How to cite:
Budi Rahmawati and Ratih Pramuningtyas. (2021). Risk Factors for
Hand Dermatitis in Hospital Nurses in Sukoharjo. Journal Eduvest.
1(11): 1296-1304
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Eduvest – Journal of Universal Studies
Volume 1 Number 11, November 2021
p- ISSN 2775-3735 e-ISSN 2775-3727
RISK FACTORS FOR HAND DERMATITIS IN HOSPITAL NURSES
IN SUKOHARJO
Budi Rahmawati and Ratih Pramuningtyas
Muhammadiyah Surakarta University, Indonesia
E-mail: dr.rahmadexa@gmail.com, [email protected]c.id
ARTICLE INFO ABSTRACT
Received:
October, 26
th
2021
Revised:
November, 16
th
2021
Approved:
November, 18
th
2021
Hands are organs that play a role in communication,
because in some jobs shaking hands is crucial. People who
are at risk of getting this disease include health workers
and it will have an impact in the future. The purpose of
this study was to determine the risk factors for hand
dermatitis in hospital nurses in Sukoharjo. This type of
research is descriptive analytic research with cross
sectional design. Cross sectional is a non-experimental
research to study the dynamics of the correlation
between risk factors and effects, by approach,
observation or data collection all at once (point time
approach). The research was conducted at dr. New Oen
Solo. The research was conducted in November-February
2020. Based on the analysis and discussion, it can be
concluded that risk factors, wet work, atopic history, age,
gender, years of service are not related to the incidence
of hand dermatitis in hospital nurses in Sukoharjo.
KEYWORDS
Risk Factor, Hand Dermatitis, Nurses
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
The skin is the first line of defense when the body comes into contact with
various types of chemicals. Hand dermatitis or hand eczema is a chronic disease and is
caused by many factors (Agarwal, Besarwal, Gupta, Agarwal, & Napalia, 2014). This
Budi Rahmawati and Ratih Pramuningtyas
Risk Factors for Hand Dermatitis in Hospital Nurses in Sukoharjo 1297
disease is usually associated with occupational diseases or daily activities in the
household. Hand dermatitis can occur due to direct exposure to chemicals that are
irritants to the hands, such as soap, detergent, perfume, iron, rubber and repeated
exposure such as irritant contact dermatitis or allergic contact dermatitis. However, in
some cases, the specific cause that causes hand dermatitis is not specific because in some
cases these complaints can be caused by a combination of complaints originating from
atopic dermatitis, irritant contact dermatitis, or allergic contact dermatitis (Tan, Rasool, &
Johnston, 2014).
The prevalence of hand dermatitis is difficult to know because not everyone who
feels this complaint goes to treatment services (Santer et al., 2012). However 2-10% of
the population is known to suffer from this disease during their lifetime. As many as 20-
30% various types of dermatitis attack the hands, and it can be concluded that this disease
is a common occupational disease. Women are more often affected by this disease than
men (2:1) due to increased exposure to wet work and household chemicals.
The pathogenesis of hand dermatitis varies depending on the underlying disease.
If caused by irritant contact dermatitis, the reaction that occurs is due to direct trauma
caused by irritant substances that cause cell damage at a certain time and concentration of
certain substances but the immunological process does not occur. Because irritants cause
damage or remove the protective layer in the upper epidermis. Usually irritants cause
protein denaturation, fat loss, and evaporation of water on the skin.
Seizures of hand dermatitis can be based on allergic contact dermatitis which is a
type IV hypersensitivity reaction, caused by an immune reaction mediated by T cells
(Rive, Bourke, & Phillips, 2013). The inflammatory reaction occurs at the site of contact
with the allergen which is characterized by polymorphic forms such as redness, papules,
vesicles and followed by with dry skin (Ale & Maibach, 2014). Itching is the main
complaint complained by the patient. Hand dermatitis can also occur in people whose
family suffers from atopic dermatitis, asthma and hay fever (Thomsen, 2015).
The appearance of hand dermatitis is diverse, such as hyperkeratotic, nummular,
resembling atopic dermatitis, housewives dermatitis, finger tip eczema, chronic acral
dermatitis (Sharmila Rao, 2018). The diagnosis of hand dermatitis was made through the
patient's general status, progression and remission of dermatitis, occupational history,
history of substance exposure, family history, and clinical examination. Examinations that
can be performed include patch tests, eosinophil counts, serum IgE levels, skin prick
tests, skin biopsies (Salvador et al., 2020).
Hand dermatitis affects one of the important organs, namely the hands and is the
most common occupational skin disease. Hands are organs that play a role in
communication, because in some jobs shaking hands is crucial. People who are at risk of
getting this disease include health workers and it will have an impact in the future. The
purpose of this study was to determine the risk factors for hand dermatitis in hospital
nurses in Sukoharjo.
RESEARCH METHOD
This type of research is descriptive analytic research with cross sectional design.
Cross sectional is a non-experimental research to study the dynamics of the correlation
between risk factors and effects, by approach, observation or data collection all at once
(point time approach). The research was conducted at dr. New Oen Solo. The research
was conducted in November-February 2020.
The sample in this study was determined using a non-probability sampling
technique with a purposive sampling approach where the sampling used was determined
based on the decision of the researcher which in his opinion seemed representative of the
Eduvest – Journal of Universal Studies
Volume 1 Number 11, November 2021
1298 http://eduvest.greenvest.co.id
population. The minimum total number of samples in this study was 30. Data was
collected using a questionnaire method using previously validated questionnaires. The
questionnaire contains questions that must be answered by the respondent and a checklist
sheet of observations that will be filled out by the researcher. The questionnaire in this
study included questions about the length of contact, exposure to formic acid, age, gender
and history of previous skin diseases.
The data were analyzed statistically based on the variables assessed using a
computerized system, namely univariate and bivariate analysis. Univariate analysis was
performed to see the frequency distribution. The data is presented in the form of a
frequency distribution table. Bivariate analysis was performed using chi-square using the
SPSS tool to determine the significant difference due to the relationship between the two
research variables. If it does not meet the chi-square requirements, other tests will be
used, such as fisher's exact. Finally, multivariate analysis was carried out, if more than 1
variable that met the P requirements, the logistic regression method would be used. The
processed data are presented in the form of distribution tables with explanations arranged
in narrative form and grouped according to the research objectives.
RESULT AND DISCUSSION
A. Characteristics of Respondents
The research respondents were nurses who met the inclusion criteria and did not
have the exclusion criteria. In this study, 40 respondents were obtained, then the research
data were collected and analyzed. The following is a description of the characteristics of
the respondents in this study.
Table 1 Frequency Distribution of Respondents by Age and Gender
F
%
Age
<30 year
4
10
30-40 year
21
52,5
40-50 year
15
37,5
>50 year
0
0
Total
40
100
Gender
Male
5
12,5
Female
35
87,5
Total
40
100
Table 1 shows that the characteristics of the respondents based on age are mostly
the age group of 30-40 years (52.5%). Then, based on gender characteristics, data
obtained from male respondents as many as 5 people (12.5%) and female respondents as
many as 35 people (87.5%).
Eduvest – Journal of Universal Studies
Volume 1 Number 11, November 2021
Risk Factors for Hand Dermatitis in Hospital Nurses in Sukoharjo 1299
B. Univariate Analysis
a) Length of Work
The frequency distribution of respondents' working hours can be seen in table 2.
Table 2 Frequency Distribution of Respondents' Length of Work
Length of working
F
%
<5 hour
0
0
5 - 10 hour
8
20
>10 hour
32
80
Total
40
100
Based on table 2, data shows that from 40 research respondents, 8 people (20%)
worked for 5-10 hours a day and 32 people (80%) worked for more than 10 hours a day.
b) Hand Dermatitis
The distribution of the frequency of respondents experiencing hand dermatitis
can be seen in table 3 below.
Table 3 Distribution of the frequency of respondents experiencing hand
dermatitis
Hand Dermatitis
F
%
Positive
15
37,5
Negative
25
62,5
Total
40
100
Table 3 above shows that of the 40 respondents who experienced hand dermatitis
from this study, 15 people (37.5%). The rest, 25 people (62.5%) did not experience hand
dermatitis.
c) History of Atopy
The frequency distribution of respondents who have a history of atopy can be
seen in table 4 below.
Table 4. Frequency distribution of respondents who have a history of atopy
Atopi History
F
%
Positive
37
92.5
Negative
3
7.5
Total
40
100
Table 4 above shows that of the 40 respondents who had a history of atopy from
this study, 37 people (92.5%). The rest, 3 people (7.5%) had no history of atopy.
d) Wet Work
The frequency distribution of respondents who do wet work can be seen in table
5 below:
Table 5 Distribution of the frequency of respondents doing wet work
Wet Work
F
%
Positive
34
85
Negative
6
15
Total
40
100
Eduvest – Journal of Universal Studies
Volume 1 Number 11, November 2021
1300 http://eduvest.greenvest.co.id
Table 5 above shows that of the 40 respondents in this study, 34 people (85%)
did wet work, while 6 (15%) did not do wet work.
Bivariate Analysis
To find out the risk factors for hand dermatitis in nurses at Sukoharjo Hospital, a
chi square statistical test was carried out but it did not meet the requirements. Therefore,
the Fisher exact test was carried out and the following results were obtained as in table 6.
Tab1e 6 Risk factors for hand dermatitis in hospital nurses in Sukoharjo
Hand Dermatitis
Risk Factor
Positive
Negative
Total
p value
f
%
f
%
f
%
Age
<30
2
5%
2
5%
4
10%
30-40
5
12.5%
16
40%
21
52.5%
0.16
40-50
8
20%
7
17.5
%
15
37.5%
Total
15
37.5%
25
62.5
%
40
100%
Gender
Male
1
2.5%
4
10%
5
12.5%
0.63
Female
14
35%
21
52.5
%
35
87.5%
Total
15
37.5%
25
62.5
%
40
100%
Length of
working
5-10 hour
2
5%
6
15%
8
20%
> 10 hour
13
32.5%
19
47.5
32
80%
0.35
Total
15
37.5%
25
62.5
%
40
100%
Atopi History
Positive
13
32.5%
24
60%
37
92.5%
Negative
2
5%
1
2.5
%
3
7.5%
0.31
Total
15
37.5%
25
62.5
%
40
100%
Wet work
Positive
14
35%
20
50%
34
85%
Negative
1
2.5%
5
12.5
%
6
15%
0.25
Budi Rahmawati and Ratih Pramuningtyas
Risk Factors for Hand Dermatitis in Hospital Nurses in Sukoharjo 1301
Total
15
37.5%
25
62.5
%
40
100%
From the data contained in table 5.6, it was found that 2 respondents who
experienced hand dermatitis aged <30 years (5%), 30-40 years old were 5 (12.5%), 8
people 40-50 years old (20% ). Most of the respondents were 14 women (35%) and 1 man
(2.5%). Respondents with 5-10 hours working duration were 2 people (5%), working
hours >10 hours were 13 people (32.5%). In respondents with a history of atopy, 13
people (32.5%) experienced hand dermatitis, while in respondents who did not have a
history of atopy, 2 people (5%) experienced hand dermatitis. Hand dermatitis also
occurred in nurses who did wet work as many as 14 people (35%) while nurses who did
not do wet work occurred in 1 respondent (2.5%).
Based on the data in table 5.6, the p value obtained from the statistical tests
carried out is 0.35 (> 0.05) for the length of work, 0.31 (> 0.05) for respondents with a
history of atopy and 0.25 (>0, for respondents who do wet work). 05) so that it can be
concluded that the length of work, history of atopy and wet work are not significant as
risk factors for the occurrence of hand dermatitis in this study.
Discussion
a) Gender and age with hand dermatitis
In this study, there were more cases of hand dermatitis in women as many as 14
people compared to 1 person in men. Similar results were obtained in a study conducted
by Adilah Afifah, the female gender has a risk of experiencing contact dermatitis on the
hands 1.8 times compared to the male sex. Of the 28 cases of contact dermatitis, 85.7%
were found to be female, while the remaining 14.3% were male. female (46.7%).
From an experimental and epidemiological study, women do not have skin that is
more sensitive to irritation than men's skin. The difference in the incidence of hand
dermatitis between men and women is not the result of differences in skin barrier
function, but rather due to differences in external exposure (Dąbrowska et al., 2018).
The most positive age for experiencing hand dermatitis in this study was the age
of 40-50 years. There is a great deal of age-related variation in the prevalence of hand
dermatitis in other studies. Dermatitis can be experienced by all age groups. An older
person has dry, thin skin that is intolerant of soaps and solvents.4 Dryness of the skin can
make it easier for chemicals to infect the skin, making the skin more susceptible to
dermatitis. In the elderly, there is usually a failure in the treatment of contact dermatitis,
resulting in chronic dermatitis. It can be said that contact dermatitis will be more easily
attacked in workers with an older age. However, from several research results, workers
with a younger age are actually more affected by contact dermatitis, this is supported by
the results of research conducted by Lestari and Utomo that as many as 26 (60.5%) of 43
workers aged <30 years exposed to contact dermatitis, while among workers aged >30
years only about 13 people (35.1%) were affected by contact dermatitis.5
In one study, age risk factors were shown to be not significantly associated with
the incidence of hand dermatitis (Mortz, Bindslev‐Jensen, & Andersen, 2014). The
average age of subjects with hand dermatitis and without hand dermatitis was almost the
same so that the statistical test results of age did not significantly affect the incidence of
hand dermatitis. Most of the research subjects with hand dermatitis were over 40 years
old. Taylor et al mentioned that after the age of 30 years, the production of important
hormones such as testosterone, growth hormone, and estrogen begins to decrease, while
these hormones affect skin health. So that along with increasing age, the decline in these
Eduvest – Journal of Universal Studies
Volume 1 Number 11, November 2021
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hormones affects the health of the skin.2 This is in accordance with the results obtained in
this study (Cristóbal et al., 2019). The statistical test of this study found a non-significant
relationship between age and gender, this is because dermatitis can occur at all ages and
genders, meaning that age and gender are not the main risk factors in the occurrence of
hand dermatitis.
b) Length of work with hand dermatitis
In this study, it was found that the length of work did not have a significant
relationship with the incidence of hand dermatitis. Research conducted by Sholehah in
2017 found the same findings where there was no significant relationship between length
of work and dermatitis. 6 Length of work was related to length of contact with irritants or
allergens. The longer the contact with irritants or allergens, inflammation or skin irritation
can occur, causing the outer layer of skin cells to experience deeper damage.
Pen statistic test in this study did not find a significant relationship between
length of work and hand dermatitis, this could be because individual skin has different
sensitivities, and the variable length of work also has other factors such as how many
times he or she is exposed in a day and contact with > 1 type of chemical. .7 Nurses also
tend to move or roll rooms so that they get different types of exposure.
c) History of atopy with hand dermatitis
In this study, there was no significant relationship between history of atopy and
hand dermatitis (p>0.05). Individuals with atopic have decreased hydration in the stratum
corneum and low content of amino acids in the skin, so it will be easier for substances to
enter, both irritants and allergens. A non-significant relationship in this study could be
due to a history of atopy that can increase a person's susceptibility to the incidence of
dermatitis but this is also influenced by other factors such as the amount of exposure and
duration of exposure and the type of exposure that causes dermatitis.
In contrast to the results obtained by Thyssen (2010) which showed that atopic
history was significantly associated with the incidence of hand dermatitis. Many studies
in the general population have reported that atopic history is the most important risk
factor for hand dermatitis.9 Atopic conditions increase the susceptibility of the dermis to
irritants and inhibit the healing process. Intact stratum corneum, a protective barrier layer
of compacted keratinized epidermal cells , has an important role to prevent the occurrence
of DKI and DKA.8
Tanaka et al (1998) reported that atopic individuals had decreased hydration in
the stratum corneum and low levels of amino acids in the skin, making it easier for
substances to enter, both irritants and allergens. In a prospective cohort study conducted
by Diepgen et al. showed that atopic skin diathesis increased the likelihood of developing
hand dermatitis with an odds ratio of 2:1. Despite atopic being a major risk factor for
hand dermatitis, those with atopic eczema accounted for only 17% of nurses with hand
dermatitis. Reducing the frequency of hand washing is the most effective strategy to
reduce the occurrence of hand dermatitis among nurses.
d) Wet Work with hand dermatitis
Wet work is defined as an activity in which workers must immerse hands in
liquid for >2 hours per shift, or wear waterproof (occlusive) gloves for an appropriate
amount of time, or wash hands >20 times per shift.14 The analysis in this study found
there is no significant relationship between wet work and hand dermatitis p = > 0.05. Wet
work has a significant relationship with the incidence of DT. Wet work in this case is
related to water and detergent. Work that requires frequent contact with water causes
maceration and dissolution of stratum corneum lipids
Over-hydration of the stratum corneum increases the penetration of foreign
material and contributes to the occurrence of irritant contact dermatitis and allergic
Budi Rahmawati and Ratih Pramuningtyas
Risk Factors for Hand Dermatitis in Hospital Nurses in Sukoharjo 1303
contact dermatitis. In addition, increased frequency of hand washing is an important risk
factor for hand dermatitis.15 Denaturation of stratum corneum proteins, changes in
intercellular lipids (lipid depletion or reorganization), reduced corneocyte cohesion, and
reduced water-binding capacity of the stratum corneum are mechanisms of skin damage
due to contact with detergents. washing hands. This study found a statistical test that was
not significant between wet work and hand dermatitis because the appearance of
dermatitis was influenced by the type of wet work and the duration of doing wet work.
CONCLUSION
Based on the analysis and discussion, it can be concluded that risk factors, wet
work, atopic history, age, gender, years of service are not related to the incidence of hand
dermatitis in hospital nurses in Sukoharjo.
REFERENCES
Agarwal, Uma Shankar, Besarwal, Raj Kumar, Gupta, Rahul, Agarwal, Puneet, &
Napalia, Sheetal. (2014). Hand eczema. Indian Journal of Dermatology,
59(3), 213.
Ale, Iris S., & Maibach, Howard I. (2014). Irritant contact dermatitis. Reviews on
Environmental Health, 29(3), 195–206.
Cristóbal, Lara, de Los Reyes, Nerea, Ortega, Miguel A., Álvarez-Mon, Melchor,
García-Honduvilla, Natalio, Buján, Julia, & Maldonado, Andrés A. (2019).
Local growth hormone therapy for pressure ulcer healing on a human skin
mouse model. International Journal of Molecular Sciences, 20(17), 4157.
Dąbrowska, A. K., Spano, Fabrizio, Derler, Siegfried, Adlhart, Christian, Spencer,
Nicholas D., & Rossi, René M. (2018). The relationship between skin
function, barrier properties, and body‐dependent factors. Skin Research and
Technology, 24(2), 165–174.
Mortz, C. G., Bindslev‐Jensen, C., & Andersen, Klaus Ejner. (2014). Hand
eczema in The O dense A dolescence C ohort S tudy on A topic D iseases
and D ermatitis (TOACS): prevalence, incidence and risk factors from
adolescence to adulthood. British Journal of Dermatology, 171(2), 313–323.
Rive, Craig M., Bourke, Jack, & Phillips, Elizabeth J. (2013). Testing for drug
hypersensitivity syndromes. The Clinical Biochemist Reviews, 34(1), 15.
Salvador, J. F. Silvestre, Mendaza, F. Heras, Garcés, M. Hervella, Palacios-
Martínez, D., Camacho, R. Sánchez, Sanz, R. Senan, González, A. Apellaniz,
& Giménez-Arnau, A. M. (2020). Guidelines for the diagnosis, treatment,
and prevention of hand eczema. Actas Dermo-Sifiliográficas (English
Edition), 111(1), 26–40.
Santer, Miriam, Burgess, Hana, Yardley, Lucy, Ersser, Steven, Lewis-Jones, Sue,
Muller, Ingrid, Hugh, Catherine, & Little, Paul. (2012). Experiences of carers
managing childhood eczema and their views on its treatment: a qualitative
study. British Journal of General Practice, 62(597), e261–e267.
Sharmila Rao, V. (2018). Clinico-epidemiological and etiological study of hand
eczema. Madras Medical College, Chennai.
Eduvest – Journal of Universal Studies
Volume 1 Number 11, November 2021
1304 http://eduvest.greenvest.co.id
Tan, Cher Han, Rasool, Sarah, & Johnston, Graham A. (2014). Contact dermatitis:
allergic and irritant. Clinics in Dermatology, 32(1), 116–124.
Thomsen, Simon F. (2015). Epidemiology and natural history of atopic diseases.
European Clinical Respiratory Journal, 2(1), 24642.
