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Transcript of Occupational Skin Diseases. Introduction The second cause of occupational diseases ( 23-25% of all...
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Occupational Skin Occupational Skin DiseasesDiseases
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Introduction Introduction
The second cause of occupational diseases ( 23-25% of all occ.diseases )
A skin disease that is caused by physical, biological or chemical factor in work
Also a worsening of pre-existing skin disease can be termed as occupational skin disease (Psoriasis , Acne)
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Absenteesm & CostAbsenteesm & Cost
4 million working days are lost due to occupational skin disease and the UK Health & Safety Executive has calculated an associated cost to British industry of £200 million per year.
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Work place agentsWork place agentsthat induced skin disorderthat induced skin disorder
ChemicalsAcidsAlkalisSolventsOilsDetergentsResinsPlasticsMetalsPetroleum productPlant & wood
PhysicalsTemperature Ionizing radiationNon ionizing radiation
BiologicViruses (orf-wart-herpes)Bacteria(anthrax-erisopeloid)Fungi(candida-dermatophyte)Parasites(scabies-(schistosomiasis)
MechanicalsPressureFrictionVibration
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Important causal agents of Important causal agents of occupational skin illnessoccupational skin illness
Machinery ◦ Cutting oils
◦ Solvents
Metal products ◦ Solvents
◦ Metallic salts
Electronic equipment ◦ Solvents
◦ Plastic & resin
Food products ◦ Fruits & vegetables◦ Soap & detergents
Agriculture ◦ Chemicals
◦ Fruits & nuts
Health services ◦ Soap & detergents◦ Infectious agents
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Diagnosis Of Occupational Skin Diagnosis Of Occupational Skin DiseasesDiseasesHistory : present illness,
occ.information, personal historyP/EDiagnostic techniquesSupplemental information
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QuestionsQuestionsWhen did disease start?In which skin area was the first
symptom?What is work technique?Free time, other worksCleaning measuresProtectionVacation, holidays
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Classification of skin diseaseClassification of skin disease
Occupational dermatitisOccupational photosensitivity reactionsOccupational phototoxicity reactionOccupational skin cancersOccupational contact urticariaOccupational acneOccupational skin infectionsOccupational pigmentary disordersMiscellaneous
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Case 1Case 1
Erythema , dryness and itching on the right hand of a printer man
What is your diagnosis ?
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Contact DermatitisContact Dermatitis Occupational dermatitis is an inflammation of the skin
causing itching, pain, redness, swelling and small blisters.
Contact dermatitis is an eczematous eruption caused by external agents, which can be broadly divided into:
◦ Irritant substances that have a direct toxic effect on the skin (irritant contact dermatitis, ICD)
◦ Allergic chemicals where immune delayed hypersensitivity reactions occur (allergic contact dermatitis, ACD).
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Prognosis Of Occupational Prognosis Of Occupational Dermatitis After TreatmentDermatitis After Treatment
25% complete recovery25% refractory50% remitting / relapsing
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How exposure can occurHow exposure can occur
Direct handling
Immersion
Contaminated surfaces
Splashing
Deposition
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Classification of ICDClassification of ICD
Acute
Chronic
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Clinical Features Of Contact Clinical Features Of Contact DermatitisDermatitis
Location◦Skin disease starts on the area of contact.
Dorsal aspects of hands and finger Volar aspects of arms Interdigital webs Medial aspect of thighs Dorsal aspects of feet
◦ May in face (forehead, eyelids, ears, neck) and arms due to airborne irritant dusts and volatile irritant chemicals
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Acute Irritant Contact Acute Irritant Contact DermatitisDermatitis
Commonly seen in occupational accidents Irritant reaction reaches its peak quickly, within
minutes to hours after exposure Symptoms include stinging, burning, and soreness Physical signs include erythema, edema, bullae, and
possibly necrosis Lesions restricted to the area where the irritant or
toxicant damaged the tissue Sharply demarcated borders and asymmetry pointing
to an exogenous cause Most frequent irritants are acids and alkaline solutions
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Chronic (cumulative) ICDChronic (cumulative) ICD
Repetitive exposure to weaker irritants -Wet : detergents, organic solvents,
soaps, weak acids, and alkalis -Dry : low humidity air, heat ,dusts ,
and powders
Disease of the stratum corneum
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OccupationalOccupational at high riskat high risk
CleanerHousekeepingConstructionFood serviceMedical dentalEngineer
HairdresserMechanicPrinterButcherAgricultural/
GardeningMachinist
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Clinical Features Of Contact Clinical Features Of Contact DermatitisDermatitis
Sign and symptoms
◦Cumulative (exposure to weak irritants) Delayed pain and burning Vesicles and little pruritus Lichenifications, fissures
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Case 2Case 2
A builder man presented with erythema , scaling and pruritus on his hands What is your diagnosis ?
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Allergic Contact DermatitisAllergic Contact Dermatitis
Caused by low-molecular weight haptens
Hapten is “incomplete allergen”Binds to carrier protein for
immunogenicityLow molecule weight enables
penetration of hapten
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Hapten penetrates through stratum corneum of a sensitized individual
A classical Type IV reaction
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Allergic contact dermatitis Allergic contact dermatitis
The most common causes of an occupational allergic contact dermatitis are:
1- rubber (23.4% of cases ) 2- nickel (18.2% 0f cases )3- epoxy and other resins (15.6%) 4- aromatic amines (8.6%)5- chromate (8.1%)6- fragrances7- cosmetics (8.0%)8- preservatives (7.3%)
Patch testing with the suspect material will confirm the correct diagnosis
Typically there is an eczematous patch test reaction
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Clinical Features ( Acute Clinical Features ( Acute Form )Form )Rash appears in areas exposed to the
sensitizing agent, usually asymmetric or unilat.
Sensitizing agent on the hands or clothes is often transferred to other body parts.
The rash is characterized by erythema, vesicles and sever edema.
Pruritus is the overriding symp.
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Clinical Features ( Chronic Clinical Features ( Chronic Form )Form )
Thickened , fissured, lichenified skin with scaling
The most common sites:◦Dorsal aspect of hands◦Eyelids◦periorbital
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Chronic OACD in an employee with Chronic OACD in an employee with exposure to exposure to cable filler gelcable filler gel confirmed confirmed with patch testwith patch test
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Diagnosis Diagnosis Complete history
◦Occupational◦Non-occupational
Physical examinationPatch test
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Patch testPatch test Patch test
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Airborne contact Airborne contact dermatitisdermatitis
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Airborne Irritant Contact Airborne Irritant Contact DermatitisDermatitis
Develops on irritant-exposed skin of the face and periorbital regions
Often simulates photoallergic reactions
Involvement of the upper eyelids, philtrum, and submental regions help to differentiate from photoallergic reaction
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A worker with itchy papules on his forearm What is your diagnosis?
Case 3
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DX : DX : Fiber glass dermatitis Fiber glass dermatitis ( kind of CD)( kind of CD)
Mechanism of skin injury is via direct penetration Pruritus and tingling are the usual initial
symptoms
Subsequently erythematous papules develop (often with follicular accentuation) on exposed areas when there is airborne exposure or on the forearms when there is contamination of a work surface
Paronychia is common and airborne exposure
may also cause burning eyes, sore throat and cough
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Diagnosis : Clinical findings Confirmed by finding the fibers on
tape stripping of affected skin or examining skin scrapings in KOH 20%.
Course: Resolves rapidly after cessation of
exposure. In most individuals, hardening
occurs and symptoms resolve over a few weeks despite of continued exposure.
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Erythematous bullous reaction on the elbow of a gardener and hyperpigmentation after resolving this eruption
What is your diagnosis?
Case 4
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Contact Contact photodermatitisphotodermatitisSome chemicals may cause CD only in
the presence of lightSunlight or artificial light sources that
emit specific wavelengths2 categories: -phototoxic -photoallergic
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Phototoxic Phototoxic photoallergicphotoallergic
Coal-tar derivativeDyes (Eosin)Drug -phenothiazines -sulfonamidesPlants&derivative -lemon
Antifungal agentsFragrancesHalogenated
salicylanilidePhenothiazinesSunscreensWhiteners
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Where involved ?Where involved ?Exposed areas: face, ant. V of the
neck, back of the hand, uncovered sites on the arm&leg
Hairy areas, upper eyelids, and below the chin may be spared
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Case 5
Erythematous patches with tingling on the fingers of a health worker
What is your diagnosis ?
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Occupational CausesOccupational CausesLatex allergy ( m/c )FormaldehydeFood industry
◦Plants◦Vegetables◦Animal products
Pharmaceutical industry◦Streptomycin
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DX :DX : Contact urticaria (due to Contact urticaria (due to latex)latex)
Pruritus and wheal-and-flare reaction
Develops within a few to 60 minutes of exposure and resolves within 24 hours
It is the protein content of latex rubber that is responsible for the associated contact urticaria
In suspected cases of latex-induced contact urticaria, the specific IgE test may be negative, requiring prick testing with a commercial latex extract
Symptoms include the development of pruritus and localized urticaria soon after donning latex gloves
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ManagementManagement of contact of contact urticariaurticaria
1- Avoidance : occupational hygiene use of personal protective equipment ( In
the case of latex, the use of powder-free gloves containing low levels of protein should reduce the development of latex hypersensitivity in the future by reducing the level of exposure
change of occupation2- Systemic antihistamines & epinephrine
depending on the severity of the attack.3- latex desensitization without significant risk
of systemic adverse reactions in the future
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Occupational Skin CancersOccupational Skin CancersThe second m/c form of
occupational skin diseasesAbout 17% of all cases of
occupational skin diseases
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Occupational Skin CancerOccupational Skin CancerUltraviolet lightPoly cyclic aromatic
hydrocarbonesArsenicIonizing radiationTrauma
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NeoplasmNeoplasmPoly Aromatic HydrocarbonsPoly Aromatic HydrocarbonsDimethylbenzantheracene ,
BenzyprineAfter latent intervals of 6-20
years : keratotic papillomas (tar warts) in
face ,forearms ,hands ,ankles ,dorsal feet ,scrotum
Co factors: UV ,trauma
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Neoplasm Neoplasm ArsenicArsenicChronic exposure: (water, fowlers
solution ,inorganic arsenic)
punctuate ,keratotic papules (arsenic keratosis) ,on palms and soles
No exposed skin surfaces ,intra epidermal SCC (Bowens disease)
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A worker man presented with numerous comedons on his face.
What is your diagnosis ?
Case 7
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A worker man with numerous retroauricular comedones and cysts
What is your diagnosis?
Case 8
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Environmental AcneaEnvironmental AcneaPreexisting acne vulgaris may be
aggravated by various occupational stress
1-Tropical acne: acne prone individuals employed in tropical climates
2-Acne mechanica: tight fitting work clothing ,pressure from seat belt
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Oil AcneOil AcneLubricating petroleum
greases ,oils ,and pitch fumes may cause follicular plugging and postular folliculitis and is seen not infrequently in machinists and automotive mechanics.
Mechanism : stimulation of follicular keratinization followed by ductal occlusion
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ChloracneChloracne 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
Poly Chlorinated Biphenyl (PCB)
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Age Age Differential Features of AcneDifferential Features of Acne
Oil acne Any age Acne vulgaris Peak
incidence, ages 11-20
Chloracne Any age
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Distribution Distribution Differential Features of AcneDifferential Features of AcneOil acne Exposed area
Acne vulgaris Face ,Neck ,Chest
Chloracne Face, Especially Malar Crescent
& Auricular Creases, Axillae, Groin, Nose
Spared
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Associated ConditionsAssociated ConditionsDifferential Features of AcneDifferential Features of AcneOil acne None
AcneVulgaris None
Chloracne Xerosis, Conjunctivitis,
Actinic Elastosis, Pheripheral Neuritis,
Liver Abnormalities
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Pigmentary disordersPigmentary disorders
Melanosis -repeated trauma, friction, chemical &
thermal burns, UV -coal tar, pitch, asphalt, creosoteLeukoderma -hydroquinone, phenol -hand & forearms spread
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Physical cause of occupational skin Physical cause of occupational skin disordersdisordersMechanical trauma:callus,corn,
lichenficationPermanent callus leading to early
retirementCallus with painful fissure
become infectedPrevention : not necessarilly
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heatheatBurn,miliaria, intertrigoBurn: after burn hypopigmentation
susceptible actinic damageHyperpigmentation and scar are
disfiguringMiliria: sweat retention3type: m.crystalina:upper epiderm
m.rubra: lower epiderm m.perfounda: upper dermis
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DX : clinical picture, Hx of excessive heat exposure
Prevention: avoiding of exposure, hexachlorophen soap, frequent clothing changes
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continuecontinueIntertrigo:macerated,
erythematus lesion in body foldResult excessive sweating in
obese workerCommon site is interdigital space
between third and fourth fingerBacterial and fungal infection is
common
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coldcoldFrosbite,chilblainFrosbite: progressive vasoconstriction
cause impairment circulationClinical symptom in mild form:
redness, transient anesthesia, superficial bullae →Initial redness replace by white waxy appearance → blistering & later necrosis
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Long-term effects: raynaud-like change paresthesia,hyperhydrosis
Scc develop in old scarRewarming, analgesic, surgical
debridementPrevention: protective clothing,
educating.
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coldcold
Chilblain:mild form of cold injuryReddish,blue,swollen,boggy
discoloration with bulla and ulceration
Finger,toe,heel,nose,ear are effectedGenetic is important back groundTreatment : symptomatically
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Vibration syndromeVibration syndromeVibration tool in cold weather
produce vasocostriction of digital arteries.(30-300)
pallor, cyanosis, erythem of finger named raynaud phenomen
Papular name : dead or white finger.
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Tingling,numbness,blanching of the tip of finger occurred
Asymmetry is diagnosticPrevention: designe of tools,
insulation, protection of hands from cold weahter.
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With thanks