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TREATMENT OF OCCUPATIONAL SKIN DISEASES

TREATMENT OF OCCUPATIONAL SKIN DISEASES. Antti I. Lauerma, M.D., Ph.D. FIOH. Occupational Skin Diseases. Allergic contact dermatitis Irritant contact dermatitis Protein contact dermatitis Contact urticaria Skin infections Acne Cancer Pigment changes. CONTACT DERMATITIS.

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TREATMENT OF OCCUPATIONAL SKIN DISEASES

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  1. TREATMENT OF OCCUPATIONAL SKIN DISEASES Antti I. Lauerma, M.D., Ph.D. FIOH

  2. Occupational Skin Diseases • Allergic contact dermatitis • Irritant contact dermatitis • Protein contact dermatitis • Contact urticaria • Skin infections • Acne • Cancer • Pigment changes

  3. CONTACT DERMATITIS • Irritant contact dermatitis and allergic contact dermatitis clinically very similar • Impossible to distinguish in histology • Cell-mediated immune responses • Antigen presenting cells more important in allergic contact dermatitis

  4. TOPICAL TREATMENTS • Wet dermatitis - wet treatment • dressings • light creams • Dry dermatitis - dry treatment • ointments • petrolatum • oils

  5. WET, BUT HEALING SKIN WET OCCLUDED SKIN

  6. DRY SKIN LESS DRY

  7. TOPICAL CORTICOSTEROIDS • Classes I, II, III, IV • Side-effects and beneficial effects mediated by same glucocorticosteroid receptor • Side-effects: • Atrophy • Systemic effects • Tachyphylaxis • Worsening of acne

  8. TOPICAL CORTICOSTEROID USE • Class I: Face, flexures, children, aged people • Class II: Body, extremities • Class III: Lichenified eczema, psoriasis • Class IV: Mycosis fungoides. Lupus erythematosus, resistant eczema

  9. TOPICAL CORTICOSTEROID APPLICATION • 1-2 times daily for 3-14 days • Pauses between treatments to avoid atrophy • New scheme: 2 times daily for 2 weeks and 2 times weekly after that. • Prevents relapses

  10. TOPICAL IMMUNOSUPPRESANTS • TACROLIMUS • PIMECROLIMUS • CYCLOSPORINE • All act through calcineurin inhibition

  11. TOPICAL CYCLOSPORINE • Not effective • Does not penetrate skin in sufficient amounts • Not effective on molar basis

  12. TOPICAL TACROLIMUS (PROTOPIC) • Effective topically • Penetrates skin • Efficient on molar basis • No skin atrophy • Effective in atopic dermatitis and allergic contact dermatitis • Effect in irritant contact dermatitis???

  13. TOPICAL PIMECROLIMUS (ELIDEL) • Less effective than tacrolimus • Effective in face, flexures? • Use in children • Expensive (150 euros/100 grams) - same price as Protopic

  14. ANTIMICROBIALS • Used when secondary infection is suspected • Cephalexin or other cephalosporins preferred (act on both staphylococci and streptocci) • Penicillin for erysipelas • Drug resistance rarely a problem in skin diseases - no need for expensive antibiotics

  15. ANTIPRURITIC MEASURES • In dermatitis antihistamines are seldom effective!! • Best effect is seen with corticosteroids, immunosuppressants and UV therapy • Basic creams help in itching caused by dryness

  16. SYSTEMIC THERAPY • Corticosteroids • Cyclosporine • Azathioprine • Antihistamines • Doxepin • Pentoxiphylline • Monoclonal antibodies

  17. PHOTOTHERAPY • SUP • UVB • PUVA • Narrow-band UVB • Grenz rays • PDP

  18. CONTACT ALLERGY AND DIET • 2.5 - 5 mg nickel may cause flare-up of nickel allergic contact dermatitis in areas of previous dermatitis • Cobalt (1 mg) may cause similar effects • Clinical importance is low

  19. CONTACT URTICARIA • Antihistamines • Corticosteroids • Tacrolimus? • Doxepin? • NSAIDs (nonimmunologic contact urticaria) • Epinephrin (anaphylaxis)

  20. Other occupational skin diseases • Bacterial and fungal infections: Antibiotics • Acne: Isotretinoin, tetracyclines • Scabies: Ivermectine • Melanodermia: Hydrokinone • Leukodermia: Cosmetic • Skin cancer: Surgical, PDT, cryotherapy

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