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DERMATOSIS AKIBAT KERJA. Changes in Incidence (1993 - 1999) From 1993 to 1999 there have been further changes in the number of cases, incidence.

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Presentasi berjudul: "DERMATOSIS AKIBAT KERJA. Changes in Incidence (1993 - 1999) From 1993 to 1999 there have been further changes in the number of cases, incidence."— Transcript presentasi:

1 DERMATOSIS AKIBAT KERJA

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5 Changes in Incidence ( ) 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. 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.

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7 Work time lost

8 Cost

9 Sifat agen penyebab dermatosis : Agen fisik : tekanan, gesekan, cuaca dingin, panas, radiasi ultraviolet, serat mineral. Agen fisik : tekanan, gesekan, cuaca dingin, panas, radiasi ultraviolet, serat mineral. Agen Biologis : beberapa mikroba, fungi, parasit kulit dan produk2 nya Agen Biologis : beberapa mikroba, fungi, parasit kulit dan produk2 nya Agen kimia, dibagi dalam 4 kelompok : Agen kimia, dibagi dalam 4 kelompok : - iritan primer - iritan primer - sensitizer - sensitizer - acnegenic - acnegenic - photosensitizer - photosensitizer

10 Iritan primer Asam, basa, pelarut lemak Asam, basa, pelarut lemak Detergen Detergen Garam garam logam Garam garam logam - garam arsen - garam arsen - garam mercuri - garam mercuri - dll - dll

11 Sensitizer Logam dan garam2nya (kromium, nikel, kobalt) Logam dan garam2nya (kromium, nikel, kobalt) Senyawa yang berasal dari anilin Senyawa yang berasal dari anilin ( p fenilendiamin, azo dyes ) ( p fenilendiamin, azo dyes ) Derivat nitro aromatik ( trinitrotoluene ) Derivat nitro aromatik ( trinitrotoluene ) Resin (epoksiresin, formaldehid, vinil, akrilik ) Resin (epoksiresin, formaldehid, vinil, akrilik ) Bahan kimia karet ( vulcanizer)  dimetil tiuran disulfida Bahan kimia karet ( vulcanizer)  dimetil tiuran disulfida Obat-2an (procain, fenotiazin, klorotiazid, penisilin,tetrasiklin Obat-2an (procain, fenotiazin, klorotiazid, penisilin,tetrasiklin Kosmetik, terpentin, tanam2an Kosmetik, terpentin, tanam2an

12 Agen acnegenic Naftalen Naftalen Bifenil khlor Bifenil khlor Minyak mineral Minyak mineral

13 Agen photosensitizer Antrasen Antrasen Pitch Pitch Derivat asam aminobenzoat Derivat asam aminobenzoat Hidrokarbon aromatik klor Hidrokarbon aromatik klor Pewarna akridin Pewarna akridin

14 Photosensitivity Many 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. Many 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. 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 kulit Agen fisik  trauma mekanik langsung ke kulit Agen kimia Agen kimia  Iritan primer : merusak kulit dengan cara mengubah PH, denaturasi protein, mengekraksi lemak, menurunkan daya tahan  Sensitizer/allergi  reaksi hipersinsitivitas tipe lambat  Acnegenic  menyumbat kelenjar dan sal, sebacea  peradangan lokal  Photosensitizer  meningkatkan sensitivitas kulit terhadap radiasi ultraviolet

17 Gejala dan tanda a. D. contact irritant 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 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. 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. 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. 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.

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22 Chrome hole, fingers 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. 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.

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, nasal When 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. When 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 allergica Ada sensitisasi sebelum timbul alergi, agen sensitisasi bereaksi dengan protein dalam epidermis membentuk kompleks hapten – protein  pembentukan antibody Ada sensitisasi sebelum timbul alergi, agen sensitisasi bereaksi dengan protein dalam epidermis membentuk kompleks hapten – protein  pembentukan antibody Reaksi hypersensitivas tipe lambat, timbul setelah 48 – 72 jam Reaksi hypersensitivas tipe lambat, timbul setelah 48 – 72 jam Zat yang biasanya sebagai primary irritant juga dapat sebagai allergen Zat yang biasanya sebagai primary irritant juga dapat sebagai allergen Bentuk akut seperti  spt D. contact irritant akut Bentuk akut seperti  spt D. contact irritant akut Bentuk kronis  timbul likenifikasi, fisura Bentuk kronis  timbul likenifikasi, fisura

26 Contoh kasus D. Contac allergica Dental Assistant (allergy to glutaraldehyde and neomycin) Dental Assistant (allergy to glutaraldehyde and neomycin)

27 Contoh kasus D. contact allergica Optician - non-dominant hand dermatitis (allergy to ethyl acrylate) Optician - non-dominant hand dermatitis (allergy to ethyl acrylate)

28 Other Resin System This 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. This 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. 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 agen Acne akibat kerja  hanya menyerang tubuh yang kontak dengan agen Lesi mikrotraumatik  disebabkan oleh serat mineral, ditandai dengan papula kecil keputihan atau kemerahan pd area yg terpapar Lesi mikrotraumatik  disebabkan oleh serat mineral, ditandai dengan papula kecil keputihan atau kemerahan pd area yg terpapar Kanker kulit ( karsinoma squamosa  hyperkeratosis, papilomatosis Kanker kulit ( karsinoma squamosa  hyperkeratosis, papilomatosis Dermatosis yg menular  zoonotik, dermatofitosis, kandidiasis, tuberkulosis verukosa Dermatosis 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 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. 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 Depigmentation The 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. The 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 Granuloma Granulomas 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. Granulomas 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 Eccrine Miliaria 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. Miliaria 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 Tumors Skin 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. Skin 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 pasti Gambaran klinis, lokalisasi dan perjalanan penyakit harus sepenuhnya sesuai dengan ciri PAK yg pasti Paparan kerja terhadap agen berbahaya perlu dipastikan Paparan kerja terhadap agen berbahaya perlu dipastikan Ada hubungan waktu paparan dan timbulnya penyakit Ada hubungan waktu paparan dan timbulnya penyakit Dermatosis contact allergica  uji tempel Dermatosis contact allergica  uji tempel

38 Uji tempel Menempelkan alergen yang dicurigai dengan kadar yang non iritatif pada kulit yang tidak terpapar selama 24 – 48 jam Menempelkan alergen yang dicurigai dengan kadar yang non iritatif pada kulit yang tidak terpapar selama 24 – 48 jam Positif bila timbul dermatosis ekzematous dibawah tempelan yang penutup Positif bila timbul dermatosis ekzematous dibawah tempelan yang penutup

39 Kerentanan Orang dengan atopi ( eksema, penyakit kulit alergi dan alergi lainnya) Orang dengan atopi ( eksema, penyakit kulit alergi dan alergi lainnya) Penyakit kulit kronik termasuk hiperhidrosis Penyakit kulit kronik termasuk hiperhidrosis Seborea atau iktiosis Seborea atau iktiosis Pimentasi abnormal Pimentasi abnormal Lesi kulit prekanker Lesi kulit prekanker

40 Penanganan kasus Dipindahkan ke area bebas alergen Dipindahkan ke area bebas alergen Kasus D. iritatant, pekerja dipindahkan sementara dan agen penyebab dikendalikan Kasus D. iritatant, pekerja dipindahkan sementara dan agen penyebab dikendalikan Pemindahan kerja sec. Permanen dilakukan bila pemindahan sementara tidak menghasilkan penyembuhan yg sempurna Pemindahan kerja sec. Permanen dilakukan bila pemindahan sementara tidak menghasilkan penyembuhan yg sempurna Kondisi prekanker mk. Pekerja harus dijauhkan dari paparan Kondisi prekanker mk. Pekerja harus dijauhkan dari paparan

41 Upaya pencegahan Allergen kuat, sensitizer, karcinogen diganti dengan zat yang kurang berbahaya Allergen kuat, sensitizer, karcinogen diganti dengan zat yang kurang berbahaya Pengendalian secara tehnik ( isolasi tempat kerja) Pengendalian secara tehnik ( isolasi tempat kerja) Eliminasi kontak dengan kulit Eliminasi kontak dengan kulit Pakaian pelindung ( apron,sarung tangan, sepatu boot, penutup wajah) Pakaian pelindung ( apron,sarung tangan, sepatu boot, penutup wajah)

42 Upaya pencegahan Fasilitas dasar untuk kebersihan diri (pancuran air untuk mandi bukan bak mandi) Fasilitas dasar untuk kebersihan diri (pancuran air untuk mandi bukan bak mandi) Kebersihan lingkungan dan house keeping Kebersihan lingkungan dan house keeping - pembuangan air bekas dan sampah industri - pembuangan air bekas dan sampah industri - pembersihan debu - pembersihan debu - cara penimbunan dan penyimpanan barang - cara penimbunan dan penyimpanan barang  Penggunaan SPF 15 untuk melindungi Sinar.matahari

43 Upaya pencegahan Diagnose dini Penyakit Dermatosis Akibat kerja melalui : Diagnose dini Penyakit Dermatosis Akibat kerja melalui : Pemeriksaan awal sebelum penempatan Pemeriksaan awal sebelum penempatan - riwayat medis - riwayat medis - fisik dengan perhatian khusus pada kulit - fisik dengan perhatian khusus pada kulit Pemeriksaan berkala : Pemeriksaan berkala : - sama spt pem.awal - sama spt pem.awal - uji tempel tdk dianjurkan bagi yg tdk menunjukan gx - uji tempel tdk dianjurkan bagi yg tdk menunjukan gx - waktu antara 6 bln – 2 tahun tgt tingkat paparan - waktu antara 6 bln – 2 tahun tgt tingkat paparan ditempat kerja ditempat kerja

44 Prognosis D. iritant, acne, infeksi  menyembuh sth agen penyebab dijauhkan D. iritant, acne, infeksi  menyembuh sth agen penyebab dijauhkan D. alergi  tgt sifat alergennya dan bila hanya ditempat kerja dan telah di hilangkan alergennya  sembuh sempurna D. alergi  tgt sifat alergennya dan bila hanya ditempat kerja dan telah di hilangkan alergennya  sembuh sempurna  allergi + infeksi sekunder  sembuhnya lama  allergi + infeksi sekunder  sembuhnya lama

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