SKIN RELATED OCCUPATIONAL DISEASES

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SKIN RELATED OCCUPATIONAL DISEASES

• Nweke Chizova Mirian
• Group 503

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Introduction

• Work-related skin diseases account for
  approximately 50 percent of occupational
  illnesses
• These dermatoses are often underreported because
  their association with the workplace is not
  recognized

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Introduction

• Occupational skin diseases affect workers of all
  ages in a wide variety of work settings.
• Industries at highest risk include manufacturing,
  food production, construction, machine tool
  operation, printing, metal plating, leather work,
  engine service, and forestry.

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Occupational Skin Diseases

• Allergic contact dermatitis
• Irritant contact dermatitis
• Protein contact dermatitis
• Contact urticaria
• Skin infections
• Acne
• Cancer
• Pigment changes

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Occupational history

• General work conditions (e.g., heat, humidity)
  and specific activities in the patient's present
  job that involve skin contact with potential
  hazards.
• Physical, chemical, and biologic agents (chemical
  and trade names) to which the patient may be
  exposed.

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Occupational history

• Presence of skin diseases in fellow workers.
• Control measures to minimize or prevent exposure
  in the workplace, including personal and
  occupational hygiene (e.g., handwashing
  instructions and facilities, showers, laundry
  service) and the availability of gloves, aprons,
  shields, and enclosures.

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Occupational history

• Compensation the patient received for skin
  disease in a previous job.
• Other exposures, including soaps, detergents,
  household cleaning agents, materials used in
  hobbies (e.g., resins, paints, solvents), and
  topical medications, especially those containing
  sensitizing agents such as neomycin (e.g.,
  Neosporin).

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Examinations

• physician should look for eczema, hives, clothing
  or food allergy, psoriasis, acne, oily skin,
  contact allergies (e.g., reactions to metal
  objects, cosmetics, home cleansers), fungal
  infections (e.g., athlete's foot, ringworm)
• systematic diseases that may have skin
  manifestations (e.g., diabetes mellitus,
  peripheral vascular disease).

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Examinations

• The appearance of the condition may also suggest
  the cause.
• a glove-pattern distribution of vesicular lesions
  on the hands strongly indicates a contact
  dermatitis.

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General Principles of Prevention and Control

• Avoid predisposing factors that contribute to
  work-related skin disease on a particular job.
• Avoidance of certain work environments by workers
  with preexisting skin disease.
• For example, a hairdresser with chronic
  eczematous eruption of the hands might be advised
  to change professions.
• Preventive measures on the job.
• For example, the employer of a worker with
  occupational acne might be advised to provide the
  worker with gloves and aprons that are impervious
  to oils.

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General Principles of Prevention and Control

• improved worker and workplace cleanliness.
• counseled about personal hygiene
• proper handwashing agents.
• Contact with organic solvents (e.g., mineral
  oils, paint thinner) should be avoided.
• provision of effective, nonirritating,
  nonallergenic skin cleansers use of emollients,
  hand lotions, and creams after handwashing
• frequent clothing changes daily showering rapid
  removal of oil- and chemical-soaked clothing use
  of company laundering facilities or separate
  washing of workers' clothing at home

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Common occupational exposures associated skin
disease

• Chemicals
• All workers
• Irritant contact dermatitis, allergic contact
  dermatitis
• Abrasions, friction "burns," pressure injuries,
  lacerations
• Construction, lumber, steel workers
• Keloids, postinflammatory pigmentary changes can
  cause spread of lesions in workers with lichen
  planus and psoriasis (Koebner's phenomenon)

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Common occupational exposures associated skin
disease

• Sunlight
• Outdoor workers, including telephone-line
  workers, sailors, postal workers, and
  construction workers
• Actinic keratosis, carcinoma (basal cell,
  squamous cell), melanoma, sunburn, photoallergic
  dermatitis, melanosis worsens preexisting
  discoid and systemic lupus erythematosus,
  granuloma annulare, porphyria, rosacea, etc.

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Common occupational exposures associated skin
disease

• Heat
• Foundry workers (e.g., metal casting), outdoor
  workers
• folliculitis, tinea pedis
• Cold
• Sailors, fishermen, other outdoor workers
• Raynaud's disease, urticaria, xerosis, frostbite

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Common occupational exposures associated skin
disease

• Moisture
• Food handlers, chefs, bartenders, dishwashers,
  hairdressers
• Irritant contact dermatitis, paronychia
• Electricity
• Electricians, telephone workers, construction
  workers
• Burns, skin necrosis

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Common occupational exposures associated skin
disease

• Ionizing radiation
• Medical personnel, welders (i.e., radiographs of
  welds), workers in the nuclear energy industry
• Skin cancer, acute or chronic radiation
  dermatitis, alopecia, nail damage (destroys
  matrix)
• Dust, fiberglass spicules, irritating solids
  (e.g., cement)
• Clothing made of tightly woven material,
  preapplication of mild dusting powder, leather
  gloves with smooth finish, steel-tipped shoes.

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Selected Occupational Exposures and Protective
Measures

• Liquids, vapors, fumes
• Face shields, plastic or synthetic rubber gloves
  and aprons, adequate ventilation
• Moderate alkalis, solvents
• Synthetic rubber, or hypoallergenic gloves with
  replaceable soft cotton liners.
• Trauma
• Leather gloves, steel-tipped shoes
• Sunlight, ultraviolet light
• Sunscreen, protective clothing (hat, long-sleeved
  shirt or jacket).

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• Specific Occupational
• Skin Diseases

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IRRITANT CONTACT DERMATITIS

• Nonimmunologic response to a skin irritant.
• Injury develops slowly over days to months.
• Xerosis dominates.
• Under excessively moist working conditions,
  however, these skin irritants can cause excessive
  cell hydration and result in maceration, most
  often in the feet and groin.

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IRRITANT CONTACT DERMATITIS

• An irritant is a substance which will induce
  dermatitis in anyone if applied to the skin
• In high concentration
• Over sufficient time
• Sufficient frequency

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IRRITANT CONTACT DERMATITIS

• The irritancy of a particular substance depends
  on its ability to remove the surface lipid layer
  or ability to produce cellular damage
• Not all workers in the same area will be affected
• Depending on individual predisposition( atopics
  are more susceptible), hygiene, circumstances

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IRRITANT CONTACT DERMATITIS

• Common irritants
• Acids
• Alkalis
• Solvents
• Detergents/soaps
• Abrasives
• Reducing agents
• Oil
• Low molecular weight plastics

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IRRITANT CONTACT DERMATITIS

• Clinical Features
• rash appears in exposed or contact areas
• in thin skin more often than thick skin (e.g.,
  dorsum of the hands rather than the palms
• area around the belt or collar
• Acute lesions
• painful, weepy, and vesicular
• chronic lesions
• dry, erythematous, cracked, and lichenified.
• clearly demarcated pattern
• often asymmetric and unilateral.
• Hardening of the skin.

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IRRITANT CONTACT DERMATITIS

• Diagnosis is based on the presence of rash in
  exposed areas and clinical improvement of the
  rash on removal of the offending agent.

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IRRITANT CONTACT DERMATITIS

• Treatment
• Reduce exposure to irritants
• Steroid
• Emollients
• Antibiotics
• Severe irritants prolonged water irrigation or
  may need hospitalization

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ALLERGIC CONTACT DERMATITIS

• Pathophysiology
• Allergic contact dermatitis is an immunologic
  cell-mediated response to even trivial exposure
  to an antigenic substance.
• Rash appears in areas exposed to the sensitizing
  agent, usually with an asymmetric or unilateral
  distribution.
• Sensitizing agent on the hands or clothes is
  often transferred to other body parts.

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ALLERGIC CONTACT DERMATITIS

• Rash is characterized by erythema, vesicles, and
  severe edema.
• Pruritus is the overriding symptom.
• Latex allergic reactions range from pruritus to
  erythematous, weeping or even can proceed to
  anaphylaxis.

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ALLERGIC CONTACT DERMATITIS

• Diagnosis
• is based of the history and clinical findings.
• Direct patch skin testing is recommended for more
  definitive diagnosis and identification of the
  sensitizing agent.
• Photopatch testing with ultraviolet light should
  be used to diagnose photoallergic dermatitis.

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ALLERGIC CONTACT DERMATITIS

• Diagnosis
• The radioallergosorbent test (RAST) is a
  blood-testing technique
• RAST measures specific immunoglobulin antibodies
  to sensitizing substances (e.g., latex IgE for
  latex allergy).
• Controversy exists regarding the sensitivity and
  specificity of RAST compared with direct patch

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ALLERGIC CONTACT DERMATITIS

• Treatment and Prevention
• Removal of the sensitizing agent.
• Steroid
• Emollients
• Antibiotics
• Persontal protective equipment
• Advise worker to leave this type of work

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OIL ACNE AND FOLLICULITIS

• Solvents and lubricants (oils and greases)
  resulting in mechanical blockage of pilosebaceous
  units can lead to "oil acne.
• Clinical Features Comedones, pustules, and
  papules may be present.
• Occupational acne may also aggravate existing
  acne.
• Secondary infection from bacterial folliculitis
  is common.

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OIL ACNE AND FOLLICULITIS

• Treatment and Prevention
• avoid contact with oils and greases.
• frequent routine cleansing of the skin and daily
  washing of work clothes.
• routine acne therapy.

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OCCUPATIONAL SKIN NEOPLASMS

• Skin tumors can result from exposure to
  substances such as polycyclic hydrocarbons,
  inorganic metals, and
• Cocarcinogenesis, such as the interaction of
  sunlight and tar, is often implicated.
• Frequently, the skin tumors do not appear until
  two or three decades after the exposure.

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Occupational infections

• Some infections may be transmitted from animals
  to man in work places.
• Dermatophyte infections from horses, cattle,
  pigs, cats, dogs.
• Bacterial infections such as erysipeloid from
  fish.

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Dermatoses due to physical agents

• Friction blisters calluses from mechanical
  trauma.
• Vibration causes Raynauds phenomenon.
• Hot humid environments may aggravate acne, cause
  sweat dut occlusion( miliaria).
• Low humidity results in chapping fissure
• Cold environments increase chilblains, Raynauds,
  cold urticaria.
• UV increases skin cancer photoaging.

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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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References

• W.F. PEATW, M.D. Occupational Skin Disease.
  American Family Physician 2002.Vol 66, No 6.
• Department of Labour. Wellington New Zealand. A
  guide to occupational skin disease 1995.

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