DERMATOSIS AKIBAT KERJA TRI MARTIANA

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DERMATOSIS AKIBAT KERJA TRI
MARTIANA
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Work time lost
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Cost
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What is it?

• The outer layer of skin acts a barrier against
  toxic substances.
• If these substances remove fats and oils from
  this layer, the substances penetrate deeper and
  combines with natural proteins to produce an
  allergic reaction.

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Acronyms

• Occupational skin disease (OSD)
• Occupational contact dermatitis (OCD)
• Occupational contact urticaria (OCU)
• Irritant contact dermatitis (ICD)
• Allergic contact dermatitis (ACD)

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The location of lesion

• Face
• Eyelids
• Neck
• Trunk
• Abdomen
• Forearms

• Hands
• Thighs
• Shins
• Legs
• Feet
• Back

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Sifat agen penyebab dermatosis

• Agen fisik tekanan, gesekan, cuaca dingin,
  panas, radiasi ultraviolet, serat mineral.
• Agen Biologis beberapa mikroba, fungi, parasit
  kulit dan produk2 nya
• Agen kimia, dibagi dalam 4 kelompok
• - iritan primer
• - sensitizer
• - acnegenic
• - photosensitizer

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Iritan primer

• Asam , basa, pelarut lemak
• Detergen
• Garam garam logam
• - garam arsen
• - garam mercuri
• - dll

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Sensitizer

• Logam dan garam2nya (kromium, nikel, kobalt)
• Senyawa yang berasal dari anilin
• ( p fenilendiamin, azo dyes )
• Derivat nitro aromatik ( trinitrotoluene )
• Resin (epoksiresin, formaldehid, vinil, akrilik )
• Bahan kimia karet ( vulcanizer) ? dimetil tiuran
  disulfida
• Obat-2an (procain, fenotiazin, klorotiazid,
  penisilin,tetrasiklin
• Kosmetik, terpentin, tanam2an

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Agen acnegenic

• Naftalen
• Bifenil khlor
• Minyak mineral

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Agen photosensitizer

• Antrasen
• Pitch
• Derivat asam aminobenzoat
• Hidrokarbon aromatik klor
• Pewarna akridin

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Photosensitivity

• Many chemicals need light to activate and produce
  the complete phototoxin or photoallergen. The
  furocoumarins in limes produced this vesicular
  phototoxic dermatitis in a bartender who squeezed
  limes all afternoon in direct sun.

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Ultraviolet cured processes

• The technology of using ultraviolet light
  sensitive chemicals is relatively new in creating
  templates for printing.
• It is also being used in the manufacture of
  certain printing inks and in dentistry. Various
  acrylates have been the sensitizers in this
  process.

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Mekanisme terjadinya dermatosis

• Agen fisik ? trauma mekanik langsung ke kulit
• Agen kimia
• Iritan primer merusak kulit dengan cara
  mengubah PH, denaturasi protein, mengekraksi
  lemak, menurunkan daya tahan
• Sensitizer/allergi? reaksi hipersinsitivitas tipe
  lambat
• Acnegenic? menyumbat kelenjar dan sal, sebacea ?
  peradangan lokal
• Photosensitizer ? meningkatkan sensitivitas kulit
  terhadap radiasi ultraviolet

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Gejala dan tanda

• Akut ditandai eritema, edema, papula vesikula ?
  biasanya di tangan, lengan bawah atau wajah
• Kronik ditandai excoriasi, crustae , eksema,
  hiperkeratosis
• Faktor yang membantu timbulnya contac iritant
  adalah adanya trauma ( digosok, digaruk)
  pakaian, sarung tangan, kulit kering, kulit sudah
  dalam kondisi sakit

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Occupational Contact Dermatitis

• ICD
• Direct effect
• ACD
• T cell mediated immune response
• Type IV hypersensitivity reaction
• Delayed response

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What is it ?

• Irritant Contact
• 90 of all dermatitis is caused by direct contact
  with a substance
• It may occur randomly

• Allergic Contact
• Once sensitised, the problem is life long and
  any exposure to the substance will result in an
  attack.

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Contact Dermatitis, Acute

• This arm shows a painful, acute contact
  dermatitis form exposure to the strong irritant,
  ethylene oxide. The arm is markedly swollen and
  shows an acute vesiculo-bullous dermatitis. A
  similar pattern may be seen on the basis of
  contact allergy.

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Contact Dermatitis, Subacute

• This patient developed a bilateral and symmetric
  sub-acute dermatitis from the rubber accelerator,
  mercaptoben zothiazole, which was leached from
  the rubber portion of his work shoe as a result
  of sweating. In this case there is some edema and
  erythema with an eczematous eruption.

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Contact Dermatitis, Chronic

• The hands, wrists and forearms are the most
  frequent sites of involvement in cases of
  industrial contact dermatitis.
• The hands and wrists of this worker with a
  chronic dermatitis show the effect of long term
  exposure to a solvent,
• in this case kerosene, which was used for
  cleaning the skin. The skin markedly thickened,
  hyperpigmented, dry and fissured, itching is
  usually a major symptom.

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• Chromic acid and alkaline chromate are agents
  commonly encountered in the tanning and
  electroplating industries.
• These substances have a corrosive action when
  they enter the skin through a minor nick or break
  in the integument.
• This results in the formation of chronic,
  ulcerative lesions known as "chrome holes".
• Typically, the lesions are found on fingers,
  hands or forearms. "Chrome holes" also occur on
  the dorsal surfaces of the feet when chrome salts
  have been allowed to permeate boots or shoes.
• The lesions are usually painless and persist for
  many months before spontaneously healing with
  permanent atrophic scar. Identical lesions can
  also be produced by arsenic or zinc salts but
  these are less frequently encountered.

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Chrome hole, nasal

• When chrome containing materials are present as
  aerosols, painless ulceration of the nasal mucosa
  and septum may occur. With continues exposure
  permanent septal perforation eventually results,
  as in this young woman who was employed in chrome
  plating small appliance parts.

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D.contact allergica

• Ada sensitisasi sebelum timbul alergi, agen
  sensitisasi bereaksi dengan protein dalam
  epidermis membentuk kompleks hapten protein ?
  pembentukan antibody
• Reaksi hypersensitivas tipe lambat, timbul
  setelah 48 72 jam
• Zat yang biasanya sebagai primary irritant juga
  dapat sebagai allergen
• Bentuk akut seperti ? spt D. contact irritant
  akut
• Bentuk kronis ? timbul likenifikasi , fisura

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Occupational Contact Urticaria

• Non-immunologic
• Immunologic
• Immune response associated with IgE
• Type I hypersensitivity reaction
• Immediate response

Wheal and flare
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Which workers are at risk of developing OCD OCU?
The workers most commonly reported to be at
increased risk include

• OCD
• Hairdressers
• Healthcare
• Cleaners
• Construction
• Catering
• Mechanics
• Metalworkers
• Chemical plant

• OCU
• Bakers
• Farmers
• Healthcare
• Food preparation

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Contoh kasus D. Contac allergica

• Dental Assistant (allergy to glutaraldehyde and
  neomycin)

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Contoh kasus D. contact allergica

• Optician - non-dominant hand dermatitis(allergy
  to ethyl acrylate)

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Other Resin System

• This severe allergic contact dermatitis was due
  to a phenol-formaldehyde resin. These resins are
  used as bonding agents for foundry sand,
  electrical devices and in molded and cast plastic
  articles. They may also produce irritant
  reactions.

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Chemical Accelerators in Rubber

• Allergic contact dermatitis due to rubber
  chmicals is fairly common in industry. Chemial
  accelerators that speed up the vulcanization
  raction and antixidants are the more frequent
  allergens. They present a potential hazard in
  finishing goods as well.

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Gejala Dermatosis yang lain

• Acne akibat kerja ? hanya menyerang tubuh yang
  kontak dengan agen
• Lesi mikrotraumatik ? disebabkan oleh serat
  mineral, ditandai dengan papula kecil keputihan
  atau kemerahan pd area yg terpapar
• Kanker kulit ( karsinoma squamosa ?
  hyperkeratosis, papilomatosis
• Dermatosis yg menular ? zoonotik, dermatofitosis,
  kandidiasis, tuberkulosis verukosa

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Occupational Acne. Acute, Oil Folliculitis

• Occupational acne is most commonly seen in
  workers exposed to insoluble cutting oils in the
  machine tool trades or in mechanics exposed to
  grease and lubricating oils.
• This worker developed folliculitis, sometimes
  called oil boils or acne, with multiple comedones
  and pustules on his arms and other covered areas
  of his body as a result of prolonged contact with
  oil.
• The lesions almost never develop from bacteria
  present in the oils

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Oil Folliculitis Chronic, Chloracne

• Chlordane is an extremely refractory type of acne
  caused by certain halogenated aromatic chemicals
  and can be certain halogogenated aromatic
  chemicals and can be accompaned by systemic
  toxicity. It represents one of the most sensitive
  indicators of biologic response to these
  chemicals. Chloracne in this herbicide production
  worker involved almost every follicular orifice
  on his face and neck with comedones, papules and
  cystlike lesions.

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Depigmentation

• The hands of this hospital maintenance worker are
  depigmented form contact with a phenolic
  germicidal detergent. Irritation or sensitization
  to the chemical is not a prerequisite for the
  pigment loss to occur. This loss of pigment may
  be permanent.

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Granuloma

• Granulomas represent a focal, chronic
  inflammatory reaction. These granulomas were
  produced by beryllium and are considered to be on
  a allergic basis. Non-allergic granulomas are
  more common and represent the skin's response to
  inoculated or implanted foreign materials such as
  wooden splinters, plant spines and silica.

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Eccrine

• Miliaria represents blockage of the eccrine sweat
  ducts and may occur in workers who perspire
  excessively. In this case of miliaria rubra of
  prickly heat, the blockage site is the granular
  cell layer of the epidermis. When more than 30
  of the skin surface is affected, an individual
  may develop thermoregulatory disorders such as
  heat exhaustion.

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Tumors

• Skin tumors, such as this ulcerating squamous
  cell carcinoma most frequently arise after years
  of occupational exposure. Malignant tumors may
  represent to occupational carcinogens such as
  coal tar and physical agents such as sunlight.
  Skin cancer is the commonest form of cancer. The
  role played by occupational factors is frequently
  difficult to determine.

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Diagnose Dermatosis akibat kerja

• Gambaran klinis, lokalisasi dan perjalanan
  penyakit harus sepenuhnya sesuai dengan ciri PAK
  yg pasti
• Paparan kerja terhadap agen berbahaya perlu
  dipastikan
• Ada hubungan waktu paparan dan timbulnya penyakit
• Dermatosis contact allergica ? uji tempel

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Uji tempel

• Menempelkan alergen yang dicurigai dengan kadar
  yang non iritatif pada kulit yang tidak terpapar
  selama 24 48 jam
• Positif bila timbul dermatosis ekzematous dibawah
  tempelan yang penutup

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Kerentanan

• Orang dengan atopi ( eksema, penyakit kulit
  alergi dan alergi lainnya)
• Penyakit kulit kronik termasuk hiperhidrosis
• Seborea atau iktiosis
• Pimentasi abnormal
• Lesi kulit prekanker

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Penanganan kasus

• Dipindahkan ke area bebas alergen
• Kasus D. iritatant, pekerja dipindahkan sementara
  dan agen penyebab dikendalikan
• Pemindahan kerja sec. Permanen dilakukan bila
  pemindahan sementara tidak menghasilkan
  penyembuhan yg sempurna
• Kondisi prekanker mk. Pekerja harus dijauhkan
  dari paparan

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Controlling the Risk

• Employer
• Use safer substances
• Provide information
• Provide training
• Supply PPE
• Comply with the law

• Employee
• Be aware of dermatitis
• Take care with substances
• Use PPE
• Maintain PPE
• Report symptoms

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Upaya pencegahan

• Allergen kuat, sensitizer, karcinogen diganti
  dengan zat yang kurang berbahaya
• Pengendalian secara tehnik ( isolasi tempat
  kerja)
• Eliminasi kontak dengan kulit
• Pakaian pelindung ( apron,sarung tangan, sepatu
  boot, penutup wajah)

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Upaya pencegahan

• Fasilitas dasar untuk kebersihan diri (pancuran
  air untuk mandi bukan bak mandi)
• Kebersihan lingkungan dan house keeping
• - pembuangan air bekas dan sampah industri
• - pembersihan debu
• - cara penimbunan dan penyimpanan barang
• ? Penggunaan SPF 15 untuk melindungi Sinar
  .matahari

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Upaya pencegahan

• Diagnose dini Penyakit Dermatosis Akibat kerja
  melalui
• Pemeriksaan awal sebelum penempatan
• - riwayat medis
• - fisik dengan perhatian khusus pada kulit
• Pemeriksaan berkala
• - sama spt pem.awal
• - uji tempel tdk dianjurkan bagi yg tdk
  menunjukan gx
• - waktu antara 6 bln 2 tahun tgt tingkat
  paparan
• ditempat kerja

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Prognosis

• D. iritant , acne, infeksi ? menyembuh sth agen
  penyebab dijauhkan
• D. alergi ? tgt sifat alergennya dan bila hanya
  ditempat kerja dan telah di hilangkan alergennya
  ? sembuh sempurna
• ? allergi infeksi sekunder ? sembuhnya lama

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