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.
