The pattern of dermatoses among brick kiln workers: A community-based cross-sectional study

Dear Editor,

The brick manufacturing industry in India, a cornerstone of its construction sector, relies heavily on traditional, labour-intensive methods, exposing workers to a myriad of occupational hazards.¹ While studies have explored the socioeconomic conditions and general morbidity of these workers, comprehensive dermatological assessments remain notably scarce.^2-4 To address this gap, we conducted a community-based, cross-sectional study in the Mannadipet commune of Puducherry, aiming to evaluate the prevalence and determinants of skin diseases among this highly vulnerable population.

Our study involved the screening of 771 brick kiln workers, comprising 442 males and 329 females, mean age of 34.4 (Standard deviation: 16.7). The findings revealed a high prevalence of dermatoses, with 96% of participants exhibiting at least one skin condition [Table 1]. Specifically, we observed a high incidence of callosities (28%), irritant contact dermatitis (ICD, 18.8%), and androgenic alopecia (11.6%). Furthermore, infectious dermatoses, including intertrigo (6.2%), pityriasis versicolor (5.8%), and pitted keratolysis (4.4%), were prevalent. Nail disorders, such as fragility (10.8%) and dystrophy (10.2%), were also frequently encountered alongside parasitic infestations like scabies (2.9%).

These findings significantly surpass previously documented morbidity rates among brick kiln workers, which have ranged from 5.5% to 12%.^2-4 This discrepancy underscores the critical need for specialised dermatological evaluations within this population. The meticulous clinical assessments conducted by our dermatologist likely contributed to the higher detection rate, emphasising the importance of focused clinical examinations.

The manual nature of the work at brick kilns, characterised by repetitive contact with abrasive materials such as bricks, moulds, and spades, directly correlates with the high incidence of callosities and frictional dermatoses (8.4%). Although often perceived as a sign of experience, these conditions represent significant occupational stress.

Exposure to intense solar radiation and ambient heat, coupled with the frequent absence of photoprotective measures, predisposes workers to sweat retention syndrome (6.9%), pityriasis versicolor, and photodermatoses, including polymorphous light eruption (3.8%) and melasma (7.2%). The lack of adequate protective clothing, particularly during the hot season, exacerbates these conditions.

The frequent exposure to water, an essential component of brick production, contributes to intertriginous candidiasis, pitted keratolysis and nail disorders. Additionally, irritants such as alumina, silica, and lime, commonly present in brick materials, most likely contribute to the high prevalence of ICD, compounded by prolonged exposure to water, which itself acts as an irritant.^5,6 Trivial traumas associated with brick handling further aggravate these dermatological issues. Callosities and miliaria were more frequently observed in males, possibly due to their involvement in physically demanding tasks like loading and firing bricks under high-heat conditions. In contrast, females showed a higher prevalence of ICD and chronic paronychia, which may be attributed to prolonged wet work, clay handling, and lack of protective measures.

Overcrowded living conditions and inadequate hygiene practices contribute to the spread of infectious dermatoses, such as scabies and folliculitis. Bivariate and multivariate analysis revealed that male workers, individuals aged 46 to 60 years, those engaged in baking, and those working for 10-20 years exhibited higher odds of developing dermatoses. This suggests that cumulative exposure significantly elevates the risk of skin diseases [Table 2].

Some individuals (7.2%) adopted basic protective measures, such as wrapping hands with plastic bags, covering the head with a cloth for sun protection, and using improvised footwear. Despite our efforts to provide health education and promote the use of personal protective equipment (PPE), the persistent lack of PPE utilisation remains a significant concern. A cost-benefit analysis of PPE usage in this group underscores the economic challenges in ensuring protective measures. The average monthly income of individuals ranged between INR 3,000 to 5,000. In comparison, the monthly cost of even basic PPE, such as gloves, boots, or hats, may amount to INR 300-500, representing a significant proportion of their earnings. Inaccessibility, lack of awareness, and prioritisation of daily sustenance over preventive health further widen the gap in PPE implementation.

Health education plays a pivotal role in decreasing the dermatological morbidity among this population. We provided health education at the end of each visit regarding personal and environmental hygiene and protective measures. Contextualised, community-driven education using pictorial flipcharts, short audiovisual messages in the local dialect, and demonstrations through field workers can greatly enhance awareness. Integrating such efforts into ongoing public health outreach programs can ensure sustainability. Involving community leaders or trusted elders as peer educators may further improve acceptability.

The cross-sectional design of our study represents a limitation, as it precludes the establishment of definitive causal relationships. Also, the dermatoses such as contact dermatitis, photodermatoses, frictional disorders and fungal infections could be occupation-related. Many other skin disorders could be incidental and non-occupation-related. Nonetheless, our findings underscore the urgent need for targeted interventions in this population.

The brick industry, despite its importance, remains largely unregulated, and workers in remote kiln locations face limited access to healthcare. The implementation of worker-friendly technologies and sustained educational initiatives is essential for mitigating these risks. Until such measures are implemented, these workers will continue to bear the burden of their hazardous working environment.