User:Saltrabook/Clinical diagnostic guidelines/Skin diseases

Definition
Skin disease which is wholly or partly caused by exposures in the work environment. The most frequent occupational medicine skin is acc. Review the pattern of eczema disorders (94%), of which over half toxic contact and a third Allergic contact, while the rest are other eczema types. Women have twice the incidence of work-related eczema mainly because of higher frequency of women in certain high-risk occupations.

Work-related skin disease must be considered
The prevalence of eczema in the general population is not known. In Work Institute's "National Occupational kohorde" studies, there has been a growing tendency to report skin problems. In the last study was the every 8 of the work that had had skin problems within a 3-month period. It is most often seen in women with wet work. (Care Sector, Iron and metal)
 * When an active person develops hand eczema
 * Eczema debuts after some time of exposure to a particular operating systems (eg wet work, working with oil, degreasers, work in the risk business. The latency for toxic contact dermatitis is from a few weeks to several years.
 * Eczema debuts after short or accidental exposure to allergy-causing chemicals

Work-related worsening of existing skin conditions that bla dyshydrotisk eczema, psoriasis and atopic eczema is often caused by a hand-straining work where mechanical exposure of the skin itself subject to deterioration (Koebners phenomenon). Rosacea and seborheaisk dermatitis may be aggravated by dust, low humidity, providing increased pruritus.

Work-related skin tumors may be due to chemical carcinogens, UV light, ionizing radiation and mechanical or thermal damage (tumor arises in scar tissue). Exposure the high-boiling aromatic hydrocarbons, can cause skin tumors (basal and spinocellulære carcinomas) on skin areas with thin skin (face, forearms and scrotum)

Exposure
The exposure anamnesis must contain detailed information about the chemical substances (with toxicological details), working with at work. Must be obtained data sheets, supplier information etc. Are there new drugs, gloves, skin care products? Is there direct skin contact, or is it on airborne contact with skin. Is it possible penetration of workwear the places that are hudaffektion. Is that correct use of gloves and hand care products? If the gloves are relevant (material and permeability). How is hand hygiene and andvendes which skin care products Does worked very handling of workpieces with rough and uneven surface may cause an increased abrasion of the skin. They have much contact with water and soap. Moreover, we must question whether indoor conditions (humidity, heat, cold, radiation, UV light, etc.) Are there other workplace problems.

Signs and symptoms of work-related contact dermatitis
Eczema is a special inflammation in the skin. A work-related contact dermatitis is caused by exogenous factors

Redness, swelling, itching, papules and vesicles and later in the chronic stage, scaling, and dryness infiltration. The most frequent localization of contact dermatitis is on the hands especially fingerinterstitserne and dorsally, but also, forearms, neck and face and rarely on the palms.

Clearing Program
The case history and exposure anamnesis is very important in the investigation. One must question whether predisposing factors in the form of atopy (familial and private atopy). Skin diseases with parents, siblings or own eczema in baby age. Debutlokalisation. Is hand eczema preceded by eczema elsewhere. At the same time eczema on the feet and eyelids, may be an indicator for the case of endogenous eczema. Hence the importance of questioning and examination of eczema elsewhere on the body. Are there seasonal variations, improvement during holidays and longer periods off.

If a chemical investigation are sensitizing allergens that are known to cause contact dermatitis (type IV allergy) refers to the dermatologist for standard and specific patch testing. The dermatologist can also test for kontakturtikaria of testing, Scratch Test Patch (application of the working power after the scratching of the skin with a cotton swab, reading after ½-1 hour) the case of material which acts as a hapten, i.e., requires a binding to a human protein of triggering a type I allergy, so requires, however, a conjugation of the chemical substance with albumin, the majority of the dermatologists can not do. Indicate the reference which substances appropriate to test with and whether there is indication for testing with the social effects if you can not clearly identify individual compounds. If you suspect urticarialignende reactions (type I allergy) made Phadiatop or standard / specific skin prick test if necessary RAST. The dermatologist agreements even with the patient how the testing is to take place, but usually must be done when the eczema is in a quiet phase. If not by the chemical investigation found allergenic substances but

only irritative substances it is not necessary with a reference to testing. F.x risk profession. Care Sectors and fabricated metal industry, where it frequently comes to toxic eczema

Have you by negative 3-day reading of the patch test remains reasonable suspicion of allergies can be supplemented with reading after 7 days MHP. Detection of late allergic response (can catch up to

10-15% of those with allergic response).

Treatment The medical treatment of eczema handled by dermatologist or doctor.

Prevention and review
Counseling At the individual level it is relevant to an advice about occupational hygiene precautions, if any repositioning or rehabilitation be considered by the sensitizer. At the company level should take contact in writing / visit, with the aim of making the company aware of the problem, EVS use BST to advise about to substitute changed work practices and personal protective with gloves and hand care products. The question of what personal protective equipment to be used requires specialized knowledge or that you contact the glove, costume manufacturers have proof of efficiency and permeability Possibly. the implementation of a combing / monitoring program on the company if it is a general and widespread problem.

If there is a suspicion of a work-related eczema, reported it to AT and ASK. Toxic and allergic eczema recognized by occupational disease list section. B2 and B3. For Allergic contact the following applies that there must be proof of allergy by testing. The occupational exposure must be made probable and exceed any recreational exposure. For irritative eczema, the occupational exposure to irritants must be made probable, and exceed any recreational exposure. If the eczema heals up after repositioning or changing jobs awarded are rarely more than one permanent disability becomes payable in less than 5%.

Literature
Autrup H, Bonde JP, Rasmussen K, Sigsgaard T. eds Textbook in environmental and occupational medicine, FADL's forelag. Chapter 23, page 235-243

Fregert S, Björker B, Bruze M, Dahlquist I, Gruvberger B, Persson C, Rulsson L. Zimerson, E.Yrkesdermatologi Lund Studentlitteratur 1990

Rycroft RJG, Menné T, Frosch PJ eds. Texbook of contact dermatitis. 2.ed. Heidelberg: Springer, 1995

Thestrup-Pedersen K, Andersen KE, Zachariae H. Clinical Dermatology and Venereology. Copenhagen: Munksgaard, 1993

Tove Agner, Klaus E Andersen, Christian Avnstorp, Lone Bergmann, Lars H Halkier-Sørensen, Knud Kaaber, Torkil Menné, Kristian Thestrup-Pedersen, Jens Thormann, and Niels K road. Reference Program on contact dermatitis. Journal Home 159 (suppl 6): 1-7, 1997.