TREATMENT OF OCCUPATIONAL SKIN DISEASES - PowerPoint PPT Presentation

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TREATMENT OF OCCUPATIONAL SKIN DISEASES

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  1. TREATMENT OF OCCUPATIONAL SKIN DISEASES Antti I. Lauerma, M.D., Ph.D. FIOH

  2. Occupational Skin Diseases • Allergic contact dermatitis • Irritant contact dermatitis • Protein contact dermatitis • Contact urticaria • Skin infections • Acne • Cancer • Pigment changes

  3. 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

  4. TOPICAL TREATMENTS • Wet dermatitis - wet treatment • dressings • light creams • Dry dermatitis - dry treatment • ointments • petrolatum • oils

  5. WET, BUT HEALING SKIN WET OCCLUDED SKIN

  6. DRY SKIN LESS DRY

  7. 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

  8. 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

  9. 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

  10. TOPICAL IMMUNOSUPPRESANTS • TACROLIMUS • PIMECROLIMUS • CYCLOSPORINE • All act through calcineurin inhibition

  11. TOPICAL CYCLOSPORINE • Not effective • Does not penetrate skin in sufficient amounts • Not effective on molar basis

  12. 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???

  13. TOPICAL PIMECROLIMUS (ELIDEL) • Less effective than tacrolimus • Effective in face, flexures? • Use in children • Expensive (150 euros/100 grams) - same price as Protopic

  14. 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

  15. 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

  16. SYSTEMIC THERAPY • Corticosteroids • Cyclosporine • Azathioprine • Antihistamines • Doxepin • Pentoxiphylline • Monoclonal antibodies

  17. PHOTOTHERAPY • SUP • UVB • PUVA • Narrow-band UVB • Grenz rays • PDP

  18. 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

  19. CONTACT URTICARIA • Antihistamines • Corticosteroids • Tacrolimus? • Doxepin? • NSAIDs (nonimmunologic contact urticaria) • Epinephrin (anaphylaxis)

  20. Other occupational skin diseases • Bacterial and fungal infections: Antibiotics • Acne: Isotretinoin, tetracyclines • Scabies: Ivermectine • Melanodermia: Hydrokinone • Leukodermia: Cosmetic • Skin cancer: Surgical, PDT, cryotherapy