Occupational Dermatoses

Question 1

what causes the majoirty of occupational dermatoses?

Answer 1

Contact Dermatitis

Question 2

What are the most common causes of ACD in occupational dermatoses?

Answer 2

Rubber> nickel>epoxy + resins> aromatic amines

Question 3

MC cause of occupational irritant ICD?

Answer 3

Soaps> wet work> petroleum products> solvents> cutting oils> coolants

Question 4

History components that lead you to occupational dermatoses?

Answer 4

Gets better when away from work, when chronic this is less clear cut. Covered areas are unusual sites of dz onset. Spread to distant sites is more common in ACD.

Question 5

How do you make the dx of ACD from the workplace?

Answer 5

Test with work materials. You can do dilutional series with the testing if unknown substances to confirm that the rxn is allergic rather than irritant

Question 6

What is a risk factor for ICD?

Answer 6

Prior eczema

Question 7

What are two chemicals that can have a delayed-type chemical burn/irritant rxn?

Answer 7

Phenol and hydrofluoric acid

Question 8

4 strong acids used in the workplace that can cause ICD?

Answer 8

sulfuric, nitric, hydrochloric, chromic

Question 9

What is the mechanism for damage from strong acids?

Answer 9

Coagulate skin proteins –> forms barrier that impedes further penetration

hydrofluoric acid though can cause liquefactive necrosis and penetrates down to the bone.

Question 10

How do you neutralize hydrofluoric acid?

Answer 10

calcium gluconate gel

Question 11

What are some strong alkalis?

Answer 11

Sodium, calcium, potassium hydroxide, wet cement, sodium + potassium cyanides

Question 12

What are alkalis worse than acids?

Answer 12

Degradation of lipids + saponification of resulting fatty acids form soaps–> aid penetration of alkalis deeper into skin.

Question 13

what are some organic and inorganic chemicals that can cause chemical burn?

Answer 13

Dichromates, arsenates, phenolic compounds

Question 14

How do Dichromates, arsenates, phenolic compounds cause damage in the skin?

Answer 14

Nerve damage –> anesthesia but rarely in the absence of visible skin damage -Vasoconstriction may lead to the necrosis that occurs–> systemic shock–>renal damage

Question 15

Some solvents and gasses that can cause ICD?

Answer 15

Acrylonitrile, ethylene oxide (sterilize med supplies), carbon disulfide, mustine

Question 16

What is the treatment for chemicals leading to chemical burns?

Answer 16

Initial: irrigation w/ large volumes of water (If insoluble to water, use soap solution) Avoid high pressure (splashes) Hydrofluoric acid: 2.5% calcium gluconate gel Chromic acid: early debridement of necrotic areas

Question 17

What is the problem with latex patch testing?

Answer 17

It is not specific, there are lots of false negatives

Question 18

If you have an allergy to peach, what other fruits are you allergic too potentially (cross react)

Answer 18

Other Rosaceae fruit (apple, pear, cherry, plum)

Question 19

Biggest causes of contact urticaria?

Answer 19

cow dander, latex, food products

Question 20

what risk factors in occupations can lead to SCC/BCC?

Answer 20

UV exposure is the key in 95%

Those at risk:

outdoor workers (agriculture and building industries), welders (UV exposure)

Polycyclic hydrocarbons ( tars, pitches, oil fractioning products)

Arsenic in glass production, copper, zinc or lead smelting, pesticide, herbicides and semiconductors

Radiologists, dentists, x-ray tech, radioactive materials

Question 21

What are the clinical findings of occupational acne?

Answer 21

Open and closed comedones, non-inflamed nodules and cysts

Question 22

Causes of occupational acne?

Answer 22

oils, halogenated polycyclic hydrocarbons, and repeated frictional trauma

Question 23

Most common cause of occupational acne?

Answer 23

Oil acne

Question 24

What is the occupational acne called that is caused by friction/truama?

Answer 24

Acne mechanica (frictional trauma occludes follicles at sites of pressure)

Question 25

What is acne cosmetica?

Answer 25

Caused from things like lanolin, petrolatum, veggie oil you get smalled closed comedones, small papules and pustules

Question 26

What are m/c causes of chloracne?

Answer 26

2/2 toxic chemicals and is a cutaneous sign of systemic exposure (chlorinated aromatic hydrocarbons) 2/2 2,3,7,9 tetrachlorodibenzo-p-dioxin (2,3,7,8 TCDD), agent orange, dioxin poisoning (Ukrainian president)

Question 27

Clinical of chloracne?

Answer 27

Open comedones more than closed + concentration over malar crescent and behind ears, axilla, scrotum, penis - Occurs w/I 2mo of exposure, lasts for years - Fades slowly after exposure but severe dz persist for years Acne 2/2 Halogens Iodides, bromides, other halogens (iododerma more severe)

Question 28

Treatment for chloracne?

Answer 28

avoidance of cause, isotretinoin, topical retinoids

Question 29

What is vibration white finger?

Answer 29

Operators of chainsaws, pneumatic tools, hand grinders who work in cold ½ workers can be affected **Pathogenesis** Vibration between 30-300Hz a/w this Increased activity of the sympathetic nervous system Smoking contributes **Symptoms** Onset w/I 3 mo to 2.5 years White patch of skin in response to cold-induced vasospasm (well demarcated) Decreased sensation 2/2 touch receptors loos of blood supply Improves with rewarming Attacks not triggered by the tool Thumbs usually spared **Grading** Stage 1: fingertips Stage 2: partial digit Stage 3: whole digit Stage 4 trophic changes and ulceration

Question 30

Common infections seen in healthcare workers?

Answer 30

herpetic whitlow, scabies, syphilis, AIDS

Question 31

Common infections are seen in farmer/abattoir worker/veterinarian?

Answer 31

Orf, Milker's nodule, brucellosis (parapoxvirus, brucella suis; b abortus; B. melitensis)

Question 32

Common infection seen in farmers, wool sorter, dock worker, butcher?

Answer 32

Anthrax (bacillus anthracis) common in cattle, sheep, goats, horses, buffalo, camels

Question 33

Common infection in Fisherman, tropical fish worker, fish market worker?

Answer 33

Mycobacterium marinum

Question 34

Common infections in Butcher, abattoir worker, meat and fish packers?

Answer 34

Butcher's warts: HPV 7 impetigo (Staph aureus) Erysipelas (GAS)

Question 35

Most common infections in a Fisherman, abattoir worker, farmer, butcher, cook, veterinarian?

Answer 35

erysipeloid (erysipelothrix rhusiopathiae) in shellfish, fish, birds and mammels (esp pigs).

Question 36

If a fisherman gets cellulitis what must you be worried about potentially?

Answer 36

vibrio vulnificus

Question 37

What infections could a farmer and veterinarian get?

Answer 37

microsporum canis (from cats, dogs) M. nanum (pigs) Trichophyton mentagrophytes (small mammels) T. Verrucosum (Cattle) T. Gallinae (chickens)