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Digunakan untuk kelainan pada kulit akibat eksposurterhadap iritan di lingkungan kerjaEfek dapat berupa kemerahan saja sampai padagatal, kulit melepuh, terbakar dan tumorKulit merupakan organ terbesar dari tubuh, denganfungsi:

daya tahan pertama thd iritan, bakteri, fungi, dll.menerima sensasi panas, dingin, tekstur, dll.mengatur temperatur tubuh: menguapkan gas, uap, sekresi minyak, asam pelindung, membuatpigmen thd matahariluasnya: 2 m2, tebal dari 0,5mm sampai 3-4 mm

Zat kimia

Tenaga mekanis

Zat fisis

Racun tumbuhan

Zat biologis

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Dari golongan zat kimia organik dan anorganikZat organik kebanyakan merupakan sensitizers

Zat anorganik kebanyakan merupakan primary iritan

Kontak langsung dengan kulitOral

immersing hands (sometimes legs) into chemicals

direct handling of contaminated workpieces

splashing (eg when liquid or powdery chemicals are mixed or handled

contact with contaminated surfaces (egworkbench, tools, clothing and containers)

in deposits in the air (eg cement dust)

Iritan primer

Penyumbat pori

Sensitiser

Menyebabkan dermatitis karena kontak langsung‘dermatitis kontak’80% dari kasus di industriContoh:

HNO3, H2SO4, NaOH: cepat membakar kulitDeterjen, sabun kuat, pelarut ‘sedang’: iritasi ringan, eksposur berulang iritasi beratkaret, plastik, lem, resin (terutama epoxy resin), pelumas: melekat pada kulit menyebabkan iritasiprimer atau sensitisasi selain melekat, mengeraspada kulit kulit jadi peka terhadap iritan/radang

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Berupa minyak, wax black heads/acne yang disebutdermatitis kulitSering terbawa pakaian kerja dan terbawa ke rumahdapat mengena keluarga pekerja

Zat kimia yang menyebabkan kelainan kulit sepertialergi timbul setelah beberapa kali eksposur reaksidelayed dan multiple Disebut ‘dermatitis sensitisasi’Sekali orang tersensitisasi eksposur sedikit jugasudah menyebabkan efek parah dan kelainan dapatmenjalar ke seluruh tubuh orang tidak dapatbekerja di tempat yang samaContoh: epoxy resin hardener, pewarna azo, derivatcoal tar, pollen, antibiotik, dll.Zat kimia yang menstimulir sel kulit tumbuh berlebih: epitelioma, papilioma, polip, dan kanker coal tar dan minyak mentah

Iritasi

Skin Sensitizer

Kanker

Friksi, tekanan kulit melepuhSumbatan oleh glass wool dan rockwool

Iritasi atau alergi gatal-gatal, terluka, melepuh

Melepuh

Kulit mengeras

Suhu ekstrim Sinar matahari, UV, IM, sinar-X, dll.

Efek yang timbul: iritasi/sensitisasi, perubahan warna, gatal, pedih, luka bakar, melepuh, dan kanker

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Tanaman beracun: poison ivy alergiBunga beracun

Efek: kulit memerah dangatal

Bakteri, jamur, parasit dan tungauDidapat di daerah pertanian, bakery, sayur, dan buah-buahan

BEDAKAN DERMATITIS INDUSTRIAL DENGAN BUKAN INDUSTRIAL SEPERTI AKIBAT KOSMETIKA, OBAT, INSEKTISIDA, DLL.

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Deterjen dan pelarut keratinDesikator, zat higroskopis, anhidridaProtein precipitantsHidrolitik, elektrolitikPengoksidasiDerivatif nitro yang toksikKeratogenik, neoplastikAgent biologisAlergi, protein anafilaktikPereduksi

Deterjen dan pelarut keratinminyak alami kulit dan sel kulit larut kulit menjadi kering danmudah terinfeksi

contoh: alkali, terpentin, alkohol, dan sabun

Desikator, zat higroskopis, anhidridamenyerap air dari kulit kulit kering dan panas

contoh: SO2=, PO4=, H2SO4, dll.

Protein precipitantsmenyebabkan koagulasi protein, kulit mengeras

contoh: garam logam berat, HgCl, asam tanat, asam pikrik, fenol, UV, formaldehid, dll.

Hidrolitik, elektrolitikbereaksi dengan air di kulit, terjadi iritasi, panas keluarselama reaksi berlangsung

contoh: gas mustard, NH4NO3

Pengoksidasibereaksi dengan hidrogen O terbebas oksidasi

contoh: FeCl2, H2O2, As, chromat, permanganat, ozon, danamonia

Derivatif nitro yang toksikmelarutkan kulit

contoh: TNT, DNT, fenol, kresol, tetryl, asam pikrat

Keratogenik, neoplastiksel kulit tumbuh berlebih kanker

As, tar, naftilamin, dll.

Agent biologismikroba, parasit infeksi

Alergi, protein anafilaktikreaksi antigen-antibodi dengan membentuk histamin alergi

contoh: tepung, pollen, dll.

Pereduksimembentuk hidrogen bebas reduksi

contoh: asam salisilat, asam oksalat, hidrokarbon alifatik, fenol, naftol, hidrokarbon-aromatik

sub-acute dermatitis from the rubber accelerator, mercaptoben zothiazole

contact dermatitis form exposure to the strong irritant, ethylene oxide

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The skin contact with an irritant results in itchy rash within minutes to an hour. They disappear within twenty-four hours, usually within a few hours. Contact urticaria is also known as nettle rash or hives. It is typified by the wheal (swellings) and flare at the site of contact. The affected person may suffer from itching, tingling or burning sensations. There are other types of urticaria. This includes immune sensitised reaction and happens in people who have previously become sensitised to a causative agent (eg latex protein in rubber gloves). This type of reaction is also called ACD.

Acne is an inflammatory disorder of the sebaceous glands. The skin eruptions from acne may be mild, involving exposed areas of the body, or severe covering of all the body.Occupational acne includes oil acne, coal-tar acne, and chloracne. Others types are related to cosmetics, heat/cold and mechanical forces.

The incidence of oil acne has declined in recent years because of decreased use of neat cutting oils. Better performing oils and improved health and safety standards in the workplace helped this decline further.The eruptions resulting from oil acne are called oil boils. When the exposure is prolonged, skin cancer, such as cancer of the scrotum, may develop. Oil acne amongst oil workers is rare because there are fewer opportunities for prolonged contact with crude oil or the heavier oil fractions.

Chloracne results from exposure to certain halogenated aromatic hydrocarbons (eg polychlorinated biphenyles (PCBc)). Individual lesions of chloracne consist primarily of blackheads, whiteheads and cysts. Choracne occurs mainly on exposed areas of the skin, but following regular exposure, lesions may appear in other regions especially the genital, groin and axillae areas of the body. Chloracne usually begins several weeks or months after the exposure and new lesions may appear even when exposure stops, because there may still be traces of the contaminants in the follicular areas of the skin.

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Coal-tar acne is associated with coal tar-based products and may be aggravated by light/UV.

Skin and eyes are vulnerable and it will cause increased pigmentation as well as acne-related symptoms (eg skin eruptions, blackheads).

Skin pigmentation disorders cause the skin to appear lighter or darker than normal. Pigmentary disorders can be due to hazardous agents found in the workplace (eg: UV, X-rays), environment (eg Sun rays) or ones genetic makeup or reaction to medicines and food. A number of chemicals used at work can cause depigmentaion

Hyperpigmentation by kerosene

Exposure to radiation can lead to skin cancer, most commonly this comes from exposure to the sun. Therefore outside workers are particularly at risk.People who are exposed ionising and non-ionising radiationmay be susceptible to work related cancers.Some chemicals can cause cancer on the skin, others may contribute to cancers found in other parts of the body. The use of unrefined mineral oils has in the past led to skin cancer affecting the exposed skin of the hands and forearms.

Oil-soaked clothing and oily rags kept in overalls caused scrotal cancer. The use of refined oils together with changes in work practice and improved personal hygiene have reduced this risk. Chemicals like Mobca is used in the manufacture of polyurethane products. It can get through the skin and may cause cancer in other parts of the body.

Penyebabzat kimia, konsentrasi pekat, temperaturekstrim tinggi, lama kontak dengan kulit

Klasifikasi luka bakar:tingkat I (first degree burn): merah, panas, gatal, sakit, rasa terbakartingkat II (second degree burn): sangat sakit, melepuh, merah, basah (terbakar lebih dalam)

mudah kena infeksitingkat III (third degree burn): kulit dankaringan bawah kulit habis terbakar

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Burn degree

1

2

3

agriculture/horticulture; catering and food processing; chemicals; cleaning; construction; engineering; hairdressing/beauty care; health care; offshore; printing; rubber.

AGENT/IRITANT

1'RY

IRRITANT

SENSITIZER

MANIFESTATIONS OF IRRITATING ACTION ON THE SKIN TYPICAL OCCUPATION

ACIDS

acetic X Dermatitis & ulcersmanufacturing acetat rayon, printing, dying, hat makers

nitric X Severe skin burn & ulcers

nitric acid worker, ekectroplaters, metal refineries, acid dippers, nitrators, soda makers

sulfuric Xcorrosive action on skin, severe inflammation of mucous membranes

Nitrator, pickers (metal), acid dippers, chemical manufacturing

chromic X XUlcers ('chrome holes') on skin, inflammation and perforation of nasal septum

platers, manufacturing chemicals and dyestuff

ALKALIS

sodium hydroxide XSevere burning of kin, deep-seated persistent ulcers, loss of fingernails

Sodium hydroxide makers, bleacher, soap and dye makers, petroleum refiners,mercerizers, tannery worker

sodium silicate X Thickening of skin, ulcers on fingers bleacher, manufacturing cardboard boxes

sodium or potassium cyanide X Blisters, ulcersElectroplaters, case hardening, extraction of gold

SALTS OR ELEMENTS

Arsenic & its compounds X X

Darkening of skin, perforation of nasal septum, ephitelioma, formation of hornt growth of tissue on palm, ezcema around mounth and nose (possible loss of nails and hair)

Artificaial leather makers, carroter (felt hats), manufaturing insecticides, glass industry and vermicides, manufacturing artificial flowers, calico printing

Mercury compounds X XCorrosion and irrtation of skin, 'mercurial eczema'

Explosive manufacturing, silver and gold extractors, manufactoring electrical appliances and scientific equipment, hat making

Zinc chloride X Ulcers of skin and nasal septum Manufaturing chemical and dyestuffs

AGENT/IRITANT

1'RY IRRITANT

SENSITIZER

MANIFESTATIONS OF IRRITATING ACTION ON THE SKIN TYPICAL OCCUPATION

SOLVENTS

Acetone X Dry (defatted) skin

Spray painters, celluloid industry, artificial silk and leather workers, acetylene workers, lacquer and varnish makers, electrical equipment manufacturing

Benzene and its homologues (toluene and xylene) X Dry (defatted) skin

Chemical, rubber, and artificial letaher manufacturing, dry cleaning

Terpentine X X Red or blistered skin, eczema Painters, furniture polisher, lacquuerers

SOME DYES INTERMEDIATES

Chlorinated compounds X Blisterlike eruptions Dye manufaturing

Dinitrochlorobenzene X X Blisterlike eruptions Dye manufaturing

Nitro and nitroso compound X Red skin and eczeme eruptions Dye manufaturing

ACNE PRODUCERS

Petroleum oil XInflammation of hair follicle, acne, skin ulcers, boils, malignant tumor Petroleum workers, machinists, mechanics

Tar (coal) X X Acne, eczema, and malignant tumorsTar manufacturing, roofing paper, felt, and pitch, road building and repairing

DYES

Including chemicals handled in sye manufacturing X Red skin, blisterlike eruptions Dye worker

PHOTO DEVELOPERS

Metal dichromated, amicdol, quinone, para aminophenol, etc. X Red skin, blisterlike eruptions Photo developers

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AGENT/IRITANT

1'RY

IRRITANT

SENSITIZER

MANIFESTATIONS OF IRRITATING ACTION ON THE SKIN

TYPICAL OCCUPATION

RUBBER ACCELATORS AND ANTI OXIDANTS

Hexamethylenetetra-mine, para phenylenediamine, pada nitrosodimethylaniline, and phenyl naphthylamine (B) X

Itchy skin, dermatitis - usually called'rubber itch'

Rubber workers, such as compound mixers and calender and mill operators

SOAP AND SOAP POWDER

containing an excess of free alkalis XEczema, blisterlike eruptions, chronic ancesses

Soap manufacturing, dishwashers, scrub-women, soda fountain clerks

INSECTICIDES

Arsenic X Red skin, blisters Manufacturing and appling insencticides

OILS

Cashew nut oil X Severe dermatitis as blisters Handlers of unprocessed cashew nuts

Cutting oils-oil emulsion or soluble oil mixtures X Oil acne, inflammation of hair follicle Machinists

RESINS

Coal tar products such as pitch and asphalt X X

Acute dermatitis, 'shagreen skin', acne, inflammation around hair follicle, ephiteliomaous cancer, eczema, ulcers

Manufacturing various coal tar products, road making, gas manufacturers

EXPLOSIVE

Chlorates, nitrates, mercury fulminate, tetryl, lead styphnate, TNT, amatol, DNT, dinitrophenil, etc. X Red skin, papular eruptions, severe irritations Explosive manufacturing, shell loading

CEGAH KONTAKPemeriksaan sebelum kerja riwayat alergiFaktor penentu: warna kulit, kesehatan, kulitbermunyak.kering, banyak berkeringat, jeniskelamin, dietHigiene memelihara kebersihan: sabunDeteksi dini: pemeriksaan periodik, lapor diriSupervisi: perawatan oleh perawatIsolasi-substitusi bahan/proses: LEV, GVAPD

Sarung tanganBaju, sepatuKebersihan APDCream pelindung terhadap iritan

berbasis sabun, larut airrepellent pelarut, dasar oli/gum seperti memberisarung tangan yang tidak tampak. Efektif terhadappelarut, mempermudah menghilangkan cat, dll.repellent air, lanolin, petroleun jelly, ethyl cellulose atau silicone yang memberi selaput yang tahan airtipe khusus: campuran zat khusus misalnyaterhadap fotosensitizers sun-exposure, poison ivy, insekta, dll.

Efek:Kekurangan cairan dehidrasi, shock, sakit sekali/pingsanInfeksi

P3K:Bilas dengan air:mata fountain, badan showerTutup/lindungi lukaBila shock infusBila ada hazardous information sheet siapkan antidotum, beri antidotum

Flush area immediately with large quantities of fresh water, using an installed deluge shower or hose, if available. Avoid excessive water pressure. Continue to flush the area for at least 15 minutes while removing the clothes, including shoes, socks, and jewelry. Dry lime powder (alkali burns) creates a corrosive substance when mixed with water; keep the powder dry and remove it by brushing it from the skin. Acid burns caused by phenol (carbolic acid), should be washed with alcohol. Then wash the area with large quantities of water. If alcohol is not available, flush the area with large quantities of water. Cover chemical burns with a sterile dressing. Material Safety Data Sheet (MSDS) for the chemical. Flush the eyes with fresh water immediately using an installed emergency eye/face bath or hose on low pressure for at least 20 minutes. Ask casualty to remove contact lenses. Use your hands to keep the eyelids open. Never use a neutralizing agent, mineral oil, or other material in the eyes.

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Monitor the airway, breathing, and circulation (ABCs). Warning - Do not attempt to neutralize any chemical unless you are sure what it is and what substance will effectively neutralize it. Further damage may be done by a neutralizing agent that is too strong or incorrect. Do not apply creams or other materials to chemical burns. Treat for shock - Keep the casualty comfortable and warm enough to maintain normal body temperature. Request medical assistance for all chemical burns. If possible, before transport, notify medical personnel of the name and other pertinent information about the chemical involved, location of the burn, and percentage of the body area affected. Send the container to medical personnel with the casualty.

For every task undertaken at your workplace, know what products or substances are being used or generated. Find out what are the health and safety hazards associated with each of the substance or product used or generated. Find out whether these substances carry warnings signs and hazard information on dangers to the skin. You can find these on product labels and/or in Safety Data Sheets. SDS must be provided by the supplier of the chemical. Frequent contact with water (wet working) is a major cause of WRD. Some substances (eg: formaldehyde in metal working fluids) may be generated during work and can cause WRD. Take account of wet work and substances generated during work in the next step. Find out which of your employees are exposed to these substances, how does their skin come into contact, for how long and the frequency.

Find out what control measure you have in place. Based on these make a judgement whether your employees are at risk of getting work related dermatitis. If there is a risk of WRD, can you get rid of the chemical altogether? This is the best and simplest solution. If you cannot get rid of the offending chemical, can you able to replace it with a less harmful chemical. Seek the advice of your Trade Association. Introduce process controls so that skin does not come into contact with the chemical. If the contact is by immersion, or splash find a solution that would provide a safe working distance (SWD) between the chemical and the skin.If the exposure is due to dust, vapour in the air, install a ventilated enclosure or provide local exhaust ventilation. Consult “COSHH Essentials”. It is likely to provide a suitable engineering control for your task.

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If you have provided all the above controls and you consider that skin exposure could not be prevented altogether, then provide chemical protective gloves and coverall as appropriate. Selection of gloves is a complicated process. Always seek the help of your chemical supplier or a reputable PPE supplier. Make sure employees: have been taught on safe working practices; use the controls provided; have been trained to correctly use process equipment and PPE; know how to check their skin for signs of dermatitis; understand the benefits and limitations of skin care creams. Provide mild skin cleaning cream that will do the job and washing facilities with hot and cold water. Tell employees to clean their hands before consuming drinks and food or before wearing gloves. Ensure pre and post work creams are used. Seek the help of occupational health professionals if you suspect that you may have dermatitis problem at your workplace. Put in place a management system that checks that all of these actions are carried out in practice.

You should take particular care if you have:fair or freckled skin that doesn’t tan, or goes red or burns before it tans; red or fair hair and light coloured eyes; a large number of moles.

In the short term, even mild reddening of the skin from sun exposure is a sign of damage. Sunburn can blister the skin and make it peel.

Longer term problems can arise. Too much sun speeds up ageing of the skin, making it leathery, mottled and wrinkled. The most serious effect is an increased chance of developing skin cancer.

Keep your top on. Wear a hat with a brim or a flap that covers the ears and the back of the neck. Stay in the shade whenever possible, during your breaks and especially at lunch time. Use a high factor sunscreen of at least SPF15 on any exposed skin. Drink plenty of water to avoid dehydration. Check your skin regularly for any unusual moles or spots. See a doctor promptly if you find anything that is changing in shape, size or colour, itching or bleeding.

SELAMAT UTS