The skin acts as a protective barrier against a number of hazards within our environment. These hazards can be:

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2 The skin acts as a protective barrier against a number of hazards within our environment. These hazards can be: chemical, e.g: acids, alkalis, solvents, cutting, or soluble oils; biological,e.g: bacteria,plant allergens, or raw food; physical, e.g: ultraviolet light, or mechanical shearing forces.

3 DEFINITION: occupational skin disease is one in which workplace exposure to some physical, chemical or biologic hazard has been a causal or a major and necessary contributing factor in the development of the disease. Also a worsening of pre-existing skin disease can betermed asoccupational skin disease.

4 THE MOST COMMON:Contact dermatitis accounts for at least 60% of occupational dermatoses1, which, in turn, account for 40-70% of occupationally acquired illness

5 Chemicals Acids Alkalis Solvents Oils Detergents Resins Plastics Metals Petroleum product Physicals Temperature Ionizing radiation Non ionizing radiation Biologic Viruses (orf-wart-herpes) Bacteria(anthrax-erisopeloid) Fungi(candida-dermatophyte) Parasites(scabies- (schistosomiasis) Mechanicals Pressure Friction Vibration 5

6 work-induced Occupational dermatitis Occupational photosensitivity reactions Occupational phototoxicity reaction Occupational skin cancers Occupational contact urticaria Occupational acne Occupational skin infections Occupational pigmentary disorders

7 Psoriasis work-aggravated

8 Contact dermatitis % Contact dermatitis 4.3% Contact urticaria 0.8% Folliculitis /acne 0.1% Infective Others 51 Neoplasia 468 Nail 1 Contact urticaria 123 Folliculitis 24 Infective 4 Mechanical % Mechanical 0.03% Nail 16.3% Neoplasia 1.8% Others 100.0% Total cases = 2876

9 Patient history: Does skin disease relate to work? Exposure: Are there causative agents (allergens, irritants) in the work-place? Clinical symptoms: Are they in accordance to clinical disease?

10 I. History A. Present illness Date of onset Body site at onset Patient description Onset abrupt or gradual Appearance, spread Effect of treatment Course of disease Effect of weekend, vacation

11 B. Occupational Information Employment dates Job title At time of onset Description of job tasks Materials contacted Protection Water exposure Date of job changes Hand washing cleansers Skin cleaning Previous job tasks or jobs Second job

12 C. Personal history Other exposures Animals Plants Hobbies Past history of skin disease History of atopy Personal/family Atopic dermatitis Medications Prescribed Over-the-counter

13 - Childhood atopic dermatitis is fairly common (greater than 10% of children in the United States). - The skin in an atopic individual is more susceptible to irritants. -

14 II. Physical examination Lesion type Secondary changes Distribution Other skin disease

15 III. Diagnostic techniques Skin scrapings Culture Skin biopsy Patch test Contact urticaria test Photopatch test

16 DEFINITION:OCD is an inflammatory skin condition resulting from cutaneous contact with materials found in the workplace. HIGHEST INCIDENCE RATE: Hairdressers, bakers, florists, agriculture and manufacturing.

17 Occupational Irritant Contact Dermatitis O-ICD Diagnosed on clinical based No test is available to definite Dx Occupational Allergic Contact Dermatitis O-ACD (type IV hypersensitivity) Diagnosed by patch test to relevant Ag Contact urticaria Type I hypersensitivity Diagnosed by prick test or RAST

18 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

19 ICD Hx. Of contact with irritant Acute onset Stinging, Burning Neg. patch test Localized known ACD Hx. Of contact with allergen Delay onset (1-3d) Itching Positive patch test spreads known

20 Accounts for approximately 80% of all contact dermatitis ICD is the result of a local toxic effect when the skin comes in contact with irritant chemicals such as soaps, solvents, acids, or alkalis

21 Acute Chronic

22 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, e.g. acrylonitrile

23 Stinging,burning, painful, erythematous eruption occur after brief contact with strong irritant chemicals. Erosion and skin ulceration may occur. May result in permanent scar.

24 Immediate pain and burning Red blister, ulcer, necrosis

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26 Repetitive exposure to weaker irritants Is due to a stepwise progression of damage to the barrier function of the skin

27 Water/wet work Detergents Antiseptics Disinfectants Soap/cleansing agents Weak Acids & alkali Wet cement Solvents Fiberglass fibers Cutting oil ( MVF) Pesticides Plants & vegetation Rubber products Acrylic resins Soldering flux Dusts/ friction Degreasing agents

28 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.

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32 Hand dermatitis due to contact with cement

33 CHRONIC ICD

34 CHRONIC ICD

35 Caused by low-molecular weight haptens Hapten penetrates through stratum corneum of a sensitized individual A classical Type IV reaction

36 Accounts for approximately 20% of all contact dermatitis ACD is a type IV, delayed or cell-mediated immune reaction that is elicited when the skin comes in contact with a chemical to which an individual has been previously sensitized TYPES: 1. Acute Pruritic vesicles, edema, erythema, bullae at site of exposure 2. Chronic Crusting leads to lichenifcation and scale

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38 Key Features Pruritic, eczematous reaction Well demarcated and located to the site of contact with the allergen (in Acute ACD and many cases of chronic ACD) Patch testing remains the gold standard for accurate and consistent diagnosis This healthy adolescent developed an intensely pruritic vesiculobullous allergic contact dermatitis from hair dye. Dermatlas.org

39 Poison oak/ivy Metals: (Chromium,Nickel,Gold,Mercury, Cobalt ) Rubber industry (Accelerators,Antioxidants) Plastic resins (Epoxy resins, Phenolic resins,formaldehyde resins,acrylic resins) Organic dyes ( azo dyes ) Methyl metacrylate Rubber products Plants Latex and its powder Germicides and biocides Some pesticides Some solvents (Formaldehyde,Turpentine,Aliphatic amines) Nitrates Ethylene oxide

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41 Chronic OACD in an employee with exposure to cable filler gel confirmed with patch test

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45 DEFINITION:characterized by transient skin or mucosal swellings due to plasma leakage. Superficial dermal swellings are wheals deep swellings of the skin or mucosa are angioedema. Wheals are characteristically pruritic and pink or pale in the center, Angioedema is often painful, less well defined and shows no color change.

46 Immunologic : Caused by proteins that act as allergens Proteins penetrate through skin bind to IgE on the surface of mast cell release of histamine and other mediators (type-1 reaction) Sometimes generalized reactions occur Latex allergy

47 Nonimmunologic: Caused by chemicals Direct pharmacologic action on skin cells No sensitization necessary More common than suspected

48 Latex allergy Formaldehyde Food industry Plants Vegetables Animal products Pharmaceutical industry Streptomycin

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52 ------Contact urticaria - Latex Rubber Contact urticaria is an important manifestation of natural rubber latex allergy. Workers exposed to latex gloves and other products containing natural rubber latex may develop allergic reactions such as skin rashes; hives (contact urticaria); nasal eye or sinus symptoms; asthma; and (rarely) shock

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54 PRE EMPLOYMENT: ---Focus on existing or previous skin problems ---Hx dermatitis(+) sometimes necessary patch test

55 Risk for irritants Severe in childhood Hands involved No Risk for irritants Hx asthma Hx hay fever

56 All at risk for: utricaria anaphlaxis From rubber latex

57 Job (CI) 1-HAIRDRESS 2-CATERING Job caution 1-NURSING 2-HCW 3-MACHINE ENGINEERING 3-DOMESTIC CLEANING 4- CONSTRUCTIO N WORKER

58 discourage those with active skin involvement or a past history of severe eczema from training as a healthcare worker. Those who do proceed should receive a carefully supervised programme of hand care and should be followed-up in case of further difficulty.

59 Risk for Infective Spread: HCW(PATIENT INFECTION) CATERING(FOOD POISONING) PHARMACEUTICAL(PRODUCT CONTAMINATION)

60 may be aggravated by exposure to chemical irritants, but hot environments will contribute most to potential flare-ups of the disease. As the hands are unaffected, restrictions for occupations involving wet work are not required. The main problem is shedding of scales from the skin with risks of bacterial contamination similar to those found in atopies.

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62 Any age Oil, pitch, tar Exposed sites ( hand, forearms) Open comedones, pustules No associated condition

63 Lubricating petroleum greases,oils,and pitch fumes Mechanism : stimulation of follicular keratinization followed by ductal occlusion(comedon formation) Induce of inflamatory reaction by rupture of the fulicular wall(postular folliculitis) 63

64 Occupation at risk Machinist Oil field worker Oil refiner Auto,truck,air craft,boat mechanics Rubber worker Roofers Road maintenance workers 64

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66 Any age TCCD( tetrachlorodibenzodioxin ) face especially malar crescent and auricular creases, axilla, groin Open & closed comedones, straw- colored cysts Xerosis, conjunctivitis, peripheral neuritis, liver abnormalities

67 Caused by polychlorinated or poly brominated aromatic hydrocarbons (halogen acne) Mechanism: induction of metaplasia,keratin filled cysts Noninflammatory comedones and cysts in malar crescents and posterior auricular folds Occurs within 2-8 weeks of exposure and regress over a 4-6 months period. 67

68 Occupation at risk Workers in production of pesticides, herbicides Electrical workers exposed to PCB (transformer oil) 68

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71 (1) identification of potential irri tants and allergens in the workplace {use of the MSDS), (2) chemical substitution or removal to prevent recur rence, (3) personal protective measures, (4) personal and environmental hygiene, (5) education to promote awareness of potential irritants and allergens both at work and home, (6) preemployment and periodic health screening, and (7) engineering controls with au tomated, closed systems.

72 THANKS FOR YOUR ATTENTION