This file has been cleaned of potential threats. If you confirm that the file is coming from a trusted source, you can send the following SHA-256 hash value to your admin for the original file. 1e3523b94c36c633fd65834f90725021e61cc802f0090d12d76e319f146e7b74 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