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A survey of skin problems in floristry

Our objective was to ascertain the frequency and suspected causes of skin problems in retail floristry. We first consulted with the factory inspectorate's area liaison officer, environmental health officers of the local authority, and local dermatologists. A questionnaire was designed. Retail florists were approached by letter, explaining the study and inviting their participation. A telephone call followed to arrange for an employment nursing adviser (ENA) to visit. A few of those so approached declined to participate. We saw 164 persons at 83 premises, selected I in 10 from listings in the Yellow Pages telephone book. Questionnaires were completed during the visits. Premises were generally small, poorly designed and unhygienic. The florists were predominantly female, the majority with either less than 5 years (young assistants) or more than 20 years (shop owners) experience. The great majority had no formal training. Of those interviewed, 46% had had a rash at some time in their employment and 84% of these thought that they knew the cause(s). Most commonly suspected was the sap from daffodil stems, followed by primula. Christmas trees and the Cupressus used for wreath making followed. Other causes given were, in decreasing frequency: hyacinth bulbs, lilies, statice, rose thorns, holly, Dieffenbachia, Eucalyptus, paint sprays, metal wire, chemicals, tulips, chrysanthemums, mosses, pollens, sweet william, Grevillea, Ruscus, Gerbera, carnations, Gypsophila, Gloxinia, broom, Mimosa, stocks and Euphorbia. The largest proportion of all thought that their rash was nonoccupational. Many rashes were present only occasionally or seasonally and very few had ever consulted a doctor about them. In 2 cases, severe dermatitis had occurred, both persons continuing at work using protective gloves and clothing. This was a survivor population and other severe cases of dermatitis might already have resulted in florists leaving the trade. 3 young women who had given up hairdressing because of skin problems were working successfully in floristry. An atopic history (hay fever, asthma, infantile eczema) was found not to be a reliable predictor of skin problems, 28/60 with atopy and 47/104 without atopy reporting rashes. Florists with formal training had more knowledge of skin hazards and better hygiene, but neither barrier cream nor protective gloves were widely used. Around 1/3 used emollients after work, those with rashes more than those without. 2 of the ENAs developed rashes themselves during the study, after Cupressus had brushed against their legs. Hausen & Oestmann's (I) study, mainly of market gardeners and wholesale florists, found chrysanthemums, tulips and Alstroemeria to be the commonest causes of allergic contact dermatitis, and the majority of skin reactions to daffodils and other Narcissus species to be irritant: allergies to daffodils and to primula were found to be rare. Thiboutot et al. (2) also found Alstroemeria to be a common sensitizer in retail florists.