Eczema – dermatitis Eczema – dermatitis Occupationals Occupationals

dermatosisdermatosisLibuše MardešićováLibuše Mardešićová

Dpt. Of Dermatovenerology FNKV Dpt. Of Dermatovenerology FNKV and 3.LF UK and 3.LF UK

Eczema - dermatitisEczema - dermatitis

most frequent skin disease (1/4)most frequent skin disease (1/4)

a group of skin diseases with a group of skin diseases with complicated, different and sometimes complicated, different and sometimes unknown unknown pathogenesispathogenesis

but with the identical clinical picturebut with the identical clinical picture

Eczema - dermatitisEczema - dermatitis

DefinitionDefinition: superfitial non-infectious inflamation of skin : superfitial non-infectious inflamation of skin frequently of allergic origin which is provoked by different frequently of allergic origin which is provoked by different external and internal factors external and internal factors

Histopathological marks are located in epidermis and upper Histopathological marks are located in epidermis and upper coriumcorium

Healing of acute forms without scars Healing of acute forms without scars ( red macules, hypo- or ( red macules, hypo- or hyperpigmentations), healing of chronical form sometimes hyperpigmentations), healing of chronical form sometimes with lichenificationwith lichenification

provoking factors are usually unknownprovoking factors are usually unknown

Eczema - dermatitisEczema - dermatitis

Different typesDifferent types - atopic eczema or dermatitis- atopic eczema or dermatitis - seborrhoic eczema or dermatitis- seborrhoic eczema or dermatitis - microbic eczema- microbic eczema - contact alergic eczema- contact alergic eczema -contact irritant dermatitis-contact irritant dermatitis

The unique morfology is typical!!!The unique morfology is typical!!!

Clinical picture ofClinical picture ofeczema -dermatitiseczema -dermatitis

Acute stadiumAcute stadium red papules(grouped)red papules(grouped) edematous swellingedematous swelling small vesiclessmall vesicles weeping of moistureweeping of moisture crustingcrusting scalingscaling

Chronical diseaseChronical disease thickening of skinthickening of skin rough skinrough skin creation of fissurescreation of fissures

Different treatment!!!

PredilectionPredilection

Eczema can be Eczema can be located at any place located at any place of the body of the body

but some of them but some of them are more often are more often presentpresent

HandsHands FaceFace

Eczema acutumEczema acutum

“ekdzein“= to spring to the surface

Eczema chronicumEczema chronicum

Eczema atopicumEczema atopicum

White dermografism, pruritus, capricious course

Seborrhoic eczemaSeborrhoic eczema

Microbic eczemaMicrobic eczema

Main differences between contact Main differences between contact dermatitis and eczemadermatitis and eczema

dermatitis dermatitis cause: cause: irritantirritant occures in all individuals occures in all individuals

contacting irritant contacting irritant burning sensations, painburning sensations, pain symptoms are symptoms are restrictedrestricted

just on the place of just on the place of contactcontact

toxical provo factorstoxical provo factors

eczemaeczema cause: cause: alergenalergen a patient is only a patient is only

genetically predisposed genetically predisposed personperson

itchingitching spreadingspreading from the from the

place of contactplace of contact

alergyalergy of the VIth type of the VIth type

Irritant contact dermatitisIrritant contact dermatitis

- due to a nonspecific reaction- due to a nonspecific reaction - contact with irritans for a sufficient - contact with irritans for a sufficient

lenght of timelenght of time - irritant in sufficient high concentration -- irritant in sufficient high concentration -

Main irritantsMain irritants

Defatting, degreasing agents, damage of Defatting, degreasing agents, damage of the skin by cytotoxic actionthe skin by cytotoxic action

- detergents- detergents - solvents- solvents - cleaners- cleaners (- strong acids and alkalis –acute severe (- strong acids and alkalis –acute severe

dermatitis)dermatitis)

Acute contact allergic eczemaAcute contact allergic eczema

Acute contact irritant dermatitisAcute contact irritant dermatitis

Chronical dermatitis Chronical dermatitis xx chronical chronical eczema eczema

dryness, some fissuring, thickening

Most frequent allergensMost frequent allergens

MetalsMetals (Ni, Co, Hg, Cr, Pt….) (Ni, Co, Hg, Cr, Pt….) RubberRubber (additives) (additives) CosmeticsCosmetics (emulgators, antimicrobials, perfumes) (emulgators, antimicrobials, perfumes) Organic dyesOrganic dyes FormaldehydeFormaldehyde Parabens and lanolinParabens and lanolin Plastics and resinsPlastics and resins (epoxy resin, acrylates) (epoxy resin, acrylates) Topically used medicamentsTopically used medicaments Plants Plants (needles, tulips, chrysantems, poisson ivy..)(needles, tulips, chrysantems, poisson ivy..)

Epi- testsEpi- tests

Alergy of the IV th Alergy of the IV th typetype

Preparation of the Preparation of the patientpatient

AnamnesisAnamnesis Concentration of Concentration of

allergenallergen VehicleVehicle

Occupational skin diseasesOccupational skin diseases

List of occupational diseasesList of occupational diseases-law-law 60-80%60-80% the the rulesrules for reporting are strictly done for reporting are strictly done specialised dpts. - assessmentspecialised dpts. - assessment reporting reporting of occupational diseases of occupational diseases legal consequenceslegal consequences: retraining, financial profit: retraining, financial profit eczema contactum allergicum, dermatitis eczema contactum allergicum, dermatitis

contacta irritativa, occupational acne (picea, contacta irritativa, occupational acne (picea, oleosa, chlorina), skin tumors, skin infections oleosa, chlorina), skin tumors, skin infections (medicals, farmers, ! teachers x sisters)(medicals, farmers, ! teachers x sisters)

Chronical contact irritative Chronical contact irritative dermatitisdermatitis

(„house wife dermatitis“)(„house wife dermatitis“) Detergents,soaps, Detergents,soaps,

cleansers, frequent cleansers, frequent washing, polishes, washing, polishes, waxes, bleacheswaxes, bleaches

weak acidsweak acids cementcement dezinficientsdezinficients organic solventsorganic solvents

(petrol, turpentyne...)(petrol, turpentyne...)

Allergy -Chromium in leather Allergy -Chromium in leather glovesgloves

Typical protective necessity among workers

Occupationals skin infectionsOccupationals skin infections

farmers (no tinea pedum)farmers (no tinea pedum) forrest workers (borreliosis)forrest workers (borreliosis) medicals (scabies x teachers –pedikulosis) + medicals (scabies x teachers –pedikulosis) +

tbc cutis verrucosatbc cutis verrucosa poultry farms (candidiasis)poultry farms (candidiasis) flesh processing (butchers, cookers)-erysipeloidflesh processing (butchers, cookers)-erysipeloid

Occupational skin infectionsOccupational skin infections

Acne venenataAcne venenata

„„venenatio“, -onis f. venenatio“, -onis f. l.l. poisoning poisoning

Acne contacta

Acne chlorinaAcne chlorina

rarerare

occupational or non-occupational or non-

through skin, ingescion, inhalationthrough skin, ingescion, inhalation

Chlorated hydrocarbons (importance of Chlorated hydrocarbons (importance of position of Cl in the molecule)position of Cl in the molecule)

Chlorated hydrocarbonsChlorated hydrocarbons

Polychlorated naftalensPolychlorated naftalens Polychlorated difenyls (PCB)Polychlorated difenyls (PCB) Polychlorated dibenzofurans (PCDF)Polychlorated dibenzofurans (PCDF) Polychlorated dibenzodioxinsPolychlorated dibenzodioxins Azobenzens a azoxybenzensAzobenzens a azoxybenzens

Chemical industry, halowax, herbicids…Prevention, accidents

Toxicity Toxicity

hepatotoxichepatotoxic: hepatitis - cirrhosis: hepatitis - cirrhosis

neurotoxicneurotoxic

kancerogenickancerogenic teratogenicteratogenic

Clinical picture of acne Clinical picture of acne chlorinachlorina

commedons – small cysts with black commedons – small cysts with black centres, centres, cysts, cysts, scaringscaring

predilection: all places with skin folliculs predilection: all places with skin folliculs (face except nose, axils, scrotum, (face except nose, axils, scrotum, penis…) penis…)

Acne oleosaAcne oleosa

Products made from crude oil- petroleumProducts made from crude oil- petroleum Other oilsOther oils (from plants) (from plants)

Metall working fluidsMetall working fluids– mineral oils, grease, – mineral oils, grease, technological fluids, oils, diesel…technological fluids, oils, diesel…

Acne oleosaAcne oleosa

Personaly dispositionPersonaly disposition Clinical picture is polymorph: a picture of Clinical picture is polymorph: a picture of

keratosis pilaris keratosis pilaris comedons comedons papules papules pustules pustules absces. Never cysts. absces. Never cysts.

Predilection: dorsal part of fingers, Predilection: dorsal part of fingers, forearms, thighs, abdomen, back, face forearms, thighs, abdomen, back, face (among young patients)(among young patients)

Prevention of acne oleosaPrevention of acne oleosa

Cleanliness of dressCleanliness of dress Cleanliness of skin during work and after it Cleanliness of skin during work and after it

(warm! Water, soaps)(warm! Water, soaps)

Cleanliness is next to godliness

Acne piceaAcne picea

asfalts, bitumens (mede f.i. from coal)asfalts, bitumens (mede f.i. from coal) many professions (contact with asfalt – many professions (contact with asfalt –

construction of roads, industry of construction of roads, industry of petroleum…)petroleum…)

Clinical pictureClinical picture: open commedons, without : open commedons, without inflammation of surrounded skin, inflammation of surrounded skin, whenever on the skin (also on the face) whenever on the skin (also on the face) + hyperpigmentations + hyperpigmentations

Prevention of acne piceaPrevention of acne picea

Ventilation in workroomsVentilation in workrooms Personaly hygienic habitsPersonaly hygienic habits Persons with seborrhoic type of skinPersons with seborrhoic type of skin (fotoprotection)(fotoprotection)

Occupationals tumors

Spinalioma

- fingers of physicians (x-rays)