University of Groningen Skin Problems Related to Indonesian Leather
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University of Groningen Skin problems related to Indonesian leather & shoe production and the use of footwear in Indonesia Febriana, Sri Awalia IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2015 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Febriana, S. A. (2015). Skin problems related to Indonesian leather & shoe production and the use of footwear in Indonesia. Rijksuniversiteit Groningen. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license. More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne- amendment. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 05-10-2021 Skin Problems related to Indonesian Leather & Shoe Production and the use of Footwear in Indonesia Sri Awalia Febriana ISBN : 978-90-367-7575-5 (printed version) ISBN : 978-90-367-7574-8 (e-version) © S.A. Febriana, Groningen, The Netherlands [email protected] [email protected] All right reserved. No part of this thesis may be reproduced, stored in a retrieval system or transmitted in any form by any means, without permission from the author. Financial support for the publication of this thesis was provided by the Directorate General of Higher Education (DIKTI) Ministry of Education, Republic of Indonesia. Printing of the thesis was financially supported by the Research Institute for Health Research (SHARE), Graduate School of Medical Science. Cover design : Obos Pramutya, Den Haag, The Netherlands Photograph : Surahyo Sumarsono and Piet Tonder, Groningen, The Netherlands Lay out : Aris Winarna, Yogyakarta, Indonesia Printing : GVO drukkers & vormgevers B.V., Ede. The Netherlands Cover story: Photographs in the cover are the traditional shoe workers in Manding Yogyakarta, Indonesia and Leather produced by Indonesian tannery where our projects took place. In the background, there is a Batik ƉĂƚƚĞƌŶ ĐĂůůĞĚ ͞WĂƌĂŶŐ ƌƵƐĂŬ͟Žƌ in English literally defective big knife, is a traditional batik pattern from Yogyakarta. It is visualized as many defective parang (big knife) with diagonally format Indonesian batik patterns and designs, which refers to the attitude of the human perspective on the environmental landscape and life, expressed in forms stellar. This design was created by Sultan Agung of Mataram (1613-1645) after a meditation on the South coast of Java. That said, inspiration comes from the phenomenon of large waves that break up rock and ruin. Skin Problems related to Indonesian Leather & Shoe Production and the use of Footwear in Indonesia PhD Thesis to obtain the degree of PhD at the University of Groningen on the authority of the Rector Magnificus Prof. E. Sterken and in accordance with decision by the College of Deans This thesis will be defended in public on Monday �� �anuary ���� at ��.�� hours Sri Awaliaby Febriana born on �� �ebruary ���� in Yogyakarta, Indonesia Promotor : Prof. dr. P.J. Coenraads Prof. dr. H. Soebono Copromotor : Dr. M.L.A. Schuttelaar Beoordelingscommissie : Prof. dr. M. Bruze Prof. dr. T. Rustemeyer Prof. dr. D. Koh Dedicated to The health of workers in Indonesia and other Newly Industrialized Countries ǡDzdz Mas Yayok, my husband, best friend and great companion Keisha and Katya, the loves of my life Paranymphs : Laura Bijkersma-Pot Astri Ferdiana Contents Chapter 1 Chapter 2 Introduction 9 Inventory of the chemicals and the exposure 47 of the workers’ skin to these at two leather Chapter 3 factories in Indonesia Occupational allergic contact dermatitis and 67 patch test results of leather workers at two Chapter 4 Indonesian tanneries Occupational contact allergy caused by 83 Chapter 5 benzidine in three tannery workers Occupational skin hazards and prevalence of 87 occupational skin diseases in shoe Chapter 6 manufacturing workers in Indonesia Occupational allergic contact dermatitis and 105 patch test results in Indonesian shoe factory Chapter 7 workers Contact allergy in Indonesian patients with 123 Chapter 8 foot eczema attributed to shoes Thin layer chromatography (TLC) and gas- 143 chromatography-mass spectrometry (GCMS) examination of footwear materials from Chapter 9 patients with shoe dermatitis Chapter 10 General discussion and future perspective 152 Appendices Summary 177 Acknowledgments 190 Publications 198 Curriculum Vitae 200 CHAPTER 1 Introduction Sri Awalia Febriana Department of Dermatology & Venereology, Gadjah Mada University, Yogyakarta, Indonesia Department of Dermatology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands. Introduction The leather manufacturing1, 2 industry as a whole has become the backbone 1 | 10 of Indonesian export. Between January and September of 2013 its total annual export3, 4 of leather and leather products was worth 163,605,136 US dollars 5 and 6,500 workers were employed in medium and large factories. Indonesian tanneries have been producing leather not only for domestic use but also for Europe, the United States, Australia, and Asia. Indonesia's footwear industry in particular has a long history. In the 1940s footwear manufacture for the foreign market began with the opening of a Czech factory, and the late 1960s marked the beginning of production for the domestic market. Since then Indonesia's footwear industry has continued to grow, and in various industrial locations throughout the country a broad variety of products are6 currently being manufactured for the market both at home and abroad. According to SATRA (Shoes and Allied Trades Research Association, UK) Indonesia, along with the other leading countries in shoe production, produced7 75.2% of 12.5 billion pairs of shoes manufactured worldwide in 2002. In 2008 the Indonesian footwear6 industry alone was producing 131 million pairs of shoes a year. From January to September3, 4 2013 Indonesian footwear export was worth 2.836.4 million US dollars and in the medium and large shoe industry alone 202,189 workers 5 were employed, as well as millions of workers in other related industries. If we consider the huge production in the leather and shoe manufacturing sector in Indonesia, the number of workers. employed, and the associated skin hazards described below, it is clear that the burden of occupational skin diseases in this sector must be high The manufacture of leather and shoes causes prolonged exposure of factory workers to many potent chemical irritants and sensitizers. During leather manufacture, employees working on various stages of leather preparation (including pre-treatment with water and lime as well as the processes of pre-tanning, tanning and finishing) come into contact2, 8-13 with chemicals designed to alter the structure of animal hides. The workers are exposed to numerous materials such as leather, rubber, dyes, preservatives, and shoe adhesives (neoprene, epoxy12-14 resin and rubber glues) containing a broad spectrum of allergens. Because of their exposure to these environmental hazards, together with very limited use of personal protective equipment (PPE), leather- and shoe-factory workers are prone to occupation-related skin problems. Occupational skin diseases are those arising during occupational activity. These diseases, currently increasing in prevalence, are of great socioeconomic importance. Not only do they have major consequences for the affected patients and their families, but the annual cost to health 1 | 11 insurance companies is equal to or even greater than that15 of other chronic inflammatory skin diseases like psoriasis and eczema. In the USA the average annual cost per claim of Occupational16 Skin Disease was $3,552 and the average disability time 23.9 days. In Germany, the annual cost to health insurance17 companies for each case of occupational hand eczema is about €9000. Epidemiological studies of occupational skin diseases (OSD) among leather18 factory workers in Europe were reported some decades ago in Sweden , and in 1996 an epidemiological study was made14 of occupational contact dermatitis (OCD) in Italian shoe factory workers. The fact that no recent reports on this subject have been made may be the result of the more current outsourcing of leather and shoe manufacturing to Newly Industrialized Countries (NICs). Low labour costs, easy supply of raw materials, and a tradition of making shoes have been reasons for moving leather and shoe manufacturing industries to NICs. Another important issue is many industries in developed countries search for the countries ��t� ���� �t������ 19�����o����ta� ���u�at�o�� o� ��o�� a� a ��o��ut�o� �a��� ���ot������. As a result, these countries are being burdened with the effects