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Acne and Occupational Problems

 

It is more common than generally thought for acne to cause an occupational problem. Severeacne with deep cystic lesions may be very painful and the lesions are sometimes so tender that it becomes impossible to wear a collar or anything on the shoulders. Luckily such severe episodes usually respond to treatment and are short-lived. A few unfortunates are persistently severely affected and it can be difficult for them to tackle a heavy laboring job or continue work in a uniformed service.

Acne can suddenly become explosively severe in moist tropical climates, especially when there are few opportunities for frequent bathing and rest in air-conditioned surroundings. This type of so-called 'tropical acne' was the cause of a great deal of evacuation from Far-Eastern war zones in recent conflicts there. The possibility of acne behaving in this way in young men who are likely to serve abroad under such circumstances should be remembered during pre-employment examinations.

Problems of appearance

It is more usual for acne to cause employment problems in another way. The prejudice that the media have created in favor of the ideal body image can result in difficulties for the youngster with bad facial acne - especially in jobs which involve meeting the public. This situation is exemplified by the case of a 23-year-old saleswoman with recurrent attacks of large papules and nodules on the forehead, cheeks and chin who worked in a small but smart clothes boutique. The manageress was concerned (unduly in my opinion) that customers would not want to be served by her, and so she was either told to go home while her acne was bad or made to do some menial job in the stockroom.


Mild acne is extremely common this shows a young woman with typical papules and comedones.


This young man's severe acne proved disabling for him as it affected the back of the neck and rubbed agians his collar

Another way in which acne can interfere with work may actually be more common and concerns the affected person's own conception of the way he or she looks. An 18year-old girl desperately wanted to be a hairdresser but because of relatively minor acne blemishes decided to work in a factory. She felt that the clients would be horrified at her appearance. Firm reassurance is required for this sort of patient, though I am sad to say it rarely seems effective.

Acne can always be improved by treatment with topical agents such as tretinoin or isotretinoin preparations or benzoyl-peroxide-containing gel (Panoxyl) or systemic antibiotics and, in the large majority of cases, subsides spontaneously after two or three years. During the time it is present sympathy and understanding are required for the problems that sometimes arise.

Occupational acne

The other side of the coin is occupational acne or acne aggravated by work. Tropical acne can be considered occupational in some cases. It is sometimes said that ordinary acne may be aggravated by hot and sweaty jobs such as baking or stoking, and it must be admitted that acne among those working in these professions does seem to improve after a spell away from work.

Frequent contact of hair-bearing skin with lubricating and cutting oils and greases can produce a type of acne. This may occur over the front of the thighs from oil-soaked overalls, and on the forearms. Although unpleasant it clears fairly quickly once contact with the oils responsible is prevented.

A more serious type of acne is that associated with exposure to small amounts of the chemical agent known as dioxin and chlorphenols used extensively in industry for insulation. There have been several incidents at chemical plants in recent years in which explosions or other accidents have resulted in contamination of the surrounding environment with chemicals of this sort, and subsequently in cases of 'chloracne'. Chloracne can be very unpleasant and persistent with many large and painful cysts.