chemical, disorder1.pdf-----Contact urtiiicaria-LRbbLatex Rubber Contact urticaria is an important...

The skin acts as a protective barrier against a number of hazards within our environment. These hazards can be: be: 

chemical, e.g: acids, alkalis, solvents, cutting, or soluble oils; soluble oils; 

biological,e.g: bacteria,plant allergens, or raw food; physical, e g: ultraviolet light  or mechanical shearing physical, e.g: ultraviolet light, or mechanical shearing forces.

DEFINITION: occupational skin disease is one inwhich workplace exposure to some physical, chemical orbi l i h d h b l j dbiologic hazard has been a causal or a major andnecessary contributing factor in the development of thedisease.

Also a worsening of pre‐existing skin disease canbe termed as occupational skin disease.

THE MOST COMMON:ContactContact dermatitisdermatitisaccounts for at least 60% of occupational dermatoses1,which, in turn, account for 40-70% of occupationallyacquired illnessacquired illness

ChemicalsAcidsAlkalisSolvents

BiologicViruses (orf-wart-herpes)Bacteria(anthrax-erisopeloid)F i( did d t h t )Solvents

OilsDetergentsResinsPlasticsMetals

Fungi(candida-dermatophyte)Parasites(scabies-

(schistosomiasis)

MechanicalsMetalsPetroleum product

PhysicalsTemperature

MechanicalsPressureFrictionVibration

Temperature Ionizing radiationNon ionizing radiation

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Occupational dermatitis Occupational photosensitivity reactions O ti l h t t i it ti Occupational phototoxicity reaction Occupational skin cancers Occupational contact urticariap Occupational acne Occupational skin infections

O i i i Occupational pigmentary disorders

I. History A. Present illness Date of onset Date of onset Body site at onset Patient description Onset abrupt or gradual Onset – abrupt or gradual Appearance, spread Effect of treatment Course of disease Course of disease Effect of weekend, vacation Work procedure change Treatment and effect on dermatitis Treatment and effect on dermatitis

B. Occupational Information Employment dates Job title At time of onset

D i ti f j b t k

Hand washing Clothing/equipment

Description of job tasks Materials contacted Protection

Protective creams/cleansers Skin cleaning Other workers affected Protection

Water exposure Date of job changes

Other workers affected Previous job tasks or jobs Second jobj g Second job

C. Personal history History of atopyy Other exposures Animals Plants

sto y o atopy Personal/familyAtopic dermatitis

Plants Clothing Hobbies

pHay feverAsthma

Past history of skin disease Plant dermatitis Hand dermatitis

Medications  Prescribed

Psoriasis Athlete’s foot

Over‐the‐counter

- Childhood atopic dermatitis is fairly common (greaterChildhood atopic dermatitis is fairly common (greater than 10% of children in the United States).- The skin in an atopic individual is more susceptible to irritants, such as rough fibers, and to changes in the environment, such as wet–dry and hot–cold changes.‐

PRE EMPLOYMENT:PRE EMPLOYMENT:

‐‐‐Focus on existing or previous skin problemsproblems

•• Severe in childhoodSevere in childhood•• Hands involvedHands involved

Risk for irritantsirritants

•• HxHx asthmaasthma•• HxHx hay feverhay fever

No Risk for irritants ay e eay e eirritants

All at risk for:All at risk for:

i ii iutricariautricaria

hlhlanaphlaxisanaphlaxis

From rubber latexFrom rubber latex

1‐HAIRDRESSJob (CI) 1‐NURSING

Job caution

2‐CATERING3‐MACHINE ENGINEERING

(CI)2‐HCW

caution

ENGINEERING

Caution is also needed in placing nursing and p g ghealthcare workers. suggests a need to discourage those with suggests a need to discourage those with active skin involvement or a past history of severe eczema from training as a healthcare severe eczema from training as a healthcare 

worker.Those who do proceed should receive a Those who do proceed should receive a carefully supervised programme of hand care and should be followed up in case of further and should be followed‐up in case of further difficulty.

II. Physical examination Lesion type Secondary changes

Di t ib ti Distribution Other skin disease

III. Diagnostic techniques Skin scrapings Culture

Ski bi Skin biopsy Patch test Contact urticaria test Contact urticaria test Photopatch test

IV. Supplemental informationppMaterial safety data sheetsWorkplaceOther physician

- Ask specifically about the amount of time spent each day with wet exposure wearing protective clothing andday with wet exposure, wearing protective clothing, and frequency of contact with irritating chemicals.

- Ask about other intermittent job tasks that may have a relationship to the onset of dermatitis.

Evidence of other skin disease especially flexural eczema- Evidence of other skin disease, especially flexural eczema, psoriasis, dermatophyte fungal infection, acne, and acute or chronic sun damage, should be noted.- The configuration of lesions, linear grouping, or cut-off at sun-exposed sites or sites of protective equipment should be notednoted.- Vesicles localized on the fingertips often are associated with allergy.- Nail changes may indicate chronicity of lesions.

DEFINITION:OCD is an inflammatory skin condition DEFINITION:OCD is an inflammatory skin conditionresulting from cutaneous contact with materials foundin the workplace.

HIGHEST INCIDENCE RATE: Hairdressers, bakers,florists, agriculture and manufacturing.

Occupational Irritant Contact DermatitisOccupational Irritant Contact DermatitisO-ICDDiagnosed on clinical basedDiagnosed on clinical basedNo test is available to definite Dx

Occupational Allergic Contact DermatitisOccupational Allergic Contact DermatitisO-ACD (type IV hypersensitivity)Diagnosed by patch test to relevant AgDiagnosed by patch test to relevant Ag

Contact urticariaType I hypersensitivityType I hypersensitivityDiagnosed by prick test or RAST

ICD Hx. Of contact with

ACD Hx. Of contact with

known irritant Acute onset

known allergen Delay onset (1-3d)

Stinging, Burning Neg. patch test Locali ed

Itching Positive patch test spreads Localized spreads

Accounts for approximately 80% of all contactdermatitisdermatitisICD is the result of a local toxic effect when theskin comes in contact with irritant chemicals suchskin comes in contact with irritant chemicals suchas soaps, solvents, acids, or alkalis

AcuteAcute

Ch iChronic

This is often the result of a single overwhelming exposure or a few brief exposures to strong irritants or caustic agents.

Common work chemicals: – Concentrated acids (sulfuric, nitric, chromic,

hydrochloric, hydrofluoric acids)– Strong alkali(CaOH,NaOH,KOH),wet concrete,

sodium and potassium cyanide– Organic and inorganic salts, e.g. dichromates, arsenic g g g

salts– Solvents, e.g. acrylonitrile

Stinging,burning, painful, erythematous eruption occur after brief contact with strong irritant chemicalschemicals.

Erosion and skin ulceration may occur Erosion and skin ulceration may occur.

May result in permanent scar.May result in permanent scar.

Immediate pain and burning Red blister ulcer necrosis Red blister, ulcer, necrosis

R titi t k i it t Repetitive exposure to weaker irritants

Is due to a stepwise progression of damage to the barrier function of the skin

Water/wet work Fiberglass fibersC i il ( MVF)Detergents

AntisepticsDisinfectants

Cutting oil ( MVF)FoodPesticidesDisinfectants

Soap/cleansing agentsWeak Acids & alkali

Plants & vegetationRubber productsAcrylic resins

Wet cementSolventsLow humidity

Acrylic resinsSoldering fluxDusts/ friction

Low humidity Degreasing agents

Usually presents with dry, scaly fissuring, Usua y p ese ts w t d y, sca y ssu g,lichenified and eczematous lesions on the fingers and hands.

Vesicular lesions do occur but are less common than in ACD.

Hand dermatitis due to contact with cement

CHRONIC ICD

CHRONIC ICD

Caused by low-molecular weight haptens Hapten penetrates through stratum corneum of a

sensitized individual A classical Type IV reactionsensitized individual A classical Type IV reaction

Accounts for approximately 20% of all contactdermatitisdermatitisACD is a type IV, delayed or cell-mediatedimmune reaction that is elicited when the skinimmune reaction that is elicited when the skincomes in contact with a chemical to which anindividual has been previously sensitizedTYPESTYPES::1. Acute

Pruritic vesicles, edema, erythema, bullaeat site of exposure

2. ChronicCrusting leads to lichenifcation and scale

Key FeaturesP iti t Pruritic, eczematous reaction

Well demarcated and located to the site of contact with the allergeng (in Acute ACD and many cases of chronic 

ACD)

P h i i h Patch testing remains the gold standard for accurate and consistent di idiagnosis

This healthy adolescent developed an intensely pruritic vesiculobullous allergic contact dermatitis from hair dye. Dermatlas.org

Poison oak/ivyM t l

Organic dyes ( azo dyes ) Metals:

(Chromium,Nickel,Gold,Mercury, Cobalt )

R bb i d t

Methyl metacrylate Rubber products Plants Rubber industry

(Accelerators,Antioxidants) Plastic resins

Plants Latex and its powderGermicides and biocides

(Epoxy resins, Phenolicresins,Formaldehyde resins,Acrylicresins)

Germicides and biocides Some pesticides Some solvents(Formaldehyde,Turpentine,Aliphatic amines)

Nitrates Ethylene oxide Ethylene oxide

Chronic OACD in an employee with exposure to bl fill l fi d ith t h t tcable filler gel confirmed with patch test

DEFINITION h t i d b t i t kiDEFINITION:characterized by transient skin ormucosal swellings due to plasma leakage.

Superficial dermal swellings are whealsSuperficial dermal swellings are whealsdeep swellings of the skin or mucosa are angioedema.Wh l h t i ti ll iti d i kWheals are characteristically pruritic and pink or

pale in the center,Angioedema is often painful less well defined andAngioedema is often painful, less well defined and

shows no color change.

Immunologic : Caused by proteins that act as allergens Proteins penetrate through skin bind to IgE on the surface

of mast cell releaseof histamine and other mediatorsof histamine and other mediators(type-1 reaction)

Sometimes generalized reactions occurg Latex allergy

Nonimmunologic: Caused by chemicals Direct pharmacologic action on skin cells No sensitization necessary

M th t d More common than suspected

Latex allergy Formaldehyde

F d i d t Food industry Plants VegetablesVegetables Animal products

Pharmaceutical industry Streptomycin

C i i L R bb------Contact urticaria - Latex Rubber

Contact urticaria is an important manifestation of natural rubber latex allergy. Workers exposed to latex gloves and other products containing natural rubber latex may developexposed to latex gloves and other products containing natural rubber latex may develop allergic reactions such as skin rashes; hives (contact urticaria); nasal eye or sinus symptoms; asthma; and (rarely) shock

Any age Oil , pitch , tar Exposed sites ( hand , forearms) Open comedones , pustulesp , p No associated condition

Lubricating petroleum greases ,oils ,and pitch fumes Mechanism : • stimulation of follicular keratinization followed by

ductal occlusion(comedon formation)• Induce of inflamatory reaction by rupture of the

fulicular wall(postular folliculitis)

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Occupation at risk Machinist Oil field worker Oil refiner Auto,truck,air craft,boat mechanics Rubber worker

R f Roofers Road maintenance workers

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Any ageCC ( i i i ) TCCD( tetrachlorodibenzodioxin )

face especially malar crescent and auricular creases, axilla, groingroin

Open & closed comedones, straw- colored cysts Xerosis, conjunctivitis, PCT, peripheral neuritis, liver

abnormalities

Caused by polychlorinated or poly brominatedaromatic h drocarbons (halogen acne)aromatic hydrocarbons (halogen acne)

Mechanism: induction of metaplasia ,keratin filled cystsfilled cysts

Noninflammatory comedones and cysts in malar crescents and posterior auricular foldsmalar crescents and posterior auricular folds

Occurs within 2-8 weeks of exposure and regress over a 4-6 months period.regress over a 4 6 months period.

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Occupation at risk

Workers in production of pesticides, herbicides

El t i l k d t PCB (t f il) Electrical workers exposed to PCB (transformer oil)

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(1) identification of potential irri-tants and allergens in the workplace {use of the MSDS),

(2) chemical s bstit tion or remo al to pre ent rec r rence(2) chemical substitution or removal to prevent recur-rence,(3) personal protective measures,(4) personal and environmental hygiene,(4) personal and environmental hygiene,(5) education to promote awareness of potential irritants and

allergens both at work and home,(6) preemployment and periodic health screening, and (7) engineering controls with au-tomated, closed systems.

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