Screening and Monitoring in Occupational Health and Safety

Screening and Monitoring in Occupational Health and Safety

OCT 420 HC

SKIN

By Kylie Stitt and David Freeman

Lecturer: Dr J. Cromie

Latrobe UniversitySchool of Occupational Therapy

Freeman and Stitt SKIN 1

Introduction

Occupational skin disease can be induced by, or aggravated by

exposure to irritant agents in the work environment. Although most

occupational skin diseases are not life threatening, they can cause

considerable discomfort to the employee. This can have an effect

on productivity, employee and team moral as well as business

operations.

It is important to recognise the effects of occupational skin disease

with respect to short and long term effects. Occupational health

and safety professionals should be aware of the types, and causes

of occupational skin disease as well as preventive measures.


Anatomy of Skin

Epidermis

- superficial layer

- epithelium cells

- varying thickness depending on site

- hair shaft

Dermis

- deep layer

- connective tissue

- blood vessels

- lymphatic vessels

- nerves

- hair shaft

- nails

Superficial Fascia

- layer below the dermis

- hair follicle

- sweat glands


Snell (1986)


Function of Skin

Protective barrier

- a protective layer of natural oils to retard moisture evaporation

and to act as a mechanical shield.

Goh (1994)

Burns

- depth indicates rate of healing and methods of treatment

Partial thickness- heal from cells of hair follicle, sebaceous glands,

sweat glands, and cells of the edge of the burn

Full thickness - deeper than sweat glands will heal slowly from

the edges of the burn only

- require skin grafting to prevent contracture and

increase the rate of healing


Skin grafting

Split thickness - removal of epidermis from donor site and

positioning graft on burn site

Full thickness - involves both the epidermis and the dermis, with

the provision of circulation supply at the burn site

and within the donor graft to survive.

Snell (1986)


Types of Occupational Skin Disease

Occupational Dermatitis

- Eczema and dermatitis- inflammation of the skin

- Contact dermatitis refers to an inflammation that is caused

by an external agent

- Most commonly these diseases are localised to the hands

and forearms and can prevent a person from continuing

employment

- Occupational dermatitis can be caused by a variety of

interactions in the workplace

- Many substances encountered in the occupational

environment can affect the skin in different ways and

cause different types of reactions


CHEMICALIrritant Absolute, Immediate first contact inflammatory reaction

of the skin – strong bases and acids (potassium chloride, ethylene oxide)

Marginal Repeat contact (Kerosene, various cutting fluids)Allergens Contact causing a reaction (epoxy resins, chemicals

used in making of rubbers, chromates, nickel)MECHANICALFriction Calluses, abrasions, lichenification of skin (violinist

neck, knuckle pads of carpet layers), Koebner’s phenomenon (development of lesions of psoriasis or lichens planus, in workers predisposed to having either of these skin disorders in traumatised areas of skin)

Pressure Blisters, nail dystrophyVibration Vibration induced white fingers, Raynaud’s Disease

(certain types of vibrating equipment)PHYSICALHeat Burns, sweating (Miliaria, intertriginous rashes)Cold Frostbite, Raynaud’s symptomsRadiation Radiation dermatitis, skin cancers (x-ray exposure),

photosensitivity eruptions, phytophotodermatitis (eruptions form contact with plants containing furocoumarin in presence of light.

BIOLOGICALPlants Poison Ivy, oak and sumac (forest fire fighters)Insects Lyme disease from bite of tick in forester)Animal Orf (viral eruption from infected sheep)Microbiological Agents

Viruses- herpetic whitlow (herpes simplex of finger in dentists)Bacterial- anthrax (contact with spores in contaminated goat hair)Fungal- Mycobacterium Marinum (fish tank cleaners)Rickettsial- Rocky Mountain spotted fever (tick bite in dog handler)Protozoa- Plazmodium (causing malaria from mosquito bite in laboratory workers)Helminthes- Ancylostoma braziliense (causing cutaneous larva margins, skin eruptions in workers who


are exposed to organisms from infected soil)Table 1 from Mc Cunney (1994) ch.17 p.

Irritant Reaction

Cause pathological reactions in the skin with

exposure in sufficiently high concentrations and

length of time

Reactions to irritants can vary greatly between

individuals

Some irritants give no visible change on one or two

contacts, but can still reduce the defence mechanism

of skin

Contact Allergy

Involves an altered type of reaction in the skin

The allergy as such does not cause any visible alteration, but

the skin can develop dermatitis when it comes into contact

with the allergens (sensitisers) to which the allergy has been

acquired

The origin of contact allergies can occur after one week of

exposure or years and even decades

The allergy is very specific and involves one or a few very

similar definitive products

Vary in intensity


The allergy normally remains for the remainder of the

person’s life, causing a reaction upon every point of contact.

Multiple Sensitisations

Multiple allergens within different products

Cross sensitisation means that contact dermatitis caused by a

primary allergen combined with allergies to chemically

similar substances, all of which can cause an outbreak of a

dermatitis reaction at contact

Phototoxic/Photoallergic Reactions

These forms of reaction only occur where there is contact

with an allergic substance and ultra violet light at the same

time.

Allergic Contact Dermatitis

Can occur after only a single contact

Characterised by redness, itching, swelling, papules, and

vesicles

Many factors affect the appearance of dermatitis such as the

location and quantity of allergen


The allergens cause skin lesions in a sensitised person and

are normally visible 6-48 hours after contact, but can take

four to five days to remedy.

Chronic allergic dermatitis

Prolonged acute dermatitis and is maintained by repeated

contact with the allergic substance

Irritant and allergic dermatitis is often difficult to distinguish

as they can occur at the same time

Diagnosis

Patch tests are used to reproduce as allergic reaction on skin

with specific products

Bacterial culture test - for blistering or crusting lesions

Conducted by a suitably qualified physician or dermatologist


Burns

Flame

In direct contact with a fire, the cause of which could be from

a multitude of sources.

The length of exposure and intensity of the heat liberated

from the fire will determine the extent of the burn suffered.

Chemical

Herrington (1995) states that “Chemical burns are uncommon,

accounting for only 3% of all burn injuries; however they are

responsible for over 30% of burn deaths”

(Herrington, 1995, p. 264).

Alkalis are more destructive to human tissue than acids due

to the different reactions with the skin and underlying tissue

When chemical exposure is suffered the continuation of

exposure will directly affect the extent of the burn wound.

Acid or alkali burns should be treated initially by continuous

flushing with copious amounts of running water.


Neutralisation is not recommended, as the heat produced with

neutralisation will exacerbate the injury.

Herrington (1995)

Electrical

Herrington (1995) states “Electrical burns are caused by the

conversion of the electrical energy to thermal energy. As the

current courses through the body, heat is liberated in proportion to

the resistance of the various tissues” (Herrington, 1995, p. 264).

Damage caused by electric current is generally not visible

The majority of the burn damage is to internal tissue, except

to the entry and exit point of the current and burns due to

associated flame proliferation when an electric arc flashes or

heat ignites.


Herrington (1995)

Types of burn

First-degree (superficial) burns

Most commonly caused by the exposure to ultraviolet

radiation or scalding due to hot liquids or surface contact

Injuries generally do not require hospitalisation and are

treatable without specialist medical attention

This type of burn should heal within a week or so.

Second-degree (partial thickness) burns

Predominately caused by scalding, contact with hot

surfaces or flame

Treated as soon as possible by flushing or where possible

submerging in cold water as this helps to limit the extent

of the burn injury.


Hospitalisation is necessary for this type of injury to

ensure appropriate treatment is received, recovery within

three to four weeks.

Herrington (1995)

Third-degree (full thickness) burns

Caused by flame, electrical contact, or immersion in hot

liquids

Affected area has constricted blood flow

Specialist treatment is required

Treatment involves the removal of the affected area and

the positioning of grafts


Herrington (1995)

Mechanical Injury

Callosity

- Hardened skin that forms when the skin is subjected to

constant friction

- Occurs during manual work and can be painful, causing

difficulty at work

Raynaud’s Phenomenon

- The fingertips change colour when exposed to the cold

- Discoloration is the result of a vasopastic reaction to cold

and in severe cases this can lead to necrosis

- Common with workers using vibrating tools such as

jackhammers, pneumatic drills and pounding machines.


Goh (1990)

Physical Injury

Heat

- The swelling of the lining of the sweat ducts can obstruct

the entrance of the sweat duct leading to sweat retention

causing miliaria

- Symptoms can be as mild as scaling of the skin, or severe

such as itchy popular rashes

- Treatment involves changing the environment of the

worker to reduce sweating and hygiene

Cold

- Frostbite and Raynaud’s phenomenon

- Environments such as cold rooms and in liquefied gas

workers can cause vasoconstriction leading to decreased


blood supply to the fingertips with severe damage being

tissue damage and necrosis.

Goh (1990)

Radiation effects

- Electromagnetic radiation is dependent on energy level

and dose

- Little or no warning properties such as odour or sound.

Ionising radiation

- Has a high energy level and occurs in waveform such as

X-rays

- Health impact varies with the type of radiation and

intensity

- Occurs in industry such as curing plastics, sterilising,

medical radiography and therapy, and electronic

equipment such as television sets.


Adams (1999)

Acute radiodermatitis

- Occupational exposure to ionising radiation is usually

localised

- Acute radiodermatitis affects the skin in stages

- Initially, there is blanching of the skin and oedema that

reaches a peak at 48 hours after exposure and rapidly

subsides. From six to ten days the skin begins to change in

colour and texture with considerable pain

- Acute radiodermatitis effects the functioning of the

sebaceous glands and hair follicles. After months of

healing a scar remains present

- As the intensity of exposure to radiation increases, the

effects become worse, with amputation a possibility.


Adams (1999)

Ultraviolet light radiation

- Common cause of cancer such as melanoma, and

squamous cell carcinoma.

- Enhances the skin ageing process and this can lead to skin

cancer

- Industry use artificial sources of UV radiation, examples

include welding and cutting torches, numerous laboratory

equipment and electric arc furnaces

- Outdoor workers are affected

- Personal protection equipment

- Some medication can cause photosensitivity reaction

effecting toenails and fingernails following exposure to

UV radiation


Adams (1999)

Irritants and Allergens

Resins

Acrylic - associated with causing allergic contact

dermatitis in the uncured form

- skin irritant and sensitiser

Epoxy - inert form is not a skin sensitiser

- can cause dermatitis

- used in thermoplastics, prosthetics, and

dentures

Polyurethane - skin irritants

- dermatitis caused by direct contact

- used in prosthetics, adhesives and

furniture


Formaldehyde - skin irritant and sensitiser

- allergic contact dermatitis possible

as formaldehyde is released from the

resin

- used in electrical and manufacturing

industries

Goh (1990)

Rubber Chemicals

Most common skin sensitiser

Allergic contact urticaria

Latex gloves can cause dermatitis

Substitutes include plastic gloves

Solvents

Skin irritants

Can cause cumulative dermatitis in hands

Used for dissolving substances, degreasing and in inks

Used as cleanser

Soaps and Detergents


Skin irritants

Skin sensitiser in fragrances

Can cause contact dermatitis

Cleansers

Goh (1990)

Foodstuffs

Uncooked food can cause skin reactions

Occupational dermatitis can be cumulative

Allergic contact dermatitis possible with preservatives and

spices

Contact urticaria result of contact with shellfish, fish meat

and fruit

Patch test can confirm allergy

Chefs and food handlers

Plants and Woods

Irritant and allergic contact dermatitis

Plant dermatitis - lesions on the skin


Wood dermatitis – airborne, exposed skin

Forest workers, florists, gardeners, and horticulturists

Goh (1990)

Metals

Skin sensitiser and irritant

Can cause contact dermatitis

Nickel - skin sensitiser and can cause contact dermatitis

- jewellery, hairdressing and electronics industries

- patch test available to detect nickel

Chromium - not a skin sensitiser

- chromate can cause allergic contact dermatitis

- dermatitis continues after stopping contact

- used in tanning leather and in cement


Goh (1990)


Health Risk Assessment

Hazard Identification

- First step in risk assessment

- What is a hazard and what the effects of exposure on

health

- Injury type or disease and exposure conditions.

Dose Response Assessment

- Relationship of dose and the occurrence of an adverse

effect

- Animal studies and human studies, showing route of

exposure, dose type, and the response.

Exposure Assessment

- Amount of exposure from the environment such as

ingestion, absorption, and inhalation.

- Duration and estimated dose of exposure is determined to

be able to identify current and to anticipate future adverse

conditions.

Risk Characterisation

- Determine the extent of the risk with respect to regulations

and legislation.

Adams (1999)


References

Adams, R.M. (Ed.). (1999). Occupational Skin Disease (3rd ed.).

Philadelphia: W.B. Saunders Company

Berger, T.G., Elias, P.R., and Wintroub, B.U. (1990). Manual of Therapy

For Skin Diseases. New York, U.S.: Churchill Livingstone

Dr. Kevin Macdonald. Occupational Physician, B.Med.Sc., M.B.B.S.,

F.A.F.O.M.

Goh, C.L. (1990). Handbook of Occupational Skin Diseases. Singapore:

P.G. Publishing

Herrington, T and Morse, L. (1995). Occupational Injuries, Evaluation,

Management and Prevention. St Louis Missouri, U. S. A.: Mosby, Year

Book Incorporated

Mc Cunney, R. (1994). A Practical Approach to Occupational and

Environmental Medicine (2nd ed.). Boston: Little, Brown and Company

Snell, R.S. (1986). Clinical Anatomy for Medical Students (3rd ed.). Boston:

Little, Brown and Company

Zenz, C., Dickerson, O., and Horvath, E. (Eds.). (1995). Occupational

Medicine (3rd ed.). St Louis Missouri, U. S. A.: Mosby, Year Book

Incorporated


Health & Medicine

Screening and Monitoring in Occupational Health and Safety