DERMATOSIS AKIBAT KERJA

1. DERMATOSIS AKIBAT KERJA

5. Changes in Incidence (1993 - 1999) • From 1993 to 1999 there have been further changes in the number of cases, incidence and proportion of occupational skin diseases. In 1999 BLS data showed 44,600 total cases of occupational skin diseases/disorders, or an incidence of 49 cases per 100,000. In 1999, 12% of all occupational illnesses reported were skin diseases/disorders.

7. Work time lost

8. Cost

9. Sifat agen penyebab dermatosis : • Agen fisik : tekanan, gesekan, cuaca dingin, panas, radiasi ultraviolet, serat mineral. • Agen Biologis : beberapa mikroba, fungi, parasit kulit dan produk2 nya • Agen kimia, dibagi dalam 4 kelompok : - iritan primer - sensitizer - acnegenic - photosensitizer

10. Iritan primer • Asam , basa, pelarut lemak • Detergen • Garam garam logam - garam arsen - garam mercuri - dll

11. Sensitizer • Logam dan garam2nya (kromium, nikel, kobalt) • Senyawa yang berasal dari anilin ( p fenilendiamin, azo dyes ) • Derivat nitro aromatik ( trinitrotoluene ) • Resin (epoksiresin, formaldehid, vinil, akrilik ) • Bahan kimia karet ( vulcanizer)  dimetil tiuran disulfida • Obat-2an (procain, fenotiazin, klorotiazid, penisilin,tetrasiklin • Kosmetik, terpentin, tanam2an

12. Agen acnegenic • Naftalen • Bifenil khlor • Minyak mineral

13. Agen photosensitizer • Antrasen • Pitch • Derivat asam aminobenzoat • Hidrokarbon aromatik klor • Pewarna akridin

14. Photosensitivity • Many chemicals need light to activate and produce the complete phototoxin or photoallergen. The furocoumarins in limes produced this vesicular phototoxic dermatitis in a bartender who squeezed limes all afternoon in direct sun.

15. Ultraviolet cured processes • The technology of using ultraviolet light sensitive chemicals is relatively new in creating templates for printing. It is also being used in the manufacture of certain printing inks and in dentistry. Various acrylates have been the sensitizers in this process.

16. Mekanisme terjadinya dermatosis : • Agen fisik  trauma mekanik langsung ke kulit • Agen kimia • Iritan primer : merusak kulit dengan cara mengubah PH, denaturasi protein, mengekraksi lemak, menurunkan daya tahan • Sensitizer/allergi reaksi hipersinsitivitas tipe lambat • Acnegenic menyumbat kelenjar dan sal, sebacea  peradangan lokal • Photosensitizer  meningkatkan sensitivitas kulit terhadap radiasi ultraviolet

17. Gejala dan tandaa. D. contact irritant • Akut ditandai eritema, edema, papula vesikula  biasanya di tangan, lengan bawah atau wajah • Kronik ditandai excoriasi, crustae , eksema, hiperkeratosis • Faktor yang membantu timbulnya contac iritant adalah ; adanya trauma ( digosok, digaruk) pakaian, sarung tangan, kulit kering, kulit sudah dalam kondisi sakit

18. Contact Dermatitis, Acute • This arm shows a painful, acute contact dermatitis form exposure to the strong irritant, ethylene oxide. The arm is markedly swollen and shows an acute vesiculo-bullous dermatitis. A similar pattern may be seen on the basis of contact allergy.

19. Contact Dermatitis, Subacute • This patient developed a bilateral and symmetric sub-acute dermatitis from the rubber accelerator, mercaptoben zothiazole, which was leached from the rubber portion of his work shoe as a result of sweating. In this case there is some edema and erythema with an eczematous eruption.

20. Contact Dermatitis, Chronic • The hands, wrists and forearms are the most frequent sites of involvement in cases of industrial contact dermatitis. The hands and wrists of this worker with a chronic dermatitis show the effect of long term exposure to a solvent, in this case kerosene, which was used for cleaning the skin. The skin markedly thickened, hyperpigmented, dry and fissured, itching is usually a major symptom.

22. Chrome hole, fingers • Chromic acid and alkaline chromate are agents commonly encountered in the tanning and electroplating industries. These substances have a corrosive action when they enter the skin through a minor nick or break in the integument. This results in the formation of chronic, ulcerative lesions known as "chrome holes". Typically, the lesions are found on fingers, hands or forearms. "Chrome holes" also occur on the dorsal surfaces of the feet when chrome salts have been allowed to permeate boots or shoes. The lesions are usually painless and persist for many months before spontaneously healing with permanent atrophic scar. Identical lesions can also be produced by arsenic or zinc salts but these are less frequently encountered.

23. Chromic acid and alkaline chromate are agents commonly encountered in the tanning and electroplating industries. • These substances have a corrosive action when they enter the skin through a minor nick or break in the integument. This results in the formation of chronic, ulcerative lesions known as "chrome holes". • Typically, the lesions are found on fingers, hands or forearms. "Chrome holes" also occur on the dorsal surfaces of the feet when chrome salts have been allowed to permeate boots or shoes. • The lesions are usually painless and persist for many months before spontaneously healing with permanent atrophic scar. • Identical lesions can also be produced by arsenic or zinc salts but these are less frequently encountered.

24. Chrome hole, nasal • When chrome containing materials are present as aerosols, painless ulceration of the nasal mucosa and septum may occur. With continues exposure permanent septal perforation eventually results, as in this young woman who was employed in chrome plating small appliance parts.

25. b. D.contact allergica • Ada sensitisasi sebelum timbul alergi, agen sensitisasi bereaksi dengan protein dalam epidermis membentuk kompleks hapten – protein  pembentukan antibody • Reaksi hypersensitivas tipe lambat, timbul setelah 48 – 72 jam • Zat yang biasanya sebagai primary irritant juga dapat sebagai allergen • Bentuk akut seperti  spt D. contact irritant akut • Bentuk kronis  timbul likenifikasi , fisura

26. Contoh kasus D. Contac allergica • Dental Assistant (allergy to glutaraldehyde and neomycin)

27. Contoh kasus D. contact allergica • Optician - non-dominant hand dermatitis(allergy to ethyl acrylate)

28. Other Resin System • This severe allergic contact dermatitis was due to a phenol-formaldehyde resin. These resins are used as bonding agents for foundry sand, electrical devices and in molded and cast plastic articles. They may also produce irritant reactions.

29. Chemical Accelerators in Rubber • Allergic contact dermatitis due to rubber chmicals is fairly common in industry. Chemial accelerators that speed up the vulcanization raction and antixidants are the more frequent allergens. They present a potential hazard in finishing goods as well.

30. Gejala Dermatosis yang lain • Acne akibat kerja  hanya menyerang tubuh yang kontak dengan agen • Lesi mikrotraumatik  disebabkan oleh serat mineral, ditandai dengan papula kecil keputihan atau kemerahan pd area yg terpapar • Kanker kulit ( karsinoma squamosa  hyperkeratosis, papilomatosis • Dermatosis yg menular  zoonotik, dermatofitosis, kandidiasis, tuberkulosis verukosa

31. Occupational Acne. Acute, Oil Folliculitis • Occupational acne is most commonly seen in workers exposed to insoluble cutting oils in the machine tool trades or in mechanics exposed to grease and lubricating oils. This worker developed folliculitis, sometimes called oil boils or acne, with multiple comedones and pustules on his arms and other covered areas of his body as a result of prolonged contact with oil. The lesions almost never develop from bacteria present in the oils

32. Oil Folliculitis Chronic, Chloracne • Chlordane is an extremely refractory type of acne caused by certain halogenated aromatic chemicals and can be certain halogogenated aromatic chemicals and can be accompaned by systemic toxicity. It represents one of the most sensitive indicators of biologic response to these chemicals. Chloracne in this herbicide production worker involved almost every follicular orifice on his face and neck with comedones, papules and cystlike lesions.

33. Depigmentation • The hands of this hospital maintenance worker are depigmented form contact with a phenolic germicidal detergent. Irritation or sensitization to the chemical is not a prerequisite for the pigment loss to occur. This loss of pigment may be permanent.

34. Granuloma • Granulomas represent a focal, chronic inflammatory reaction. These granulomas were produced by beryllium and are considered to be on a allergic basis. Non-allergic granulomas are more common and represent the skin's response to inoculated or implanted foreign materials such as wooden splinters, plant spines and silica.

35. Eccrine • Miliaria represents blockage of the eccrine sweat ducts and may occur in workers who perspire excessively. In this case of miliaria rubra of prickly heat, the blockage site is the granular cell layer of the epidermis. When more than 30% of the skin surface is affected, an individual may develop thermoregulatory disorders such as heat exhaustion.

36. Tumors • Skin tumors, such as this ulcerating squamous cell carcinoma most frequently arise after years of occupational exposure. Malignant tumors may represent to occupational carcinogens such as coal tar and physical agents such as sunlight. Skin cancer is the commonest form of cancer. The role played by occupational factors is frequently difficult to determine.

37. Diagnose Dermatosis akibat kerja • Gambaran klinis, lokalisasi dan perjalanan penyakit harus sepenuhnya sesuai dengan ciri PAK yg pasti • Paparan kerja terhadap agen berbahaya perlu dipastikan • Ada hubungan waktu paparan dan timbulnya penyakit • Dermatosis contact allergica  uji tempel

38. Uji tempel • Menempelkan alergen yang dicurigai dengan kadar yang non iritatif pada kulit yang tidak terpapar selama 24 – 48 jam • Positif bila timbul dermatosis ekzematous dibawah tempelan yang penutup

39. Kerentanan • Orang dengan atopi ( eksema, penyakit kulit alergi dan alergi lainnya) • Penyakit kulit kronik termasuk hiperhidrosis • Seborea atau iktiosis • Pimentasi abnormal • Lesi kulit prekanker

40. Penanganan kasus • Dipindahkan ke area bebas alergen • Kasus D. iritatant, pekerja dipindahkan sementara dan agen penyebab dikendalikan • Pemindahan kerja sec. Permanen dilakukan bila pemindahan sementara tidak menghasilkan penyembuhan yg sempurna • Kondisi prekanker mk. Pekerja harus dijauhkan dari paparan

41. Upaya pencegahan • Allergen kuat, sensitizer, karcinogen diganti dengan zat yang kurang berbahaya • Pengendalian secara tehnik ( isolasi tempat kerja) • Eliminasi kontak dengan kulit • Pakaian pelindung ( apron,sarung tangan, sepatu boot, penutup wajah)

42. Upaya pencegahan • Fasilitas dasar untuk kebersihan diri (pancuran air untuk mandi bukan bak mandi) • Kebersihan lingkungan dan house keeping - pembuangan air bekas dan sampah industri - pembersihan debu - cara penimbunan dan penyimpanan barang  Penggunaan SPF 15 untuk melindungi Sinar .matahari

43. Upaya pencegahan • Diagnose dini Penyakit Dermatosis Akibat kerja melalui : • Pemeriksaan awal sebelum penempatan - riwayat medis - fisik dengan perhatian khusus pada kulit • Pemeriksaan berkala : - sama spt pem.awal - uji tempel tdk dianjurkan bagi yg tdk menunjukan gx - waktu antara 6 bln – 2 tahun tgt tingkat paparan ditempat kerja

44. Prognosis • D. iritant , acne, infeksi  menyembuh sth agen penyebab dijauhkan • D. alergi  tgt sifat alergennya dan bila hanya ditempat kerja dan telah di hilangkan alergennya  sembuh sempurna  allergi + infeksi sekunder  sembuhnya lama