Treatment of occupational skin diseases
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TREATMENT OF OCCUPATIONAL SKIN DISEASES. Antti I. Lauerma, M.D., Ph.D. FIOH. Occupational Skin Diseases. Allergic contact dermatitis Irritant contact dermatitis Protein contact dermatitis Contact urticaria Skin infections Acne Cancer Pigment changes. CONTACT DERMATITIS.

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TREATMENT OF OCCUPATIONAL SKIN DISEASES

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Treatment of occupational skin diseases

TREATMENT OF OCCUPATIONAL SKIN DISEASES

Antti I. Lauerma, M.D., Ph.D.

FIOH


Occupational skin diseases

Occupational Skin Diseases

  • Allergic contact dermatitis

  • Irritant contact dermatitis

  • Protein contact dermatitis

  • Contact urticaria

  • Skin infections

  • Acne

  • Cancer

  • Pigment changes


Contact dermatitis

CONTACT DERMATITIS

  • Irritant contact dermatitis and allergic contact dermatitis clinically very similar

  • Impossible to distinguish in histology

  • Cell-mediated immune responses

  • Antigen presenting cells more important in allergic contact dermatitis


Topical treatments

TOPICAL TREATMENTS

  • Wet dermatitis - wet treatment

    • dressings

    • light creams

  • Dry dermatitis - dry treatment

    • ointments

    • petrolatum

    • oils


Treatment of occupational skin diseases

WET, BUT HEALING SKIN

WET OCCLUDED SKIN


Treatment of occupational skin diseases

DRY SKIN

LESS DRY


Topical corticosteroids

TOPICAL CORTICOSTEROIDS

  • Classes I, II, III, IV

  • Side-effects and beneficial effects mediated by same glucocorticosteroid receptor

  • Side-effects:

    • Atrophy

    • Systemic effects

    • Tachyphylaxis

    • Worsening of acne


Topical corticosteroid use

TOPICAL CORTICOSTEROID USE

  • Class I: Face, flexures, children, aged people

  • Class II: Body, extremities

  • Class III: Lichenified eczema, psoriasis

  • Class IV: Mycosis fungoides. Lupus erythematosus, resistant eczema


Topical corticosteroid application

TOPICAL CORTICOSTEROID APPLICATION

  • 1-2 times daily for 3-14 days

  • Pauses between treatments to avoid atrophy

  • New scheme: 2 times daily for 2 weeks and 2 times weekly after that.

    • Prevents relapses


Topical immunosuppresants

TOPICAL IMMUNOSUPPRESANTS

  • TACROLIMUS

  • PIMECROLIMUS

  • CYCLOSPORINE

  • All act through calcineurin inhibition


Topical cyclosporine

TOPICAL CYCLOSPORINE

  • Not effective

  • Does not penetrate skin in sufficient amounts

  • Not effective on molar basis


Topical tacrolimus protopic

TOPICAL TACROLIMUS (PROTOPIC)

  • Effective topically

  • Penetrates skin

  • Efficient on molar basis

  • No skin atrophy

  • Effective in atopic dermatitis and allergic contact dermatitis

  • Effect in irritant contact dermatitis???


Topical pimecrolimus elidel

TOPICAL PIMECROLIMUS (ELIDEL)

  • Less effective than tacrolimus

  • Effective in face, flexures?

  • Use in children

  • Expensive (150 euros/100 grams) - same price as Protopic


Antimicrobials

ANTIMICROBIALS

  • Used when secondary infection is suspected

  • Cephalexin or other cephalosporins preferred (act on both staphylococci and streptocci)

  • Penicillin for erysipelas

  • Drug resistance rarely a problem in skin diseases - no need for expensive antibiotics


Antipruritic measures

ANTIPRURITIC MEASURES

  • In dermatitis antihistamines are seldom effective!!

  • Best effect is seen with corticosteroids, immunosuppressants and UV therapy

  • Basic creams help in itching caused by dryness


Systemic therapy

SYSTEMIC THERAPY

  • Corticosteroids

  • Cyclosporine

  • Azathioprine

  • Antihistamines

  • Doxepin

  • Pentoxiphylline

  • Monoclonal antibodies


Phototherapy

PHOTOTHERAPY

  • SUP

  • UVB

  • PUVA

  • Narrow-band UVB

  • Grenz rays

  • PDP


Contact allergy and diet

CONTACT ALLERGY AND DIET

  • 2.5 - 5 mg nickel may cause flare-up of nickel allergic contact dermatitis in areas of previous dermatitis

  • Cobalt (1 mg) may cause similar effects

  • Clinical importance is low


Contact urticaria

CONTACT URTICARIA

  • Antihistamines

  • Corticosteroids

  • Tacrolimus?

  • Doxepin?

  • NSAIDs (nonimmunologic contact urticaria)

  • Epinephrin (anaphylaxis)


Other occupational skin diseases

Other occupational skin diseases

  • Bacterial and fungal infections: Antibiotics

  • Acne: Isotretinoin, tetracyclines

  • Scabies: Ivermectine

  • Melanodermia: Hydrokinone

  • Leukodermia: Cosmetic

  • Skin cancer: Surgical, PDT, cryotherapy


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