3 - 27 - OCCUPATIONAL SKIN DISEASES

Question 1

exposure classification of organic and inorganic compounds, elemental substances

Answer 1

chemical

Question 2

exposure classification of friction, pressure, vibration

Answer 2

Mechanical

Question 3

exposure classification of ionizing and nonionizing radiation, thermal stress

Answer 3

Physical

Question 4

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

Answer 4

Irritant contact dermatitis

Question 5

exposure classification of bacteria, viruses, fungi, parasites, insects, plants, animals

Answer 5

Biologic

Question 6

reaction to a substance by a type IV, delayed hypersensitivity reaction

Answer 6

ACD

requires prior sensitization to an allergen, which is usually a low-molecular weight chemical that acts as a hapten

Question 7

differentiate ICD from ACD

Answer 7

Atopic dermatitis is known to increase the susceptibility of skin to irritants but not to allergens

Question 8

consequence of multiple subthreshold insults to the skin with insufficient time between insults to allow complete restoration of the skin barrier function

Answer 8

Cumulative Irritant Contact Dermatitis

Clinical symptoms develop only when the damage exceeds an individually determined manifestation threshold.

Question 9

treatment of Burning metal fragments of sodium, potassium, and lithium

Answer 9

• 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.

Question 10

treatment for Hydrofluoric acid

Answer 10

• Flush with running water;
• then administer calcium gluconate gel (2.5%) followed by intralesional injection, if needed

Question 11

treatment of White phosphorus

Answer 11

• vigorous water washing
• copper (CuSO4) sulfate

Question 12

treatment of Phenolic compounds

Answer 12

Question 13

treatment of Bromine or iodine

Answer 13

Wash frequently with soap and water followed by treatment with 5% sodium thiosulfate.

Question 14

may arise after acute skin trauma, such as lacerations, burns, or acute ICD

Answer 14

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.

Question 15

• 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

Answer 15

Asteatotic Dermatitis

Question 16

result from exposure to specific irritants such as croton oil, mineral oils, tars, greases, and naphthalenes

Answer 16

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.

Question 17

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.

Answer 17

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

Question 18

transient wheal and flare reaction from direct contact with a chemical or protein agent

Answer 18

Contact urticaria (CU)

Lesions appear within minutes to an hour and resolve within hours after exposure

Question 19

caused by a wide array of agents in exposed individuals who develop a wheal and flare reaction without previous sensitization

Answer 19

NONIMMUNOLOGIC CONTACT URTICARIA

not inhibited by H-1 antihistamines, but oral or topical nonsteroidal antiinflammatory medications are effective

Question 20

Most Frequently Reported Occupational Skin Allergens

Answer 20

Question 21

Question 22

Identify the stage of Immunologic Contact Urticaria

Generalized urticaria

Answer 22

Stage 2

Question 23

Identify the stage of Immunologic Contact Urticaria

Urticaria and rhinoconjunctivitis, asthma, or GI symptoms

Answer 23

Stage 3

Question 24

Identify the stage of Immunologic Contact Urticaria

Localized urticaria, dermatitis, or nonspecific symptoms (itching, tingling, burning, etc.)

Answer 24

Stage 1

Question 25

# Identify the stage of Immunologic Contact Urticaria Anaphylaxis

Answer 25

Stage 4

Question 26

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.

Answer 26

CONTACT URTICARIA OF UNCERTAIN MECHANISM

Question 27

Contact urticaria of uncertain mechanism is most commonly caused by what substance?

Answer 27

**ammonium persulfate** in bleaching hair boosters ## Footnote typically has a sudden onset characterized by erythema, edema, severe pruritus, urticaria, and occasionally syncope with wheezing and dyspnea

Question 28

Exposures to certain dioxins, naphthalenes, biphenyls, dibenzofurans, azobenzenes, and azoxybenzenes also have been associated with one of the more notable forms of acne

Answer 28

chloracne ## Footnote 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

Question 29

most important cause for all types of skin cancer to include melanoma, squamous cell carcinoma, and basal cell carcinoma

Answer 29

Ultraviolet radiation (UV), both natural and artificial

Question 30

Outdoor workers, loosely defined as individuals who work outdoors for how many hours?

Answer 30

3 or more hours on a typical workday ## Footnote They are at high risk of harmful UV exposure and development of skin cancer

Question 31

Three measures successful in the prevention of skin cancer in outdoor workers

Answer 31

* 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 ## Footnote 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

Question 32

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.

Answer 32

Mycobacterium marinum ## Footnote * acid-fast, nontuberculous mycobacterium * Vectors of the infection include fresh or salt water fish, shellfish, snails, water fleas, or dolphins

Question 33

* 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

Answer 33

**Erysipeloid (Fish-Handler Disease)** *caused by gram-positive bacterium Erysipelothrix rhusiopathiae ## Footnote Occupations at risk include fisherman, butchers, farmers, veterinary surgeons, and poultry dressers

Question 34

Pitted keratolysis is a rather common dermatologic condition caused by what organism?

Answer 34

gram-positive bacterium (usually **Corynebacterium** species) ## Footnote infects the stratum corneum of the plantar skin, leading to malodor, hyperhidrosis, and sliminess of the skin

Question 35

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.

Answer 35

Pitted Keratolysis

Question 36

* 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

Answer 36

Brucellosis

Question 37

Tularemia is a potentially severe zoonosis caused by Francisella tularensis, a gram-negative bacterium transmitted by what vectors?

Answer 37

ticks, fleas, deerflies ## Footnote 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

Question 38

The most common presentation of tularemia

Answer 38

ulceroglandular form ## Footnote ulcer arises at the site of inoculation and regional lymphadenopathy develops

Question 39

Bartenders, waitresses, and food handlers are prone to developing what fungal infection?

Answer 39

**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

Question 40

puncture wounds from thorns, splinters, sticks, and sphagnum moss can lead to what disease?

Answer 40

sporotrichosis ## Footnote caused by Sporothrix schenckii

Question 41

zoonotic infection caused by a **parapoxvirus** that commonly infects **sheep and goats **and is transmitted to humans through contact with infected animals or fomites

Answer 41

Orf (Ecthyma Contagiosum) ## Footnote Veterinarians, sheep herders, and farmers are most at risk, though it has been reported in children after visiting petting zoos and livestock fairs

Question 42

viral infection transmitted by direct contact from infected cows’ udders to farmers, veterinarians, and also fresh meat handlers

Answer 42

Pseudocowpox (Milker Nodule)

Question 43

Butcher wart virus

Answer 43

HPV-7

Question 44

3 bloodborne viruses that are known to pose a serious occupational threat to health care workers

Answer 44

* hepatitis B virus (HBV), * hepatitis C virus (HCV) * HIV

Question 45

allergy test used for the identification of IgE-mediated immediate hypersensitivity reactions (eg, immunologic contact urticaria)

Answer 45

skin prick testing (SPT) ## Footnote * 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

Question 46

Diagnostic algorithm for evaluation of contact urticaria

Answer 46

Question 47

Question 48

wet work conditions is defined as exposure of skin to liquid for more than how many hours per day?

Answer 48

**2 hours per day**, use of occlusive gloves for more than 2 hours per day, or frequent handwashing

Question 49

# 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

Answer 49

HAZARD IDENTIFICATION

Question 50

4 main components of health risk assessments

Answer 50

(1) hazard identification, (2) dose-response relationship, (3) exposure assessment, and (4) risk characterization

Question 51

# 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.

Answer 51

HAZARD IDENTIFICATION

Question 52

helps delineate relative threshold concentrations of an exposure that results in adverse health effects

Answer 52

DOSERESPONSE RELATIONSHIP ## Footnote 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.

Question 53

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

Answer 53

exposure assessment

Question 54

monitoring is often performed since certain toxic substances have legal permissible exposure limits (PELs) enforced by OSHA This exemplifies what health risk assessment

Answer 54

Exposure assessment

Question 55

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?

Answer 55

Exposure Assessment