5 Changes in Incidence (1993 - 1999) From 1993 to 1999 there have been further changes in the number of cases, incidence and proportion of occupational skin diseases. In 1999 BLS data showed 44,600 total cases of occupational skin diseases/disorders, or an incidence of 49 cases per 100,000. In 1999, 12% of all occupational illnesses reported were skin diseases/disorders.
14 PhotosensitivityMany chemicals need light to activate and produce the complete phototoxin or photoallergen. The furocoumarins in limes produced this vesicular phototoxic dermatitis in a bartender who squeezed limes all afternoon in direct sun.
15 Ultraviolet cured processes The technology of using ultraviolet light sensitive chemicals is relatively new in creating templates for printing. It is also being used in the manufacture of certain printing inks and in dentistry. Various acrylates have been the sensitizers in this process.
16 Mekanisme terjadinya dermatosis : Agen fisik trauma mekanik langsung ke kulitAgen kimiaIritan primer : merusak kulit dengan cara mengubah PH, denaturasi protein, mengekraksi lemak, menurunkan daya tahanSensitizer/allergi reaksi hipersinsitivitas tipe lambatAcnegenic menyumbat kelenjar dan sal, sebacea peradangan lokalPhotosensitizer meningkatkan sensitivitas kulit terhadap radiasi ultraviolet
17 Gejala dan tanda a. D. contact irritant Akut ditandai eritema, edema, papula vesikula biasanya di tangan, lengan bawah atau wajahKronik ditandai excoriasi, crustae , eksema, hiperkeratosisFaktor yang membantu timbulnya contac iritant adalah ; adanya trauma ( digosok, digaruk) pakaian, sarung tangan, kulit kering, kulit sudah dalam kondisi sakit
18 Contact Dermatitis, Acute This arm shows a painful, acute contact dermatitis form exposure to the strong irritant, ethylene oxide. The arm is markedly swollen and shows an acute vesiculo-bullous dermatitis. A similar pattern may be seen on the basis of contact allergy.
19 Contact Dermatitis, Subacute This patient developed a bilateral and symmetric sub-acute dermatitis from the rubber accelerator, mercaptoben zothiazole, which was leached from the rubber portion of his work shoe as a result of sweating. In this case there is some edema and erythema with an eczematous eruption.
20 Contact Dermatitis, Chronic The hands, wrists and forearms are the most frequent sites of involvement in cases of industrial contact dermatitis. The hands and wrists of this worker with a chronic dermatitis show the effect of long term exposure to a solvent, in this case kerosene, which was used for cleaning the skin. The skin markedly thickened, hyperpigmented, dry and fissured, itching is usually a major symptom.
22 Chrome hole, fingersChromic acid and alkaline chromate are agents commonly encountered in the tanning and electroplating industries. These substances have a corrosive action when they enter the skin through a minor nick or break in the integument. This results in the formation of chronic, ulcerative lesions known as "chrome holes". Typically, the lesions are found on fingers, hands or forearms. "Chrome holes" also occur on the dorsal surfaces of the feet when chrome salts have been allowed to permeate boots or shoes. The lesions are usually painless and persist for many months before spontaneously healing with permanent atrophic scar. Identical lesions can also be produced by arsenic or zinc salts but these are less frequently encountered.
23 Chromic acid and alkaline chromate are agents commonly encountered in the tanning and electroplating industries.These substances have a corrosive action when they enter the skin through a minor nick or break in the integument. This results in the formation of chronic, ulcerative lesions known as "chrome holes".Typically, the lesions are found on fingers, hands or forearms. "Chrome holes" also occur on the dorsal surfaces of the feet when chrome salts have been allowed to permeate boots or shoes.The lesions are usually painless and persist for many months before spontaneously healing with permanent atrophic scar.Identical lesions can also be produced by arsenic or zinc salts but these are less frequently encountered.
24 Chrome hole, nasalWhen chrome containing materials are present as aerosols, painless ulceration of the nasal mucosa and septum may occur. With continues exposure permanent septal perforation eventually results, as in this young woman who was employed in chrome plating small appliance parts.
25 b. D.contact allergicaAda sensitisasi sebelum timbul alergi, agen sensitisasi bereaksi dengan protein dalam epidermis membentuk kompleks hapten – protein pembentukan antibodyReaksi hypersensitivas tipe lambat, timbul setelah 48 – 72 jamZat yang biasanya sebagai primary irritant juga dapat sebagai allergenBentuk akut seperti spt D. contact irritant akutBentuk kronis timbul likenifikasi , fisura
26 Contoh kasus D. Contac allergica Dental Assistant (allergy to glutaraldehyde and neomycin)
27 Contoh kasus D. contact allergica Optician - non-dominant hand dermatitis (allergy to ethyl acrylate)
28 Other Resin SystemThis severe allergic contact dermatitis was due to a phenol-formaldehyde resin. These resins are used as bonding agents for foundry sand, electrical devices and in molded and cast plastic articles. They may also produce irritant reactions.
29 Chemical Accelerators in Rubber Allergic contact dermatitis due to rubber chmicals is fairly common in industry. Chemial accelerators that speed up the vulcanization raction and antixidants are the more frequent allergens. They present a potential hazard in finishing goods as well.
30 Gejala Dermatosis yang lain Acne akibat kerja hanya menyerang tubuh yang kontak dengan agenLesi mikrotraumatik disebabkan oleh serat mineral, ditandai dengan papula kecil keputihan atau kemerahan pd area yg terpaparKanker kulit ( karsinoma squamosa hyperkeratosis, papilomatosisDermatosis yg menular zoonotik, dermatofitosis, kandidiasis, tuberkulosis verukosa
31 Occupational Acne. Acute, Oil Folliculitis Occupational acne is most commonly seen in workers exposed to insoluble cutting oils in the machine tool trades or in mechanics exposed to grease and lubricating oils. This worker developed folliculitis, sometimes called oil boils or acne, with multiple comedones and pustules on his arms and other covered areas of his body as a result of prolonged contact with oil. The lesions almost never develop from bacteria present in the oils
32 Oil Folliculitis Chronic, Chloracne Chlordane is an extremely refractory type of acne caused by certain halogenated aromatic chemicals and can be certain halogogenated aromatic chemicals and can be accompaned by systemic toxicity. It represents one of the most sensitive indicators of biologic response to these chemicals. Chloracne in this herbicide production worker involved almost every follicular orifice on his face and neck with comedones, papules and cystlike lesions.
33 DepigmentationThe hands of this hospital maintenance worker are depigmented form contact with a phenolic germicidal detergent. Irritation or sensitization to the chemical is not a prerequisite for the pigment loss to occur. This loss of pigment may be permanent.
34 GranulomaGranulomas represent a focal, chronic inflammatory reaction. These granulomas were produced by beryllium and are considered to be on a allergic basis. Non-allergic granulomas are more common and represent the skin's response to inoculated or implanted foreign materials such as wooden splinters, plant spines and silica.
35 EccrineMiliaria represents blockage of the eccrine sweat ducts and may occur in workers who perspire excessively. In this case of miliaria rubra of prickly heat, the blockage site is the granular cell layer of the epidermis. When more than 30% of the skin surface is affected, an individual may develop thermoregulatory disorders such as heat exhaustion.
36 TumorsSkin tumors, such as this ulcerating squamous cell carcinoma most frequently arise after years of occupational exposure. Malignant tumors may represent to occupational carcinogens such as coal tar and physical agents such as sunlight. Skin cancer is the commonest form of cancer. The role played by occupational factors is frequently difficult to determine.
37 Diagnose Dermatosis akibat kerja Gambaran klinis, lokalisasi dan perjalanan penyakit harus sepenuhnya sesuai dengan ciri PAK yg pastiPaparan kerja terhadap agen berbahaya perlu dipastikanAda hubungan waktu paparan dan timbulnya penyakitDermatosis contact allergica uji tempel
38 Uji tempelMenempelkan alergen yang dicurigai dengan kadar yang non iritatif pada kulit yang tidak terpapar selama 24 – 48 jamPositif bila timbul dermatosis ekzematous dibawah tempelan yang penutup
39 KerentananOrang dengan atopi ( eksema, penyakit kulit alergi dan alergi lainnya)Penyakit kulit kronik termasuk hiperhidrosisSeborea atau iktiosisPimentasi abnormalLesi kulit prekanker
40 Penanganan kasus Dipindahkan ke area bebas alergen Kasus D. iritatant, pekerja dipindahkan sementara dan agen penyebab dikendalikanPemindahan kerja sec. Permanen dilakukan bila pemindahan sementara tidak menghasilkan penyembuhan yg sempurnaKondisi prekanker mk. Pekerja harus dijauhkan dari paparan
41 Upaya pencegahanAllergen kuat, sensitizer, karcinogen diganti dengan zat yang kurang berbahayaPengendalian secara tehnik ( isolasi tempat kerja)Eliminasi kontak dengan kulitPakaian pelindung ( apron,sarung tangan, sepatu boot, penutup wajah)
42 Upaya pencegahanFasilitas dasar untuk kebersihan diri (pancuran air untuk mandi bukan bak mandi)Kebersihan lingkungan dan house keeping- pembuangan air bekas dan sampah industri- pembersihan debu- cara penimbunan dan penyimpanan barang Penggunaan SPF 15 untuk melindungi Sinar .matahari
43 Upaya pencegahanDiagnose dini Penyakit Dermatosis Akibat kerja melalui :Pemeriksaan awal sebelum penempatan- riwayat medis- fisik dengan perhatian khusus pada kulitPemeriksaan berkala :- sama spt pem.awal- uji tempel tdk dianjurkan bagi yg tdk menunjukan gx- waktu antara 6 bln – 2 tahun tgt tingkat paparanditempat kerja
44 PrognosisD. iritant , acne, infeksi menyembuh sth agen penyebab dijauhkanD. alergi tgt sifat alergennya dan bila hanya ditempat kerja dan telah di hilangkan alergennya sembuh sempurna allergi + infeksi sekunder sembuhnya lama
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