3 - 27 - OCCUPATIONAL SKIN DISEASES Flashcards
exposure classification of organic and inorganic compounds, elemental substances
chemical
exposure classification of friction, pressure, vibration
Mechanical
exposure classification of ionizing and nonionizing radiation, thermal stress
Physical
esults from a nonimmunologic reaction to a chemical, physical, or mechanical irritation of the skin causing cutaneous inflammation via a direct cytotoxic effect from an agent
Irritant contact dermatitis
exposure classification of bacteria, viruses, fungi, parasites, insects, plants, animals
Biologic
reaction to a substance by a type IV, delayed hypersensitivity reaction
ACD
requires prior sensitization to an allergen, which is usually a low-molecular weight chemical that acts as a hapten
differentiate ICD from ACD
Atopic dermatitis is known to increase the susceptibility of skin to irritants but not to allergens
consequence of multiple subthreshold insults to the skin with insufficient time between insults to allow complete restoration of the skin barrier function
Cumulative Irritant Contact Dermatitis
Clinical symptoms develop only when the damage exceeds an individually determined manifestation threshold.
treatment of Burning metal fragments of sodium, potassium, and lithium
- Extinguish with Class D fire extinguisher (containing sodium chloride, sodium carbonate or graphite base) or with sand;
- cover with mineral oil;
- extract metal particles mechanically
Use of water to extinguish burning metal fragments is contraindicated because of the formation of highly alkaline hydroxides.
treatment for Hydrofluoric acid
- Flush with running water;
- then administer calcium gluconate gel (2.5%) followed by intralesional injection, if needed
treatment of White phosphorus
- vigorous water washing
- copper (CuSO4) sulfate
treatment of Phenolic compounds
treatment of Bromine or iodine
Wash frequently with soap and water followed by treatment with 5% sodium thiosulfate.
may arise after acute skin trauma, such as lacerations, burns, or acute ICD
Traumatic Irritant Contact Dermatitis
The latter is seen frequently after use of harsh cleansers, and inquiring if patients have cleansed their skin with strong soaps or detergents is warranted.
- unique variant seen predominantly in elderly individuals with a history of extensive usage of soaps and cleansing products.
- This leads to dry-appearing skin with ichthyosiform scaling, and patients experiencing intense pruritus
Asteatotic Dermatitis
result from exposure to specific irritants such as croton oil, mineral oils, tars, greases, and naphthalenes
Pustular and Acneiform Irritant Contact Dermatitis
- This syndrome should always be considered when acneiform lesions develop in postadolescent patients who never had teenage acne.
- The pustules are sterile and transient.
characterized by the lack of objective clinical signs as individuals complain of a sensation of burning or stinging (sensory irritation) after contact with certain chemicals.
Subjective Irritant Contact Dermatitis
Though no visible cutaneous irritation is generally observed, these reactions are usually dose-related and have been observed with chemicals such as lactic acid, which can be found in cosmetic products
transient wheal and flare reaction from direct contact with a chemical or protein agent
Contact urticaria (CU)
Lesions appear within minutes to an hour and resolve within hours after exposure
caused by a wide array of agents in exposed individuals who develop a wheal and flare reaction without previous sensitization
NONIMMUNOLOGIC CONTACT URTICARIA
not inhibited by H-1 antihistamines, but oral or topical nonsteroidal antiinflammatory medications are effective
Most Frequently Reported Occupational Skin Allergens
Identify the stage of Immunologic Contact Urticaria
Generalized urticaria
Stage 2
Identify the stage of Immunologic Contact Urticaria
Urticaria and rhinoconjunctivitis, asthma, or GI symptoms
Stage 3
Identify the stage of Immunologic Contact Urticaria
Localized urticaria, dermatitis, or nonspecific symptoms (itching, tingling, burning, etc.)
Stage 1
Identify the stage of Immunologic Contact Urticaria
Anaphylaxis
Stage 4
This type of reaction may occur with substances that produce a CU and a generalized histamine-type reaction but lacks a direct or immunologic basis for the reaction.
CONTACT URTICARIA OF UNCERTAIN MECHANISM
Contact urticaria of uncertain mechanism is most commonly caused by what substance?
ammonium persulfate in bleaching hair boosters
typically has a sudden onset characterized by erythema, edema, severe pruritus, urticaria, and occasionally syncope with wheezing and dyspnea
Exposures to certain dioxins, naphthalenes, biphenyls, dibenzofurans, azobenzenes, and azoxybenzenes also have been associated with one of the more notable forms of acne
chloracne
Chloracne from these chemical exposures are typically characterized by multiple closed comedones and straw-colored cysts primarily over the malar crescents and retroauricular folds that may also involve the neck, trunk extremities, buttocks, scrotum, and penis
most important cause for all types of skin cancer to include melanoma, squamous cell carcinoma, and basal cell carcinoma
Ultraviolet radiation (UV), both natural and artificial
Outdoor workers, loosely defined as individuals who work outdoors for how many hours?
3 or more hours on a typical workday
They are at high risk of harmful UV exposure and development of skin cancer
Three measures successful in the prevention of skin cancer in outdoor workers
- regular use of sunscreen,
- protection from direct UV radiation by suitable clothing,
- changes in behavior with awareness of health and diseases resulting from exposure to UV radiation
Even with recommended strategies to use protective measures such as wide-brimmed hats, longsleeve shirts and pants, sunscreen, and avoiding peak UV times (10 ÏÐ to 3 ÑÐ), many studies have shown inadequate use of sun protection measures by outdoor workers
It is responsible for fish tank granuloma (also known as swimming pool granuloma), a distinct infection presenting as a warty nodule or plaque usually at a point of trauma, often 6 weeks after exposure.
Mycobacterium marinum
- acid-fast, nontuberculous mycobacterium
- Vectors of the infection include fresh or salt water fish, shellfish, snails, water fleas, or dolphins
- Human infection is associated with handling of decaying animal products such as fish, shellfish, mammals, and poultry.
- Infection occurs when a worker has a predisposing insult to the skin, such as an abrasion or cut that allows entry of the bacteria
Erysipeloid (Fish-Handler Disease)
*caused by gram-positive bacterium Erysipelothrix rhusiopathiae
Occupations at risk include fisherman, butchers, farmers, veterinary surgeons, and poultry dressers
Pitted keratolysis is a rather common dermatologic condition caused by what organism?
gram-positive bacterium (usually Corynebacterium species)
infects the stratum corneum of the plantar skin, leading to malodor, hyperhidrosis, and sliminess of the skin
Though well documented among bare-footed laborers, such as paddy farmers in the tropics, it is also observed in soldiers, miners, and laborers as a result of occlusive, protective shoe-wear that creates a warm and moist environment for the bacteria.
Pitted Keratolysis
- multisystem disease that presents with symptoms such as fevers, night sweats, myalgia, weight loss, and arthralgia but has a propensity for more serious chronicity.
- Occupationally, the disease is contracted through inhalation of contaminated aerosols, contact with conjunctival mucosa, or entry of bacteria through cuts in the skin as a result of contact with infected animals or their products
- Cutaneous findings are often nonspecific, and findings include disseminated papular and nodular eruptions, nodosum-like erythema, extensive purpura, diffuse macular and papular rash, chronic ulcerations, and abscesses
Brucellosis
Tularemia is a potentially severe zoonosis caused by Francisella tularensis, a gram-negative bacterium transmitted by what vectors?
ticks, fleas, deerflies
also transmitted by ingestion, inhalation, or direct contact with infected tissues
Health care workers in tularemia-endemic areas should consider a diagnosis of tularemia in landscapers who have fever or pneumonia
The most common presentation of tularemia
ulceroglandular form
ulcer arises at the site of inoculation and regional lymphadenopathy develops
Bartenders, waitresses, and food handlers are prone to developing what fungal infection?
candida skin infections as a result of their wet work, which provides a favorable environment for the yeast in macerated skin near the nails and between the digits
puncture wounds from thorns, splinters, sticks, and sphagnum moss can lead to what disease?
sporotrichosis
caused by Sporothrix schenckii
zoonotic infection caused by a parapoxvirus that commonly infects **sheep and goats **and is transmitted to humans through contact with infected animals or fomites
Orf (Ecthyma Contagiosum)
Veterinarians, sheep herders, and farmers are most at risk, though it has been reported in children after visiting petting zoos and livestock fairs
viral infection transmitted by direct contact from infected cows’ udders to farmers, veterinarians, and also fresh meat handlers
Pseudocowpox (Milker Nodule)
Butcher wart virus
HPV-7
3 bloodborne viruses that are known to pose a serious occupational threat to health care workers
- hepatitis B virus (HBV),
- hepatitis C virus (HCV)
- HIV
allergy test used for the identification of IgE-mediated immediate hypersensitivity reactions (eg, immunologic contact urticaria)
skin prick testing (SPT)
- The skin prick introduces a small amount of allergen into the epidermis eliciting a localized response in the form of a wheal and erythema at the site of testing when positive.
- the test is used to help make a diagnosis when contact urticaria is suspected
Diagnostic algorithm for evaluation of contact urticaria
wet work conditions is defined as exposure of skin to liquid for more than how many hours per day?
2 hours per day, use of occlusive gloves for more than 2 hours per day, or frequent handwashing
Health risk assessment
The initial step to identify workplace hazards should incorporate knowledge from industries involving similar work practices and recognize potential injuries and illnesses that can result from related exposures
HAZARD IDENTIFICATION
4 main components of health risk assessments
(1) hazard identification,
(2) dose-response relationship,
(3) exposure assessment, and
(4) risk characterization
identify the health risk assessment.
Hazardous chemicals, in particular, legally require Safety Data Sheets (SDSs, formerly known as Material Safety Data Sheets [MSDSs]), which display not only chemical properties but also adverse health effects, protective equipment necessary for safe handling, and first aid measures for acute exposure treatment among others.
HAZARD IDENTIFICATION
helps delineate relative threshold concentrations of an exposure that results in adverse health effects
DOSERESPONSE RELATIONSHIP
For many OCDs, the adverse effects are often dose-dependent with exposure
It is important to recognize health conditions (eg, atopic dermatitis) that can contribute to adverse health effects (eg, ICD) at lower exposure doses.
The work task duration and frequency should also be noted as adverse health effects can not only be dose-dependent but time-dependent as well.
This exemplifies what health risk assessment
exposure assessment
monitoring is often performed since certain toxic substances have legal permissible exposure limits (PELs) enforced by OSHA
This exemplifies what health risk assessment
Exposure assessment
The National Institute for Occupational Safety and Health (NIOSH) and American Conference of Governmental Industrial Hygienists (ACGIH) provide recommended exposure limits that are based on adverse health effects.
This exemplifies what health risk assessment?
Exposure Assessment
