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To view the reconstructed contents, please SCROLL DOWN to next page. Dr Vivek.N.Dabade Medical Officer, OHC Vashi Complex Occupational Skin Disorders (OSDs) also termed Occupational Dermatoses or Occupational Skin Diseases are those in which work place exposure to some physical, chemical, mechanical or biologic hazard has been a causal or a major and necessary contributing factor in the development of the disease.
A persons existing skin disorder may also be made much worse by work activities and such cases are also considered as Occupational Skin Diseases.
Occupational skin disorders are important causes of morbidity and disability in the workplace.
The skin is the body’s largest organ, accounting for more than 10 percent of body mass. For the average adult human, the skin has a surface area of between 1.5-2.0 square metres (16.1-21.5 sq ft.). Because large surface areas of the skin are often directly exposed to the environment, this organ is particularly vulnerable to occupational and environmental diseases and Injuries. OSD s are under reported, under diagnosed and contribute to the loss of productivity, loss of time off work, change of jobs because of skin problems or no working at all, increased financial costs to the system. OSD is MORE than just a rash, sometimes the skin disease is so bad that an employee cannot work or carry out their usual activities.
there is no scientific method to measure the consequences and level of the body's exposures to risks via dermal contact, no dermal exposure standards are set.
Animal models have been developed to measure the irritant potential of chemical substances, but most existing data pertain only to single applications at full strength.
This increases the importance of recognising risk factors for OSDs and developing methods of assessing ,control and prevention of OSDs.
Diagnosis requires a high index of suspicion and knowledge of the worker's environment. Every case of dermatitis occuring to a worker in an industrial set up may not necessarily be a case of occupational dermatitis. Early recognition and diagnosis of OSD leads to better outcomes. Occupational skin disorders are preventable. Paracelsus (1498–1541), in his Morbis Metallicus, was the first to write about OSD, including changes in the skin caused by salt compounds. Agricola described in his book (in 1556 ) "De re metallica" about deep skin ulcers in metal workers at the same time. Ramazzini (1700), the father of modern occupational medicine, made observations about OSD in his classical work De Morbis Artificium Diatriba. Sir Percival Pott (1775) described carcinoma of the scrotum among chimney sweeps. Earlier texts include Prosser White's The Dermatergoses or Occupational Afflictions of the Skin (1915), and Schwartz, Tulipan, and Birmingham's Occupational Diseases of the Skin
Workplace exposure to different kinds of hazards may be responsible for development of OSDs . Mechanical . Physical . Biological . Chemical
Contact Dermatitis: Irritant or Allergic Contact Urticaria Photosensivity Dermatitis Folliculitis and acneform dermatoses Sweat-induced reactions Pigment change Occupational Skin Diseases Caused by UV Radiation Neoplastic lesions Ulcerative changes Granulomas OSD caused by biological agents OSD caused by various physical agents like heat, cold, humidity, barometric pressure, radiation etc
Chemicals: Organic and inorganic chemicals are the major source of hazards to the skin by acting as primary skin irritants and allergic sensitizers.
60 to 75% of all OSDs is "CONTACT DERMATITIS"
Chemicals cause Irritant contact dermatitis (ICD)and allergic contact dermatitis.(ACD)
75% of the occupational dermatitis cases are by primary irritant chemicals and 25 % is allergic
Irritants can be : rapidly destructive (strong or absolute) as would occur with concentrated acids, alkalis, metallic salts, certain solvents and some gases. Through a cumulative effect repeated contact with both weak and moderate irritants can cause a sub-acute/chronic form of contact Dermatitis.
Common irritants include: wet work, soaps and detergents, solvents, food ingredients and metalworking fluids. Common occupational allergens include: nickel, chromium, epoxy, acrylates, formaldehyde resins, rubber additives, paraphenylenediamine and preservatives Related to the Related to the person Related to the substance environment
.Temperature .Properties of the .Region of the .Humidity,moisture, chemical skin(e.g.,hands,arms,fa .Barometric pressure, .Solubility ce .Friction, .Form:solid,liquid, .Health of the .Contaminated gas skin(e.g.,cuts,abrasions clothing/environment .Concentration ,rashes,preexisting .Occlusive .Length and atopicdermatitis,acne clothing/gloves frequency of etc exposure .Dryness .Sweating .Age .Genetic backgroung Features Irritant contact dermatitis Allergic contact dermatitis
Mechanism of Direct cytotoxic effect Delayed type cellular immunity/ production Sensitization Concentration of the High:immediate chemical burns/ Low contactant Weak irritants act by a cumulative effect Potential victims Everyone exposed A minority of exposed individuals Onset Progressive ,after repeated or Rapid,within 12-48 hrs in prolonged exposure sensitized individuals Signs/symptoms Subacute to chronic eczema Acute to subacute eczema with (warmth,vesiculation,ooze,swelling erythema,edema,bullae,and )Dryness,cracking, scaling vesicles with pruritus pain and burning sensation, Chronica nail dystrophy. Sites Hands,forearms,inner wrist Hands/foreams,but can occur at Dusts/vapours:forehead/eyelids remote sites as well, Rarely spreads to surfaces that do Widespread:contaminated not have obvious contact clothing/enviro Investigations History and examination:No History and specific tests but a temporal examination:Patch tests association with cutaneous toxicity And manner of exposure. Irritant contact dermatitis A patch test is a method used to determine if a specific substance causes allergic inflammation of the skin.
Any individual with eczema suspected of having allergic contact dermatitis and/or atopic dermatitis needs patch testing and even to exclude an allergic component in case of irritant contact dermatitis. Patch testing is intended to produce a local allergic reaction on a small area of skin where the diluted chemicals are planted. The chemicals included in the patch test kit are the offenders in approximately 85-90 percent of contact allergic eczema and include chemicals present in metals (e.g. nickel), rubber, leather, hair dyes, formaldehyde, lanolin, fragrance, preservative and other additives The allergens are mixed with a non-allergic material (base) to a suitable concentration. They are then placed in direct contact with the skin, usually on the upper back, within small aluminium discs. Adhesive tape is used to fix them in place, and the test sites aremarked. The patches are left in place for 48 hours, during which time it is important not to wash the area or play vigorous sport because if the adhesive tapes peel off the process will have to be repeated. The patches should not be exposed to sunlight or other sources of ultraviolet (UV) light. After 48 hours the patches are removed and an initial reading is taken one hour later. The final reading is taken a further 48 hours later. Additional readings beyond 48 hours increase the chance of a positive test patch by 34 per cent. The patient should refrain from washing until the last reading is taken. Notatio Description Interpretation n no skin changes in the negative _ tested area
faint, non-palpable doubtful reaction ? erythema
palpable erythema - weak reaction + moderate edema or infiltrate, papules not present or scarce, vesicles not present strong infiltrate, numerous strong reaction ++ papules, vesicles present
coalescing vesicles, bullae extreme reaction +++ or ulceration Industry Irritants Allergens Agriculture Animal feeds, Plants, gloves, animal and fertilisers, solvents, feeds, pesticides, Horticulture plants, oils, disinfectants disinfectants, pesticides Chemical and Chemicals, acids, Chemicals, Pharmaceutic alkalis, water, medicaments, latex al detergents gloves and rubber masks Construction Cement, Cement, rubber or and Building preservatives, leather gloves and fiberglass, solvents, boots, oils epoxy resins, woods, paints Electronics Solvents, acids, Resins (epoxy, alkalis, resins, acrylates, isocyanates, fibreglass formaldehyde), soldering fluxes, nickel, chromate, cobalt, gloves and finger cots Industry Irritants Allergens
Food and Vegetable and food Food, gloves, Catering juices, water and antioxidants, detergents preservatives
Hairdressing Shampoos, Nickel, hair dyes, permanent wave fragrances, latex or solutions, water rubber gloves Healthcare Alcohol, disinfectants, Latex gloves, rubber antiseptics, chlorine, masks, formaldehyde, aldehydes(Glutaraldehyde preservatives, resins ), hydrogenium peroxide and alcohols. Metal Cutting fluids, oils, Cutting fluids and oils Fabrication coolants Industry Irritants Allergens
Shipbuilding and Cutting fluids, oils, Cutting fluids and Repair coolants oils, welding fumes, resins
Woodworking Wood dust, Woods, rubbers or and resins, soaps and latex gloves, resins, Furnituremaking detergents, solvents, wood oils, turpentine preservatives Contact urticarias may be caused by non immunological or immunological mechanisms. Non-immunological contact urticaria occurs : . without prior exposure of a patient's immune system to an allergen. . typically causes mild localised reactions that clear within hours, e.g. stinging nettle rash. Ingredients of cosmetics and medicaments Balsam of Peru, Benzoic acid, Cinnamic alcohol, Sorbic acid, Raw meat, fish, and vegetables
Immunological contact urticaria occurs : . most commonly in atopic individuals . . Prior exposure to an allergen/sensitization is required for this type of contact urticaria to occur.
Natural rubber latex (e.g. surgical gloves), Many antibiotics , Some metal, eg. nickel,, Benzoic and salicylic acids, Polyethylene glycol,, Raw meat, fish, and vegetables . ,
Symptoms:Local burning sensation, tingling or itching Signs: Localised or generalised red swellings or weals may occur, especially on the hands. Severity of redness and swelling can range from slight redness or spots with minimal swelling to fiery redness with tense swelling and weals. Rash usually resolves by itself within 24 hours of onset. Signs and symptoms may occur in other organs other than the skin. These are known as extracutaneous reactions and are more likely to occur in patients with immunological contact urticaria. Features of extracutaneous reactions include: Wheezing (bronchial asthma) Runny nose, watery eyes Lip swelling, hoarse throat, difficulty swallowing Nausea, vomiting, diarrhoea, cramps Severe anaphylactic(this can be life-threatening)
Occupational group Substances causing contact urticaria
Agricultural and dairy workers Cow dander, grains and feeds
Bakers Ammonia persulfate, flour, alpha- amylase
Dental workers Latex, acrylate and epoxy resins, toothpaste
Electronic workers Acrylate and epoxy resins
Food workers Foodstuffs, e.g. cheese, egg, milk, fish, shellfish, fruit, flour, wheat
Hair dressers Ammonia persulfate, latex
Medical/veterinary workers Latex Sometimes it is easy to recognise contact urticaria and no specific tests are necessary. In most cases the rash rapidly clears up completely once the offending substance is no longer in contact with the skin. RAST tests (a blood test) where available, can be used to confirm allergy. Skin prick test and scratch patch tests confirm the diagnosis of contact urticaria but do not differentiate between allergic and non allergic mechanisms.
Patient should have an understanding of the nature of their urticarial reaction (non-immunological vs immunological). Patients with immunological contact urticaria should wear medical alert tags and be aware of the potential life- threatening reactions of the condition.
The main aim of treatment is to avoid the substances that cause the urticarial reaction, and find suitable alternatives. Gloves may be used to protect hands from contact with materials of concern, but avoid rubber gloves if allergic to latex. Medications that may be used to minimise the reaction include antihistamines and adrenaline for more severe reactions.
Contact urticaria Photosensitivity dermatitis is the name given to an eczematous eruption arising in response to exposure to electromagnetic radiation. It is most provoked by exposure to sunlight/artificial light sources alone or in combination with various chemicals, plants or drugs can induce a phototoxic or photoallergic response. reaction may relate to UVB, UVA and/or visible light. It arises in all skin types.
Photosensitivity dermatitis has several causes. Contact photoirritant or photoallergic dermatitis Photosensitivity eruptions due to drugs Photoaggravated atopic dermatitis Idiopathic chronic photosensitivity dermatitis Photosensitivity dermatitis can be phototoxic or photoallergic Phototoxic reaction is generally limited to light-exposed areas photoallergic reaction can develop frequently on non-exposed bod y surfaces. Photosensitivity eruptions affect the exposed areas. Most often, these are the following sites. Face: sparing behind ears, under nose, eyelids, hairline (make-up may be protective) Neck: sparing the anterior portion under the chin and including a V on the anterior chest Dorsum of hands: sparing finger webs Forearms: sharp cut-off at cuff level Feet: dorsum of feet, sparing strap marks from sandals
Drugs can cause photosensitivity by toxic and allergic mechanisms. A toxic, or sunburn-like reaction is most likely with: Tetracyclines Nonsteroidal anti-inflammatory drugs Retinoids Methoxsalen (used for photochemotherapy) Chlorpromazine The most common drugs implicated in the development of an allergic reaction are: Hydrochlorthiazide Sulphonylureas Quinine
Investigations : Patch testing should be carried out in chronic photosensitivity reactions. It is negative in most patients with atopic dermatitis but there are often contact allergies in those with idiopathic chronic photosensitivity dermatitis Photopatch tests are similar to patch tests. Two sets of perfumes, antiseptics, plant materials and sunscreens may be applied. After removal, one set is exposed to a small dose of ultraviolet radiation (UVA) (5 J/cm2). Interpretation of results : Contact allergy: Reaction to allergen exposed to light equal to unexposed site Contact photoaggravation: Reaction to allergen exposed to light greater to unexposed site Contact photoallergy: Reaction to allergen exposed to light but no reaction to unexposed allergen Skin biopsies and laboratory investigations, such as antinuclear antibody (ANA) panels and porphyrin profiles
DD of Photosensitivity dermatitis Polymorphic light eruption (PMLE Actinic prurigo: Chelitis is characteristic. Solar urticaria: rare acquired wealing reaction to exposure to ultraviolet radiation. Porphyrias: inherited or acquired photosensitivity due to accumulated photosensitising porphyrins in skin and blood (porphyria cutanea tarda and erythropoeitic protoporphyria are the most common types).
Photo toxic Dermatitis pellagra cutaneous Polymorphic light eruption lupus (PMLE): grouped papules erythematosus, arising within hours of sun exposure and disappearing within days
Cutaneous porphyria Folliculitis and acneform dermatoses, including Chloracne Follicular and acneform lesions are caused by overexposure to insoluble cutting fluids,/oils ,greases as in machining operations/automotive repair work.
Lesions generally occur on the dorsal forearms and hands, less often on the thighs and buttocks, but they can occur anywhere except on the palms and soles.But may be severe if clothing becomes saturated.
Chloracne may be caused by exposure to chlorinated or halogenated naphthalenes,diphenyls,dioxins,azoxybenzenes. Chloroacne is characerised by closed comedonal lesions(NON INFLAMMATORY)some inflammatory lesions may be present) and usually involves cheeks,temples,ears and post auricular areas of the face.
Acquired lesions are relatively resisant to treatment,but new lesions cease to form wihin 6 to 12 months of exposure.
Chloracne is a sensitive measure of exposure and is present in 95% of cases wih systemic symptoms(liver,neurologic changes)
Folliculitis and acneform dermatitis Sweat-induced reactions: Many types of work involve exposure to heat and where there is too much heat and sweating, followed by too little evaporation of the sweat from the skin. Sweat –induced reactions include miliaria, chafing of the affected area by skin rubbing against skin, secondary bacterial or fungal infection may frequently occur. Sites involved:underarm area, under the breast, in the groin and between the buttocks. Increased pigmentation induced by photosensitizers like tar, pitch or furocoumarins generally results from melanin stimulation and overproduction,post inflammatory Hypopigmentation or depigmentation at selected sites can be caused by a previous burn, contact dermatitis, contact with certain phenolic/catecholic compounds like p-tertiary butylphenol,p-tertiary butyl catechol, hydroquinone compounds or other antioxidant agents used in selected adhesives and sanitizing products. Occupationally induced changes in skin colour slate grey or melanotic discolouration: heavy metals like silver,arsenic mercury, Direct chemical staining due to nitrite compounds like nitric acid,dinitrophenol,trinitrotoluene,due to nitration of certain aromatic amino acids incorporated in cutaneuos proteins. Explosive/abrasive forces:adventitial tattooing due to embedding of pigmented foreign material e.g. coal miners tattoo.A blue gray discolourationfrom inoculation of coal dust. Toxic vitiligo
Hyperpigmentation Skin manifestations in outdoor workers after acute intense or long-term exposure to solar UVR, but may also develop in indoor workers exposed to artificial sources, welders working with electric arc welding.
Skin manifestations include e.g., pigmentations, telangiectasias or other stigmata, which do not affect working capacity. Acute exposure to sunlight causes sunburn, immediate and delayed tanning, immune alteration, and participates in phototoxic and photoallergic reactions, whereas chronic exposure causes actinic keratoses, actinic cheilitis, solar urticaria or polymorphous light eruptions,DNA damage, immunosuppression, premature aging of the skin, and malignant tumors of the skin such as basal cell cancer, squamous cell cancer and malignant melanoma. Characteristic lesions occur in sun exposed areas: face,neck, decolletage, and extensor surface of the forearms,and hands. Neoplastic lesions of occupational origin may be malignant or benign Benign lesions: Traumatic cysts, fibromata, petroleum and tar warts and keratoacanthoma, are typical benign new growths. Keratoacanthomas can be associated with excessive exposure to sunlight and also have been ascribed to contact with petroleum, pitch and tar.
Malignant tumors of the skin such as basal cell cancer, squamous cell cancer and malignant melanoma'
The role of Aromatic hydrocarbons such as coal tar,pitch,creosote,mineral oils in the induction of cutaneous papillomas,keratoses and malignant conditions is well recognised.
Ionizing radiation and UV radiation may induce a radiodermatitis and neoplastic transformation,
Cutaneous Lymphoma ,mycosis fungoides has been epidemilogically linked to manufacturing industries,evidence suggesting that it may evolve from chronic bouts of allergic dermatitis with subsequent maignant T-Cell transformation,
Biological:Bacteria,viruses,fungi or parasites may cause primary or secondary infections of the skin,bacterial infections are more common in certain jobs, such as animal breeders and handlers, farmers, grain handlers and harvesters, fishermen, food processors, bakers, bartenders, cooks, dishwashers and hide handlers Orf, milkers nodules, viral warts, Erysipeloid ,folliculitis caused by pseudomonas aeroginosa, swiming pool granuloma,Herpetic Whitlow in nurses and dental professionals.
Benzene:respiratory tract irritation,central nervous system depression arrhythmias ,bone marrow depression leukemia.
Aniline dyes:Functional anemia due to methaemoglobinemia, bladder carcinogen.
Benzidine:hematuria (blood in the urine); secondary anemia from hemolysis; acute cystitis; acute liver disorders; dermatitis; painful, irreg urination; [potential occupational carcinogen], liver, kidney & bladder cancer
Patch tests O P compounds: Decreased plasma or red blood cell (RBC) cholinesterase activity, Acute exposure:CNS,RS,CVS,Musculoskeletal, Chronic:reproductive effects in fertility, organophosphate-induced delayed polyneuropathy (OPIDP), and chronic organophosphate- induced neuropsychiatric disorder (COPIND) Phenol: corrosivesubstance,CNS,RS,CVS, Gastrointestinal,metabolic acidosis, Renal failure has been reported in acute poisoning, Hematologic : hemolysis, methemoglobinemia, bone marrow suppression, and anemia, kidney inflammation, Liver damage , coronary artery disease. Radioactive skin contamination with Iodine,Caesium,Tritium has a potential for percutaneous absorption.
Chromic acid, concentrated potassium dichromate, arsenic trioxide, calcium oxide, calcium nitrate and calcium carbide are documented ulcerogenic chemicals. The fingers, hands, folds and palmar creases are the favorite attack sites. Several of these agents also cause perforation of the nasal septum. Granulomas can be caused by occupational exposures to bacteria,fungi, viruses or parasites. Inanimate substances, such as bone fragments, wood splinters, cinders, coral and gravel.
Minerals such as beryllium, zirconium, can also cause allergic granulomatous reactions after skin embedment.
Chemically induced granulomas ae seen from talc,silica, and do not induce hyprsensitivity. Mechanical: such as Friction, pressure, trauma, vibration can result in callus, blisters, myositis, tenosynovitis,osseous injury, nerve damage, laceration, shearing , abrasions. Injuries may additionally pave the way for secondary bacterial /fungal infections. Users of pneumatic tools are at greater risk of suffering neurovascular, soft tissue, fibrous or bone injury to the hands and forearms. because of the repetitive trauma from the tool. Heat,cold,humidity,electricity,sunlight,artificial sunlight,laser,radiation. High temperature and humidity may induce miliaria, intertrigo, skin maceration, thermal burns and supervening secondary bacterial and fungal infections. Low humidity,warm dry air may cause generalised pruritus,dryness, irritated sinuses and throat, and itchy eyes. Prolonged exposure to cold water/extreme cold can cause mild to severe injury ranging from erythema, blistering, ulcerations and gangrene.(ie chill blains,frost nip to frost bite) Vasospastic disease may result from exposure to vibrating pneumatic tools lke drills,chain saw etc
Hair loss can be caused by burns, mechanical trauma or chemical exposures to Thallium containing rodenticides,boric acid,arsenic may cause a diffuse toxic alopecia. Absorption of Pesticides into the nail folds may result nail plate deformity and altered growth. Acroosteolysis , a type of bony disturbance of the digits, plus vascular changes of the hands and forearm (with or without Raynaud's syndrome) has been reported among polyvinylchloride polymerization tank cleaners. Occupational scleroderma like disorders have occured following exposure to epoxy resins hardener and perchloroeyhlene.
Occupational History Clinical examination Diagnostic tests:
Occupational History: The title of the job, the nature of the work, the materials handled, how long the job has been done, Ask for the worker’s past work history and any relevant information for previous jobs held when and where on the skin the rash appeared: the onset and duration of symptoms (temporal relationship between exposure and onset of symptoms); the behaviour of the rash away from work, work-relatedness (e.g., the rash is likely to worsen during work and improve when worker is off work or on leave); Whether other employees were affected, work organisation (e.g., work hours, breaks, overtime). what was used to cleanse and protect the skin, use of personal protective equipment (e.g., gloves, respirators); presence of engineering control (e.g., process enclosure, local exhaust ventilation, general ventilation) what has been used for treatment (both self medication and prescribed medication) h/o dry skin or chronic hand eczema or psoriasis or other skin problems. past and present health and work status of the employee. Habits:smoking,alcohol,tobacco etc Dietary history and nutritional status Use of cosmetics,fragrances,topical antibiotics Family history, particularly of allergies, personal illness in childhood and the past,f/h/o malignancies Exclude non-occupational causes, pre-existing and predisposing factors. Hobbies,other secondary jobs MSDS will provide additional information on the type and toxicity of materials and chemicals handled at work.
Test Examples of Examples of suspected conditions Occupational groups
diagnostic patch tests occupational as well as non-occupational allergies
Prick testing Contact urticaria Protein contact dermatitis
Blood testing Atopic eczema Food handlers, wet IgE ’ Contact urticaria workers RAST Protein contact dermatitis Veterinarians analytical chemical Arsenic,lead,aniline examination of blood, dyes, urine, or tissue (skin, hair, nails).
Skin biopsy Chloracne Chemical workers Skin cancer Mineral oil workers Other non-eczematous dermatoses An occupationally induced acute contact eczematous dermatitis tends to improve upon cessation of contact. Chronic eczematous dermatoses, acneform lesions and pigmentary changes are less responsive to treatment even when contact is eliminated. Ulcerations usually improve with elimination of the source. With granulomatous and tumour lesions, eliminating contact with the offending agent may prevent future lesions but will not dramatically change already existing disease. Dermatoses caused by metals such as nickel or chrome have a notoriously prolonged course partly because of their ubiquitous nature. Elimination: Substitution: Engineering controls: Administrative controls: Personal protective equipment Medical measures Notification: Prevention Planning Prevention and control methods Effective planning requires preliminary assessment of the following basic elements: Targeting working populations at greatest risk such as manufacturing workers agricultural workers, Cooks and food service workers, laborers, machine operators and outdoor workers . available prevention control methodologies, health care delivery practices, resources of professional health and safety manpower, economic and material resources. Engineering controls Administrative controls: Hygiene controls Personal protective equipment: Medical control measures Reporting and Notification Process engineering: involves isolation, enclosure, or containment of equipment or machinery Chemical engineering involving : elimination of harmful chemical exposure altogether, or substitution of less noxious substances.Eg introduction of powder free gloves,chromate free cement,elimination of aldehyde disinfectants eg gluteraldhyde Automation of the work process, no-touch techniques for handling wet objects such as the use of tongs or baskets and crates to raise products out of liquids.
Provision of ventilation systems and isolation booths can prevent hazardous agents from contacting workers' skin
*The causative agent may be an integral part of the production process and no substitute may be available,hence elimination and substitution may not be viable options Task rotation, time restriction, task distribution amongst more number of workers. providing training programs that educate workers about hazards that they may be exposed to and ways to protect themselves from the hazards.
Training programs in occupational dermatology for occupational medical specialists, nurses, industrial hygienists, safety engineers) Motivation of workers and management to maintain safe and healthy work environments,and regulation of workplace exposures,Proper use of PPEs
Preventing of eating/drinking inside the workplace. Hygiene controls may be directed at either the work environment or the skin Nonspecific measures include good housekeeping, dust suppression, and waste elimination. Disinfection of work tools, equipment, and work areas Attention to housekeeping refers to proper storage of substances, frequent disposal of waste, prompt Removal of spills, and maintenance of equipment to keep it free from dust, dirt and drippings Surface wipe sampling ,Field Portable X-Ray Fluorescence Sampling, Dermal Sampling and Biological Monitoring are carried out is conducted to assess the risk of dermal exposure to contaminants in the workplace areas . Process monitoring may be aimed at detecting exposure levels to specific causal agents such as dusts, mists, residues, and vapors in the work environment Adherence to the PEL,REL Adherence to the ALARA principle,and AERB Radiation safety guidelines/SOPs for radiation workers Provision of washrooms/Decontamination booths Copious flushing with water alone is usually sufficient following skin contact with acids and alkalis, Specific protocols for decontaminating the skin have been recommended to prevent chemical burns from hydrofluoric acid , phenol, alkyl mercury compounds , white phosphorus,and dor radioactive decontamination. The overuse or incorrect use of soaps, abrasives, or waterless cleansers may be more irritating to the skin than the substances they are intended to remove, particularly when they are used to clean areas with preexisting dermatitis
Since the PPE is the last line of defense for protecting the skin, care must be taken to ensure it provides the protection expected. Personal protective equipment such as aprons/coats or coveralls, gloves, safety glasses or goggles Chemical Protective Clothings (CPC), and boots should be provided by employers and worn by workers working in hazardous processes. Selection of Chemical Protective Clothings (CPC) should be based on performance , physical properties .chemical permeability, Breakthrough time , Degradation ,wider size ranges, improved comfort, and better functional and protective characteristics. Chemical protective clothing (CPC) should be tested against the actual chemicals or chemical mixtures used in the workplace CPC should not be reused wherever allergic reactions or systemic toxicity are a concern. toxic substances that have permeated and may remain there and pose a theoretical risk of accidental exposure during reuse. Glove degradation and reuse of gloves can also dramatically reduce a glove's impermeability to chemicals. Know the type of potential contact (e.g., occasional contact or splash protection or continuous immersion of hands). Determine the contact period/glove permeability.
protective clothing can contribute to heat stress; reduced dexterity; grip or tactile functions; poor comfort; or may contribute to skin conditions non-specific irritation from secondary sweat entrapment and friction of the clothing against the skin; Accidental entrapment and occlusion of chemical substances against the skin; the development of contact allergy to CPC (e.g., chemical additives in rubber glove.
the training of workers in the proper use and care of protective gear andth e selection, fitting, maintenance and inspection of the protective clothing a nd gloves prevent dermatitis.
The three-step skin protection program is recommended : skin protection – by the application of protective measures (BC) before work, cleaning of the skin – by hand washing with mild soaps and water, skin care – use of care creams after work.
The beneficial effects of appropriate protection allow to : reduce the risk of penetration of macromolecular compounds to the skin, eg. resins; reduce the defatting of the skin (eg. due to influence of solvents ordetergents); reduce the abrasion of the epidermis after repeated mechanical contact; provide an adequate level of hydration of the epidermis; facilitate the cleansing of the skin after work;
BC can be applied to different parts of the body: hands, wrists, forearms, face except the mucous membranes and damaged skin.
Barrier creams either against water and aqueous solutions of harmful substances (hydrophobic BC) or from organic substances (hydrophilic BC) In cases of skin exposure in a wet work environment frequent application of the hydrophobic cream may be required Hydrophilic preparations are applied to protect the skin from organic substances – oils, greases, solvents and all substances except toxic (in this case protective gloves are required). May aggravate existing dermatitis and should only be used on normal noninflamed skin. Barrier creams (BC) may inhibit the action of low hazard irritants, but can not be used as a basic protection against corrosive substances, toxic and other presenting a significant risk in the workplace Their use should be complemented by the use of protective clothing and gloves, and minimizing the emission of irritants at the workplace
BC, of not more than 2 mg/cm2, should be applied each time before work after washing hands, after the breakfast break etc., or every 2 to 4 hours)
Emollient creams may also be used
UV radiation protecting products Sunscreens with high solar-protection factors (SPF 15 or greater) are extremely extremely effective barriers against ultraviolet radiation also may prevent the formation of skin cancer
Health Care Delivery Provision of prompt and adequate treatment for most: dermatological conditions of occupational origin Dermatologists to be taken whenever necessary. Prompt decontamination in cases of spills/splashes of hazardous chemicals.Specific decontamination procedures are recommended for chemicals such as phenol,HF ,radioactive contamination etc Provision of prompt first aid for injuries[Even First-aid preparations may contain common contact allergens(e.g., neomycin, benzocaine) to which injured workers occasionally become sensitized. ] Pre-placement physical examinations for pre-existing cutaneous diseases (e.g., atopic dermatitis and psoriasis). Routine pre-placement patch testing for work duties involving exposure to potential allergens is not recommended except when personal history suggests prior sensitization to the allergen. Conducting regular Periodic Medical Examinations for early diagnosis and treament of Occupational Dermatoses and surveillance for systemic toxicity for chemicals with possibility of percutaneous absorption. The prime aim in dermatological rehabilitation is to keep the patient in the same job by treating the dermatosis and by altering the working practice to avoid recurrence. Sometimes this prime aim may not be achievable and the patient and his or her medical adviser(s) may then be left with a difficult choice.
Whenever possible, employees should be redeployed within companies rather than dismissed. Once again, sound medical advice about suitable alternative work should be sought. Employers should therefore remember that occupational dermatoses are almost invariably neither infectious or contagious Calcium gluconate for HF
Diphoterine for PHENOL Of the 29 Notifiable diseases listed in the Factories Act, 1948, Schedule 3, sections 89 & 90, the following diseases and conditions pertain to OSDs and cases of systemic toxicity for chemicals which carry a possibility of percutaneous absorption in addition to other routes of absorption: 1. Lead poisoning including poisoning by any preparation or compound of lead or their sequelae. 2. Lead tetra-ethyl poisoning 3.Phosphorous poisoning or its sequelae. 4. Mercury poisoning or its sequelae. 6. Arsenic poisoning or its sequelae. 8. Carbon bisulphide poisoning. 9. Benzene poisoning, including poisoning by any of its homologues, their nitro or imido derivatives or its sequelae.
10. Chrome ulceration or its sequelae. 11. Anthrax. 13. Poisoning by halogens or halogen derivatives of the hydrocarbons, of the aliphatic series. 14. Pathological manifestation due to : a. radium or other radioactive substances. b. X –rays. 15. Primary Epitheliomatous cancer of the skin. 18. Oil acne or dermatitis due to mineral oils and compounds containing mineral oil base. 21. Occupational or contact dermatitis caused by direct contact with chemicals and paints.
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