The History

Predisposing Factors

Not every worker exposed to an agricultural environment will develop an occupational skin disease. Factors that place the worker in greater or lesser jeopardy are age, the work environment, a history of atopy and other allergic conditions, the presence of concomitant skin disease such as psoriasis, plant or field cleanliness, worker cleanliness, and the gender of the worker. Younger workers may be inexperienced or not follow safety regulations. There is also the phenomenon of "hardening" seen in older workers who have been working in the particular agriculture environment for a long time. On the other hand, younger workers may heal faster (Table 18.1) (9,14).

Temperature and relative humidity are also important factors in the development of skin disorders. Cool, dry environments favor xerosis and xerotic eczema. Warm, humid environment favors the development of miliaria and folliculitis. Sun exposure leads to skin tumors, increasing in severity and number with the extent of exposure and with certain skin types. Poor hygiene

Table 18.1. Predisposing factors of skin disease in agriculture.

Age

Relative humidity

Younger workers

Wind

Positive

Sun exposure

Heal faster

Presence of concomitant skin disease

More resilient

Psoriasis

Negative

Atopy

Fail to follow safety regulations

Irritant contact dermatitis potentiating

Inexperienced in job tasks

allergic contact dermatitis

Older workers

Work-site cleanliness

Positive

Worker cleanliness

Hardening phenomenon

Availability of wash stations

Follow safety regulations

Gender of the worker

Experienced in job task

Men are more prone to acneiform

Negative

eruptions

Less resilient and heal slower

Women tend to be more fastidious

Environment

in cleanliness

Temperature

Use of safety equipment and procedures

Source: Data from Peate (9) and Wollenberg et al. (14).

Source: Data from Peate (9) and Wollenberg et al. (14).

and lack of bathing facilities may extend the time the offending substance is on the skin and exacerbate the illness (8-11,15).

Having a skin disorder can predispose a worker to other skin disorders. Workers with atopic dermatitis are more prone to allergic contact dermatitis. Psoriasis (through the Koebner phenomenon) worsens on exposure to heat, irritating chemicals, or extreme cold. Workers with preexisting irritant contact dermatitis or xerosis are more likely to develop secondary allergic sensitization (9).

Gender also makes a difference. Hairiness, sebum and sweat production, and the pH of the skin make male workers more prone to acneiform eruptions. Women seem to be more fastidious in removing dirt from skin and clothing and are thus more protected (8,9).

History of the Illness

It is important to accurately record the worker's personal data and history of the illness as summarized in Table 18.2 (8,9,16-19).

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