قراءة
عرض

Occupational Skin Diseases

By
Dr. Ashraf Hussain
Msc, PhD. Com. Med.
Introduction
The second cause of occupa onal diseases ( 15-25% of all occupa onal 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)
Causes of OSD include
Chemical agents
are the main cause of occupational skin diseases and disorders.
These agents are divided into two types: primary irritants and sensitizers.
Primary or direct irritants act directly on the skin though chemical reactions.
Sensitizers may not cause immediate skin reactions, but repeated exposure can
result in allergic reactions.
A worker’s skin may be exposed to hazardous chemicals through:
1. direct contact with contaminated surfaces.
2. deposition of aerosols.
3. immersion, or
4. splashes.
Contact 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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The symptoms and presentation of ICD and ACD are so similar, it is extremely

difficult to distinguish between them without clinical testing (e.g. patch testing).
Irritant contact dermatitis (ICD)
is a non-immunologic reaction that manifests as an inflammation of the skin caused
by direct damage to the skin following exposure to a hazardous agent.
ICD represents approximately 80% of all cases of occupa onal contact derma s.
The reaction is typically localized to the site of contact.
ICD may be caused by
ü phototoxic responses (e.g., tar),
ü acute exposures to highly irritating substances (e.g., acids, bases,
oxiding/reducing agents),
ü or chronic cumulative exposures to mild irritants (e.g., water, detergents,
weak cleaning agents).
Allergic contact dermatitis (ACD)
• Caused by an immunologic reaction triggered by dermal contact to a
skin allergen sensitizing agents producing a response after a single or
multiple exposure and only in some individuals
• The reaction is not confined to the site of contact and may result in
systemic responses.
• Systemic responses (difficulty breathing, inflammation of airways,
pulmonary edema
ACD may be caused by industrial compounds (i.e. metals, epoxy and acrylic resins,
rubber additives, chemical intermediates), agrochemicals (i.e. pesticides and
fertilizers), and commercial chemicals.
The severity of contact dermatitis is highly variable and depends on many factors including:
1. Characteristics of the hazardous agent (irritant and/or allergen)
2. Concentration of the hazardous agent (irritant and/or allergen)
3. Duration and frequency of exposure to the hazardous agent (irritant and/or
allergen)
4. Environmental factors ( e.g., temperature, humidity)
5. Condition of the skin (e.g., healthy vs. damaged skin, dry vs. wet)
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Contact urticaria (CU)

In immunologic CU the reaction is an immunglobulin E mediated early immune
response against the sensitizing chemical substance.
Symptoms are itching and hives (urticaria) at the place of contact usually within an
hour.
This can be accompanied by (allergic) rhinitis, conjunctivitis, asthma and rarely
anaphylaxis
A well-known form of allergic CU is latex-allergy among healthcare and cleaning
workers who are wearing latex gloves.
Tackling CU is more difficult, because it requires a total elimination of the allergen
due to the risk of the more serious complications; thus change of job is more
frequently recommended to avoid/ prevent exposure
Contact photodermatitis
Some chemicals may cause CD only in the presence of light
Sunlight or artificial light sources that emit specific wavelengths
2 categories:
-phototoxic
-photoallergic
Phototoxic Reactions
Involves a chemical along with UV radiation
Localized areas of tenderness at exposed location
Example: roofer is more easily sunburned on skin that has been exposed to tar
fumes.
Photoallergic Reaction
Involves a chemical along with UV radiation
Involves the immune system
Only affects some individuals
Example: squeezing a lime while working in the sun
Occupational Skin Cancers
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The second m/c form of occupational skin diseases

About 17% of all cases of occupa onal skin diseases
Risky exposures include:
v Ultraviolet light
v Ionizing radiation
v Poly cyclic aromatic hydrocarbones
v Arsenic
Other occupational skin ailments:
Occupational acne
These are comedos (pinheads), papules and pustules caused mostly by industrial oils
and greases .
Caused by exposure to industrial chemicals.
Unlike common acne, these eruptions manifest at the site of skin contact.
Suspected in : a. Unusual sites of involvement e.g. forearms. b. Unusual age e.g.
middle age males.
Car mechanics, maintenance workers are most at risk.
Tar derivatives and halogen-containing compounds (polychlorinated naphtalenes),
iodides and bromides) may cause acne, just like certain pharmaceuticals.
Hyper pigmentation
Darkening of the skin from chronic physical irritation (e.g., itching)
Some chemicals may stimulate the production of melanin (thus darkening)
Tars, arsenic compounds, plant sensitizers.
Skin diseases of physical origin
Physical exposures range from direct stimuli and thermal conditions to radiation.

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Mechanical trauma
Recurring rubbing or increased pressure can thicken the inflamed skin with “crazy-
paving pattern” (lichenification) and callosity.
Called occupational stigmas are frequent at body parts exposed: shoulders of sack
carriers, fingertips of guitarist.
Temperature
Heat
ü Sweat stagnation can cause miliaria .
ü Overlapping skin surfaces can become sodden, ending up in intertrigo.
Cold temperature
ü Reynaud-like symptoms (blanching attacks of fingers)
ü frostbites.
Skin Diseases of Biological Origin
Bacterial infections
Occupational pyodermas (folliculitis, furuncle, carbuncle, impetigo, ecthyma,
paronychia, etc.)
Skin tuberculosis
Fungal infections (mycoses)
Yeast infections
Candida albicans,
onychomycosis (nail),
paronychia (around the nail bed),
interdigital mycosis (between the fingers or toes).
Viral skin diseases
Milker's nodules
Parasitic skin lesions
Arthropod bites from animal parasites
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Bee and wasp

Scabies is caused by Sarcoptes scabiei.
Prevention of Occupational Skin Damage
1. Elimination
2. Substitution
3. Engineering Controls
a) process re-design to eliminate or reduce contact, automation, closed systems
b) Make plans for spills and leaks
4. Administrative Controls
a. Training, personal hygiene (remember lead and ingestion), barrier creams,
rotation
b. Requires all workplaces contain a basin for washing, hot and cold running
water, soap, clean towels or hot air dryers
5. PPE: gloves, aprons, boots, full body suits, face shields, goggles,
Provide a barrier; meet specifications for degradation and permeation

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رفعت المحاضرة من قبل: Ahmed monther Aljial
المشاهدات: لقد قام 4 أعضاء و 122 زائراً بقراءة هذه المحاضرة






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