Pak Dermatosis2

7/28/2019 Pak Dermatosis2

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DERMATOSIS AKIBAT

KERJA


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Changes in Incidence

(1993 - 1999) From 1993 to 1999 there have

been further changes in thenumber of cases, incidenceand proportion of occupational

skin diseases. In 1999 BLSdata showed 44,600 totalcases of occupational skindiseases/disorders, or anincidence of 49 cases per100,000. In 1999, 12% of alloccupational illnesses reportedwere skin diseases/disorders.


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Work time lost


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Cost


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Sifat agen penyebab

dermatosis : Agen fisik : tekanan, gesekan, cuaca dingin,

panas, radiasi ultraviolet, serat mineral.

Agen Biologis : beberapa mikroba, fungi,parasit kulit dan produk2 nya

Agen kimia, dibagi dalam 4 kelompok :

- iritan primer

- sensitizer- acnegenic

- photosensitizer


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Iritan primer

Asam , basa, pelarut lemak

Detergen

Garam garam logam

- garam arsen

- garam mercuri- dll


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Sensitizer

Logam dan garam2nya (kromium, nikel,kobalt)

Senyawa yang berasal dari anilin

( p fenilendiamin, azo dyes ) Derivat nitro aromatik ( trinitrotoluene )

Resin (epoksiresin, formaldehid, vinil, akrilik )

Bahan kimia karet ( vulcanizer) dimetiltiuran disulfida

Obat-2an (procain, fenotiazin, klorotiazid,penisilin,tetrasiklin

Kosmetik, terpentin, tanam2an


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Agen acnegenic

Naftalen

Bifenil khlor

Minyak mineral


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Photosensitivity

Many chemicals needlight to activate andproduce the complete

phototoxin orphotoallergen. Thefurocoumarins in limesproduced this vesicularphototoxic dermatitis in

a bartender whosqueezed limes all

afternoon in direct sun.


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Ultraviolet cured

processes The technology of

using ultraviolet lightsensitive chemicals is

relatively new increating templates forprinting. It is alsobeing used in themanufacture of certain

printing inks and indentistry. Variousacrylates have beenthe sensitizers in thisprocess.


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Mekanisme terjadinyadermatosis :

Agen fisik trauma mekanik langsung ke kulit

Agen kimia

Iritan primer : merusak kulit dengan cara

mengubah PH, denaturasi protein, mengekraksilemak, menurunkan daya tahan

Sensitizer/allergi reaksi hipersinsitivitas tipelambat

Acnegenic menyumbat kelenjar dan sal, sebacea peradangan lokal

Photosensitizer meningkatkan sensitivitas kulitterhadap radiasi ultraviolet


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Gejala dan tanda

a. D. contact irritant- Akut ditandai eritema, edema, papula

vesikula biasanya di tangan, lengan

bawah atau wajah- Kronik ditandai excoriasi, crustae , eksema,

hiperkeratosis

- Faktor yang membantu timbulnya contaciritant adalah ; adanya trauma ( digosok,digaruk) pakaian, sarung tangan, kulitkering, kulit sudah dalam kondisi sakit


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Contact Dermatitis, Acute

This arm shows a painful,acute contact dermatitisform exposure to the

strong irritant, ethyleneoxide. The arm ismarkedly swollen andshows an acute vesiculo-

bullous dermatitis. Asimilar pattern may beseen on the basis ofcontact allergy.


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Contact Dermatitis,

Subacute This patient developed a

bilateral and symmetric sub-acute dermatitis from the

rubber accelerator,mercaptoben zothiazole,which was leached from therubber portion of his work

shoe as a result of sweating.In this case there is someedema and erythema withan eczematous eruption.


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Contact Dermatitis,

Chronic The hands, wrists and forearms

are the most frequent sites ofinvolvement in cases of industrialcontact dermatitis. The handsand wrists of this worker with achronic dermatitis show theeffect of long term exposure to asolvent, in this case kerosene,which was used for cleaning the

skin. The skin markedlythickened, hyperpigmented, dryand fissured, itching is usually amajor symptom.


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Chrome hole, fingers

Chromic acid and alkaline chromate areagents commonly encountered in thetanning and electroplating industries.These substances have a corrosiveaction when they enter the skin througha minor nick or break in the

integument. This results in theformation of chronic, ulcerative lesionsknown as "chrome holes". Typically, thelesions are found on fingers, hands orforearms. "Chrome holes" also occur onthe dorsal surfaces of the feet whenchrome salts have been allowed topermeate boots or shoes. The lesions

are usually painless and persist formany months before spontaneouslyhealing with permanent atrophic scar.Identical lesions can also be producedby arsenic or zinc salts but these areless frequently encountered.


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Chromic acid and alkaline chromate are agentscommonly encountered in the tanning and electroplatingindustries.

These substances have a corrosive action when theyenter the skin through a minor nick or break in theintegument. This results in the formation of chronic,ulcerative lesions known as "chrome holes".

Typically, the lesions are found on fingers, hands orforearms. "Chrome holes" also occur on the dorsalsurfaces of the feet when chrome salts have been allowedto permeate boots or shoes.

The lesions are usually painless and persist for many

months before spontaneously healing with permanentatrophic scar.

Identical lesions can also be produced by arsenic orzinc salts but these are less frequently encountered.


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Chrome hole, nasal

When chrome containingmaterials are present asaerosols, painless ulcerationof the nasal mucosa andseptum may occur. Withcontinues exposurepermanent septalperforation eventuallyresults, as in this young

woman who was employedin chrome plating smallappliance parts.


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b. D.contact allergica Ada sensitisasi sebelum timbul alergi, agen

sensitisasi bereaksi dengan protein dalamepidermis membentuk kompleks hapten protein pembentukan antibody

Reaksi hypersensitivas tipe lambat, timbulsetelah 48 72 jam

Zat yang biasanya sebagai primary irritant

juga dapat sebagai allergen Bentuk akut seperti spt D. contact irritant

akut

Bentuk kronis timbul likenifikasi , fisura


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Contoh kasus D. Contac

allergica Dental Assistant

(allergy to glutaraldehyde and neomycin)


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Contoh kasus D. contact

allergica Optician - non-dominant hand dermatitis

(allergy to ethyl acrylate)


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Other Resin System

This severe allergiccontact dermatitis wasdue to a phenol-

formaldehyde resin.These resins are used asbonding agents forfoundry sand, electrical

devices and in moldedand cast plastic articles.They may also produceirritant reactions.


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Chemical Accelerators in

Rubber Allergic contact dermatitis

due to rubber chmicals isfairly common in industry.

Chemial accelerators thatspeed up the vulcanizationraction and antixidants arethe more frequent

allergens. They present apotential hazard in finishinggoods as well.


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Gejala Dermatosis yang

lain Acne akibat kerja hanya menyerang tubuh yang

kontak dengan agen

Lesi mikrotraumatik disebabkan oleh seratmineral, ditandai dengan papula kecil keputihanatau kemerahan pd area yg terpapar

Kanker kulit ( karsinoma squamosa

hyperkeratosis, papilomatosis

Dermatosis yg menular zoonotik, dermatofitosis,kandidiasis, tuberkulosis verukosa


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Occupational Acne. Acute,

Oil Folliculitis Occupational acne is most

commonly seen in workersexposed to insoluble cutting oils inthe machine tool trades or in

mechanics exposed to grease andlubricating oils. This workerdeveloped folliculitis, sometimescalled oil boils or acne, withmultiple comedones and pustuleson his arms and other covered

areas of his body as a result ofprolonged contact with oil. Thelesions almost never develop frombacteria present in the oils


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Oil Folliculitis Chronic,

Chloracne Chlordane is an extremely

refractory type of acne causedby certain halogenated aromaticchemicals and can be certain

halogogenated aromaticchemicals and can beaccompaned by systemictoxicity. It represents one of themost sensitive indicators ofbiologic response to these

chemicals. Chloracne in thisherbicide production workerinvolved almost every follicularorifice on his face and neck withcomedones, papules and cystlikelesions.


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Depigmentation

The hands of thishospital maintenanceworker are

depigmented formcontact with a phenolicgermicidal detergent.Irritation orsensitization to the

chemical is not aprerequisite for thepigment loss to occur.This loss of pigmentmay be permanent.


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Granuloma

Granulomas represent a focal,chronic inflammatory reaction.These granulomas wereproduced by beryllium and areconsidered to be on a allergicbasis. Non-allergic granulomasare more common andrepresent the skin's response toinoculated or implanted foreign

materials such as woodensplinters, plant spines and silica.


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Eccrine

Miliaria represents blockageof the eccrine sweat ductsand may occur in workerswho perspire excessively. In

this case of miliaria rubra ofprickly heat, the blockage siteis the granular cell layer ofthe epidermis. When morethan 30% of the skin surfaceis affected, an individual maydevelop thermoregulatorydisorders such as heatexhaustion.


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Tumors

Skin tumors, such as thisulcerating squamous cellcarcinoma most frequently ariseafter years of occupationalexposure. Malignant tumors mayrepresent to occupationalcarcinogens such as coal tar andphysical agents such as sunlight.Skin cancer is the commonestform of cancer. The role played

by occupational factors isfrequently difficult to determine.


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Diagnose Dermatosis

akibat kerja Gambaran klinis, lokalisasi dan

perjalanan penyakit harus sepenuhnya

sesuai dengan ciri PAK yg pasti Paparan kerja terhadap agen

berbahaya perlu dipastikan

Ada hubungan waktu paparan dantimbulnya penyakit

Dermatosis contact allergica ujitempel


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Uji tempel Menempelkan alergen yang dicurigai

dengan kadar yang non iritatif padakulit yang tidak terpapar selama 24

48 jam Positif bila timbul dermatosis

ekzematous dibawah tempelan yang

penutup


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Kerentanan

Orang dengan atopi ( eksema,penyakit kulit alergi dan alergi lainnya)

Penyakit kulit kronik termasukhiperhidrosis

Seborea atau iktiosis

Pimentasi abnormal

Lesi kulit prekanker


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Penanganan kasus

Dipindahkan ke area bebas alergen

Kasus D. iritatant, pekerja dipindahkansementara dan agen penyebab dikendalikan

Pemindahan kerja sec. Permanen dilakukanbila pemindahan sementara tidakmenghasilkan penyembuhan yg sempurna

Kondisi prekanker mk. Pekerja harusdijauhkan dari paparan


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Upaya pencegahan

Allergen kuat, sensitizer, karcinogendiganti dengan zat yang kurang

berbahaya Pengendalian secara tehnik ( isolasi

tempat kerja)

Eliminasi kontak dengan kulit Pakaian pelindung ( apron,sarung

tangan, sepatu boot, penutup wajah)


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Upaya pencegahan

Fasilitas dasar untuk kebersihan diri(pancuran air untuk mandi bukan bak

mandi) Kebersihan lingkungan dan house

keeping

- pembuangan air bekas dan sampahindustri

- pembersihan debu

- cara penimbunan dan penyimpanan

barang


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Upaya pencegahan

Diagnose dini Penyakit Dermatosis Akibatkerja melalui :

Pemeriksaan awal sebelum penempatan

- riwayat medis

- fisik dengan perhatian khusus pada kulit

Pemeriksaan berkala :

- sama spt pem.awal- uji tempel tdk dianjurkan bagi yg tdkmenunjukan gx

- waktu antara 6 bln 2 tahun tgt tingkatpaparan


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Prognosis

D. iritant , acne, infeksi menyembuh sth agen penyebab

dijauhkan D. alergi tgt sifat alergennya dan

bila hanya ditempat kerja dan telah di

hilangkan alergennya sembuhsempurna

allergi + infeksi sekunder

sembuhnya lama


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