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Occupational Skin Diseases

Occupational Skin Diseases. Dr. Alireza Safaiean Occupationala Medicine Specialist. Introduction. The second cause of occupational diseases ( 23-25% of all occ.diseases ) A skin disease that is caused by physical, biological or chemical factor in work

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Occupational Skin Diseases

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  1. Occupational Skin Diseases Dr. AlirezaSafaiean OccupationalaMedicine Specialist

  2. Introduction • The second cause of occupational diseases ( 23-25% of all occ.diseases ) • A skin disease that is caused by physical, biological or chemical factor in work • Also a worsening of pre-existing skin disease can be termed as occupational skin disease

  3. CONTACT DERMATITIS FOLLICULITIS AND ACNE PIGMENTARY DISTURBANCE NEOPLASMS, ULCERATION GRANULOMA CHEMICAL X X X X MECHANICAL X PHYSICAL X X BIOLOGICAL X CAUSES OF SKIN DISORDERS

  4. Classifications of skin diseases • Occupational dermatitis • Occupational photosensitivity reactions • Occupational phototoxicity reaction • Occupational skin cancers • Occupational contact urticaria • Occupational acne • Occupational skin infections • Occupational pigmentary disorders • Miscellaneous

  5. Work-aggravated Skin Diseases • Psoriasis • Acne

  6. APPROACH TO THE WORKERWITH SKIN DISEASE • History • Physical examination • Diagnostic techniques • Supplemental information

  7. History A. Present illness • Date of onset • Body site at onset • Patient description • Onset – abrupt or gradual • Appearance, spread • Frequency • Effect of treatment • Course of disease • Effect of weekend, vacation • Work procedure change • Treatment and effect on dermatitis

  8. History B. Occupational information • Current employer • Employment dates • Job title (At time of onset, Description of job tasks, Materials contacted, Protection, Water exposure, Hand washing) • Clothing/equipment: (Protective creams/cleansers, Skin cleaning, Method and frequency) • Other workers affected • Job since dermatitis • Previous job tasks or jobs • Episodes of dermatitis • Second job • Dates of disability • Date of job changes

  9. History C. Personal history • Other exposures (Animals, Foods, Plants, Clothing, Personal care products, Hobbies) • Past history of skin disease (Plant dermatitis, Hand dermatitis, Psoriasis, Athlete’s foot) • History of atopy • Personal/family (Atopic dermatitis, Hay fever, Asthma) • Medical problems • Medications

  10. Physical examination • Lesion type • Secondary changes • Distribution • Other skin disease • Photographic documentation

  11. Diagnostic techniques • Skin scrapings • Fungus • Fibers • Culture • Skin biopsy • Patch test • Contact urticaria test • Photopatch test

  12. Supplemental information • Material safety data sheets • Medical records • Workplace • Other physician

  13. Diagnosis Of Occupational Skin Diseases • Clinical symptoms: Are they in accordance to clinical disease? • Patient history: Does skin disease relate to work? • Exposure: Are there causative agents (allergens, irritants) in the work-place?

  14. CAUSES OF OCCUPATIONAL SKIN DISEASE

  15. Chemical agents The main cause of occupational skin diseases and disorders. These agents are divided into two types: • Primary irritants: Primary or direct irritants act directly on the skin though chemical reactions. • Sensitizers: may not cause immediate skin reactions, but repeated exposure can result in allergic reactions. A worker’s skin may be exposed to hazardous chemicals through: • direct contact with contaminated surfaces, • deposition of aerosols, • immersion, • splashes

  16. Other Causes • Physical agents such as extreme temperatures (hot or cold) and radiation (UV/solar radiation). • Mechanical trauma includes friction, pressure, abrasions, lacerations and contusions (scrapes, cuts and bruises). • Biological agents include parasites, microorganisms, plants and other animal materials. (Animal breeders, vets, horticulturists, bakers, tanners, bricklayers, etc. are all possible victims of biological)

  17. CAUSES OF OCCUPATIONAL SKIN DISEASE • Predisposing Factors • Age & experience • Skin type • Sweating • Gender • Seasons and humidity • Hereditary allergy • Personal hygiene • Preexisting skin disease

  18. Contact Dermatitis • Occupational dermatitis is an inflammation of the skin causing itching, pain, redness, swelling and small blisters. • Contact dermatitis is an eczematous eruption caused by external agents, which can be broadly divided into: • Irritant substances that have a direct toxic effect on the skin (irritant contact dermatitis, ICD) • Allergic chemicals where immune delayed hypersensitivity reactions occur (allergic contact dermatitis, ACD).

  19. Types of contact dermatitis Irritant Contact 80% of all dermatitis is caused by direct contact with a substance It may occur randomly Allergic Contact Once sensitised, the problem is life long and any exposure to the substance will result in an attack

  20. The Causes Irritants • Detergents • Solvents • Engine oils • Cutting fluid • Lubricants • Fibreglass Allergens • Salts • Nickel • Epoxy resins • Dyes • Rubber

  21. Common site of involvement • Skin disease starts on the area of contact. • Dorsal aspects of hands and fingers, volar aspects of arms, interdigital webs, medial aspect of thighs, dorsal aspects of feet.

  22. Prognosis Of Occupational Dermatitis After Treatment • 25% complete recovery • 25% refractory • 50% remitting / relapsing

  23. Irritant Contact DermatitisICD

  24. Classification of ICD • Acute • Chronic

  25. Acute ICD • This is often the result of a single overwhelming exposure or a few brief exposures to strong irritants or caustic agents. • Common work chemicals: – Concentrated acids (sulfuric, nitric, chromic, hydrochloric, hydrofluoric acids) – Strong alkali(CaOH,NaOH,KOH),wet concrete, sodium and potassium cyanide – Organic and inorganic salts, e.g. dichromates, arsenic salts – Solvents/gases, e.g. acrylonitrile, ethylene oxide, CS2

  26. Clinical Presentation • Stinging, burning, painful, erythematous eruption occur after brief contact with strong irritant chemicals. • Erosion and skin ulceration may occur. • May result in permanentscar.

  27. Chronic (cumulative) ICD • Repetitive exposure to weaker irritants -Wet : detergents, organic solvents, soaps, weak acids, and alkalis -Dry : low humidity air, heat ,dusts , and powders • Disease of the stratum corneum • Is due to a stepwise progression of damage to the barrier function of the skin

  28. Predisposing Factors • Endogenous factors: • Dryness vs. wetness • Sweating • Age • Atopic predisposition • Hx of skin diseases

  29. Causes of Chronic ICD • Water/wet work • Detergents • Antiseptics • Disinfectants • Soap/cleansing agents • Weak Acids & alkali • Wet cement • Solvents • Low humidity • friction • Fiberglass fibers • Cutting oil • Food • Pesticides • Plants & vegetation • Rubber products • Acrylic resins • Soldering flux • Dusts • Degreasing agents

  30. 35% Washing • 10% Solvents • 6% Plastics and adhesives • 6% Foodstuff • 5% Dirty, wet work • 5% Mineral oils • At risk occupations: • Bartenders • Caterers • Cleaners • Hairdressers • Metalworkers • Nurses • Solderers • Fisherman • construction workers.

  31. Clinical Presentations • Usually presents with dry, scaly fissuring, lichenified and eczematous lesions on the fingers and hands. • Vesicular lesions do occur but are less common than in ACD. • May in face ( forehead, eyelids, ears, neck) and arms due to airborne irritant dusts and volatile irritant chemicals

  32. Management • In workplace Removal from exposure in active lesion Skin cleansing (water rinse without soap if possible) Barrier cream Gloves • Treating the active case Topical corticosteroids Soap substitutes Emollients (either water- or oil-based) • Second line (for steroid resistant cases): • Topical PUVA • Azathioprine • Cyclosporin

  33. Allergic Contact DermatitisACD

  34. Allergic Contact Dermatitis • Caused by low-molecular weight haptens • Hapten is “incomplete allergen” • Binds to carrier protein for immunogenicity • Low molecule weight enables penetration of hapten • Hapten penetrates through stratum corneum of a sensitized individual • A classical Type IV reaction

  35. Occupational Skin Allergens • Poison oak/ivy • Metals: • Chromium • Nickel • Gold • Mercury • Cobalt • Rubber industry • Accelerators • Antioxidants • Plastic resins • Epoxy resins • PU resins • Phenolic resins • Formaldehyde resins • Acrylic resins • Rosin ( colophony ) • Soft soldering • Organic dyes ( azo dyes ) • Methyl metacrylate • Plants • Latex and its powder • Germicides and biocides • e.g. lanolin • Some pesticides • Some solvents • Formaldehyde • Turpentine • Aliphatic amines • Nitrates • Ethylene oxide

  36. Classification of ACD • Acute • chronic

  37. Clinical Features ( Acute Form ) • Rash appears in areas exposed to the sensitizing agent, usually asymmetric or unilat. • Sensitizing agent on the hands or clothes is often transferred to other body parts. • The rash is characterized by erythema, vesicles and sever edema. • Pruritus is the overriding symp.

  38. Acute Allergic Contact Dermatitis Showing Erythema, Edema, and Vesiculobullae

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