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o ther dermatoses R:Rosenstock. By M.H.Davari MD Shahid Sadoughi University of medical sciences. Work-related health problems as reported by UK occupational physicians during 1996. Problem Musculoskeletal Dermatological Respiratory Hearing loss Other . Percentage 45.3 23.4 9.2 - PowerPoint PPT Presentation
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OTHER DERMATOSESR:ROSENSTOCK
By M.H.Davari MDShahid Sadoughi University of medical sciences
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Work-related health problems as reported by UK occupational physicians during 1996
Problem
Musculoskeletal
Dermatological
Respiratory
Hearing loss
Other
P.M
Percentage
45.3
23.4
9.2
8.7
13.9
Thirty percent of occupational injury and 40% of occupational disease are dermatologic
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OCCUPATIONAL ACNE
1. Oil acne (folliculitis) Pathogenesis: hair follicle is particularly
susceptible to irritation from lipids plugging of the follicle (comedo formation) or induce an inflammatory reaction by rupture of the
follicular wall (folliculitis) Petroleum distillates, cutting oils, pitch, and tar
Clinical course: dorsae of the hands and forearms
Diagnosis: area of involvement history
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Age: any age Prevention:
Protective clothing Mandatory daily laundering of work clothes
Treatment: similar to those for routine acne Oral antibiotics (tetracycline and erythromycin) Topical antibiotics (clindamycin; erythromycin) Refractory Comedones long-term topical retinoids
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ACNE VULGARIS
Persons at risk: workers in fast food restaurants, actors, actresses, models, and cosmeticians
Age: peak 11-20 yrs Pathogenesis: in addition to oil, Friction, heat, and
sweating Clinical course: face, neck, upper chest and back Diagnosis: history of exposure Treatment and prognosis: like oil acnea
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Viktor Yushchenko, the Ukranian President who was supposedly assassinated by the KGB with dioxin poisoning.
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CHLORACNE
Sensitive indicator of systemic exposure to specific polyaromatic hydrocarbons
Persons at risk include workers: hydrocarbonbased pesticides and herbicides, electrical workers exposed to older polychlorinated biphenyl (PCB)
Pathogenesis: follicular level of the agent may be of greatest importance
Clinical course: pale yellow (straw) cyst + comedo inflammatory papules and pustules of acne vulgaris are
not evident postauricular folds, the malar crescent, and the genitalia. The nose typically is spared onset within 2w–2m regress over a 4–6m (1-2 yr)
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Non-cutaneous findings: Hepatomegaly, Hepatic porphyria, Peripheral neuropathy
TCDD causing chloracne at the lowest concentrations
Diagnosis: history of exposure (suggest) Serum levels of suspect compounds and
metabolites should be obtained (confirmation of exposure) (GC/MS)
Biopsy cause loss of follicular sebaceous glands (DDX: actinic elastotic comedones)
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Treatment: Difficult Oral antibiotics, topical retinoic acid, and oral
isotretinoin Cyst formation prevent by early retinoid therapy
Prevention: Even minute exposures must be avoided shower facilities Use disposable clothing for workers Routinely monitor for plant contamination using
wipe samples Routinely educate and monitor workers.
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PIGMENTARY DISORDERS
1. Hyperpigmentation Types:
1. Exogenous pigment deposition2. Deposition in skin systemically3. Photoeruptions (more common)4. PIH (more common)Or by wood lamp examination:5. Epidermal?6. Dermal7. Mix
Workers at risk: heavy metals, organic nitrogen compounds and dyes
17 Hyperpigmentation: nitro compounds and dyes that stain skin
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Hyperpigmentation: metals that may be systemically or locally deposited in skin
Clinical course: The most striking form of dyspigmentation is
argyria due to systemic deposition of silver. Pigmentation from heavy metal toxicity exacerbated
by exposure to the sun PIH occurs at the sites of skin injury
Diagnosis:1. History & examination2. Wood lamp examination3. Biopsy
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Prevention: Sun screen Protective clothes (exposure to organic dye-like
component) Treatment:
Tattoos and systemic heavy metal toxicity may be irreversible
PIH: may persist for months (dark skin)1. Retinoic acid2. Hydroquinone
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2. Hypopigmentation:1. PIH
Cutaneous injury, from inflammation or trauma2. Leukodermia
Hydroquinone or derivatives of alkyl phenols and catechols
Workers at risk: rubber workers, photographic developers, hospital housekeepers, printers, and workers in the oil, paint and plastics industries
Pathogenesis: direct cytotoxic effect on melanocytes formation of antigens, which activate
lymphocytes Diagnosis : wood lamp Treatment:
1. long-term PUVA2. allograft
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Picture of a phototoxic drug reaction
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PHOTODERMATOSES
UVA: aging, occupational dermatosis UVB: sun burn UVA,B,C: carcinogen
Outdoor occupationsPhototoxic: Nonimmunologic, reactive O2, improve immediately with avoidancePhoto allergic: type IV imune reaction, substance convert to hapten, Not improve immediately with avoidance
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PHOTOTOXIC AGENTS
Some common plants containing furocoumarins
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Picture of photoallergic and phototoxic dermatides
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Diagnosis: History of sun exposure Typical photodistribution Exposure to photoactive substances biopsy may be helpful to exclude other causes of
photosensitivity (lupus erythematosus, medications)
Prevention: Sunscreens: (SPF) rating of #15 or better ,(which
is less effective in preventing UVA) Use of protective clothing EPA (enviromental protection agency)
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Treatment: open-wet dressings bland emollients Rarely systemic steroids for severe cases.
Prognosis: Workers with clinical signs of chronic sun
exposure are at risk for cutaneous malignancies and should be followed closely
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ERYTHEMA AB IGNE
The area usually is regional corresponding to the site of repeated applications of heat
Workers exposed to furnaces, such as cooks, stokers, glass blowers, and kiln operators
Clinical course: Early:
vasodilation (livedo reticularis)Later:
Poikiloderma(epidermal atrophy, telangiectasia, and pigment alteration)
SCC and Merkel cell carcinomas occur in the poikilodermatous area
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Diagnosis: The local nature of the condition, along
with a history of exposure to heat, is suggestive
Biopsy: exclude other conditions associated with livedo reticularis
Prevention: Repeated exposure avoidedEducation of workers at risk is the key to
prevention. Treatment
Cessation of exposure in early changes.permanent change: monitored for future
development of skin carcinoma
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MILIARIA
Bakers, foundry workers, cooks, coke oven operators, and workers with similar exposure to excessive heat that causes sweating
blockage of the sweat ducts Trunk: most commonly affected location, especially the
chest, back, submammary, and axillary areas Clinical lesions are on a spectrum encompasssing clear vesicles 1. if the blockage is in the superficial epidermis (miliaria
crystallina)2. macules or papules if the blockage is in the lower
epidermis (miliaria rubra) or3. flesh-colored to pale white papules if the obstruction is
in the dermis (miliaria profunda).
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Symptoms usually are absent with miliaria crystallina, while miliaria rubra and miliaria profunda may be pruritic or painful
May lead to inadequate body thermoregulation with accompanying heat exhaustion
Pathogenesis: Sweating and maceration cause plugging of
the eccrine sweat duct with ductal keratin. Microbial organisms may invade the macerated keratin and cause further plugging of the duct
Diagnosis: clinical picture, symptoms, and the history of onset
after excessive heat exposure and sweating.
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Prevention: exposures should be avoided Hexachlorophene soap decrease bacterial population. Maceration of the skin should be avoided by frequent
clothing changes when sweating is profuse. Treatment and prognosis
Removal A period of a week or more should elapse before re-
exposure of the individual to the hot environment is attempted, particularly if the eruption is severe enough to cause a decrease in systemic heat tolerance.
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Cleaners of vinyl chloride polymerization reactor tanks1. Raynaud’s phenomenon 2. Osteolytic bone changes3. sclerodermia
Silica dust have been reported to be at risk for developing:1. Raynaud’s phenomenon2. Scleroderma
organic solvents has also been associated with: systemic sclerosis
OCCUPATIONAL ACRO-OSTEOLYSIS AND SCLERODERMA
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Diagnosis: Patients presenting with Raynaud’s phenomenon
without a history of vibration exposure should be questioned regarding exposure to vinyl chloride, silica, organic solvents, and epoxy resins
Prevention Workers cleaning polymerization reactor tanks of vinyl
chloride need complete skin and respiratory protection.
Respiratory protection also is critical in those workers exposed to silica.
All workers with Raynaud’s phenomenon, whether or not the condition is job related, should have protection of their hands from cold weather
Treatment and prognosis Acro-osteolysis stabilize after withdrawal from vinyl
chloride monomer exposure Scleroderma of any cause, however, tends to be
progressive.
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FOREIGN BODY REACTIONS
Workers in construction, electronics, metal working, and mining1. Fiberglass (extremely pruritic)2. Beryllium3. Sillica 4. unusual form clam diggers as a result of exposure
to avian schistosomes5. Hairdressers
Acute reactions resemble irritant dermatitis. Chronic reactions typically are more
papulonodular Secondary bacterial infection may
complicate the clinical picture
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Pathogenesis: A granulomatous respons is typically a non-
allergic response Beryllium is due to delayed hypersensitivity
Treatment and prognosis Localized granulomas of any cause may be
treated surgically. Topical therapies including open wet
dressings and topical steroids are useful in the treatment of acute foreign body reactions.
Fiberglass may be removed by using tape stripping of the skin.
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BIOLOGIC CAUSES OF OCCUPATIONAL DISEASESBACTERIAL DISEASES: work with animals and those in the
construction trades
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FUNGAL DISEASES
workers at greatest risk are thosein the agricultural trades
Candida and dermatophyte infections are the most common superficial fungal infections
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An unusual variant of tinea pedis (one hand–two feet tinea) needs to be considered in the differential diagnosis of hand dermatitis
Diagnosis: potassium hydroxide examination of scale fungal culture
Treatment: Topical antifungal agents usually are adequate
for treatment, although occasionally administration of oral antifungals (griseofulvin, ketoconazole, itraconazole, terbinafine) is necessary
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VIRAL DISEASES
HSV1/2 infection of the finger (herpetic whitlow) 1. Healthcare workers.2. Farm workers 3. Meat handlers
Untreated infections last for 1 to 2 weeks Athough therapy with oral antivirals is helpful in
shortening the course. Diagnosis:
Tzanck smear, showing multinucleated giant cells viral culture
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PARASITIC DISEASES
Parasites are unusual causes of occupational disease in temperate climates
However, workers in developing countries are at particular risk.
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