Occupational dermatoses contact dermatoses
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Occupational dermatoses (“Contact dermatoses ”). Conf. Dr. Brandusa Constantin. Definition : cutaneous diseases caused by the contact with different substances and materials during working. Professional stigma. Traumatic bubbles : adaptive responses

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Occupational dermatoses contact dermatoses

Occupational dermatoses (“Contact dermatoses”)

Conf. Dr. Brandusa Constantin


Occupational dermatoses contact dermatoses

Definition:

  • cutaneous diseases caused by the contact with different substances and materials during working.


Professional stigma

Professional stigma

  • Traumatic bubbles:

    • adaptive responses

    • professions: mining, asphalt, young people using shovels, pickers

    • appearance: localized hyperkeratosis (calluses)

  • Pigmentation to:

    • wind, rain, sun

    • heat

    • professions: workers from:

      • construction

      • furnaces, ovens, forging

      • metallurgy and glass industry

        ! It can turn into precancerous keratoses!


Occupational dermatoses contact dermatoses

  • Epidermis and nail coloration:

    • After contact with mercury (black nails), sulphate of copper, iron (green nails and epidermis)

    • Yellow nails: picric acid

  • Abrasion of fingerprints: the workers who work with paper, cardboard, wood conglomerates

  • Scars: after burns, wounds ofsmelters, glassmakers

  • Nail injury:

    • “in parrot beak”- at the tapestry owrkers

    • abrasion of free edge – polishers

    • fragmentation and irritation around the nail - to formaldehyde


Classification 1

Classification 1

  • Pathogenic criteria:

    dermatoses:

    • ortoergic (OD)

    • allergical (AD)

      B. Clinical criteria:

      dermatoses:

  • ortoergic (OD)

  • eczematiform(ED)


  • Classification 2

    Classification 2

    According to Work Protection Norms related to the skin and hypodermic tissue diseases:

    • contact allergicdermatitis;

    • contact irritative dermatitis;

    • mixt contact dermatitis (allergic and irritative);

    • urticaria.


    Occupational dermatoses contact dermatoses

    • microbial- fungal- viral- parasitic

    Ortoergic Dermatoses

    Due to microorganisms

    Arising from physical agents

    • Micro traumatisms- Thermal origin

    • Radiation (Infrared, UV, ionizing)

    Due to chemical agents (chemicals with direct irritant action)

    Allergical Dermatoses


    Ortoergic dermatoses

    Ortoergic Dermatoses

    Due to microorganisms

    • By direct infection mechanism and/or

    • sensitisation action

  • ex: occupational syphilis (finger chancre of the midwives), occupational tuberculosis, pyodermatitis, microbial onyxis

  • microbial

    micotic

    • Superficial epidermo-mycoses - confectioners, cannery workers- Epidermophyton disease - in jobs that involve wearing rubber boots- Sycosis trycophitic - milking, veterinary personal

    viral

    • Milkers’ nodule

    • Verruca vulgaris viruse

    parasitic

    - Animal scabies, grain scabies, contact dermatitis caused by larvae


    Ortoergic dermatoses1

    Ortoergic Dermatoses

    • Arising from physical agents

    • ragada, ulcerations, callosities;

    • hyperkeratosis of digital pulp – harpist

    • palm callosity - gymnasts

    microtraumatisms

    • facial erithrosis (steelmakers

    • sudamine (steelmakers, smelters) – white/red miliary dematitis

    • cold: frostbite, acrocyanosis, reticular livido

    thermal origin

    Ionizing and non ionizing electromagnetic radiation

    • Actinic dermatiris (light radiation)- Dermatoses by photosensitivity


    Ortoergic dermatoses2

    Ortoergic Dermatoses

    Irritant contact dermatitis

    Due to chemical agents                    - Direct action


    Occupational dermatoses contact dermatoses

    • Dermatoses to coal:The appearance of the lesion: skin tattoos resulting from infiltration with carbon particles.     The appearance of the lesion:skin biopsy found the presence of dermatitis and peri-vascular lymphocytic infiltrate with ortho-keratosis compatible with contact dermatitis


    Diagnostic

    Diagnostic

    • Occupational exposure

    • Clinical picture

    • Paraclinical tests


    Occupational exposure sheet form of exposure to occupational hazards

    Occupational exposure – sheet form of exposure to occupational hazards!

    • Occupational history - the most important element in occupational dermatoses diagnosis

    • Profession (exact);

    • Analysis of the technological process, indicating all agents / substances involved;

    • Seniority at work;

    • Professional route;

    • Use of protective equipment (which may be protective or harmful);

    • Methods for cleaning skin! Visit to workplace "Occupational diseases are known in workplaces" (Ramazzini, 200 years ago)


    Jobs with high incidence of occupational dermatoses

    Jobs with high incidence of occupational dermatoses

    • Cleaners, cooks, restaurateurs – dermatitis of wear, irritant dermatitis, allergic dermatitis, trophic conditions of nails

    • Builders (who works with cement) - irritant dermatitis, allergic dermatitis, skin mycosis, skin cancer lesions

    • Painters - irritant dermatitis, allergic dermatitis, skin cancers, traumatic tattoos

    • Health care staff: nurses, dental surgeon - allergic dermatitis, skin infections

    • Hairdresser - allergic dermatitis, urticaria, irritant dermatitis

    • Persons who handles plastic - dermatitis to fiberglass, irritant contact dermatitis

    • Auto mechanics - repeated trauma (palmary hyperkeratosis, hematoma, traumatic tattoos), irritant dermatitis (caustic agents, motor oil), allergic dermatitis


    Clinical picture

    Clinical picture

    Irritant contact dermatitis

    It has various clinical aspects, by the nature of the agent, mode of action, acute or chronic form:

    -erythema;-edema;-vesication;-necrosis;-desquamation, micro-fissures


    Clinical picture1

    Clinical picture

    Allergic contact dermatitis

    • It is always pruritic;- Onset - site action, but remain localized rarely, it spreads at distance

    • Appears only in predisposed subjects


    Paraclinic

    Paraclinic

    Skin tests - patch-test: highlighting the responsible allergen -it should be practiced after stopping of corticosteroid general therapy and antihistamines;-first reading is at 48 hours, the second at 72 or 96h.


    Differentiation

    Differentiation

    • Despite their different pathogenesis, allergic and irritant contact dermatitis show a remarkable similarity wirh respect to clinical appearance, histology, and immunohistology.

    • A study - Department of Dermatology, Univ. Kiel, published in 1992 in the Journal of Investigative Dermatology - compared the cellular infiltrates in irritant and allergic patch-test reactions by immunostaining with a broad panel of monoclonal antibodies. patch test  biopsies;After 72 hours it was found that both type of reaction were characterized by an identical dermal infiltrate consisting mainly of memory T cells, many of which were activated, and macrophages; dermal and epidermal Langherhans cells density and HLA-DR expression of keratinocytes were also identical.The conclusion was that it is the same type of inflammation, including activation of T cell, obviously independent of exogenous antigen.

    Journal of Investigative Dermatology (1992) 98, 166–170; doi:10.1111/1523-1747.ep12555804


    Differentiation1

    Differentiation

    • Study: confocal laser scanning microscopy can differentiate in vivo allergic and irritant contact dermatitis dermatitis

    • Objective: viewing, characterization and in vivo differentiation of allergic and irritant contact dermatitis;epidermal volume was measured and images by reflectance confocal microscopy were made

    • Results: Compared with allergic dermatitis, the irritant dermatatitis were observed greater damage of the stratum corneum and more parakeratosis, also increased increased epidermal volume.

    • Conclusions: confocal laser scanning microscopy by reflectance is a promising and noninvasive tool for dynamic studying, and for differentiation of the two types of contact dermatitis

    J Am Acad Dermatol. 2004 Feb;50(2):220-8.


    Treatment

    Treatment

    • Immediate interruption of contaminant contact (immediate decontamination -external, removal from exposure, changing jobs - after);

    • Fighting inflammation: local application of topical corticosteroids, alternating with wet compresses and moisturizing cream; systemic corticosteroids is not recommended, except in exceptional cases of generalized eczema;

    • Antibiotics, in case of suprainfection;

    • Oral antihistamines for allergic dermatitis and urticaria (to reduce itching);

    • Avoiding contact with other skin irritants or sensitizers (professional or non-professional).


    Prophylaxis

    Prophylaxis

    • Technical and organizational measures

      • Eliminating direct contact of the skin with harmful substances;

      • Protective equipment;

      • Individual hygiene;

      • Use of skin protection ointment

    • Medical measures

      • Recognition of risks regarding health

      • Medical examination at employment

      • Periodic medical examination


    Occupational dermatoses contact dermatoses

    Dermatitis looking keloid to mineral oils:Skin lesion:- Micro-traumatisms which are predisposed to fissures and scratching induced by excoriation and dystrophic changes of nails; rough skin, pruritus, burning and stinging.The appearance of the lesion:- irritation of the skin of palmar sides of the hands, manifested by papules and pustules


    Occupational dermatoses contact dermatoses

    Miliaria rubra caused by heat.The appearance of the lesion: sudamine in form of microvesicles


    Occupational dermatoses contact dermatoses

    Contact discoloration that is part of occupational non-eczema dermatoses caused by chemical agents.Appearance: lesions of back sides of hands, fingers and forearms, clinically manifested by irregular skin depigmentation (white patches of skin) with precise shape and variable size, as a result of destruction of melanocytes.


    Occupational dermatoses contact dermatoses

    Occupational dermatoses caused by biological factors: mycobacterial skin infections:Lesion appearance: small macules and papules with inflammatory purpuric halo, some tend to have the appearance of umbilicated vesicles at level of upper limb


    Occupational dermatoses contact dermatoses

    Allergic contact dermatitis to soaps and detergents:The appearance of the lesion: the injuries are acute, which begins with a erythemato-squamous placque, blisters, sores and cracks.

    The eruption is preceded and accompanied by pruritus.


    Occupational dermatoses contact dermatoses

    Thermal burns:The appearance of the lesion:- Electrical burn-degree II, with partial epidermal and dermal destruction and capillary network. The burnt skin is white or like paper, with agglutinated blood vessels, and areas with mottled appearance.


    Occupational dermatoses contact dermatoses

    ChloracneThe appearance of the lesion: itchy comedons, red-purple papules and pustules, with extensive character from face to neck (without affecting the nose), anterior and posterior chest, shoulders and arms, fingers and nail hyper pigmentation.


    Occupational dermatoses contact dermatoses

    Dermatophytes:The appearance of the lesion:-suppurative mycosis of the scalp and chin, pustulo-nodular-follicular, intense inflammatory.


    Occupational dermatoses contact dermatoses

    Chemical burns:The appearance of the lesion:- Onycodystrophy accompanied by necrosis of the distal, medial and proximal phalanges, mummified (dark) aspect, skin without elasticity and sensitivity. Necrosis advanced to both palms.


    Occupational dermatoses contact dermatoses

    Heat urticaria:The appearance of the lesion: generalized rash manifested by erythematous-edematous papules and plaques,well defined and pruriginous, with sizes from 1 to 7 mm, preceded by strong burning feeling.


    Occupational dermatoses contact dermatoses

    Chronic lichenified eczema:The appearance of the lesion:keratoses placards, with variable extent, confluent between them, with raised and rough surface, being covered by a fine whitish network, known asof Wickham striae.


    Occupational dermatoses contact dermatoses

    Occupational purpura

     The lesion appearance:- The presence of red-purple and bleeding spots at facies, chest, arms and legs levels, which does not disappear to vitro-pressure, painless, apparently due to spontaneous extravasation of blood in skin and mucous membranes. Lower limb lesions have the appearance of purple petechiae (purpuric spots are small, round, well-defined) and upper limb purpuric lesions tend to have a necrotic appearance (petechiae with areas of necrosis).


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