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23.0 Why Plant Dermatitis Must Be Eliminated

It is imperative that this most debilitating and deconstructive of afflictions be addressed. People have
to much to do in their daily lives without having to worry about the thousands of hazardous plants in the workplace. I believe the onus is on the authorities and the employer to educate and care for the health of their employees. It is their own interests to do so. Employees are an asset. Assets mean profit. A happy functioning and healthy employee is worth more than one who is suffering from continual set backs due to minor complaints, that can be easily and simple eliminated. Skilled horticulturists are in great demand in this industry, often gaining their knowledge over many decades. It is imperative that these profitable assets be managed and cared for, so they stay in tip top condition. To eliminate this affliction would be to create jobs, save millions and revive confidence in the industry and its recruitment.

24.0 Changes Advocated
There is a simple and straight forward programme I have devised from the study of the skin,
dermatitis and plants, that involves minor changes in the approach to  protection, cleanliness, education, allergy testing, cleansing agents,  plants,  and clothing, which will have a national  effect,  that will eliminate 60% of all severe cases of dermatitis within 5 years saving well over 40 billion pounds, create new jobs and profit for all companies concerned. This hinges on government,
employer and employee awareness, persuasion and co-operation .

24.1 Changes Advocated To Law & Compensation

The most significant and far reaching change I wish to make for the benefit of treatment, compensation and protection from dermatitis, would be to acknowledge the affliction "Dermatitis of the skin caused by plant origin" as a prescribed industrial injury and disease. "Horticulture and associated work with vascular plants" should then be recognised as prescribed and registered occupations. This would be very practical as Horticulture and Agriculture are the biggest industries in the United Kingdom. Every other conceivable industrial occupation is registered. This would enable a multitude of good deeds to be done. First those suffering from the affliction would be eligible for treatment and care from the DSS and NHS, be eligible for application for compensation and insurance, if they are severely disabled and unable to work. Those who have to take a spell off work to recover would be eligible for Sickness Pay.  The affliction then taken seriously, would release other important factors detailed below that would allow greater protection at work, by forcing employers to provide adequate protection, and safe practices. They would then be responsible for the well being, welfare and education of his employers skin, and prosecutable if he failed to carry this out. Also COSSH would be able to appoint stricter control on hazardous plants. EMAs and Safety officials would be able to carry out thorough surveys and dispatch orders for changes that need to be made in a particular area. The HSE would then be able to ensure that an education and screening programme is drawn up, and that the employer is made responsible for implementing their advice for protecting his employees skin. The employee would also have the chance for greater input as to his own care and welfare, and that of others, which the employer would have to listen to, or be fined. The personal protective clothing guidelines will also then become law, requiring the employer to provide the necessary clothing outlined below.

24.2 Changes Advocated For Employer Insurance
As plant dermatitis is now, under my scheme, registered as an occupational disease, and plants classified as items containing hazardous substances, Insurance companies would recognise the affliction. The employer would be wise to take out insurance against the chance of an employer developing more severe cases of dermatitis, that disable an employee from work, if it is found that the employer has been negligent in provision of protection or education. This would doubly ensure that he implements screening programmes and provides adequate protective clothing. Employees would also be wise to take out private medical insurance in case of disablement from dermatitis, and periods he has had to take off from work.

24.3 Changes Advocated To Surveillance Programmes

If the EMA's are to carry out their surveillance, they must have an incentive. If the laws above were changed, then they would be able to implement thorough screening programmes, and asses whether the employer has implemented my ideas for prevention and protection below, and issue fines and edicts for those who do not comply, or where there is high incidence of dermatitis. His powers would be equal to that of the catering industry. Employers must then agree by law to inspections of work practices every year, and questioning of employees on work conditions. He would be able also to collect reported data from the DSS, HSE and Employers as to the numbers
of cases encountered and map and isolate those places who constantly offend.

24.4 Changes Advocated For COSSH
COSSH should take into account that as the acids, alkalis and harmful substances contained in plants, if concentrated, are hazardous substances and are treated and labelled as such, then so should those plants, containing these chemicals, that are considered a significant hazard of causing dermatitis in employees and public.
(Appendix 1) This will mean providing new labels to all hazardous plants in all major nurseries, retailers  and colleges. These may be compulsorily attached to all such plant packets, seeds, and pots in accordance with a list drawn up by COSHH, as is done with some bulbs. There should be two labels provided.  One should be used for those with sharp spines, barbs, hooks, thorns, and the other for those with leaves containing hazardous or dermatitis inducing chemicals or hairs/bristles. These figures should be displayed prominently. It could be accompanied with the irritant cross sign, that is sometimes used with internally poisonous plants.

FIGURE 24.3.1 Labelling Advocated For Irritant Plants.
24.5 Changes Advocated In Protection
Workers should not be required to handle the irritants, if can be helped. Each worker should be allocated several boiler suits with hoods of fashionable design for winter and disposable lightweight paper, padded coveralls for summer, which are often used by the painting industry. They are very strong, breathable, non absorbent and cool in hot weather, and come with a zip. They often come with hoods, for all round protection, eliminating pollen fallout, down the neck.
Vinyl Gloves should be provided for the hands as they are non absorbent, dextrous and come in a range
of thickness from thick for heavy duty to thin for delicate work. They are also washable and non irritant. Cotton gloves may then be worn over the vinyl for absorption of the chemicals, or both types incorporated into a new type of glove. Leather gloves may be used in soil work. All these gloves must extend to the elbow, If this is not possible then a tubular arm protection with rubber banding on each end can be worn on the forearm. These should be vinyl/ cotton  or combinations where possible. Vinyl, cotton and leather are the only non-irritant materials that are flexible enough to be used.  These clothing allocations should be made compulsory for employees, and fines introduced for those who do supply or wear the clothing, enforceable by the HSI HMI or EMA . All clothing must be then  dumped in a solvent then washed, and gloves changed regularly. For those who suffer from hay fever from pollen, they must either avoid the situation, or wear suitable face masks. Those in the forestry industry who have to wear heavy duty clothing, should consider using the above methods, and ensure they have hoods covering their necks and face.

FIGURE 24.5.1 Diagram Depicting Proposed Changes In Protection For Workers In & Out.
24.6 Changes Advocated To Cleansing Methods
Washing with copious amounts of water will degrade most irritant chemicals, if applied directly after contact, and is recommended as the best prevention. This will also rid the body of perspiration. If the hands are dirty also, Sulphonated oils should be used for washing, these are not hydrophobic, and will not degrade the natural oils of the skin, and will clean thoroughly. Lubricants can be used to stop fissuring and drying of the skin, which will also lubricate vinyl gloves to be worn. After work a conditioning cream should be used to retain water and oils.

24.7 Changes Advocated In Work Practices
Although it may not be possible to change the conditions of work due to lack of finance, but where possible adequate space should be provided for the work activity intended. In intensive conditions they should be made tolerable with adequate breaks between, giving the employee the chance to wash and rest, avoiding stress, perspiration. Clean clothing is a must as mentioned, with daily cleaning in hazardous situations. In wet or very hot weather work, all activities should be slowed down or minimalised to avoid harm from chemicals that are likely to be exacerbated in such conditions.  The most important factor would be for the commonly offending varieties of plants containing irritants to be replaced, discarded or substituted for less harmful varieties. This is very feasible, as genetics is very advanced these days.
Children, although the backbone of the bulb industry in summer, are not suitable for this work, as their skin is easily sensitised. If this practice can be aborted until the age of 16, and the law implemented to prosecute those who employ those under 16,  and fail to protect those adolescents with protective clothing, outlined above, there may be a significant reduction in the number of sensitised cases developing in later years, in the employers most valuable and vulnerable asset, his recruits. Older people must ensure they receive adequate rest periods, and work at a steady pace, avoiding sunny conditions.

24.8 Changes Advocated For Pre Employment Screening
If those people who have very sensitive skin can be removed from the occupations and plants they are most at risk from, then there will be benefit to all. I am not recommending that employers reject everyone with sensitive skin, merely to be selective and inquisitive, to reduce numbers of people affected. Some of the best gardeners may suffer acutely from this affliction. People, it must be recognised, are assets to a business, and must be "road tested" for worthiness. The best stage for this to carried out is at the wicket gate, in the induction week. I have recently discovered a new method of allergy testing that is now being widely used in herbal shops all over Britain. It does not involve any chemicals being applied to the skin, and therefore is 100% safer than current patch testing methods. It involves measuring the "energy waves" from the skin, from which the computer system measures thickness, amount of electromagnetic activity, heart beat. Along with this information, is entered the age and characteristics of the person. The computer is then able to deduce which substances that person is likely to react to from a list of over 10,000, which can be narrowed for his/her occupation. This would be an invaluable guide for the employer, who could either reject the application of the employee if he was ultra sensitive or confine the activities of that person to a particular area of work, and importantly act as a guide for avoidance of particular plants. The employee would then have a greater
awareness as to his health, and will take greater care in future, without complacency as regards protective clothing. The test is very cheap and widely available, and I advocate it is carried out on every new recruit to horticulture. This could be carried out by the industrial dermatologist as mentioned below, that is registered with the institution. This would be especially beneficial to the pubescent youngsters who have not yet been sensitised to any plant. Many youngsters are concerned about their health and future, and this may appear as a fashionable accessory,  that they are aware of their own allergies and take responsible steps to avoid them. This would clearly then prolong, not only the effectiveness of the skin, but the effective working life of the individual, who when reaching his 50th birthday, when his skin deteriorates be free from extra burden of dermatitis.

24.9 Changes Advocated For Education
Education along with these other changes, will be the single most important factor in eliminating plant dermatitis. The younger the people are when they are told, the better the memory and the less likely they are to contact these plants, sensitise and develop plant dermatitis when older.  The most practical way of educating people will be at colleges and work inductions, in an informative and interesting way.  Employers will always have a health and Safety seminar at somepoint during the introduction week. In establishments dealing specifically in horticulture, a greater amount of time should compulsorily, by law, be devoted to awareness of skin afflictions, the plants that cause them, and the protection available. Distribution of my leaflet (Appendix 7) would be beneficial at these seminars, and even world-wide, for all who are concerned with plants. Everyone will benefit from this information, as we can see from my survey, So many people are unaware of the affliction, especially the smaller employers, who regard dermatitis as an infectious disease that is likely to create further problems and expenses for them. People will often remember such inductions, and when done, the cases of dermatitis will drop considerably because of their awareness. The HSE it seems is largely responsible for the monitoring of health and safety education. If the laws are changed as mentioned, then a compulsory demand of the employer to educate will hopefully be met by them.

24.10 Changes Advocated For Doctor Registration
If not done already employers should register with an industrial dermatologist/doctor, specifically one familiar with plant dermatitis, who would be able to provide immediate advice and cover, as he will be familiar with the employees. The employer, with his employee records, should keep a record of all health complaints, possible allergies and outcomes of allergy tests, while employed there.

24.11 Changes Advocated To Treatment
If at all possible I wish to eliminate doctors from the chain of dermatitis treatment,
in all but the most severe cases and anaphylactic shock, as it is perfectly treatable at home by natural means. However it will be necessary for people to visit the doctor if he wishes to claim compensation. Therefore I strongly advocate that doctors review their method of treatment. Although I am no expert on this field, I am able to determine that the way doctors treat their patients is wrong. The fiend being the corticosteroids. I advocate that all sensitising products and steroids are avoided, for all but the most serious cases. If my ideas for protection and prevention are implemented, then there will be little need for treatment.  Doctors must also instil a sense of confidence and professionalism in his ability and his patients from my new methods to be able to cure the affliction. The doctor must act as a hypnotiser, expressing his most exaggerated optimism for the patient. Healing a wound often hinges on the patients frame of mind, if he believes he will heal, then his immune cells will get into action and cure him. Confidentiality must also be adhered to. So many people are avoiding treatment because of what others might think or say, or the embarrassment of showing a doctor their body. If female nurses, photography or remote cameras have to be used then so be it, but if the doctor as noted above adopted a more confident, professional and friendly manner, or as in changes to registration; Chap 23.10, the worker is familiar with the doctor, then there may not be a problem in coming forward.

In physical treatment cooling cleaning and protecting will become a priority again, along with an in-depth questioning of their medical history and possible cause. If the person has received an allergy test by the computer method mentioned, there will be a faster response from the doctor, who armed with knowledge of the cause, will avoid delay, wrong treatment, and will be able to pinpoint the exact treatments available for those particular causes. The initial treatment will consist of:

* Cleaning with copious amounts of water
* Opening vesicles and bullae, applying a cold compresses.
* A poultice, of clay paste which can then be applied directly to the skin, and covered    
with a bandage for 3 hours, washing off with water. This will soothe the skin and will
draw out the poisons, and cool the skin.
* To dissipate boils a wrung very  hot wooden  towel can be applied,
covered with a dry cloth and left for 2 to 3 minute.
* Simple creams are then  applied to lubricate. There are however few curative agents for the
treatment of the skin, as it is such a complex organ. Ethyl chloride , has shown to be useful.
Aloe Vera juice applied to the skin, and consumed internally daily, is recommended, along with
zinc oxide for an itchy skin. For dry skin Aloe vera juice can be mixed with almond oil.
Very dry skin can be treated by mixing the clay poultice with pure virgin olive oil. 
* A bandage or occlusive dressing as described in Chap 11.0  must be applied.
* Above all rest, avoiding inactivity must be observed, eating very well with
   supplementary Vitamin E. It has been discovered that the skin will heel very
   quickly with this method.

24.12  After Care Treatment Of Skin
*  In after care olive or almond oil can be massaged into flaky areas before a bath.
* Use Sulphonated oils for general cleansing.
* Cold compresses should be applied regularly with a towel.
* Bathing should be carried out with the filling of a bath with luke warm water and either
adding Potassium permanganate, Epsom salts (500-700g) with 250g of Sea salt  or oatmeal
held in a muslim bag, squeezing bag to release substance. Then lying in bath for 20 min.
These methods could be used for widespread aftercare of dermatitis. The Epsom salt bath is
however very tiring and should be used twice a week, and not for the very frail.

24.13 Changes Advocated In Personal Health Care [ 11 ]
Those suffering from high stress levels are very susceptible to dermatitis as we have outlined in Chap 7, those in the horticultural industry are often paid low wages, and may not eat well. These employees often work very hard in cramped conditions. It is therefore important if dermatitis is to be eliminated then the people must be treated well, and given the correct conditions to work in, as well as individual interest by the manager into their personal lives. I believe that stress would be significantly reduced by changing the work practices above, providing adequate breaks between work, giving significant time for food to digest and this eaten slowly. Out of work activities may be arranged to involve employees in team games etc, to strengthen ties, and team building. For the individual It is recommended that in stress and anger, it is helpful to smile, relax and laugh often, see the light side of problems taking deep breaths. Exercise at least 3 times a week will release pent up energy and release pain killing substances within the body. Drinking and smoking do not help, and must be reduced, as they poison and tense the body, local groups are available to combat this. Also doing too many things at once is the downfall of many a Major. Jobs must be taken in order of importance. An action plan must be drawn up, planning ahead leads to order. All problems must be forgotten once in a while, and thrown away, as if putting the rubbish out. Good food is also necessary to keep the skin healthy. Fruit, Veg, Milk,  Nuts, Fish, Sunlight and extra vitamins all provide protein and nutrients to keep the immune system active to combat disease and bacteria. Food will also reduce stress and keep people happy. There is no reason at all for anyone to be hungry at all in this day and age.

Dermatitis In the Horticulture Industry By James M. Burton In Association With Pencoed College Copyright 1997.
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