chemical, e.g: acids, alkalis, solvents, cutting, or

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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 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 i 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 be termed as occupational skin disease.

4 THE MOST COMMON:ContactContact 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) d t Parasites(scabies- (schistosomiasis) Mechanicals Pressure Friction Vibration 5

6 Occupational dermatitis Occupational photosensitivity reactions Occupational phototoxicity htt iit reaction Occupational skin cancers Occupational contact urticaria Occupational acne Occupational skin infections Occupational pigmentary disorders

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8 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 Work procedure change Treatment and effect on dermatitis

9 B. Occupational Information Employment dates Hand washing Job title At time of onset Clothing/equipment Description of fjob tasks Protective creams/cleansers Materials contacted Skin cleaning Protection Other workers affected Water exposure Previous job tasks or jobs Date of job changes Second job

10 C. Personal history Other exposures Animals Plants Clothing Hobbies Past history of skin disease Plant dermatitis Hand dermatitis Psoriasis Athlete s foot History of atopy Personal/family Atopic dermatitis Hay fever Asthma Medications Prescribed Over the counter

11 - 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, such as rough fibers, and to changes in the environment, such as wet dry and hot cold changes.

12 PRE EMPLOYMENT: Focus on existing or previous skin problems

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

14 All at risk for: utricaria i anaphlaxis From rubber latex

15 Job (CI) 1 HAIRDRESS 2 CATERING Job caution 1 NURSING 2 HCW 3 MACHINE ENGINEERING

16 Caution is also needed in placing nursing and healthcare workers. suggests a need to 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.

17 II. Physical examination Lesion type Secondary changes Distribution ib ti Other skin disease

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

19 IV. Supplemental information Material safety data sheets Workplace Other physician

20 - Ask specifically about the amount of time spent each day with wet exposure, wearing protective clothing, and frequency of contact with irritating chemicals. - Ask about other intermittent job tasks that may have a relationship to the onset of dermatitis.

21 - Evidence of other skin disease, especially flexural eczema, psoriasis, dermatophyte fungal infection, acne, and acute or chronic sun damage, should be noted. - The configuration of lesions, linear grouping, or cut-off at sun-exposed sites or sites of protective equipment should be noted. - Vesicles localized on the fingertips often are associated with allergy. - Nail changes may indicate chronicity of lesions.

22 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.

23 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

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

26 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

27 Acute Chronici

28 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

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

30 Immediate pain and burning Red blister, ulcer, necrosis

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32 Repetitive exposure to weaker irritantsit t Is due to a stepwise progression of damage to the barrier function of the skin

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

34 Usually presents with dry, scaly fissuring, Usua y p ese ts w t d y, sca y ssu g, lichenified and eczematous lesions on the fingers and hands. Vesicular lesions do occur but are less common than in ACD.

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39 Hand dermatitis due to contact with cement

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41 CHRONIC ICD

42 CHRONIC ICD

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

44 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

45 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 diagnosisi This healthy adolescent developed an intensely pruritic vesiculobullous allergic contact dermatitis from hair dye. Dermatlas.org

46 Poison oak/ivy Metals: Mtl (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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48 Chronic OACD in an employee with exposure to cable filler gel confirmed with patch test t

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

53 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

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

55 Latex allergy Formaldehyde Food dindustry Plants Vegetables Animal products Pharmaceutical industry Streptomycin

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59 ------Contact urticaria i - 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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63 Any age Oil, pitch, tar Exposed sites ( hand, forearms) Open comedones,pustules No associated condition

64 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) 64

65 Occupation at risk Machinist Oil field worker Oil refiner Auto,truck,air craft,boat mechanics Rubber worker Roofers Road maintenance workers 65

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

68 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. 68

69 Occupation at risk Workers in production of pesticides, herbicides Electrical l workers exposed to PCB (transformer oil) 69

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72 (1) identification of potential irri-tants and allergens in the workplace {use of the MSDS), (2) chemical substitution tion or removal to prevent ent recur-rence, r 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.

73 THANKS FOR YOUR ATTENTION