Occupational Dermatoses in Rural America: A Review of Skin Disease Burden Among Agricultural and Outdoor Workers
Main Article Content
Keywords
Occupational dermatoses, Rural dermatology, Agricultural skin disease, Pesticide exposure, Photodermatoses, Frictional dermatitis, Infectious dermatoses, Dermatologic access barriers
Abstract
Background: Rural agricultural and manual laborers in the United States face significant occupational exposure to ultraviolet radiation, agrarian chemicals, mechanical friction, and infectious agents. All of which contribute to a broad spectrum of dermatologic conditions. Dermatologic disease in rural workers remains understudied and underserved, with limited access to preventive care, education, and early intervention.
Objective: This review synthesizes existing literature on occupational dermatoses in rural U.S. populations, highlighting key exposure types, health consequences, access disparities, and opportunities for public health intervention.
Findings: 22 studies were reviewed and grouped into four exposure categories: UV radiation, chemical irritants, frictional/mechanical stressors, and infectious exposures. UV-related dermatoses were common, with studies citing high rates of photodamage, sunburn, and skin cancer. Chemical exposures often led to allergic and irritant contact dermatitis and systemic toxicity in certain populations, especially child laborers. Frictional dermatoses were under-documented but prevalent, particularly among female and immigrant workers. Infectious conditions, including skin and soft tissue infections caused by multidrug-resistant Staphylococcus aureus, were associated with livestock contact and poor hygiene infrastructure. Structural barriers such as cost, language, and rural provider shortages further delayed care.
Conclusion: Occupational dermatoses in rural America represent a preventable yet neglected public health issue. Solutions to such issues include, but are not limited to: teledermatology, field-based screenings, community-based education, and policy reforms that prioritize equity in access to dermatologic care.
References
2. Kearney, G. D., Xu, X., Balanay, J. A. G., & Becker, A. J. (2014). Sun Safety Among Farmers and Farmworkers: A Review. Journal of Agromedicine, 19(1), 53–65. https://doi.org/10.1080/1059924X.2013.855691
3. Armitage, T. L., Mitchell, D., & Schenker, M. (2012). Mortality in the California Farmer Health Study Cohort. Journal of Agromedicine, 17(3), 288–299. https://doi.org/10.1080/1059924X.2012.687614
4. McKnight, R. H., & Spiller, H. A. (2005). Green Tobacco Sickness in Children and Adolescents. Public Health Reports®, 120(6), 602–605. https://doi.org/10.1177/003335490512000607
5. Pichardo‐Geisinger, R., Muñoz‐Ali, D., Arcury, T. A., Blocker, J. N., Grzywacz, J. G., Mora, D. C., Chen, H., Schulz, M. R., Feldman, S. R., & Quandt, S. A. (2013). Dermatologist‐diagnosed skin diseases among immigrant Latino poultry processors and other manual workers in North Carolina, USA. International Journal of Dermatology, 52(11), 1342–1348. https://doi.org/10.1111/j.1365-4632.2012.05580.x
6. Nadimpalli, M., Stewart, J. R., Pierce, E., Pisanic, N., Love, D. C., Hall, D., Larsen, J., Carroll, K. C., Tekle, T., Perl, T. M., & Heaney, C. D. (2016). Livestock-Associated, Antibiotic-Resistant Staphylococcus aureus Nasal Carriage and Recent Skin and Soft Tissue Infection among Industrial Hog Operation Workers. PLOS ONE, 11(11), e0165713. https://doi.org/10.1371/journal.pone.0165713
7. Wardyn, S. E., Forshey, B. M., Farina, S. A., Kates, A. E., Nair, R., Quick, M. K., Wu, J. Y., Hanson, B. M., O’Malley, S. M., Shows, H. W., Heywood, E. M., Beane–Freeman, L. E., Lynch, C. F., Carrel, M., & Smith, T. C. (2015). Swine Farming Is a Risk Factor for Infection With and High Prevalence of Carriage of Multidrug-Resistant Staphylococcus aureus. Clinical Infectious Diseases, 61(1), 59–66. https://doi.org/10.1093/cid/civ234
8. Feldman, S. R., Vallejos, Q. M., Quandt, S. A., Fleischer, A. B., Schulz, M. R., Verma, A., & Arcury, T. A. (2009). Health Care Utilization Among Migrant Latino Farmworkers: The Case of Skin Disease. The Journal of Rural Health, 25(1), 98–103. https://doi.org/10.1111/j.1748-0361.2009.00205.x
9. Quandt, S. A., Newman, J. C., Pichardo‐Geisinger, R., Mora, D. C., Chen, H., Feldman, S. R., & Arcury, T. A. (2014). Self‐reported skin symptoms and skin‐related quality of life among Latino immigrant poultry processing and other manual workers. American Journal of Industrial Medicine, 57(5), 605–614. https://doi.org/10.1002/ajim.22291
10. Weeks, W. B., Chang, J. E., Pagán, J. A., Lumpkin, J., Michael, D., Salcido, S., Kim, A., Speyer, P., Aerts, A., Weinstein, J. N., & Lavista, J. M. (2023). Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS Global Public Health, 3(10), e0002420. https://doi.org/10.1371/journal.pgph.0002420
11. Hinckley, M., Feldman, S. R., Fleischer, A. B., Vallejos, Q. M., Whalley, L. E., Quandt, S. A., Heck, J., Cabral, G., Brooks, T., Schulz, M. R., & Arcury, T. A. (2008). Common Skin Disorders Seen in the Migrant Farmworker Health Care Clinic Setting. Journal of Agromedicine, 12(4), 71–79. https://doi.org/10.1080/10599240801986272
12. Thompson, B., Coronado, G., Puschel, K., & Allen, E. (2001). Identifying constituents to participate in a project to control pesticide exposure in children of farmworkers. Environmental Health Perspectives, 109(suppl 3), 443–448. https://doi.org/10.1289/ehp.01109s3443
13. Perry, M. J. (2003). Children’s Agricultural Health: Traumatic Injuries and Hazardous Inorganic Exposures. The Journal of Rural Health, 19(3), 269–278. https://doi.org/10.1111/j.1748-0361.2003.tb00573.x
14. Kong, F., Galzote, C., & Duan, Y. (2017). Change in skin properties over the first 10 years of life: A cross-sectional study. Archives of Dermatological Research, 309(8), 653–658. https://doi.org/10.1007/s00403-017-1764-x
15. Castillo, F., Mora, A. M., Kayser, G. L., Vanos, J., Hyland, C., Yang, A. R., & Eskenazi, B. (2021). Environmental Health Threats to Latino Migrant Farmworkers. Annual Review of Public Health, 42(1), 257–276. https://doi.org/10.1146/annurev-publhealth-012420-105014
16. Cho, H. (2010). Predictors of Summer Sun Safety Practice Intentions Among Rural High School Students. American Journal of Health Behavior, 34(4). https://doi.org/10.5993/AJHB.34.4.3
17. Chung, G. Y., Brown, G., & Gibson, D. (2015). Increasing Melanoma Screening Among Hispanic/Latino Americans: A Community-Based Educational Intervention. Health Education & Behavior, 42(5), 627–632. https://doi.org/10.1177/1090198115578748
18. Reding, D. J., Fischer, V. V., Berg, R. L., & Lappe, K. A. (1998). Assessment of Farmers’ Acceptance of Veterinarians as Human Health Advocates. Journal of Agromedicine, 5(3), 47–60. https://doi.org/10.1300/J096v05n03_07
19. Wu, Y. P., Parsons, B., Jo, Y., Chipman, J., Haaland, B., Nagelhout, E. S., Carrington, J., Wankier, A. P., Brady, H., & Grossman, D. (2022). Outdoor activities and sunburn among urban and rural families in a Western region of the US: Implications for skin cancer prevention. Preventive Medicine Reports, 29, 101914. https://doi.org/10.1016/j.pmedr.2022.101914
20. Watanabe‐Galloway, S., Ratnapradipa, K., Hymel, E., High, R., & Farazi, P. A. (2023). Predictors of cancer risky and preventive behaviors among the Nebraska farmers population. The Journal of Rural Health, 39(2), 392–401. https://doi.org/10.1111/jrh.12731
21. Fenton, G. D., Brasier, K. J., Henning, G. F., Radhakrishna, R. B., & Jayarao, B. M. (2010). Occupational Health Characteristics of Women on Dairy Farms in Pennsylvania. Journal of Agromedicine, 15(1), 7–15. https://doi.org/10.1080/10599240903389649
22. Anderson, S. E., & Meade, B. J. (2014). Potential Health Effects Associated with Dermal Exposure to Occupational Chemicals. Environmental Health Insights, 8s1, EHI.S15258. https://doi.org/10.4137/EHI.S15258
23. Elias, P. M., Hatano, Y., & Williams, M. L. (2008). Basis for the barrier abnormality in atopic dermatitis: Outside-inside-outside pathogenic mechanisms. Journal of Allergy and Clinical Immunology, 121(6), 1337–1343. https://doi.org/10.1016/j.jaci.2008.01.022
24. Wittenauer, R., Shah, P. D., Bacci, J. L., & Stergachis, A. (2024). Locations and characteristics of pharmacy deserts in the United States: A geospatial study. Health Affairs Scholar, 2(4), qxae035. https://doi.org/10.1093/haschl/qxae035
25. Johnson, M. C., Patel, P., Ayers, A., & Spears, K. M. (2025). Resource Management Challenges in Rural Dermatological Care: A Mapping Review. Cureus. https://doi.org/10.7759/cureus.77544
26. Theodosopoulos, L., Fradelos, E. C., Panagiotou, A., Dreliozi, A., & Tzavella, F. (2024). Delivering Culturally Competent Care to Migrants by Healthcare Personnel: A Crucial Aspect of Delivering Culturally Sensitive Care. Social Sciences, 13(10), 530. https://doi.org/10.3390/socsci13100530
27. Dorevitch, S., Tharenos, L., Demirtas, H., Persky, V., Artwohl, J., & Fortman, J. D. (2007). Inverse association between rural environment in infancy and sensitization to rodents in adulthood. Annals of Allergy, Asthma & Immunology, 98(5), 440–446. https://doi.org/10.1016/S1081-1206(10)60758-2
28. Ngondwe, P., & Tefera, G. M. (2025). Barriers and Facilitators of Access to Healthcare Among Immigrants with Disabilities: A Qualitative Meta-Synthesis. Healthcare, 13(3), 313. https://doi.org/10.3390/healthcare13030313
29. Pandey, M., Maina, R. G., Amoyaw, J., Li, Y., Kamrul, R., Michaels, C. R., & Maroof, R. (2021). Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: A qualitative study. BMC Health Services Research, 21(1), 741. https://doi.org/10.1186/s12913-021-06750-4
30. Park, H., Sprince, N. L., Jensen, C., Whitten, P. S., & Zwerling, C. (2002). Health Risk Factors Among Iowa Farmers. The Journal of Rural Health, 18(2), 286–293. https://doi.org/10.1111/j.1748-0361.2002.tb00888.x
31. Pichardo-Geisinger, R., Mora, D. C., Newman, J. C., Arcury, T. A., Feldman, S. R., & Quandt, S. A. (2014). Comorbidity of Tinea Pedis and Onychomycosis and Evaluation of Risk Factors in Latino Immigrant Poultry Processing and Other Manual Laborers. Southern Medical Journal, 107(6), 374–379. https://doi.org/10.14423/01.SMJ.0000450705.67259.26
32. Srinivas, C., & Sethy, M. (2023). Occupational dermatoses. Indian Dermatology Online Journal, 14(1), 21. https://doi.org/10.4103/idoj.idoj_332_22
33. Pesticide Worker Safety. (2025, April 28). United States Environmental Protection Agency (EPA). https://www.epa.gov/pesticide-worker-safety
34. CDC - 2023 BRFSS Survey Data and Documentation. (n.d.). U.S. Centers for Disease Control and Prevention. Retrieved May 4, 2025, from https://www.cdc.gov/brfss/annual_data/annual_2023.html
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons Attribution (CC BY): lets others distribute and copy the article, to create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honor or reputation.
Authors retain copyright in their work and license the publisher to publish the content. The publisher is the National Society for Cutaneous Medicine, with production and publishing support provided by OJS, Open Journal Systems,see https://pkp.sfu.
Prior to January 2022, authors transferred copyright to the National Society for Cutaneous Medicine. However, all articles are freely available to anyone in the world. There are no subscription fees, page charges, or article processing charges.