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

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
slide5
WET, BUT HEALING SKIN

WET OCCLUDED SKIN

slide6
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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