Occupational dermatoses (“Contact dermatoses ”)

1. Occupational dermatoses (“Contact dermatoses”) Conf. Dr. Brandusa Constantin

2. Definition: • cutaneous diseases caused by the contact with different substances and materials during working.

3. Professional stigma • Traumatic bubbles: • adaptive responses • professions: mining, asphalt, young people using shovels, pickers • appearance: localized hyperkeratosis (calluses) • Pigmentation to: • wind, rain, sun • heat • professions: workers from: • construction • furnaces, ovens, forging • metallurgy and glass industry ! It can turn into precancerous keratoses!

4. Epidermis and nail coloration: • After contact with mercury (black nails), sulphate of copper, iron (green nails and epidermis) • Yellow nails: picric acid • Abrasion of fingerprints: the workers who work with paper, cardboard, wood conglomerates • Scars: after burns, wounds ofsmelters, glassmakers • Nail injury: • “in parrot beak”- at the tapestry owrkers • abrasion of free edge – polishers • fragmentation and irritation around the nail - to formaldehyde

5. Classification 1 • Pathogenic criteria: dermatoses: • ortoergic (OD) • allergical (AD) B. Clinical criteria: dermatoses: • ortoergic (OD) • eczematiform(ED)

6. Classification 2 According to Work Protection Norms related to the skin and hypodermic tissue diseases: • contact allergicdermatitis; • contact irritative dermatitis; • mixt contact dermatitis (allergic and irritative); • urticaria.

8. microbial- fungal- viral- parasitic Ortoergic Dermatoses Due to microorganisms Arising from physical agents • Micro traumatisms- Thermal origin • Radiation (Infrared, UV, ionizing) Due to chemical agents (chemicals with direct irritant action) Allergical Dermatoses

9. Ortoergic Dermatoses Due to microorganisms • By direct infection mechanism and/or • sensitisation action • ex: occupational syphilis (finger chancre of the midwives), occupational tuberculosis, pyodermatitis, microbial onyxis microbial micotic • Superficial epidermo-mycoses - confectioners, cannery workers- Epidermophyton disease - in jobs that involve wearing rubber boots- Sycosis trycophitic - milking, veterinary personal viral • Milkers’ nodule • Verruca vulgaris viruse parasitic - Animal scabies, grain scabies, contact dermatitis caused by larvae

10. Ortoergic Dermatoses • Arising from physical agents • ragada, ulcerations, callosities; • hyperkeratosis of digital pulp – harpist • palm callosity - gymnasts microtraumatisms • facial erithrosis (steelmakers • sudamine (steelmakers, smelters) – white/red miliary dematitis • cold: frostbite, acrocyanosis, reticular livido thermal origin Ionizing and non ionizing electromagnetic radiation • Actinic dermatiris (light radiation)- Dermatoses by photosensitivity

11. Ortoergic Dermatoses Irritant contact dermatitis Due to chemical agents                    - Direct action

12. Dermatoses to coal:The appearance of the lesion: skin tattoos resulting from infiltration with carbon particles.     The appearance of the lesion:skin biopsy found the presence of dermatitis and peri-vascular lymphocytic infiltrate with ortho-keratosis compatible with contact dermatitis

13. Diagnostic • Occupational exposure • Clinical picture • Paraclinical tests

14. Occupational exposure – sheet form of exposure to occupational hazards! • Occupational history - the most important element in occupational dermatoses diagnosis • Profession (exact); • Analysis of the technological process, indicating all agents / substances involved; • Seniority at work; • Professional route; • Use of protective equipment (which may be protective or harmful); • Methods for cleaning skin! Visit to workplace "Occupational diseases are known in workplaces" (Ramazzini, 200 years ago)

15. Jobs with high incidence of occupational dermatoses • Cleaners, cooks, restaurateurs – dermatitis of wear, irritant dermatitis, allergic dermatitis, trophic conditions of nails • Builders (who works with cement) - irritant dermatitis, allergic dermatitis, skin mycosis, skin cancer lesions • Painters - irritant dermatitis, allergic dermatitis, skin cancers, traumatic tattoos • Health care staff: nurses, dental surgeon - allergic dermatitis, skin infections • Hairdresser - allergic dermatitis, urticaria, irritant dermatitis • Persons who handles plastic - dermatitis to fiberglass, irritant contact dermatitis • Auto mechanics - repeated trauma (palmary hyperkeratosis, hematoma, traumatic tattoos), irritant dermatitis (caustic agents, motor oil), allergic dermatitis

16. Clinical picture Irritant contact dermatitis It has various clinical aspects, by the nature of the agent, mode of action, acute or chronic form: -erythema;-edema;-vesication;-necrosis;-desquamation, micro-fissures

18. Clinical picture Allergic contact dermatitis • It is always pruritic;- Onset - site action, but remain localized rarely, it spreads at distance • Appears only in predisposed subjects

19. Paraclinic Skin tests - patch-test: highlighting the responsible allergen -it should be practiced after stopping of corticosteroid general therapy and antihistamines;-first reading is at 48 hours, the second at 72 or 96h.

20. Differentiation • Despite their different pathogenesis, allergic and irritant contact dermatitis show a remarkable similarity wirh respect to clinical appearance, histology, and immunohistology. • A study - Department of Dermatology, Univ. Kiel, published in 1992 in the Journal of Investigative Dermatology - compared the cellular infiltrates in irritant and allergic patch-test reactions by immunostaining with a broad panel of monoclonal antibodies. patch test  biopsies;After 72 hours it was found that both type of reaction were characterized by an identical dermal infiltrate consisting mainly of memory T cells, many of which were activated, and macrophages; dermal and epidermal Langherhans cells density and HLA-DR expression of keratinocytes were also identical.The conclusion was that it is the same type of inflammation, including activation of T cell, obviously independent of exogenous antigen. Journal of Investigative Dermatology (1992) 98, 166–170; doi:10.1111/1523-1747.ep12555804

21. Differentiation • Study: confocal laser scanning microscopy can differentiate in vivo allergic and irritant contact dermatitis dermatitis • Objective: viewing, characterization and in vivo differentiation of allergic and irritant contact dermatitis;epidermal volume was measured and images by reflectance confocal microscopy were made • Results: Compared with allergic dermatitis, the irritant dermatatitis were observed greater damage of the stratum corneum and more parakeratosis, also increased increased epidermal volume. • Conclusions: confocal laser scanning microscopy by reflectance is a promising and noninvasive tool for dynamic studying, and for differentiation of the two types of contact dermatitis J Am Acad Dermatol. 2004 Feb;50(2):220-8.

22. Treatment • Immediate interruption of contaminant contact (immediate decontamination -external, removal from exposure, changing jobs - after); • Fighting inflammation: local application of topical corticosteroids, alternating with wet compresses and moisturizing cream; systemic corticosteroids is not recommended, except in exceptional cases of generalized eczema; • Antibiotics, in case of suprainfection; • Oral antihistamines for allergic dermatitis and urticaria (to reduce itching); • Avoiding contact with other skin irritants or sensitizers (professional or non-professional).

23. Prophylaxis • Technical and organizational measures • Eliminating direct contact of the skin with harmful substances; • Protective equipment; • Individual hygiene; • Use of skin protection ointment • Medical measures • Recognition of risks regarding health • Medical examination at employment • Periodic medical examination

24. Dermatitis looking keloid to mineral oils:Skin lesion:- Micro-traumatisms which are predisposed to fissures and scratching induced by excoriation and dystrophic changes of nails; rough skin, pruritus, burning and stinging.The appearance of the lesion:- irritation of the skin of palmar sides of the hands, manifested by papules and pustules

25. Miliaria rubra caused by heat.The appearance of the lesion: sudamine in form of microvesicles

26. Contact discoloration that is part of occupational non-eczema dermatoses caused by chemical agents.Appearance: lesions of back sides of hands, fingers and forearms, clinically manifested by irregular skin depigmentation (white patches of skin) with precise shape and variable size, as a result of destruction of melanocytes.

27. Occupational dermatoses caused by biological factors: mycobacterial skin infections:Lesion appearance: small macules and papules with inflammatory purpuric halo, some tend to have the appearance of umbilicated vesicles at level of upper limb

28. Allergic contact dermatitis to soaps and detergents:The appearance of the lesion: the injuries are acute, which begins with a erythemato-squamous placque, blisters, sores and cracks. The eruption is preceded and accompanied by pruritus.

29. Thermal burns:The appearance of the lesion:- Electrical burn-degree II, with partial epidermal and dermal destruction and capillary network. The burnt skin is white or like paper, with agglutinated blood vessels, and areas with mottled appearance.

30. ChloracneThe appearance of the lesion: itchy comedons, red-purple papules and pustules, with extensive character from face to neck (without affecting the nose), anterior and posterior chest, shoulders and arms, fingers and nail hyper pigmentation.

31. Dermatophytes:The appearance of the lesion:-suppurative mycosis of the scalp and chin, pustulo-nodular-follicular, intense inflammatory.

32. Chemical burns:The appearance of the lesion:- Onycodystrophy accompanied by necrosis of the distal, medial and proximal phalanges, mummified (dark) aspect, skin without elasticity and sensitivity. Necrosis advanced to both palms.

33. Heat urticaria:The appearance of the lesion: generalized rash manifested by erythematous-edematous papules and plaques,well defined and pruriginous, with sizes from 1 to 7 mm, preceded by strong burning feeling.

34. Chronic lichenified eczema:The appearance of the lesion:keratoses placards, with variable extent, confluent between them, with raised and rough surface, being covered by a fine whitish network, known asof Wickham striae.

35. Occupational purpura  The lesion appearance:- The presence of red-purple and bleeding spots at facies, chest, arms and legs levels, which does not disappear to vitro-pressure, painless, apparently due to spontaneous extravasation of blood in skin and mucous membranes. Lower limb lesions have the appearance of purple petechiae (purpuric spots are small, round, well-defined) and upper limb purpuric lesions tend to have a necrotic appearance (petechiae with areas of necrosis).