factor?+
Yes. Wet work is the dominant cause of occupational contact dermatitis across the literature, ahead of specific chemical exposures. It is also the least assessed, because water does not appear on a safety data sheet and does not look like a hazardous substance. Food handling, healthcare, cleaning and hairdressing all create substantial wet work exposure by design.
Do gloves cause dermatitis?+
They contribute in two ways. Occlusive gloves worn for more than two hours per shift count as wet work, because trapped sweat macerates the skin and degrades the barrier. Separately, rubber accelerators used in glove manufacture are a recognised sensitiser. This does not mean stop using gloves where chemical protection is needed; it means glove time is an exposure to be minimised alongside the chemical.
When should health surveillance start?+
HSE guidance G403 recommends a baseline skin assessment within six weeks of a worker starting a role with relevant chemical or wet work exposure, with ongoing frequency set by an occupational health professional and proportionate to risk. Without a baseline, later checks have nothing to compare against and early change is invisible.
What symptoms should we ask about?+
Itching, scaling or flaking, dry or cracking skin, colour changes, blistering, weeping and soreness. Asking a general question about skin problems produces very few reports, because people attribute dry cracked hands to winter or to washing up at home. The specific list is what produces early detection, which is when removal from exposure is still protective.
What should happen when someone reports symptoms?+
Remove them from the specific exposure, refer to occupational health for assessment including consideration of patch testing, review the assessment for that task, and check whether anyone else doing the same work is affected. That last step is the one that matters most, because a single case is frequently the first presentation of an exposure affecting a group.
The agents
What the agents do with it
The assessment is straightforward once wet work is being counted. What fails is the exposure nobody measured and the case treated as one person's bad luck.
Holds the assessment against roles and tasks, schedules baseline and ongoing surveillance, and keeps clinical detail separate from the operational record.
Links a reported case to everyone performing the same task, so a single report triggers a population check rather than an individual referral.
Connects glove specification and wear time to the assessment, so the control and the exposure are visible together.
Flags hand hygiene frequency in food areas, where the wet work exposure is created by a requirement that cannot be relaxed.
This template lives in KnowHealth — employee wellbeing. Exposure monitoring, health surveillance, case management and return to work.
Meet KnowHealth→Sources
Sources
- HSE G403, COSHH Essentials, health surveillance for occupational dermatitis
- HSE guidance on skin at work and health surveillance
- Control of Substances Hazardous to Health Regulations 2002, regulations 6, 7 and 11
- TRGS 401, risks resulting from skin contact, wet work thresholds (Germany)
- Behroozy A, Keegel TG, Wet-work exposure: a main risk factor for occupational hand dermatitis