Dermatoses OcupacionaisTenho o prazer de conhecer o Dr. Salim Amed Ali hmaisdetrintaanos.Napocaemquetiveo privilgio de conhec-lo, vinha o Dr. Salim, acom-panhadopeloProf.NelsonGuimaresProena, expressarseuinteresseemseaproximardo AmbulatriodeDoenasProssionaisquea Fundacentro organizara junto Escola Paulista de Medicina, com o intuito de se desenvolver no campo de Dermatologia Ocupacional.NapocaeutrabalhavanaFundacentro,che-ando a Diviso de Medicina do Trabalho e pos-teriormente como Diretor Tcnico da Instituio.Por caminhos distintos, o Dr. Salim alcanou seu desiderato.No s se desenvolveu em Dermatologia Ocupa-cional,comoeprincipalmentedesenvolveu, eleprprio,estecampoemnossopas.Elefeza ponte entre a Medicina do Trabalho e a Derma-tologia, esta j enriquecida pelas constribuies pioneirasdeprofessorescomoRotberg,Sam-paio,Peryassu,Rabello,BrumNegreiros,Bellibo-ni,Pimenta,Cuc,Proena,entreoutrosfunda-doreseilustresrepresentantesdedistintas escolas de Dermatologia em nosso pas.TambmcontribuiuoDr.Salimparaampliara ponteMedicinadoTrabalho-Dermatologia,in-cluindo a Alergologia.Nocounasuperfcienaepiderme(literal-mentesobreapele)doproblema,aprofun-dando-senacompreensodosmecanismosde ao, da toxicologia, dos aspectos mdico-sociais edaprevenodoproblema.Olhou-ocomas lentesdaepidemiologia(literalmentesobreo povo).Quandoorganizeimeuprimeirolivro Medicina do Trabalho Doenas Prossionais, publi-cado em 1980, o captulo das dermatoses ocupa-cionaisfoientregueaoDr.Salim.Em1995,em meu novo livro, Patologia do Trabalho, este captu-loapareceescritonovamentepeloDr.Salim, quinze anos amadurecido, mais sbio.Aproximadamentehtrintaanos,oDr.Salimno couali(compermissodeusarseusobrenome...) onde o conheci.0DepoisdetrabalharnoServiodeMedicina Industrial do Sesi, como Dermatologista Ocupa-cional, por quase dez anos, ingressou na Funda-centro, em 1983, onde foi Mdico Pesquisador em Dermatologia Ocupacional.Frequentou servios de Dermatologia Ocupacio-nalnaUniversidadedeSoFrancisco(Prof. Maibach)enaUniversidadeJohnsHopkins (Prof. Emmett), nos Estados Unidos, em 1984.Atuou,econtinuaatuando,comoprofessor convidado em inmeros cursos sobre Dermato-logia Ocupacional, no Brasil e no exterior, estan-domaisefetivamenteligadoFaculdadede Cincias Mdicas da Santa Casa de So Paulo.PertenceSociedadeBrasileiradeDermatolo-gia,SociedadeBrasileirade Alergia, Associa-o Nacional de Medicina do Trabalho, Ameri-canContactDermatitisSociety,American AcademyofDermatology,entreoutras.Seus inmerostrabalhospublicadosaparecemem anaisdecongressos,emcaptulosdelivros,em revistas especializadas de Medicina do Trabalho e em Dermatologia.Quemtem,comoeu,oprivilgiodeconhecero Dr.Salimsabeque,maisdoqueumgrande especialistaemdoenasdepelerelacionadas com o trabalho, um homem inteiro, de profun-daexperinciacrist.Umhomememqueo corao provvel sede da alma fala mais alto do que sua voz, expressa melhor o que sua pena escreve.Umhomememqueobrilhodosolhos expressaobrilhodaalma.Depoisdetantas coisaslindasarespeitodoDr.Salimmeu colega, amigo e irmo , que tal ler e estudar seu livro?Ren MendesProfessorTitularaposentadodoDepartamen-to de Medicina Preventiva e Social da Faculdade deMedicinadaUFMG,BeloHorizonte,MG; Senior AssociatedaEscoladeSadePblicada Johns Hopkins University, Baltimore, EUA.DermatosesOcupacionaisEstaobraconseguiureunirduasfacesdoconhecimentodeumassunto:uma grandeexperinciavividaeumprofundoestudobibliogrco.Somentecom estafelizuniopdeproduzirumapanhadoto vasto,e,aomesmotempo,to profundoarespeitodasdermatosesocupacionais.Asdezenasdefotosque ilustramaslesesdescritasforamtiradasdacoleoparticulardoautor;as centenas de informaes sobre substncias e/ou processos industriais so deta-lhadosporassuntos,como:leosdecorteelubricantes,madeiras,polmeros, resinas, metais, radiaes e microrganismos, trazendo aos leitos, de forma orga-nizada,ofrutodeanosdeestudosintensos.Ostestesepicutneos,toimpor-tantesparaodiagnsticodasdoenasdermatolgicasocupacionais,sotrata-dos de forma abrangente e detalhada, possibilitando ao leitor faz-los de acordo comasorientaesprescritas. Almdeabordarodiagnstico,soenfocadoso tratamento e a preveno, bem como os aspectos legais a respeito doenquadra-mento previdencirio e acidentrio das dermatoses ocupacionais.Jos Tarcsio P.Buschinelli9 7 8 8 5 9 8 1 1 7 4 0 9ISBN978-85-98117-40-9CMYCMMYCYCMYKCapa_DermOcup2.ai 19/5/2009 14:55:01Dermatoses OcupacionaisPresidente da RepblicaLuiz Incio Lula da SilvaMinistro do Trabalho e EmpregoCarlos LupiFundacentroPresidenteJurandir BoiaDiretor ExecutivoJorge MagdalenoDiretor TcnicoJlo Moreira Lima JniorDiretor de Administrao e FinanasPaulo Jos de Souza Almeida CavalcanteSalim Amed AliMdico Especialista em Medicina do Trabalho,Alergia e Dermatologia OcupacionalDermatoses Ocupacionais2 Edio: 20092009M I N I S T R I ODO TRABALHO E EMPREGOFUNDACENTROFUNDAO JORGE DUPRAT FIGUEIREDODE SEGURANA E MEDICINA DO TRABALHOSo PauloCIS`c iccccs c ,c|c'|c| |scc ,css|cc|CDUoo ic|c cuctc ccu icctc|c|c c|||cc iccccs cutcccso+o Ocu,cc|cc|s !||cc c scuc ccu,cc|cc|s.+!o`|| c|| `c.+!oicctcscs ccu,cc|cc|s / c|| `c `|| . c cc i cu|c uccctc .00.+!o!. ,|| cc|c.+ c.+!o!i` !0.+!o icctcscs |scc ic:|ss|cc| iccccs c ,c|c !||cc ccu,cc|cc| ! |tu|c!i|`c '|c|ooo+o.! |css|':|ccccc c ctc !tcct|cc| :cct|cs c ccu|tc ct !)|cc u cvc||i| |css|:|ccccc icc|c| ||vcsc|Qualquer parte desta publicao pode ser reproduzida, desde que citada a fonte.Disponvel tambm em: www.fundacentro.gov.brDados Internacionais de Catalogao-na-Publicao (CIP)Coordenao de Documentao e Bibliotecas - CDB / FundacentroSo Paulo - SPFicha Tcnicaccccccc c|tc|c| i||sc|ct| css| c C|cuc|c cccscv|scc cct|cc| \c|c `c|c i|..c|ctc c cc,c i c|| `c `||ics| ccc c cc,c \c||c C icstc `,c||c|c`cc||.cccc \c|c `,ccc|c C|cvcc||| c c|c c|ctc csccAgradecimentosTucc,uccc||.ccsccst|tu|scsc|ccuv|ccscctc|ccu|tcs ,uccc||.ccctcsccs\u|tcc,ucsc:c.:c|cc,|ccc|tccccc|cc `cssc tc,uc ,csscc| :c| cc cs ,uctc :c| cccssc|c ,cc sc c|cc c| Os cstcs cs c|cs cs ,cc|ctcstc|c||cccs c,uc|cs ,uc |ctc cu ||ctcctc cs c,ucc c scc tctcs cs ccs ,uc scctc icus c scu cc c |ccc |cvcc c ccc,csc c ccc u c,uc|cs ,uc cct||u|c ,cc c cc||.cccc cstc c|cDedico este trabalho minha famlia. minha esposa Maria,e aos meus lhos Priscila, Joo Marcos, Beatriz, Deborah eSalim Augusto, minha gratido pelo amor ecompreenso a mim dedicados.Salim Amed AliApresentaoCc|ccc|cc||stc|ccstc||vccu||c|ccctccc,c|stctcccc+ ,ucc ccvcscvccs c|| `c c cu sc|c c :utuc c icctc|c|c c ics||cctcvccscs,c:ucsucccs,uccstcvccccccccssc,c|sc cc,cccccc|ccc|c|cccucccs|uc|ctc,c:ucsccc|.cccc scc|c|cscc|cccscv|cc,c,u|cccccsu|ctccccsc|ccccsu|ccs c c| ,c c|ctcccc|cc|ccs c ccc|uscc ,uc tc|c c ,ct|cc c|cc ||c ,cssc ,c c|:|cccccs |uc|ctc s||:|cct|vcs ic cc,|c c v|tuc c c,|c |ust|c||.cccc c istcccccicu|ccvcccccccc|c|c,cu||stc,ccccstuccstccs||ccsc c|c|c tc,|cc| ||c ,ccss|vcctc ccc |uc cc ccscctc |tccssc ,c|cs ,c||ccs cccs ,c cssc csc |ust|c||.ccccictc cs cvcs tccs cs cctcscs ,c:|ss|cc|s ||c cc:cc ccc|u|cs c cutc ,c.c ccu,c ,c,c| c cstc,uc c cc,utc cs ccccs ,c:|ss|cc|s`c c,ccc c cctctc cc c uccctc c cc c cv|cc cc|c| c !ust|c cs|` tcccs cc|cc|ctc c u :ctc |tccssctc cs scv|ccs c|ccs cst|ccs cc ctc|ctc cs ccccs ,c:|ss|cc|s |cv|c s|c cc|.ccs ,cc ctcc c c|c|c |tcc ,ct|cu|cctc c ccc c ,cuc|c|c i ,cc su,csc c scus cc|.cccs cscctcscs,c:|ss|cc|s,ccstcvcc,csctccctccc|stcccscccc `||usc css| u |cc cc,c c ct|v|cc ,cc c cctc|c|stc c ccc c c|c|c c tc|c||cc|| `c `|| |cv|c cc|.cc c sctc c `|c|c icctc|c|cc c |||cc icctc|c|cccctccsccccicu|ccstcctcc,c|c|c:|ccucc|cccccsuc vctcc c sc|c c suc :cc|||cc c cs|c c |cvc :c|c c|c u expert cssc ccc ccuccstutuc,c,ucccsu|tcc:|c|ctc,ccc||cuc|ccucc|stctcc icctc|c|c c cc icu|c`cc tccu ,cc ,uc sucs c,t|ccs cs,ctcssc c |tccssc c cs| ||c|c|ctc c cuccctcc,c|s,ccutc|c||cccu`csccsscu|tcsc||,csscuc |||tc c c|cs cs |st|tu|cccs cc |uc| c,c|c c c:|c|cc|ccc |cc c v|scc scc|c| c,|c sc,c ccs|ccu ,uc c ,c,c| :ccc c cvcs ,uccs :c|c ,ctc |tcctc c sucs ct|v|ccs ccc c|cccctc|c|stc ||cc c c|c|c c tc|c||c ccc|cc cvcs ,c:|ss|cc|s ,cc tc|cctc scu|c c|ctc|cs ccctcctc |cc|ccccs ,cc c ctc|ctc cs cctcscs ,c:|ss|cc|s c| cstccvc|v|ctcccc:ccccc,c:|ss|cc|,uccccccucsct|c,uctc:c.|c :c|tc u ||vctctc cs,cc|c||.cc c tcc csc|tc c ,ctuucs cc,ucc cs cc|cccs cs,cc|:|ccs c cssc c|c \u|tcs vc.cs cc ccvcsccs sc|c cstc cccss|cc cstc,uc| ,uc sc|c ||s,cscvc| ,uc c|c ,c,|c cssu|ssc c cccccccc c tcc |,ctctc ,c,ctc` ||c|ct|vc sc :c| v|c||||.cc ,c,uc c uccctc cctcc c scus ,uccs cc ||ctcscccv|sccc|cc|cccc||u,ctcc|ccc|cccc,csctc||vc tcccc uc c,|cu|c cc||cc` c|c|ccccc c c|c tcvc c ,ct|c|,cccc c cs,cc|c||stcs ,uc cc|ccc c ,c:u|cc cs tccs ,uc ||cs :cc cst|ccs ic| ,cccs c:|c ,uc cstc ,|c|c c|ccc |c sc c |c|ctc ccc|tc c |cc,ccc cs |||||ctcccs c ,uctcs cstc,c |tccssccs c c|c|c c tc|c||cicsc ,c c ctcvc c vct|c|c ,uc cstc c|ccc |c ccc cs c|cccs :utucs cv|stcs cctuc||.ccstcs:ccccicctcscsOcu,cc|cc|scccsu|tcc||ctc|c,cc ,uctcs sc |tccssc ,c|c ,ctcccc c scuc c tc|c||cc`c|sc Cu|cccs iccccPrefcio da 1 EdioAscctcscsccu,cc|cc|stccct||u|cccc|,ctctccccccusc c ccs cs c|s vc|ccs c |tc|cc :|s|cc c tc|c||cc `,csc c c|cs cc ,cu.|c c|tcccccs cvcs c scuc ccc|c tccv|c ctc|cc ccvcs c |vcscs t|,cs c uccsc c ,c|c c ccs scus cccsicscc:ctc ,u|c vc|cvc| :c|ctcs |vcscs tcucs ||,cccctcscs cct|tcs ||tct|vcs c c|c|ccs |scc|cs cu,cccs ccc|:ccs u|ccccccs tuccs c|cct|.cs sc,uc|cs |vcscs c|ucs ctc cc cc,cct|ctc ,s|ccsscct|cc c,csctc ctc|ccsc|ccccctccscscc|cccsc!||ccccuccccc|c||cc cssc ,c|s i c|us ccscs cvc|vcc ,cc|ctcs c|c|ccs tccsc cccssc|c c c:cstcctc c:||t|vc c c||ctc c tc|c||c cccs|ccc ,c,u|.cs tctc cc c,ccc ,uctc cc c,ccc\|scc c:cccc |:cccccs ,uc ,cssc ,ccc|c c cssc c|c |ccucs sc|c c cssutc c ,uc cs ,c,usccs c |vu|c ,ctc c ctc|c| ,uc tc s|c ut|||.cc cs cuscs c \c|c|c c c|c||c c ccu|cc c |cc|cs \c|ccs c ctc csc c cc icu|c |c ccc cs cuscs c icctcscs Ocu,cc|cc|s ||stccs |c vc|cs ccs c uccctc ctc cc|cc `cc|cc| c cc icu|cOucccs |.c ,uc :c| c c u tc|c||c ,uc c|c c|ccccc c tc,c \cs |stc c u|tc ,cucc |ctc c u|tc ,uc c|c cstc ,c :c.c cstc ccc tcc ccctc c cssc ,c|s O tc|cctc c c ccc|cc|ctc cs ,c||ccs ||ccs c icctc|c|c cs c,cscs ,cc|sc ct|| cs cctc|c|stcs c ,c:|css|c|s ||ccs c cuc Ocu,cc|cc| i c |stc c,ucc|,ct|vccscsccccccccstcc|cctccctc,ctccs,ctcc|csccs,cccs ,uc cs cc|cc|ctcs c,u| |sc|cs ,cssc :c.c |:cccc c ccutc :ctc ccs ,c||ccs c ,c|c sc,c :c,uctcs c cssc c|cicsc,ccs c|c ,uc cstcs cs|cctcs ,cssc cu|||c c c|ctc cscs` c|ccs cs` c:cc|cscs` c cutcs ,c:|ss|cc|s cvc|v|cs cc c scuc c c scuccc c tc|c||cc `c sc ,csscc vc|cs ccs ,ucc c tcc icctcscs Ocu,cc|cc|s :c| c|ccc ,c | c ||vc c ic: cc \ccs \c|c|c c c|c||c c iccccs ic:|ss|cc|s i|tcc cv|c 0 c|cvccs cssc cc,|tu|c cc cstc c:|cccc O|cc|s cc,|ctc sc|c c cssutc cstc cs cc|tccccs c cutc ,cc :utuc ,c|c`cstcs u|t|cs ccs c ,uc v|cs |||tcc c ccc c cuc Ocu,cc|cc| ccc c|cc c ,cs,u|scc c uccctc ,cccs |.c ,uc u|tc ,c :c| :c|tc c scuc c scuccc ,cc c tc|c||cc cs u|tc cstc c|c ,c :c.c i c ,uc cstc cvc|vc cs:ccc cc,utccs,c:|ss|cc|scscuccss||cctcscstc|c||cccscc,ccccs cccvcc\u|tcssc|ucccscstcccccvc|vccs,cctcs,c||t|ccs,uc,cc|scsc c||stccs ,c|cs ,ctcs |tccssccs icstcccs vc||csc cu|||c c c|cssc tc|c||ccc cucccc c sct|c c |uscc |ccs cc|cccs c scuc cc |vcst| cc|ccctc c ,cvcccc`cccc c icus ,c|c v|scc ,uc c,u|| cstc ,c||cc c ,c|cs sc|ucccs ,uc cstcc |s,c|vc|s |c ccc c ,css|||||cc |csc c ut|||.cccc c |stuctcs tcc|ccs c ,c||t|ccs c,c,|ccs c cc|ccccc cu |||.cccc cs |sccs c scuc c tc|c||ccSalim Amed AliPrefcio da 2 EdioNcvcs|:cccccstcc|ccsc|ccctcc|stctccctctcsct|v|ccs,uc c|cccs c :|cc ,c,|ccs cc tctcs cv|ccs icc cc,|cctc c|ucs cstcs |:cccccs c,||ccs c cv|sccs c tctc c vc|cs cc,|tu|cs` cc|c|ccccc c cutccs c,c|ctcs c ccc c scuc ccu,cc|cc| ,css|||||tcu cccscctccs cvcs cc,|tu|cs c c,||ccs c cctcuc |ct|cc c ,csctc c|ccc Ouccs tc|c|cs c |ccscct||uc,cctccc|ucs|:cccccsc|scc,ccs|vc|s`tcvcsc |||||cc:|cs cs,cc|:|ccs c s|tcs c |tcct ,ccucusc tcc c |:ccccc cccss|vc| i:| cccs ,uc c ||vc c|c c uc :ccctc |,ctctc c vc||csc ,cc c|ctc cs ,c:|ss|cc|s c ccc c scuc c scuccc c tc|c||c c cc|cc|ctc cs vc|cs cs,cctcsccctc|c|cccu,cc|cc|\c|sucvc.cuccctc\||stc|cc c|c||cci,ccc,csctcsuccct||u|cccccc:cccccstcc|cccvcc|ccc c,||cc c ctuc||.cc is,ccsc ,uc c c,||ccccc cs cc|cc|ctcs c,u| |sc|cs cct||uc,cc|||.cc,cvc|ccvcscscucctc|c||cccccctcsc c,cs|ccc ccu,cc|cc| `cs cc|c|ccccs `|c \cc ic||Occ ! cc|c c||c \cc|c |scc||c \c|c |st|c Cc.cc iucc Ccc|c Ccc|c !c|cs csc c O||vc|c !ct|c |c||c \c|tc iu| c cc \ccs ,uc cc suc cc,cc|cc c cc,ctcc|c cc|ccc c scv|cc c cs|c c icctc|c|c Ocu,cc|cc| |:cccccs vc||cscs c |ssc|cccc c cc|cc|ctc cssc ccc tcc |,ctctc ,cc c scuc c tc|c||cc c,cssccs cssc c|cccc c ct|ccSalim Amed AliSumrio1 Introduo23Definio de dermatose ocupacional ...................................................................................................... 23Causas de dermatoses ocupacionais ........................................................................................................24Referncias ...................................................................................................................................................................... 272 Diagnstico31Anamnese ocupacional ......................................................................................................................................... 31Exame fsico .................................................................................................................................................................... 31Diagnstico diferencial ........................................................................................................................................ 33Exames de laboratrio .......................................................................................................................................... 35Inspeo no local de trabalho........................................................................................................................ 46Informaes fornecidas pelo empregador .........................................................................................47Referncias ......................................................................................................................................................................473 Agentes Fsicos49Calor ..................................................................................................................................................................................... 49Frio ..........................................................................................................................................................................................54Eletricidade ..................................................................................................................................................................... 57Radiaes Ionizantes ............................................................................................................................................. 60Radiaes no-ionizantes...................................................................................................................................63Microondas .................................................................................................................................................................... 69Laser (Light Amplification by Stimulated Emission of Radiation) ............................... 69Vibraes de alta frequncia ...........................................................................................................................70Monitor de vdeo .........................................................................................................................................................71Agentes Mecnicos ................................................................................................................................................... 72Referncias ...................................................................................................................................................................... 734 Cimento77Cimento Portland ......................................................................................................................................................79Cimento aluminoso .................................................................................................................................................79Aditivos do cimento ................................................................................................................................................79Etiopatogenia das dermatites de contato pelo cimento ........................................................ 81Cronicidade das dermatoses alrgicas pelo cimento e seu prognstico................. 89Infeco secundria e dermatite de contato ....................................................................................92Outros quadros clnicos produzidos pelo cimento .....................................................................93Exposio ao p do cimento, sua inalao e cncer ................................................................... 94Aspectos mdico-legais das dermatoses pelo cimento ............................................................95Referncias ......................................................................................................................................................................975 Dermatoses Ocupacionais por Aditivos da Borracha e pelo Ltex101Borracha sinttica .................................................................................................................................................. 103Borracha natural e sinttica ......................................................................................................................... 103Dermatite alrgica de contato (DAC) ..................................................................................................... 109Alergia ao ltex ........................................................................................................................................................... 113Dermatite irritativa de contato (DIC)......................................................................................................116Discromias por aditivos da borracha .....................................................................................................116Referncias .....................................................................................................................................................................1196 Dermatoses Ocupacionais por Solventes121Solventes ........................................................................................................................................................................... 121Dermatoses causadas por solventes inorgnicos .......................................................................126Dermatoses ocupacionais por solventes ............................................................................................ 127Dermatite irritativa de contato (DIC).....................................................................................................128Dermatite alrgica de contato (DAC) por solventes ...................................................................129Efeitos sistmicos e cutneos de solventes.......................................................................................130Tratamento das dermatites de contato .............................................................................................. 132Referncias ....................................................................................................................................................................1347 Dermatoses na Indstria Metalrgica137leos de corte ou fludos de corte ............................................................................................................. 137Principais dermatoses na indstria metalrgica ...................................................................... 139Dermatite irritativa de contato (DIC)..................................................................................................... 139Dermatite alrgica de contato (DAC) .......................................................................................................141Erupes acneiformes ..........................................................................................................................................141Fluidos de corte e ao sobre as vias areas superiores e olhos ..................................... 142Cncer cutneo .......................................................................................................................................................... 142Discromias................................................................................................................................................................... 144Distrofias ungueais (onicopatias ocupacionais) ......................................................................... 144Fluido de corte e controle de bactrias na emulso .................................................................. 145Cremes de proteo e seu uso na indstria metalrgica ..................................................... 147Testes epicutneos com fluidos de corte ............................................................................................ 147Referncias ................................................................................................................................................................... 1488 Dermatose Ocupacional pelo Nquel Metlico e seus Sais151Nquel e o processo de eletrodeposio ................................................................................................. 151Nquel suas aes sobre a pele e outros rgos ......................................................................... 152Alergia ao nquel ....................................................................................................................................................... 153Dermatite alrgica de contato (DAC) pelo nquel ......................................................................... 162Referncias .................................................................................................................................................................... 1659 Dermatoses Ocupacionais pelo Cromo e seus Sais167Eletrodeposio de metais ..............................................................................................................................168Dermatoses causadas pelos sais de cromo .......................................................................................169Sensibilizao a cromatos ............................................................................................................................... 170Liberao de cromo VI no processo de soldagem de ao cromo .................................... 170Dermatite irritativa de contato (DIC) - lceras do cromo ..................................................... 171Dermatite alrgica de contato (DAC) por cromato..................................................................... 172Aes do cromo hexavalente sobre as vias areas superiores ......................................... 172Erupes acneiformes e miliria rubra ............................................................................................... 174Referncias .................................................................................................................................................................... 17410 Dermatoses Ocupacionais por Cdmio, Cobalto, Cobre, Estanho e Zinco177Dermatoses causadas pelo cdmio.......................................................................................................... 177Referncias .................................................................................................................................................................... 177Dermatoses causadas por cobalto ........................................................................................................... 178Referncias .................................................................................................................................................................... 179Dermatoses causadas pelo cobre .............................................................................................................. 179Dermatite alrgica de contato (DAC) pelo cobre........................................................................... 179Referncias ................................................................................................................................................................... 180Dermatoses causadas pele estanho .........................................................................................................181Referncias .................................................................................................................................................................... 182Dermatoses causadas pelo zinco ............................................................................................................... 182Referncias .................................................................................................................................................................... 18311 Dermatoses Ocupacionais por Plantas e Madeiras185Dermatites irritativas de contato ............................................................................................................ 187Dermatite alrgica de contato (DAC).................................................................................................... 188Dermatite alrgica de contato com adornos de madeira ....................................................189Dermatites de contato com fotossensibilidade ...........................................................................190Eritema multiforme por madeiras ..........................................................................................................190Dermatites de contato por conservantes da madeira ............................................................. 191P de madeira e asma ocupacional .......................................................................................................... 193P de madeira e cncer do septo nasal ................................................................................................. 193Referncias ....................................................................................................................................................................19612 Dermatoses por Resinas199Resinas naturais .......................................................................................................................................................199Resinas sintticas .................................................................................................................................................. 200Principais resinas termofixas .................................................................................................................... 200Principais resinas termoplsticas.......................................................................................................... 200A. Resinas termofixas ..........................................................................................................................................201B.Resinas termoplsticas .............................................................................................................................. 205Referncias .................................................................................................................................................................... 22113 Dermatoses Ocupacionais por Fibra de Vidro e L de Vidro225Dermatite irritativa de contato (DIC).................................................................................................... 227Dermatite alrgica de contato (DAC) ..................................................................................................... 227Referncias ................................................................................................................................................................... 22914 Dermatoses Ocupacionais por Agrotxicos e Congneres231Principais atividades onde pode haver exposio aos agrotxicos ........................... 232Uso em ambientes fechados ......................................................................................................................... 236Medidas preventivas necessrias para o trabalho com agrotxicos ....................... 236Testes epicutneos ................................................................................................................................................ 237Principais grupos de agrotxicos........................................................................................................... 238Referncias .................................................................................................................................................................... 25115 Dermatoses e outros Agravos na Indstria Canavieira259O trabalho dos cortadores de cana-de-acar ..............................................................................260Acidentes de trabalho no corte manual da cana-de-acar .............................................. 261Dermatoses nos cortadores de cana ..................................................................................................... 263Fatores condicionantes para aparecimentode hiperceratose palmar e plantar .........................................................................................................266Exposio excessiva s radiaes solares e cncer cutneo ocupacional ............ 267Referncias ...................................................................................................................................................................26916 Dermatoses Ocupacionais na Indstria da Castanha-de-Caju271Propriedades medicinais atribudas castanha-de-caju ................................................... 272Processo de corte da castanha-de-caju ............................................................................................... 272Etiopatogenia............................................................................................................................................................ 273Quadro clnico ........................................................................................................................................................... 274Dermatites irritativas de contato (DIC) .............................................................................................. 274Dermatites alrgicas pelo LCC ..................................................................................................................... 275Ceratlise das polpas digitais ...................................................................................................................... 275Impregnao marrom das mos pelo LCC ....................................................................................... 275Queimaduras qumicas ..................................................................................................................................... 275Oniclises e desgaste progressivo da lmina ungueal .......................................................... 276Paronquias .................................................................................................................................................................. 276Dermatite de contato sistmica ................................................................................................................ 277Reaes anafilticas ingesto de castanha-de-caju ............................................................ 277Referncias ................................................................................................................................................................... 27817 Dermatoses Ocupacionais na Indstria Salineira279Extrao manual.................................................................................................................................................... 280Quadro clnico ............................................................................................................................................................281Extrao do sal por processo mecanizado ..................................................................................... 284Outras dermatoses .............................................................................................................................................. 284Referncias ...................................................................................................................................................................28618 Dermatoses Ocupacionais em Padeiros, Confeiteiros, Cozinheiros e Similares287Principais dermatites em panificadoras, confeitarias e alimentos......................... 288Dermatoses em trabalhadores de padaria e afins ...................................................................289Dermatite de contato por protenas em manipuladores de alimentos .................. 291Referncias ................................................................................................................................................................... 29319 Dermatoses Ocupacionais em Pescadores na Regio do Pantanal Matogrossense295Referncias .................................................................................................................................................................. 30020 Discromias301Vitiligo no-ocupacional ...................................................................................................................................301Vitiligo ocupacional .............................................................................................................................................. 302Hipercromia ou melanodermia ocupacional ................................................................................308Hipercromias por azocorantes ..................................................................................................................309Outros agentes causadores de hipercromia ...................................................................................309leos de corte.............................................................................................................................................................310Hipercromias sistmicas causadas por medicamentos ........................................................ 311Outras discromias .................................................................................................................................................. 312Tratamento das hipercromias e outras discromias ................................................................ 312Referncias .................................................................................................................................................................... 31321 Onicopatias Ocupacionais315Agentes biolgicos, qumicos e fsicos ................................................................................................... 316Onicopatias ocupacionais por agentes biolgicos ...................................................................... 316Fungos ............................................................................................................................................................................... 317Leveduras........................................................................................................................................................................ 317Bactrias .......................................................................................................................................................................... 317Vrus .................................................................................................................................................................................... 317Onicopatias ocupacionais por agentes qumicos ........................................................................ 318Acrostelise pelo cloreto de vinila ........................................................................................................... 320Agentes fsicos ........................................................................................................................................................... 320Traumas ........................................................................................................................................................................... 321Calor ................................................................................................................................................................................... 322Frio ....................................................................................................................................................................................... 322Umidade .......................................................................................................................................................................... 322Radiaes ionizantes ........................................................................................................................................... 322Microondas .................................................................................................................................................................. 322Vibraes ........................................................................................................................................................................ 322Discromias ungueais ........................................................................................................................................... 323Discromias ocupacionais endgenas .................................................................................................... 323Discromias no-ocupacionais endgenas......................................................................................... 323Foto-oniclises associadas ingesto de antibiticos........................................................... 323Discromias exgenas ........................................................................................................................................... 323Glossrio ......................................................................................................................................................................... 325Referncias ................................................................................................................................................................... 32522 Cncer Cutneo Ocupacional327Teoria e mecanismo da carcinognese ............................................................................................... 327Agentes fsicos cancergenos para o tegumento ........................................................................ 329Cncer cutneo no-melanoctico ...........................................................................................................332Cncer cutneo melanoctico .......................................................................................................................332Cncer cutneo ocupacional - estudo de exposio aos carcingenos ................... 339Controle de Engenharia de Produo para a atividade de risco ................................... 345Referncias .................................................................................................................................................................. 34623 Dermatoses do Esporte351Dermatoses virais ...................................................................................................................................................352Fatores que influenciam o aparecimento de viroses ..............................................................353As viroses mais frequentes............................................................................................................................353Como fazer o diagnstico .................................................................................................................................355Diagnsticos diferenciais .................................................................................................................................355Tratamento ...................................................................................................................................................................355Dermatoses no virais ........................................................................................................................................357Referncias ................................................................................................................................................................... 36224 Psicodermatoses365Dermatite artefacta Simulao (Malingering)......................................................................... 367Referncias ................................................................................................................................................................... 37225 Tratamento373Abordagem teraputica das dermatoses ocupacionais..................................................... 373Leses elementares dos principais quadros dermatolgicos ......................................... 373Quadros clnicos mais frequentes das dermatoses ocupacionais .............................. 374Consideraes finais ............................................................................................................................................ 379Bibliografia .................................................................................................................................................................. 38026 Preveno das Dermatoses Ocupacionais381Preveno .......................................................................................................................................................................381Preveno primria .............................................................................................................................................. 383Preveno secundria ........................................................................................................................................ 383Preveno terciria ............................................................................................................................................... 383Proteo coletiva .....................................................................................................................................................386Proteo individual ..............................................................................................................................................386Cremes de proteo, creme de barreira ............................................................................................. 387Higiene pessoal .........................................................................................................................................................389Controle mdico ......................................................................................................................................................389Referncias ...................................................................................................................................................................390Anexo393A EPI para proteo da cabea............................................................................................................... 393B EPI para proteo dos olhos e face................................................................................................. 393C EPI para proteo auditiva....................................................................................................................394D EPI para proteo respiratria.........................................................................................................394E EPI para proteo do tronco................................................................................................................ 395F EPI para proteo dos membros superiores......................................................................... 395G EPI para proteo dos membros inferiores...........................................................................396H EPI para proteo do corpo inteiro ............................................................................................... 397I EPI para proteo contra quedas com diferena de nvel...........................................39827 Aspectos Mdico-Legais das Dermatoses Relacionadas com o Trabalho399Estabelecimento de nexo causal entre a dermatose e o trabalho ..............................399Caracterizao legal das dermatoses relacionadas com o trabalho ........................ 401Dermatose relacionada com o trabalho e afastamento do trabalho ..................... 403Disfuno e incapacidade provocadas pelas dermatoses relacionadas com o tra-balho ................................................................................................................................................................................. 404Concluso ...................................................................................................................................................................... 406Bibliografia .................................................................................................................................................................. 407Anexo4091IntroduoAscctcscsccu,cc|cc|sc,csctc,ccc|c,cccvc|csccccs,c:|ss|cc|suc,cvc|cc|ccccvc||cccc|:|c||ccc,|ccscc,ucccucc c|cs cc c|cc cs cstct|st|ccs c sc,uc cc cc|cc|ctc cs cs,cc|c||stcs \u|tcs scccutctctccscutcssccctc|csc,c,|cc|u|ctc|ccc,csc`|ucs c|cc ctc c c|||cc c c cs,cc|c||stc cs ccscc|cs c|ccs ,uc ,cstc css|stcc|c c c|c c ccvc|c cc c !st|tutc `cc|cc| c cuc cc|c| !`` `,ccs uc ,c,ucc ,ccc|c cstcs cctcscs c|cc ctc cs scv|ccs cs,cc|c||.ccs`tctcc,cccstcs|tuccccc:ctctccscctcc|c|cctc|:|c||cvc||c c tcc c suc ctcscc c ucc |c|c| c tc|c||cccs c:ctccs cc c v|stc cstc cs,cctccssc.cc,|ccccvc||cccc,uctcccucccc|cscctcscscccusc ,c:|ss|cc|,cccscsccss|tcccccscstct|st|ccscs,c|scs|ust|c||.ccsc:|csccstcuccsccuscsc|sccusccccc,c:|ss|cc|`cs ` ictt +` ` cv|scc c ` ctcvcs c ictc|c .! c . c c.c|c c ! c|:|ccc ,c|c ictc|c cc c|c c o c,||cu c cc|ctuc cs ccccs c scuc sc| c cs,csc||||cc c c,ccc i|cs ` !ssc ,cc sc :ctc |,ctctc ,cc c||c cc|ccc cssc cc||cc c ccc c scuc c tc|c||cc` c|tcccc c ccs c ctc|ctc cs tc|c||cccs c |:cc||cc ,ccc c :utuc,c|cscc|s|ccc|cc|cO\||stc|cccuccstc|s,c|||||.cc ccuscs ,cc c|c c ctc|ctc ctcvcs cs | ,ccc|ctcs ,uc c||cc c cc||c|tc c c cc.ccctc c ccs c:cctcs c scuc c tc|c||ccDefinio de dermatose ocupacionalcc c|tccccc c uccscs ,c|c c scus cccs ,uc sc,c |ctc cu ||ctcctc ccuscc cc|c|ccc ct|c cu ccvcc ,c cctcs ,csctcs c ct|v|cc ,c:|ss|cc| cu c c||ctc c tc|c||c `|| `24Salim Amed Ali` ,c|c c c c|c cstutuc c cssc cc|sc c tc :ucccs |,ctctcs c ,ctcccc c c tcccu|cccc c cssc cc,cQuadro 1istutuc c :ucccs c ,c|c c ,css|vc|s c|tcccccs c c|c ccu,cc|cc|istutuc uccc `|tcccccs cutcccsccc cccc icc|c cctc cctcs ||c|c|ccs :|s|cc c ,u||ccsicscccccc ssucs cc|ccccc c|scccc ,ccutccci,|cc cccc cs,||csc c |csc||tcsc c cccc cccc ccccccc tcc|uc| `|scccc c |u. sc|cicct|tcs c cctctc |:cccccs ,uc|cucs cccc cutccc\c|ccc|tcs `|scccc c c|cccc |\ !|,c c ||,c,|ctcccc v|t|||c c|cccc|u|cs c icc|cs !uccu|cccc icct|tc c|c|cc c cctctc |ccsc :uc|cc|u|cs scsc|c|s c c \c|c| iccc,ccc tct|| `cuc,ct|cs tc|ccs\cscs c cstcc|tcs `ut|ccc c tcccu|cccc |c,uc tc|cc ut|cc|c c|tcc ccs |cccscc|c cc,ut|vc ictcccc c,cc tcc|uc| cucs |:cccccs cu|cc csccc c|cstcsc csc|ccccC|cu|cs suc|,ccs cc|cs cccu|cccc \|||c|cc|stc||c c u|cC|cu|cs sc|ccccs |tcsc ||,||cc :ccccc c ctc ||,||cc ,! cutccciu,cccs ccc|:ccs c|cccc :uucu|csic|cs cstcc :c||cu|c ictcccc scsc|c| cstct|cc c||cu||tcs c|c,cc|c tc|cc||cs uccc c cc c ,ccscc c ,c,uccs c|,ctcsi|stccs ,cc|,u|cs c|cc||scsctc `ct|cc| !st|tutc c: Occu,ct|cc| c::ct) c !cc|t| `!O!`Causas de dermatoses ocupacionaisic|s ccs u,cs c :ctccs ,cc sc cucccs ccc cc|c|ccccs c cctcscs ccu,cc|cc|sccuscs ||ctcs cu :ctccs ,c|s,cctcsccuscs |ctcs ccst|tu|cs ,c cctcs ||c|c|ccs :|s|ccs ,u||ccs c|stctcs c c|c c||ctc c ,uc ctuc|c |ctcctc sc|c c tcuctc ,uc ccuscc c cctcsc ,uc ccvcc uc ,cc|stctc i|||c `Causas indiretas ou fatores predisponentesIdade:tc|c||cccs ,cvcs scc ccs c,c|ctcs c ccstuc sc c|s c:ctccs ,cc|cccccccutc|ccc|,u|ccccccctcs,u||ccs,ctcc|c|ctc ,c|cscs,ccc,c|ciccutc|ccctcuctcc|cccsccc,tcucccctctctc 25Dermatoses Ocupacionais,cc ,cu.| cs,csscctc c cccc cccc !cc|` tc|ccc|c cu cc,tcccc cc cctc ic|tcustc c \c||cc| `Sexo:|ccscu||ccsscc|uc|ctcc:ctccsctuccsu||ccsc,csctcc|ccc,cct|ctccsccsc,ccc,csctc,uccsccscvcsc c c|sscc c|s c,|c ict|| c \c||cc| !` \c| .000` `s u||ccs c u cc cc| c,csctc c||c ,ccst|cc c suc cctcsc `ct|ccctt c !c|css +`Etnia:,cssccscscccsccc|ccccsccc|s,ctc|cscctccccccc|u. sc|c ,uc ,cssccs c ccc |ccc ccs c,csctc cs,cstcs ,uc|c|cccs cc c|c :c,ucc|c,uc|cccsi|stc|:ccccscc|c|sc,cctccccccctcs,u||ccs ccutcssu|stcc|csc,c|cc|c||cccsccccccc,csctc,cctccccc cctcscc,ucccccccuccs|cc`ccccccccccccccc,csctcu c|c ucc c ccccs c c cscccccc cs,ctccc cstc cccc c ucs vc.cs c c|c c|c ,uc cs cccs |ccc c ccc|c vc|c ct c|. !` icccscc c \c||cc| o`Clima:tc,cctuc c u|cc |:|ucc|c c c,ccc|ctc c cctcscs ccc ,|cc|tcs |||c|c c |:cccccs :u|ccs !csc| ct c| .000` O tc|c||c cc c ||vc c :c,uctcctc su,c|tc c cccc c |u. sc|c ,|cccs c |sctcs cctctc cc vcctc|s c,cs|ccc c c|uvc c cc vctc |c ccc c cctcs |vcscs ,ctcc|c|ctc ,c|cscs ,cc c ,c|cAntecedentes mrbidos e dermatoses concomitantes:,ctcccs c cct|tc ctc,|cc cu cc |ctcsc ctc,|cc scc c|s suscct|vc|s c cccc c cctcs ||tctcs ,|c|,c|ctc cs c|cc||cs c ,cc cscvc|vc cct|tc c cctctc ,c ||tcccc c|cc c| c u|cc c cs c||ctcs cc tc,cctuc c|cvcc ,ctcccs c cctcscs c ct|v|cc cc.cc uu|c cc.cc ||tct|vc cctc:|tcsc ,sc|csc ||,uc ,|cc ctc` scc c|s ,c,cscs c cscvc|vc cctcsc ccu,cc|cc| cu tcc suc cctcsc ccvcc c c||ctc c tc|c||c ccsc c|cs ,ctctccs cs,cc|:|ccs sc,c c||cc|ccsictcccs c ccc c cc.cc sc|cc|cc ,cc ccvc suc cctcsc ,ucc c,cstcs c sc|vctcs c|cccs c|ccs cccs c ccs O sc|cc|cc ,ccc tc c|c suc cctcsc ccvcc ,c ,cc|cs csu|tctcs c cscstc c ctc|c| ,|cst|cc c cutcs O ctc,|cc cvc cv|tc c tc|c||c c c||ctcs ,uctc u|c cu c cctctc cc c|ccs ccs cccs c cutcs su|stcc|cs ,u||ccs ,ctcc|c|ctc ||tctcs ictcccs c c|tcc ,c|c c c :cccc c c)cu cc cvc tc|c||c cuc|ctc cc c,u|,cctcs ,uc v||c c c|tc :c,ucc|c c c||ctcs :|cs cu c cctctc cc su|stcc|cs :|csCondies de trabalho:c tc|c||c c ,cs|ccc ctcstct|cc c tc|c||cccs ,c|s,cstcs ,cc |cvc cc c,ccc|ctc c cct|tc c cstcsc c vc|cs vc|ccscs cu ccvc cs ,c c|stctcs icsccccvc,ccscscsc,cc|cscc|ccs|||tcsctc|ccc|c,ccsc:ctc ,c|s,cctc|ccccccuscc|cc||u|ccccvct||ccccc,c,|ccccsc|tc|cs c c|uvc|cs cc,uccs c ||,cs ,c|cs ccs |ccc|s c tc|c||c ` cc ut|||.cccc c ,ctcccc cc,ucc cu suc ut|||.cccc |ccctc cu c|c c usc c i,u|,cctc c ictcccc !|v|uc| ii!` c c ,uc||cc c c cc c|scvcc|c ,c|c tc26Salim Amed Ali|c||cc cs ccs c |||cc c scuccc ,cc|.ccs ,cc c ct|v|cc ,uc cccutc ,cc tc ,c,c| |,ctctc c c,ccc|ctc c cctcscs ccu,cc|cc|sCausas DiretasAgentes biolgicosicc ccusc cctcscs ccu,cc|cc|s cu :uc|cc ccc :ctccs csccccctcs ccccctcscuccvctcsOscctcs||c|c|ccsc|sccusscc|cctc|cs:ucs |cvcucs v|us c |sctcs `scscc|cccsc|||cc,csscc|csscc|ccsccstcuct|scsc:c|ctcsc c|c ccu,cc|cc| ,cc sc :ctccs ccvctcs ccuscc cc,||cccccs |cctc|ccs ccc :c||cu||tcs |,ct|c ctc cc cctcscs ccu,cc|cc|s ,c,|cctc |tcs cc|ccsccc|s|,c|c|cccsc|cc|csc|,u|cccsccccc|c|ccctc cs c|,u|cccs c ccucs c c|c|s ,c|cs c ctc c ccc|c !cc|t| c c:ct) iccut|vc ` \ccu|| `Vrus:vc|csct|v|ccs,ccc,csctc|:cccccsccu,cc|cc|sctcc|csct|stcs,c:|ss|cc|scccccscucvctc|c|cscc|cccscu|ccscc|cccs`cccuuc|csccutcs,ucc,csctccctctc|ctcc:c,uctcccc|c|sc ccc c c|c|s |:cctccs \cc|ct .` \cc|ssc ct c| .000` ctc|iccv|cc ct c| ` Fungos e Leveduras: ic|||cCccc|vcs `|c|c`||c|ccicc|c o` |cstc c icv| !` c|ctc c:cccccs ccc|csc|vcscsct|v|ccsOcutc ctccu|vcscstc|c||cccsc|ccsc cstcuctcs|cvcccsccc,csc,ctcs` ccc|||csc|tc||tc|csccscscs c cctc:|tcscs c tctcccs c c|c|s c|c|c|cscctcctcscscucsc c|,u|cccs c cvcs c cctc:|tcscs ,cc|stctcs ccvccs c c||ctc c tc|c||c,uctctc|sccccc|c|cs:u|cccsc cutcs |uc `cs,cct|ccscccu,cc|cc|,cccccc c ,c|c|cs |ct|cu|tccs c c c,cc|cs ,uc c|,u|c ,c||c ,cc c|c|cc utccc`c``|c|s|c|csc c,cccccc||c|c|ccscctc|c||csc c|ctucc,|cccscctcsicccccc||c|c|ccscccs|tcctc|c|ccutccc Figura1.1|cccu|sccc,c|sct||c c|cc c|c|c| cuc| c |utccs c tc|c||cc ,uc ccc|c sucs ct|v|ccs c sctc u|tc ,uctc c c,csc27Dermatoses Ocupacionaisc,u|cc,ccccccctc|c||cccsc,cstcsccccscc|ccs\c|||t) c \ctc||t) vcc||) c,ct ` |uc .Insetos: i|cccs ,c vcs,cs c c|c||cs c ,cssccs ,uc tc|c||c c c||ctcs ctccs\c|,cscscccc!)|cs|cic,|c,tcc!c||cuc|cc`c,ccccccc ,uct|cc c ctc|ccs c,cccs c cc c c c|tc sc|cvcc |ccc|s ||u|ccs c |||cc ctc|c| :|ccs` ,uc ,cctc c ,c|c c,cstc c tc|c||cccs c cutcs ccuscc |csccs c|tcctc,c,u|c ,u||cscs ,uc |vc|uc c ,c|cc c uc c ucs scccs C|cssc ct c|. +`Animais peonhentos e outros: i|cccs ,c cc|cs c ccc iccscc|cs c i|ccut|c ,cc ccusc |csccs c c c |ccc| c:ctcc ,ccc cccc cccsc c cccc c 0csccscsOvccccccst|tu|c,|c|,c|ctc,cc.|cs,ctc|ccs:cs:ctcsc c|cc||c :cs:c||c|csc cstccsc ||c|uc|csc c csc|c||csc O tctcctc ccs|stc c c,cusc c|cvcccc c c|c c:ctcc c cc,csscs :|cs O ,cccssc |cctc|c ,uc scuc ,cc sc cctc|cc cc ,c|scc .0 /|c c ct|||ct|ccs i|tc|c|c tctcc|c||c c cutcs` i|cccs c c|cccs c ,cvcs cccc c|ccs cu|ccs cs ct c| .00` c|cs cc|cs|cctc cscc,|cc cc|ctcs cc ,c|cs !ct|sc` c cutcs ,cc ccusc|csccsc,c|cctc|c||cccscsct|v|ccsc,ucc|scccc,cs|ccc,cssc cccc cs ct c| .00` `cc| ct c| .` !cc c ccsc ` `c|ctcs cc c|c|s c||cs tc|c ,cc cccc cuciuctcs ct c| .000`Referncias`cs \ !|||s| cctcscs ` Occu, \c.+.+!`|| ` icctcscs ccu,cc|cc|s cc icu|c uccctc`cc|ctc|\cuc|c|ccst|ccctctcctcccc|ctcs,cc|c|s ,ccc|ctcs ics|||c ucccc `cc|cc| c cuc.Figura 1.2is,cct|ccsc c c|ccctc|ccc,c|c|c cc,csc,ucsc:cu,c,ucc:c|ctcccctctccc vcctc|s,ucccc||.cvcsuc ct|v|ccctccc|c,c|c,c:cssc `c|sc C icccc28Salim Amed Aliicccscc i \c||cc| ! cc|c| |:ccccs | s|| ,ct|c,|)s|c|c) ` ` `cc icctc| o+!!`oo.i|||ci`Ovcv|ccccu,ct|cc|s|||sccscs!!tcct|cc|ic|cu Oc|.ct|c ic|c|c,cc|c c: cccu,ct|cc| |cc|t| c sc:ct) , .! i|cstc)ccs|scc,u|ccccu,ct|cc||)u|,c||ccc|ccct|cc|ccc \\v \c| \ctc| v||) c, !`00i|cs i Oc|.cccc c ctcccc c scuc c tc|c||c ! cc|c ` \ cuc c tc|c||c tccs |cs|ccs ,cc c ,css|cc| ,uc cu|c c scuc cs tc|c||cccs cc icu|c ccc , ..ictt i` Occu,ct|cc| s|| |sccsc ` `||c) || !uc| +.o`o!outcc`cis,cct|ccscccu,cc|cc|c:c|||ccvicscucOcu, o.o`+C|cssc\ctc|utcsc,|c|ccsccct|tcccuscc,cc|,cscscccc |)|cs|c|c,|c,tcc|c||cuc|cc`cistcccccicu|cics||cvcuciu|||cc +.+`..0!cc`\ccsc`iicctcscs,cvccccs,cc|c|svcccscs`ics icctc| !`!!!!cc|t| c c:ct) iccut|vc `t|c |cc|t| |c.cs Cu|ccc ctc i! .+ ! 0oo icc !csc|`ctc|cu|ct|cc:t|ccutcccusc||c|cccct|c|)|u||t)ctcct icct|t|s .000!..`!ic|tcustc!\c||cc|!!ctcctcct|t|suctc||tct|c!`cs\Occu,ct|cc| s|| |sccsc . c i|||cc|,||c vi cucs c 0 , \c|ii|::ccccs|ctccsccs|t|cctcc|c|ctcs|||sccscctcct icct|t|s .000!+.`o\ccu||iOccu,ct|cc||cc||c|cctcsc!\c||cc|!!Occu,ct|cc|c |ust|c| cctc|c) . c ||ccc 'cc icc| \c|cc| iu|||s|cs , \cc|ct `\ !c,cs s|,|c v|us |:cct|c c cccu,ct|cc| |c.c | ctc| ,cct|cc ` \|c||c ictc| `sscc .o!.0+\c|||t)c\ctc||t)vcc||)c,cti|cstc)ccs|scc,u|ccccu,ct|cc||)u| ,c||c c c|ccct|c c|ccc \c| \ctc| v||) c, ! `00`ct|ccctt ` !c|css ii i|sccsc cutccc | c|cs |t| cccu,ct|cc| s|| |sccsc ` ` `cc icctc| ++0!`o!ic|||cCccc|vcs ` `s,cctcs ,css|cc|s cs |ccscs cv `sscc \c ics .++++!ict|| \c|c|cc| !! i::cct c: cc c sc c t|c c||c|tct|c c: ||tct cctcct cct|t|s ctcct icct|t|s !+0.o!|c|c `i u| cs |ust|c| |c.cs Occu, !cc|t| c: !`!+29Dermatoses Ocupacionaiscs !! ct c| `ccct|c ccc|||s ` ` `cc icctc| .00.!!!`o! cs!!ctc|`|ctccccuctcccscsc:iccscc|cscc|usccvccct|c`` `cc icctc| .00!!!`o0+ctc|iccv|ccctc|`cu|ccscc|cccsc|ctccc.ccscs`|cs cctc| .`!0cuciuctcsictc|iu,t|cccusc|)ccc,sccc|c|cctccticct|t|s .000!..0|cstci\icv)Occu,ct|cc|||tctcctcctcct|t|sc:uc||:cct|c| ccstuct|c c|cs ctcct icct|t|s !+.+0\cc|ssc C ct c| Occu,ct|cc| |s| c: |:cct|c |) vc|cc||c .cstc v|us | ic||c |cc|t|ccc c|cs c scc,cvc|ccc stu) Occu, iv|c \c .000 o`o.ovc|c i` !c)ccCc)|c C c|| |c)cs c cs|t) c: `cc c cuccs|c stctu cccu ` !vcst icctc| !o.o`o+||c|c icc|c i Occu,ct|cc| )ccscs i ` ! \c o!+002DiagnsticoO | ccst|cc cs cctcscs ccu,cc|cc|s c :c|tc cc c|ct|vc :cc|||cc sc|vc c c|usccscs|||tc:csc,ucsctcc|:|c||:c.c|c|s|co`i|||c ` `|us cs,cctcs scc u|tc |,ctctcs ,cc c c| tcccc c u |ccst|cc ,cc|sc ictc c|cs c|tccscccsc ccu,cc|cc|ccc :|s|cc|ccst|cc |:ccc|c|cccs c |c|cctc|c ||stc,ctc|c|c tcstcs c cctctc|s,cccc c |ccc| c tc|c||c|:cccccs :ccc|cs ,c|c c,cccAnamnese ocupacional` cccsc ccu,cc|cc| tc| ccc cccc c tccs cs cs,cc|c||ccs c|ccs c |,ctctc :ccctc ,cc c |ccst|cc |c |cc ||stc|c ccu,cc|cc| |c cs ccu.| cc,css|vc|cctcct|c|c|ccicc|sscccccssc|c|s,ccc|cc,c,|ccccu ctc|c ,c,ccc c ,uc sccc cctccs cs ccs cccssc|cs Exame fsicoO ccc :|s|cc c c suc |,ctcc|c ,cc sc cvc||c c t|,c c |ccc||.cccc c c ctcscc cs |csccs c,csctccsccc,c|ccvcsccc|cccctccscsc,css|vc|cu|cccccsc|cc c ,c,c| ,c,|c c |ccc||.cccc cs |csccs32Salim Amed AliQuadro 1icccc ,cc css|c|c cs |csccs ccctccs c ccc :|s|cc`cicctc|c|cOcu,cc|cc|cs|csccsccccccc|c:c,ucc|ccccs ctc|cccs |cccs ,cscccc :ccc c ,ccs ctuc c c|us ccscs tcc c tcuctc ,cc sc ct||c c ,css|vc| ,ccsc |cc||.c uc :|c|c c,c,|cc c :| c sc cctc cs cc|ccs c ccc :|s|cc istc cvcc cctc ccs ,uc ,cssc c|ctc c tctcctc cc,cvccccccvcscc||vcs`uc:|c|ccc|cc,uc,ccsccc,tcc,cc|vcscs s|tuccccs cvccc ccstc ccs ,uc :cc|||tc c |scccc c |:cccccs ,uc cs c,uc c cstc|c|ccc c |ccst|cc c c cc ccusc|cc.!cc+|,c :|s|cc!ic|csccc ` c|ccsc ` Ouct|cc cccss|vc c ,c|cs `c|cccs c |||cc ,csscc||cc ` cu|c ` c `o\cstuc|c||,c ` su,c ` u|tc su,c `icsc|ccc ctc||cc cs |csccsc`iccc||.cccc|`|ct|cc`c`ccc`i|stc |,ctcc|c c ccc c:ctcc` s|` cccs,ucccs,ucc|c|tc|c|tcctc `cs \Occu,ct|cc| ctcct icct|t|s,+ o33Dermatoses OcupacionaisDiagnstico diferencialConsideraesCccucccc:cccccscctc|c|ccscccc||ccccc|ccst|cc,|c|c c cctcsc ccu,cc|cc| cc c|stctc u|tcs c|cs cccs,ccc c ,cccsscs cctc|c|ccs cc ccu ,cc|cc|s `cstc s|tucccc c cs,cc|c||stc cvcc cstc|c |ccc c |ccst|ccccctcsccscccccscccccccscccs,ucsc:|.cccccssc|cs ,cc tc|ictccscct|tcsccutcsc:cccccscctc|c|ccsccc||cc|ucs,uc c,csctccsvc.cscccctc|st|ccsccusc,uc|cscc|cccu,cc|cc|cu:cc ccvccs c c||ctc c tc|c||c cc tc|s cucccs cs scu|tcs `|| `icct|tc c cctctc ccccu,cc|cc| iu,cccs ,c ccs.i|s|cscs ctccctcscs+`cuccct|tcs iscc||csc!icct|tc ctc,|cc 0 i|,uc ,|ccic.cc uu|c i|cccs c |sctcs c ccccc c |sctcsoicctctcscs . icct|tc ctc:cctc s|u|ccccc||c|`1Dermatite de Contato no-ocupacionaliucvccc|ccct|tcccctctccctucuc|cccccsc,ccccs cstc ,uc c|c cc c c ct|c|c|c ccu,cc|cc| c ,ctctc cc tc cc ccusc| uc ccusc ,|c|,c| ,cc sc cccctc c vc|cs ct|v|ccs cs s c sccc tc|s ccc |c.c ccsctcs c cs|cc|c c cutccvc| ctc2Disidrosescccu,cccsvcs|cu|ccscucsc ccctcscucc|ccs,uc,ccct||:cccs |ctcc|s cs ccs cs ccs c cs ,cs |c ccc ,c|cs c ,|ctcs ` ct|c|c|c c vc|cc tc|s ccc |sc|c ,s|ccc|cc cctctc ctc,|c scs|||||.cccc cc |,uc| cutcs3Neurodermatite Circunscrita ou Lquen Simples Crnicoi ccst|tu|c ,c |cscc c ,|ccc ||,uc|cc c c u|tc ,u||csc ` ctc,|c c c tcscc ccc|cc| ,cc sc :ctccs cc|c|cctcs cstc cctcsc4Dermatite Atpica ou Neurodermatite Dis seminadai uc c:ccccc cctc|c|cc c ,uc| :c,uctcctc cccc cuctc ccctucc c |uc|c|u||c !i icc cstc csscc|cc c csc c ||tc c c cc,ut|v|tc c|c|cc Occc c ||v|ucs ||,ccct| vcs c ,uc| :ctccs c||ctc|s c tc|c||c ,cc csc cccc cc.cc csc ||tc cu cc,ut|v|tc ic,|cs |c|ctcs ccc|s,csc|cs cctcs ,u||ccs cc|c :|c |cs c|c|s cu vcctc|s34Salim Amed Ali5Eczema Numularcst|tu|c ,c |csccs cc.cc tcscs c ,|cccs cs vc.cs c :cc c ccc cs vc.cs s|ct|ccsucct|c|c|ccccc|ccc|cc|ccu csc,ct|csccsccsccs ,cc cssu| cs ,cctc cc.cctcsc u|tc scc||ctc c,uc|c c cc.cc uu|c icc cccc cct|tc c cctctc cc cs ,cctc uu|c c ,cc|cs6Dermatofitosecc c:cccccs cutcccs ccusccs ,c :ucs `|c cs cccs ,ucct||.ccs cu sc|,ucct||.ccs c c,|cc cs ,c|cs cs u|cs `| ucs |ccscs su,cc|c|s scc ccc|tcs ccc ccu,cc|cc|s ,c|c cuc c `c|ctcs c c|c||c c c|us ,c|scs ic,|c |cc ,c|s c c,cc|cs c |cs c ccvcc7Erupes por Drogascc cccccs cutcccs |u .|cs ,c cc ucc c su|stcc|cs ,u||ccs c c,csctc cs,cstc cutccc vc|cc csc |cscc cu tccc |ccc||.cc c ccc||.cc u|tcs vc.cs cvcs c ctc :ctc|s `,uc|cs ,uc c|s cs |tccssc cc,ccciu,cccscc.cctcscsscc:c,uctcsc,ccsccsccccccs,cccccctc,|cc cuc| |stccccs|stc|ccc,cccsu|:csc t|||ct|ccsccstcs|ccstc,|ccs tctccc|c u ,ccc|c |c.ccc|c ||ucc|c c cutcs` ccu|c|s |tc:uc.cc c ccscvctc c tc,|ccs ct||cc |c|c ,cc||c||c.cctcs`iu,cccs vcs|cc|c||cscs |ccc||.ccs cu |s sc|ccs `ctcs c|s ccus ccs cctcc c suc :cu|cccc |cctcs |cctcs csc|cc sc||c||ctcs ccu|c|s :cc|:tc|c|ciu,cccsccc|:ccssccc|scvccs,c|ccctctcccc|vccsc|cccscct|cc|cs :|ucccs cu ,c|c |cstcc c |cctcs |cctcs c|cccc|c|c|c8Fotodermatoses`|ucs su|stcc|cs ,u||ccs ,ucc c cctctc cc c ,c|c ,ctcc|c||.c c cccc c |u. u|tcv|c|ctc c sc| istcs cccccs ccst|tuc cs cccccs :ctctc|ccs c cc cvc|vc ccc|sc |ucc|c|cc Os ,|c|,c|s csccccctcs ,c cctctc sccc|vccs c |ccctc ||cctc|t| tcc|cc|vccs cs u|c||:ccs c|,c c cccuc |cccccctcs ctc,u|cc c|vccs c cc||c ccs|c c :|uccscc|csu|:ctc c cc|c,|c|c cccsctc\u|tcs cstcs cccccs ,cc sc ccst|tu| c vccc|cs cctcscs ccu,cc|cc|s |c |cc cccsc c :ucctc| ,cc sc cstc|c|ccc c cc ccusc|9Escabiose ou Sarna`:ccccc cctc|c|cc ccu ccuscc ,c|c ccc,tcs scc||c| vc |c||s \u|tcs vc.cscs|ust|csccccvccc|csc,|c|csccscc||csccc,ucc||c|c|c cc:u|c cc c|c|c c cctcs ,u||ccs c|,u|ccs ,c|c tc|c||cc icssc cc c u|tc |,ctctc ,uc c c|cc c tc|c||c cstc|c|ccc c |ccst|cc ,ccccc c :ccc c tctcctc cc,ucc )cc:t c c|c `35Dermatoses Ocupacionais10Lquen Planoiu,ccc,c,u|c,u||csc,ccccccctc,c|cuccscscu|cs`ct|c|c|cc cscc|cc|c cs |c |uccs cc,|cs c ||,uc ,|cc |u.|c ,c ccs tc|s ccc ,u||c cuc c|vccs c ,cc:c||cc|c|c `|| icccc c \u||c ` csccvcc ccscs c ||,uc ,|cc ccu,cc|cc| ccusccs ,c cctcs cvc|cccs :ctccccs c|vccs c ,cc:c||cc|c|c11Picadas de Insetos e Reao a Lepidpterosiccccst|tu|cvctuc|ctcuvccc|c,ucccctc|c|cccc|c ccu,cc|cc| ,|c|,c|ctc c,uc|cs c,cc|cs ,uc tc|c||c c ccstuccc c cstccs csctcctc c|ctuc c ,|cccs c ctc ccstuccc c ,|stcs c ,cusc c sc|vc O ,ucc cctc|c|cc ,cc sc t|,|cc c ccccc c ,|cccs c c cutcs ccscs ,cccc su| |csccs c ,|cccs ,c,u|c c|tcctcscs ,u||cscs u|tcs vc.cs cc|ccs c icccc cccctcs c cctctc cc |cvcs c |cctcs ccsc c !cc ` .00`12Dermatite Artefacta`cct|tcctc:cctccu:cct|c|ccu,ucccctc|c|cc:c,uctccsc,cc|cs ,ctcccs c cctcscs ccu,cc|cc|s cs c|s |vcscs ct|c|c|cs \|sc csscc|c|ctc c ,cccc|c c scuc ,c ,c|ccs c|s ,c|cccs ` sus,c|tc c uc cct|tc ctc:cctc cvc sc,c sc cc|tcc ,ucc c cvc|uccc c ,cccssc cctc|c|cc sc c|cc sc ,uc c|stc ccusc cc| ,uc c ,ust|:|,uc icvcc ` Consideraes: Ccc ucc c c:cccccs cctc|c|ccs c ccc||cc cc c |ccst|cc,|c|cccctcscccu,cc|cc|ccc|stctcu|tcsc|cscccs,ccc c ,cccsscs cctc|c|ccs ccccu,cc|cc|s `cstc s|tucccc c cs,cc|c||stc cvcc cstc|c|ccc c |ccst|cc c c:ccccc c sc ,cc|sc cccc ccs cccs su|s||c|cs ,uc sc .cc cccssc|csExames de laboratrioHistopatologia`||stc,ctc|c|ccscc.ccsccctctcc|c|ccscstcuccstutuct|,|ccc cc.cc c :csc cuc`c cc ccctccs ccc cc |vc| cs ,c,||cs c|ccs c cs cs,cccs ,c|vcscu|ccs c cc su,c:|c|c|!c |:||tcc ||:cc|tc|c cc ,csccc c cstcc|tcs ccs|c:||cs cutc:||cs`c|cc|csc|cc|cscc|tccc,c|c,cscccccccccc|ucscccs c|stc cs,cctc vccuc|c c |c||cs c c|cc |csc|36Salim Amed Ali`|tcccccs c|s ccctuccs cccc c c,|cc cc sc vc|:|cc ccctc||sc |sscc|cccccscc|u|cscccccc|,|||cccs,c|cscccc|tccc|u|c`vcs|cu|csc |c||cs |tcc,|c|ccsicc cccc ,ccccctcsc ,csccc c cc|u|cs uc|cccs` c cccc cccci |,ctctc sc||ctc ,uc cs ,uccs cc.cctcscs cucs ,c scs|||||.cccc cu ||tcccc scc |:|cc|s c scc |:ccc|ccs u c cutc ctcvcs c ||stc,ctc|c|cTestes de Contato (Testes Epicutneos ou Patch Teste)Introduo` cc||.cccc c tcstc c cctctc :c| ,ccc|.cc ,c|c ,|c|c vc. ,c `ccssc| c cc sc|ccs |c,c cs cct|tcs c cctctc c|c|ccs scc c|ccs ,c ccc|sc |uc|c|cc c c|css|:|cccs scuc Cc|| ct c|. ` ccc ||,cscs|||||cc c t|,c ctccc cu c|cc ,c cc|u|cs c t|,c !\`tc c :| c sccu|c .!. ccc|tcvcsc ,uc tccs cs cc.ccs t|vcssc c|c cccc `ccssc| ` apud Cc|| ct c| ` ccstcu ,uc cc ,css|vc| c,cu.| |csccs cc.cctcscs c tcuctc ,c|c c,||ccccc c ,ccc ccu|c| c u ,cc|ctc ,uc t|vcc tc,cs ctcs ccccc c cstc su|stcc|c c,cs c|u|ci 0! `cst|c c cstc apud Cc|| ct c|. ` |c,cctcctc ccstcc ,uccc,css|vc|,cu.||csccscc.cctcscsctcuctcccc,||ccccccsuccctc|c c :c||cs c ,|u|c c|cc|cc c ,cc|ctcs scs|||||.ccs c cstc ,|ctc istucs ,cstc|ccsccutcs,cs,u|scccscstcccccccscc.cctcscscvc|cscutcs su|stcc|cs cvc|cc ,uc u|tcs cc.ccs ctcs c|css|:|cccs ccc ccccs t||c c cc||cc c|c cccciuci|cc|++`:c|ccc|cct|vcccstcstcsccctctc\c||ccuc tcc|cccc,||ccccccu.|cctcc|cctcstc,cccc,c|c,|c|cvc.cucu c |c|tuc c tcstc csc ccccc c|tcctcsc ctc u|cccccc c cccsc |ccc|icscvc|vcu c cccc|tc c ccccc cu.cc c csccvcu cs ,|c|cs ccscs c cct|tc c cctctc s|stc|cc icc|.cu cs ,|c|cs |ctc|cs ,cc c tcstc c cctctc cc cccc c c. su|stcc|cs ictc c|cs cs scu|tcs su|||cc cu ,ccc c ccu|c tcc||t|c c:tc|cc t|tuc c c|cc ,|u|c |cc:c|c c|c|ctc c ,u||c tccs ||u|cs c c :cc|c|c cu,c ||u|ccc ,c|c vc|c c c i !0 icstc|c c |csc !.` ccscu|c ,c|c ,|c|c vc. tcs:c| c ||,cscs|||||cc c t|,c !\ c c|c|s ccscs|||||.ccsConceitoO tcstc c cctctc c u ctcc c |vcst|cccc c|c|cc cc ccs c :ucctcs |ccstc|c|cc|cs`tcvcsc|c,cccs|:ccc|ccicct|tc!|tct|vccctctc i!`cicct|tc`|c|cccctctci``c|csccstcscsu|tccs,ccccs c|ctc c ,cc|ctc c :| c cv|tc :utucs cctctcs cs` cctcs` |c||ccs` cc c 37Dermatoses Ocupacionais,c|c c |st|tu| c|cs ,cvct|vcs cc,uccs ,ucc cvcs cctctcs :cc |,cct|vcs |s|c c !c !|||c ` `c|cc ctcct icct|t|s cc|ct) !` Os tcstcs c cctctc cvccc sc ||cccs c,cs uc cccsc ccucc uc|cs c ctcc|c|c c|c|c ,uc ,ccc cs c,uc c cstc|c|ccc c cctc ccusc| c|ccs ,uc tctc cs i! ,uctc cs i` ,cc sc |vcst|ccs c :cc sctc|c| icccs cssc cc cstc|c|ccc ,ccctcs ,uc |cc cs c,uc c ccctc cs` cctcs` cs,cscvc||s` iccuc usc c scu|tc cs,uccOcu,cccc ,uc| c ct|v|cc ,|c|,c| c ,uc ,cutcs cu su|stcc|cs ctc c cctctc c :cc |c||tuc| cc cs cccs cc,cct|cs c ,uc ,cc|c sc |c||ccs|sc c ii! c|stc ccc|cccc ctc c usc c ii! c c cct|tc c,csctcc ,c|c tc|c||ccicutcs c |||cc ,csscc| c ccsct|ccs c|u ccsct|cc cu ,uc|,uc cutc cctc uscc c |||cc ,csscc| ,cc|c ucc c|cccc cc c cct|tc`||ctc cs|cc|c| c|stc c c||ctc cs|cc|c| cctctc |c||tuc| cc ,|ctcs c cu/c|c|s iccutc cs,cc|cc cu |c||tuc|ctc c,ccs c c,u|cs c cs|cc|c cu c cutccvc| !c ,css|vc| cctctc cc t|tcs sc|vctcs c|ccs ccs cssc c c|ctc c cutcs`t|v|ccs c |c.c ,ct|cc c|u t|,c c cs,ctc ,uc ,cc tc |tccccc cc cs cccs c:ctccs ccuscc ccvcctc cu ctccc suc cucctcctc c:ctucc cs ,cutcs usccs c tctcctc c cct|tc |cvcc c c||cc cu c ,|cc c ,ucc c|||cc !c c|u tc,|cc cs,cc|:|ccctc ,uc ccvcu c ,ucc c|||cc !c ,|cc cc c :|c cu cc|c !c c||cc cc c:cstcctc c ct|v|cc c ,|cc ,ucc cccc c ctcc c c cc,cs|ccc ccs cscs cctcs cusscccu ct c|. .`Quadro 2i|ccst|cc cs cct|tcs c cctctc ||tct|vcs c c|c|ccsO ,ucc c|||cc c cc,ct|vc| cc cct|tc c cctctcOccc c c||ctc c tc|c||c c,cs|ccc c cctcs ||tctcs cu ,ctcc|c|ctc c|cc|ccsi|stc cc ctc c ||c|c c cctcsc c c ,c|cc c c,cs|ccc ccccc|c cccst|cc``s |csccs cstcc |ccc||.ccs c cccs c cctctc cc cs cctcs sus,c|tcs ccccc|c tc,cccc`!c c||cc cc c:cstcctc c/cu ,|cc cc c ctcc c csc ct|v|cci ,css|vc| cc|u| c c,cs|ccc ccccu,cc|cc| ccc :ctc ccusc|i ,css|vc| ctcvcs c tcstcs c,|cutcccs |ct|cc c ,cvcvc| cctc ccusc|O|s `,csctcc c|cc csscs c|tcct|vcs ,cs|t|vcs ccs|ccsc :ctc sus,c|ccc c cctcsc ccu,cc|cc|O tcstc c cctctc cvc sc c|c|ccc cc c|cccs c |cc ,ccccc|c c ,uc||cc `|stuccc|ccccccvc|cu|ccvcsccc|s|ccccc,css|vc|cc|ccccc tccc|c|c c,c,|cc Os tcstcs cvc tc c|tc cu c ,uc||cc c c,csctc |cc scs|||||cc c cs,cc|:|c|cc |s|c c \c||cc| 0`cs|||||cc c tcstc cstc |ctcctc c|cc|ccc c suc cc,cc|cc c |ct|:|cc sc c ,cc|ctc c,csctc c|c|c ,c cctctc38Salim Amed Aliis,cc|c|cccccc,cc|cc,ucctcstcc,csctcc|sc||cucvccc|c ccccc c|c|cc c cutc cc c|c|ccicc|scc cu ccucc|c c c scctc|c c scs|||||cc c c cs,cc|:|c|cc c tcstc` |c|c scs|||||cc c tcstc ,cc c,cssc u :c|sc cct|vc` |c|c cs,cc|c|cc c tcstc ,cc c,cssc u :c|sc ,cs|t|vcRelevncia` c|cvcc|c c u tcstc ,cs|t|vc c cc ,c|c c|cccc c|stctc ctc c cctc ccusc| c,ctccctcstccc,uccc|||ccc,cc|ctcctc|cc,uccct|ccccctc ccusc| |cvc c cuc cu c c||cc c ,ucc c|||cc iccc ct c|. !`\u|tcs vc.cs cs cuscs c cs,cc|c||.cccc c \c|c|c c c|c||c cu c sc|c|cs suc c ,cutc Ouc cvc :c.c cs tcstcs c cctctc \u|tcs ccccs cs,cc|c||stcs c,ccs|.c\ccc,ucc,u||c,c|cc|cccc||.ccccctcstcitccvccccvc :c.c|c sc| c c|ctcccc c u ,c:|ss|cc| ,uc ,c tc|c c|uc c,c|cc|c ` cc||.cccc :c,uctc c tcstc c suc |tc,ctcccc c ccc|cccc cc c ,ucc c|||cc |c c cc:|ccc c ||ccccc ccc vc. c|s cc,ucc c tcstc c cctctc ccv|c c cstc|c|cc|ctc c c|cvcc|c c c cc cs,csc||||cc c ccc ccu,cc|cc| ,c,uc |ssc |c c,csctc ,cc c tc|c||cc c cstc|c|cc|ctc ccctc c cc ccusc|`cs ccscs c ,uc c ,c:|ss|cc| ccs c,c|ctc c,ccsc cc uv|cs ,uc ,cssc|stccccccccusc|cctccccvc|ctc,uccstctc|c||ccsc,cccc||cc ,ccuctcccuccc|c||cccc,c:|ss|cc|sc|sc,c|ctcs ,cssc ||| cvctuc|s uv|cs c:cctcs cc cstc|c|cc|ctc c cc c c c|cvcc|c cs tcstcsTeste de contato com bateria padro e suspeitosO tcstc c cctctc cvcc sc c:ctucc sc,c cc u ,ccc ,uc scc ut|||.cc c tccs cs sus,c|tcs cc i` |t|||.c cs tc|c|cs c cccctcccc ,cc|.ccs ,c|c Cu,c c istucs cs icct|tcs c ctctc c cc|ccc ics||c|c c icctc|c|c`|c c ,ccc tcstc cs su|stcc|cs c:c|cs ,c|c ,cc|ctc ,c c|c c cccsc ,uc cvc sc |c c|c|ccc c cu|ccscOsc|cccssus,c|tcsc|t|cs,cc|cccccsccvcccsctcstccs,utcctcccc|ctc|c,cccicCcctctc|!`||stcccccc,uctc||su|stcc|cs ,cc|.ccs ,cc tcstcs c cctctc istc ucc tccv|c ccscc c ccc cc c cc ,uc ,cccs cc ,uc ,c tc|c u|tc,csscc cstc cccccs cs ,cccucccs cvc sc tcccs ,ucc sc tcstc su|stcc|cs c cc,cs|ccc cscc|cc|cVeculo para o teste de contatoO vc|cu|c |cc| ,cc cs tcstcs c cctctc c c vcsc||c ictc|ctu |i` ctuc c,ccc c su|stcc|c ,ccccs usc cuc c|cc c c||vc ccctcc c|ccc| c cutcs39Dermatoses OcupacionaisLocais de aplicao do teste de contato`,||cc c tcstc c cctctc sc|c c ,c|c cc| `s cccs c c|c|ccc ,cc c,||cc|c scc c csc c c scuc |uc c :ccc ctcc c |cccOs tcstcs scc c,||cccs c scuc:c|c i0` ccv|cs c ,uctc:c|c i.` ! |ccs c,cs c c,||ccccc c ||cs c sctc:c|c i!` o |ccs c,cs c c,||cccccInstrues ao paciente`cc c||c c tcstc c cctctc`cc cccc c ccc c tcstciv|tc ccc|c|cs cu cv|ctcs |usccs!stu|c,cc|ctcc,cccc\|cc,cccsctc|ccsctcstcccscsccs,cc`c ct|c c :|tc ucc cs |ccc|s c tcstc cc ccctc cs:ccc:|cc cu ||cc:|cc ictc,c c uccccc ccc||cc cc :|tc \|cc,cc c . cu ut|||.c c cccc :ccc|c ,c|c | |c|cs ,cc cstc :|c||cc`ucc cccc c +0 |utcs c,cs c ct|cc c tcstc c cctctc ,cc :c.c c ,|c|c |c|tucInterpretao dos resultados` ,cs|t|v|cc c ||ccc c scu| cc:cc ,ccc cstc|c|cc|c ,c|cs u,cs cuc,cus c ctccc|cccs )cc:t ct c|. .```cc |cuvc ccccc`ic||c c|tcc uv|csc``ccccc :ccc c|tcc,c,u|c`ccccc :ctc c|tcc,c,u|c ccctcscvcs|cu|cs |sc|ccs`ccccc u|tc :ctc ccc,c,u|cvcs|cu|cs ccc|cscctcs :ccc vcs|cu|cs c|ccs!`ccccc ||tct|vc` |c|tuc :|c| c :c|tc c i! cu sc,c o |ccs c,cs c c,||ccccc c tcstc cctccsc cs csu|tccsi|tcc c |ccc| c tcstc c cctctc ,uc sc ctc cu cuctc c |c|tuc c o |ccs c sucst|vc c scs|||||.cccci|tcc ,uc cscccc cu csc,cccc ! |ccs c,cs c ccccc c tcstc c cctctc cstc ,css|vc|ctc csscc|cc c cccc ||tctc c su|stcc|c tcstccReaes falso-positivasicc cccc cccccs :c|sc,cs|t|vcs cs scu|tcs s|tuccccsc su|stcc|c tcstcc cstc c cccctcccc c|cvccc tcstc c cctctc :c| c,||ccc c cccs c ,uc c ,c|c cstcvc ||tccc vc|cu|c uscc ,cc c tcstc c cctctc c ||tctc ,cc c,uc|c ,cc|ctccccccs ,c|c :|tc ccs|vc cscccc c ccc c tcstc c s|u|cc cccccs ,cs|t|vcs40Salim Amed Alisu|stcc|cscvc|cu|c||,u|c,ucsctccccccctccsccctc,cusccs c,cs c,|cccc c ,c.c`su|stcc|cs sc||cs cc|c |ccc|c` ,cc ccusc c:c|tc ,csscc c |ccc| c tcstcReaes falso-negativasc cccctcccc c c|ccc cstc |c|cc su|stcc|c c sc tcstcc cstc c cccctcccc cccvc|cu|c cc c cc,uccc cc|uscc c |su:|c|ctcc,cs|ccc c ,c|c cc sc| uctc uc cu c|s scccs cc cs c|cccs sccc c,||cccs ,cc |||| c cs,cstc cc tcstc|c|tuc c ccs c ! |ccsusc c cct|cc|c tc,|cc c |ccc| c tcstc c,|c c ccccc|ucsu,cssccs cct|cc|c cc| c cscs c .0 cu c|s c,|c c ccccc cc tcstc c cctctccct|cc|c c c,cs|tc cs,cc cccc c + scccs ,cc c cc||.cccc c tcstcReaes fracamente positivascccccs:cccctc,cs|t|vcsccccccccctc,|ccscccsct|ccscsuccc c|c|c scc c ,cucc s||:|ccc c|||cc ctc|c c ,cc|ctcs cc cccccs :cccs c |ccctc c ,ctcss|c c ,cc:c||cc|c|c iii`` uctc v|tc ccs cstcc ,uc cstcs ||v|ucs ,cccccc ||vcs c cctcscs i ,css|vc| ,uc cstcs |vc|s |c|cs c scs|||||.cccc sc,c uc c,csscc |uc|c|cc ,uc ,cv|c scs|||||.ccccs c|s ,ctctcsicc cccc c c,ccc|ctc c ||,c cu ||,c,|ctcccc c c|cc c tcstc c cctctc icc|ctcs ,ctcccs c ,sc|csc ||,uc ,|cc v|cscs cutcccs ,cc c,csctc c,cuccc c |cscc :cccc c !cc|c` c |ccc| c tcstcc sus,c|tccs ,uc ctc|cc su|stcc|c cc cs,cstc :ctcctc ,cs|t|vc cvcccs tcstc|c |sc|ccctc !|v|ucs ,uc tcs,|c c ccs|c cu ,ccccc c |ccc|s u|cs cu ,uctcs cvccc :c.c c tcstc c cctctc c |ccc cvcc sc :|cc cc :c|c c :|tc |cc,cc i ccsc c c|s cu c|s tcstcs c cctctc :ctcctc ,cs|t|vcs ,uc cstc,c ,c|cs us cs cutcs c ,uc cc c,csctc c|uc c|cvcc|c cc c ,ucc c|||cc c ,cc|ctc iuctc !` ccccc ,uc csscs su|stcc|cs sc,c ctcstccsscccsc,cssc,cccctcc:|csccscctcc,css|||cccc) |cc|Queixas referidas pelo paciente aps a colocao do teste epicutneo`tcvcs c u ,ucst|cc|c !cct ct c|. .000` .cc u cstuc ,||ctc cc !0 ,cc|ctcs .oo c scc :c||c c + c scc cscu||c `s ,uc|c c,csctccs ,cc sc v|suc||.ccs c c|c|c 41Dermatoses OcupacionaisTabela 1Ouc|cs su|,ct|vcs c,csctccs ,c|c ,cc|ctc c,cs c c,||ccccc c tcstc c,|cutccc|tccs !0` i0` i+`iu|c ..iu|c c csc + oiu|c c |ccc| c cctcsc 0+iu|c c cutcs |ccc|s o !cs:|cc . !c|c ! oic c cc|ccc o0 .csccc ! +ctuc . !!sc|c i|stu||cs cst|ccs . iu|c cs ccstcs!|c|cc c D00!|c|cc c D10!|c|cc c D2..iu|c csc,cccc c i0iu|c csc,cccc c i!oiu|c ,csctc ctc i++0 ucc c ,cc|ctcsSegurana e os testes de contato com substncias padronizadas e outrasTeste de contato com cosmticos e medicamentos:\c|ccctcs tc,|ccs ccsct|ccs c vcstuc|c ,cc sc tcstccs ccc sc c,csctc istcs ,cutcs ,c c:||ccc cc cvc ||tc c tcuctc ic cstc c.cc cccccs :cccctc ,cs|t|vcs cu sus,c|tcs c cstcs su|stcc|cs sccc cu|ccscctc cvc||ccsc,c ,uc ,css|vc| tctc |ct|:|cc c su|stcc|c cu su|stcc|cs cct|cs c ccsct|cc cu c|ccctc ,uc |u.|c c ccccc c|c|cc\u|tc ,cccuccc cvc sc tccc ,ucc tcstcs cc su|stcc|cs cc ,cc|.ccs :cc cc||.ccs ` cccctcccc cvc sc tc| ,uc cc ccusc ccccc c ,c|c c ,cc|ctcs cc scs|||||.ccs i ccsc c tcstc ,cs|t|vc cc csscs su|stcc|cs cccccsc ut|||.c ,c|c ccs tcs cctc|cs ,cc sc c:cstc c ,css|||||cc c ||tcccc|t|||.c cs tc|c|cs c cccctcccc ,cc|.ccs ,c|c International Contact Dermatitis Group Research !iC` c ,c|c North American Contact Dermatitis Group ``iC` cu u ||vc cs,cc|:|cc cc cccctccccs ,cc|.ccs ,cc u|tcs su|stcc|cs ic Ccct !` O Cu,c ics||c|c c icct|tcs c ctctc Cii` ,cc|.cu uc |ctc|c ,ccc cc 42Salim Amed Alit|tccc,cctcsc,uccccs|stucsc,ucc|ucssu|stcc|csscctcstccs cccs,cc c cc||cc c ,ucctc c c|tc su|stcc|cs v|c c|c|c .``s |ctc|cs c tcstcs ut|||.ccs cc:cc c ,ccc ,ccc|.cc ,c|c Cii ut|||.c vc|cu|cs c su|stcc|cs i` ic`c||sc` c :| c cv|tc cccccs ,c |,uc.csOucc ut|||.ccs ,cutcs ctuc|s c tcstc c cctctc cs |cu|ccs scc c|ccs ,c|s c cc.ccctc c c|cccc c cccccc c c cc|c ,cc c|tcc c ,c,cccc cs scs|||||.ctcs c su|stcc|c O ctc|c| c,ucsc cvc sc uccc c c|cc|c ,cc c|c uc||||ccTabela 2ictc|cs ,cc|.ccs cs u,cs |tccc|cc|s c cstuc c cct|tc c cctctcu|stcc|cCiiiics|| ``iC !iCcc \c|cu|c cc \c|cu|c cc \c|cu|c`tc,u|cc . \csc||c sc||c \csc||c sc||cic|scc c icu .\csc||c sc||c. \csc||c sc||c. \csc||c sc||cic.ccc|c \csc||c sc||c \csc||c sc||c \csc||c sc||ci|ccctc c ictcss|c 0\csc||c sc||c0 \csc||c sc||c0 \csc||c sc||ciut||:cc| ,cctcc|c|c \csc||c sc||c \csc||c sc||c \csc||c sc||cc|c \!.`i|:c||uc||ci|ct|||t|ccc|cctc c .|cci|ct|||t|ccc|cctc c .|cc+\csc||c sc||c |cctc c c|c|tc \csc||c sc||c \csc||c sc||c \csc||c sc||cc|c:c|c .0\csc||c sc||c.0 \csc||c sc||c.0 \csc||c sc||cit||cc|c|c \csc||c sc||c \csc||c sc||c \csc||c sc||ccc|c|c `uc `uc `uc!|c,u|cc \csc||c sc||c !csc \csc||c sc||c !ct|c C 0\csc||c sc||c `uc`43Dermatoses OcupacionaisTabela 2ictc|cs ,cc|.ccs cs u,cs |tccc|cc|s c cstuc c cct|tc c cctctcu|stcc|cCiiiics|| ``iC !iCcc \c|cu|c cc \c|cu|c cc \c|cu|cicc||c +0\csc||c sc||c+0 \csc||c sc||c+0 \csc||c sc||c\ccc,tc \!.`\ccc,tc|c.ct|c.c|i||c.ct|c.c| |ssu|:ctc\c:c||||cccc,tc|c.ct|c.c|`|c|c|c|| .|c.ct|c.c| su|:cc|c.\csc||c sc||c `cc|c|c .0\csc||c sc||c.0 \csc||c sc||c.0 \csc||c sc||c`|tc:uc.cc \csc||c sc||c icc|c \!.`\ct||,cc|cit||,cc|cic,||,cc|ciut||,cc|cic.||,cc|c\csc||c sc||c \csc||c sc||c \csc||c sc||cicc:c||cc|c|c \csc||c sc||c0 \csc||c sc||c \csc||c sc||cic:uc \!.``|ccc| c|c|cc`|c|c c|:cc|| c|c|cciucc|!sccucc|Ccc|c|!|c|c|tcc|c|Oc| \css `|sc|utc\csc||c sc||c \csc||c sc||c \csc||c sc||ciii \!.``!sc,c,|| `c|| ,cc:c||cc|c|c`` i|:c|| ,cc:c||cc|c|c0!\csc||c sc||c0o \csc||c sc||c0o icctc.|c \csc||c sc||c ic,||cc||cc| 0\csc||c sc||c Ouctc|u 0\csc||c sc||c\csc||c sc||c\csc||c sc||c``44Salim Amed AliTabela 2ictc|cs ,cc|.ccs cs u,cs |tccc|cc|s c cstuc c cct|tc c cctctcu|stcc|cCiiiics|| ``iC !iCcc \c|cu|c cc \c|cu|c cc \c|cu|cOu|c||c \!.`|c,u|c|c|||c,u|c|o\csc||c sc||c o\csc||c sc||ccs|ci,c| \csc||c sc||c\csc||c sc||c\csc||c sc||cu|:ctc c `|,uc| \csc||c sc||c\csc||c sc||c\csc||c sc||ccc||t|c 0\csc||c sc||c||ccsc| 00 \csc||c sc||c0 \csc||c sc||c |uc \!.`ctcct||t|uc |ssu|:ctc \i`ctcct||t|uc ccssu|:ctc \\`\csc||c sc||c \csc||c sc||c \csc||c sc||cc,cctcs c ictc|||t tcctictc|c,ccc |cs||c|c c tcstc c cctctcTeste de contato com slidos:cu.| c su|stcc|c sc||c c ,c,uccs |c|cs ,ct|cu|cs cu ,c c c,||cc|c sc|c c :|tc |cccc cc cuc cst||cc cu c|cc c c||vcict|cu|cs sc||cs ,cc ,cu.| cccccs :c|sc,cs|t|vcs c v|tuc c ,csscc ccc|c c |ccc| c tcstc c cctctc ,|c|,c|ctc sc c ,cc|ctc :c ,ctcc c cccscccccccccsc,ccccc|c|tucco|ccsctcstcccct|vccsc,cs|stc c|tcc cu ccc cu vcs|cu|cccc c tcstc c ,cs|t|vcTeste de contato com tecidos:Os tcc|cs c scc tcstccs ,cc sc ccctccs c ,ccccs cc cccc c c c c,||cccs |ctcctc sc|c c tc c scu|c ucccc|cs cc cuc cst||cc cu c|cc c c||vcReaes aos testes de contato causadas pela fita adesiva:cccccs c|c|ccs cc cs,ccc,c ccu scc c|s :c,uctcs ,cc ccs cc \|cc,cc `,uc|cs ,cu.|cs ,c|c :|tc ccs|vc c tcstc c cctctc cscccc c,|cctc .0 c o0 |utcs c,cs c suc ct|ccc |cuvc uc vccc|c ccccc c|c|cc c tc c c|tcc ,cu.|c ,cs|st|c ,c .! |ccs cu c|s ,ccc |c|us|vc csccc cccccs ,cs|t|vcs cc tcstc c cctctc c |cuvc uv|cs c tcstc c cctctc cvcc sc c,ct|c usccsc cutc t|,c c tc ccs|vc`45Dermatoses OcupacionaisComplicaes:iccc|cccc c cctcsc csscs ccscs ,cc cccccc.cct|.cccc c |ccc| c tcstc c cctctcccu|.cccc c cctcsc cs cccs ,||t|vcscc.cct|.cccc c cvcs cccsccccc ,ustu|c||tct|vc||,c cu ||,c,|ctcccc c |ccc| c tcstcu|cccccc c ctc cccsc:ccccc c ,uc|c|c |:ccccc sccuc|c v|c| cu |cctc|cc:cccc c !cc|c |uccc c cctcsc c |ccc| c tcstc c cctctc s|||c c cctcsc ,cc|stctc c ,cc|ctc tc|s ccc,sc|csc ||,uc ,|cc cctcsc v|c|c|stc c ,css|||||cc c scs|||||.ccs c ,cc|ctc ctcvcs c tcstc c cctctc ,cc cc c ,cc|.cccc cs tcstcs c c cc ,uct|cc c c|ccc c ,uc c ,cc|ctc :|cc c,cstc c ccc tcstc cstc ,css|||||cc |c,c c |cstctc cctcs|cc c ,c|c ||,ccc|tcc scuc iuctc !` ccctc|.csc ,c|c cs,cstc cccc|cc c ,c|c cc vc|cs tcstcs ,cs|t|vcs cs |c|tucs c ! c o |ccs c ,uc sc cct|vc ,ucc c ,cc|ctc c ctcstcc scccs c,cs i uc ccccc|c ,cucc :c,uctc i ,cc|ctcs ,c c|c tcstccs cstc |c|cc|c c|cc c o ,|c|,c|ctc ,ucc sc c|tc c tcstc vc|cs cs,cstcs ,cs|t|vcs sc ccc|cccc ,|cus|vc| cc c ,ucc c|||cccccccs cc:||ct|ccs ,cc cccc ,|c|,c|ctc ,ucc tcstccs c|ccctcs cc c|stctc ,cccs |:c| ,c|c ,uct|cc c ,cc|ctcs tcstccs c c ucc c ccscs csc|tcs ,uc cstcs cccccs scc ccs `c|c ct c|. .00+`Efeitos da medicao sistmica e tpica sobre o teste de contatoct|cc|cs c cscs cc|s .0 cu c|s` cu !\ cu i\ |c||tuc|s ,cccc ,c,u|cc cs cccccs cc tcstc c cctctc `cstcs cscs c|cs ,cc|c |||| cu csccc cs cccccs :cccctc ,cs|t|vcs ,uc u|tc ,cvcvc|ctc cc tc|c s||:|ccc c|||cc ctuc cv|tcsc tcstc c v|cc|c c cct|cctcc,|c O|s Os tcstcs :ctcctc ,cs|t|vcs scc ,cucc c:ctccs ,c cstcs cscs c cct|cc|cs ct|cc|c tc,|cc c ccc c tcstc c c cc |,ctcc|c ,c|s ,cc su,|| c cs,cstc cc tcstc c cctctcct|cc|c c c,cs|tc cucc cccc c + scccs ,cc sc ,cccc cc tcstc c cctctc`t|||stc||ccs cc tc |:|ucc|c s||:|cctc c cs,cstc cc tcstc c cctctcEfeitos da luz ultravioleta sobre os testes de contatoi,cs|cccc|u.sc|ccu|\cc|c.ccctccu.cuccccc|u|cscicc|cs c ,c|c c |||c c cs,cstc cutccc ccs tcstcs c cctctc46Salim Amed AliInterpretao do teste de contato`s scu|tcs ,css|||||ccs ,cc cccc c |tc,ctcccc c tcstc c cctctcMonossensibilizao| c|ccc ,cs|t|vc c c cs,cscvc| ,c|c i` uc ct|cc tctc| |cvcc c cuc c ,ucc c|||cc Polissensibilizao!c vc|cs c|cccs ,cs|t|vcs c c ct|cc c tccs |cvcc c cuc cu c||cc s||cct|vcPolissensibilizao:!c vc|cs c|cccs ,cs|t|vcs cs c ct|cc c tccs cc |cvc c cuc cu c||cc s||cct|vc `cstc ccsc vc|cci|stc cutcs c|cccs cc tcstccs c ,uc cc :cc ctcctccs ctcvcs c `ccsc Ocu,cc|cc|icct|tc :cct|c|c cu cct|tc ctc:cctc cu cutc|cs|c|sc O tc|c||cc cc|ccc c|cs c ctc suc cctcsc ct|vc ,cc cv|tc suc c|sscc cu ,cc c |cc:|c|cs cu cutcs vctccs su|,ct|vcsOtc|c||ccc:cstcccct|v|cc,cccvctuc|ctccccutctc|c||cstc,cc|cs ||cc` ,cc c||cc suc cc c cstc ct|v|cc ctc c cctctc cc cctcs ||tctcs cu scs|||||.ctcs ,uc |:|cu|tc c ctcc c |cc cccc c tctcctc ,c,cstcInstrues ao paciente sensibilizado`s |stucccs cc ,cc|ctc scs|||||.cc cvc sc cs,cc|ccs c cs c|s c|ccs ,css|vc|s ic,|c ,cc|ctc c|c|cc c |ccc|c cvc cv|tc c cctctc cc i,u|,cctcs c ictcccc !|v|uc| ii!` c |ccc|c tc|s ccc |uvcs |ctcs cvctc|s ctc c cccssc|c usc i,u|,cctcs c ictcccc !|v|uc| ii!` cccc c c,u|,cctcs cu,cs cc,cctcs cccctc|ccc|cccctcctccctcstcc:c|uvccccccc,cccc ct|v|cc |uvc c v||| |t|||cc cu c i\Inspeo no local de trabalhoistc sc ,css|vc| cvcc sc c:ctucc ,c|c ,c,|c c|cc ctcctc ,uc cvcc :cccc ccs cu|||ccs ,cc c |ccst|cc\c|ccsu|stcc|cs c|,u|ccs ,c|c ,cc|ctccc|cccs c ii!cc|cccs |scucs c |ccc| c tc|c||cc|stcc|c c cutcs tc|c||cccs |uc|ctc c:ctccs cs cscs cc|cccs c tc|c||c47Dermatoses OcupacionaisInformaes fornecidas pelo empregadorO|tc ,utc cc c,ccc tccs cs |:cccccs cccssc|cs ,cc sc cstc|c|ccc cc ctc c cctc c c cctcsc is,cc|c| ctcccc cvcc sc cc ccs scu|tcs cs,cctcscc cccc|c| c ,cutc sus,c|tc:|c|c tcc|cccc,cs|ccc ,u||cc,csccc c su|stcc|cs scs|||||.ctcs,csccc c su|stcc|cs ||tctcsReferncias`|| ` icctcscs Ocu,cc|cc|s cc icu|c uccctc , !!`||`icccc`C\u||c!i|,uc,|cc|u.|c,ccvc|cccs:ctccccs` |c cctc| .!+.`c|ccctccticct|t|scc|ct)cscsusc:t|c`c|ccctccticct|t|s cc|ct) |ccs|s c: c||c|c cctcct cct|t|s |` cv !i|||ci`Ovcv|cOccu,ct|cc|s|||sccscs!!tcct|cc|ic|cu Oc|.ct|c ic)c|c,cc|c c: Occu,ct|cc| !cc|t| c c:ct) Ccc|c cc, .oicvcc\\c||c|icst|,u)c||c||ssc|cccc|cu|ctc,|c)Occu, !cc|t| c: !.`+o!0icCcctictc|cst|tcstcccctct|cscvc||c|cs:c+00c|c|cc|s.c `stcc i|scv|c!ccsc ` i!cc ` \ `c|ctcs ,c ic,|c,tccs |cvcs c cu|tcs c c|,cscs` cstuccscs,cctcsc,|c|c|c|ccsctcc,cut|ccs`icsicctc|\c|0o, iuctc !`C |cc c ,c|c cc|tcc `) icc|` '|ssctcccc' cc icu|c ||vcs|cc c cc icu|cccu|cc c \c|c|c !|s|c `` ctcct cct|t|s + c i|||cc|,||c iccc||c o , !!|s|c !|||c `! ictc| tcst| tcc||,uc ` ` `cc icctc| .+0.|s|c\c||cc|!O!,cvc|utct,c:cct,ctc|tcst|``ctccticct 0.`+0cusscccu ` icc..c\c||cc| ! Occu,ct|cc| cctcct cct|t|s c|||cc| c c|c|cc| cs,ccts i|||cc|,||c vi cucs c . , .!Cc|| i!C cc|s ` icc|c i` !||cc| cs,ccts c: |uc|c) O:c i|cc|c|| c|ct|c iu|||cct|cs !cct`\c||c!),tcsc|sc,ctciu|ictc|cst|``ctcct icct .000`!.48Salim Amed Ali`c|c \ iu).cc| ii `c,|)|cct|c ccct|c c||c|tc |) ,ctc| tcst| |t| |c|c:ccc ctcct icct|t|s .00+!.`!icstc|c ! |csc \v i,c|cts c tcs:c c: cutcccus scs|t|v|t) tc s|,|c cc,cus icc cc i, i|c| \c !.!oiccc i iucs i i||c i` ic|ct|c c: ,ctc| tcst csu|ts ctcct icct|t|s !.+!)cc:t `C ct c| cs` ct|cc| c: cctcct cct|t|s Occu,ct|cc| cctcct cct|t|s ic|| ,|c\c|c . , ...o0)cc:t `C c|c i Occu,ct|cc| scc||cs i|t \c ` .o0.`+0+!3Agentes FsicosOs ,|c|,c|s cctcs :|s|ccs cc,c.cs c ,cu.| cctcscs ccu,cc|cc|s scc cc|c :|c c|ct|c|cc c|ccccs |c|.ctcs c cc|c|.ctcs cctcs ccc|ccs v||ccccs |ccccs |csc Cc|| o` !ccvc 0` i|||c `Calor`s|csccs,cu.|cs,c|ccc|csccu|tcccusccsscc|ciccsucc||c cc,ccscccucccscs,|c|,c|scctcsc:ctcs,cutccsc|csccscctc|c|ccsSlidosctc|s c,ucc|cscs|cs,|c|c cs:c|tc|uccs cutcs cctcs sc||cs c,ucc|cs ,uc c cctctc cc c ,c|c ,cc |csc|cLquidoscuc ,uctccucsc|ccsGasesc c,ucc|cvc,ccscvccs:ucs50Salim Amed AliMaterial inflamvelcc|c,ctc|cc c scus c|vccsc|ccc| c cutcs sc|vctcsc|cc c ccc|cc c cutcs !cc) !`Outros agentes capazes de causar queimaduras cutneasQuadro 1i|c|,c|s cctcs ||c|c|ccs :|s|ccs c ,u||ccs cc,c.cs c ccusc ,uc|cucs cutcccs`ctcs i|c|,c|s cctcsi|c|c|ccs`cccs cucsv|vcs cccvc|cs |cctcs ,|ctcs |vcscsOu||ccsi|,u|cs |ccvc|s cscs c,ucc|cs cc|cs c|cc||s cc,cstcs ,uctcc|cs c cc|c c cutcs|s|ccs ctcs tc|ccs c cc|c :|c c|ct|c|cc c|cccc |c|.ctc c|cccc cc|c|.ctcic cccc cc C|||cs,|c .` cs ,uc|cucs scc cc|ctc c|css|:|cccs c scu|tc :cci|c|c cu |csc c,ccs c c,|cc |c restitutio ad integrumcuc cu ct|c c cc su,c:|c|c| c ,c:uc c|c c|cct|.cs cs| uc|sccc|c cu ct|c c su|cutccc c ,|cc uscu|c c cs ,ctcs cssccs c|c c|cct|.cs cs|uc|s c ,cc ccusc sc,uc|csOuctc c cv|cc cs ,uc|cucs ,cc sc s|,|cs ccccs c cvcs|,|cs cs |csccs ccc|cs scc c ,|c|c cu c tcc suc ctcscc cu c,csctc |csccs c scuc cu c ctc c ccc cc,cc| cu |csccs c tccc|c cu cc ,uc.csu,c:|c|ccc,cc|csc,uccccstc,ccc|ccc|tc|cccutcs cccs v|tc|s |uc +Figura 3.1Ouc|cuc s|,|cs cc.cuscv|cc,ucc cc|ctc|cc|cc,uctcccc.||c|c c |ust|c icsccs c :csc c c|sscc51Dermatoses Ocupacionais\ccccs cccc |csccs c scuc cu c c +0 c ccc cc,cc| c/cu |csccs c tccc|c cucccsc0cccccc,cc|ccctc ccs ,cs :ccc c c|tc||c`Ccvcs cccc |csccs c scuc cu c c|s c +0 c ccc cc,cc| c |csccs c tccc|c cu cc|sc0cccc,uc|ccc:ccccs ccs cs ,cs c c c|tc||c`s ,uc|cucs ,cc sc c|cs ,c|c cc cs cvc |uc +.` cu cc c iu|cs|) c c|ssc `|| ` i uc cc u|tc ut|| c icctc|c|c Ocu,cc|cc|,c|scs,c|tc,uct|cccccc c ,c|c cc,cct|c c|c|c ` sc,c ,c|c ,uc|cuc cu |scc|c cu ccc cc.cct|.cc cu ,uc|,uccutccc,cct|ctcc,c|cccstc ctcc,cccscc|ccccctcscccsu,c:|c|c cc,cc| cc,cct|c c ,uc c tcc u|tc ut|| c c|ctc|cs cu |cucs ,c|c|c|sTabela 1\c|c ,ccctuc| cst|cc ,cc c ccc cc,cc|c|cc c cc,c vc|c c|cc c cc,c vc|c Cabea Antebrao esquerdo +Pescoo anterior e posterior . Mo direita +Dorso anterior + Mo esquerda +Dorso posterior + Coxa direita Ndegas Coxa esquerda Genitlia Perna direita Brao direito ! Perna esquerda Brao esquerdo ! P esquerdo +Antebrao direito + P direito +ctc \c|ccc c c ! uct |cc,|) + , !`s,uc|cucs,ccc|csc/cuc|cc||s:ctcscc|ctcscc,c:ucscsuccv|ccc|ctcctc,c,cc|cc|ccccctccccctc|c|ccccctc,cccctctc cc c cctc `|us cctcs ccuscccs c ,uc|cucs ccu,cc|cc|s c cssc c|c cccctc c|ctc u|c c|s ct|tc ||c|c c sc|c `cO!` cc|c su|:u|cc !.O!` cc|c :|uc||cc !` :cc|s sc|s ,uctcc|cs c cc|c` c,csctc ccc|cccc |ctc ccctc,ccc,cs|ccctc|c|ccctc,cccctctcccc,c|cOuctcc|ccs cstcs vc|cvc|s c|ccs cs ccs ccusccs c ,c|c c tc|c||cc c,cstc |uc ++Figura3.2cccscvcciu|cs|| cc|sscctcc,ccscc,||c :cc,uct|tct|vccsu,c:|c|ccc,cc| cc,cct|cRegra dos 9 de Pulaski e Tenisson52Salim Amed AliRecomendaes importantes`c|cs c c|cc||s :ctcs c cutcs sc|s ,uctcc|cs c cc|c ,ucc c cctctc cc c,c|c,ccccusc|csccsscvccs`cv|ccc|cscccstc|ctcctcc|cc|ccc cc tc,c c cctctc cc c ,c|c c c tc|c|cc c su|stcc|c `cstcs ccscs |cvc |c|ctcctc c |ccc| c:ctcc cc cuc ccctc uctc c .0 |utcs c c ctc|c| :c sc||c cu,cccust|ccccvccctcsc,ccccc|cvccc|ccc|`c|sccutcscccs |cccccvcstuc|ccctc|cccvcsc,ctcctcccv|cscc|ccc|ct||c|cvccc:c,css|vc|uscc|uccccc||ctc||ctctcc:|csccv|tc csscccctc c |ccc|i sc|cccs cs |csccs ,cvccccs ,c ,uc|cucs ,cc cccc c ,uctc cc|cs|:cctcs:c|sccscsc|c:cctcscctc|c|,ucct|cc,c|ccs,ctc|c cccc c |u. u|tcv|c|ctc c|t|c ,c|c :ctc c sc|c c ,uc|cuc cc|ctc| ,c|c c|cc c sc|c iu ct c|. !` |uc +!Figura 3.3Ouc|cuc ,u||cc ,c `cO! Oucc cc|ctc| c tc,uccctccscc||u|c icsccsscvccsctc+cuccuscc|cc,cc|cctc,cc|c c tc|c||ccFigura 3.4icsccs cu|cctcscs,cc|cccc|\csc|cc `s|csccs|c|ccct|tc:ctcc|c|cci|cssc|st||uc,c cccsc,cstcsc:ctcc,cuccc :ccc ,uc sc cc|cvc ,ctc|c c|c||cc:c.uctcvc|cs|cs cctcc,cccsctc||ccscsscs ccsc|cc|ct|ccccsscc,cs|ccccct|uccccuscucccccs cutcccs scvccs53Dermatoses Ocupacionaisc c tc|c||cc c,csctc ,uc|cucs cu,c ccc c:ctcc sc,c c|c ,uc c|cc cct|ctcs c ,uc cc,cctc c cc ,c:uc c c ||,ccc c ccvc|ctc ccc||c|c ,cc tctcctc c scv|cc cs,cc|c||.ccicsccs c scuc cu cu c|s c :ccc c c|tc||c cs ct|cu|ccccs cs c|cs su,c|ccs c |:c|ccs cvc sc cvc||ccs ,c scv|cc cs,cc|c||.cc`c ccsc c ,uc|cucs cc cc|c :|uc||cc cccctcc c c|cc cc,cct|c cvc sc |c|ctcctc |cvcc ct|c c vcstuc|c ct||c c |cvc tcc c |ccc| ,c cccc c |utcs `cs cccs ct||cs usc ,ccc cu ccc c c|c c ccs|c cu |uccctc c cc|c|c c c c cc|ctc ccccu ctc uc c ucs |ccs ctcs c usc c tc,|ccs cvc sc cc,ucc cc c,||ccccc c sc|uccc c |uccctc c cc|c|c c 0 ` cccc c cc|c :|uc||cc c |s||csc ,ccc c ccc cc,cct|c :|cc c|tcctcsc cu cccc|cc ` c|c ,uc c cc|c vc| ,cctcc ,ccsc ,ccc|c c cv|cc c |cscc ccsc c|cs tcc,cut|ccs sc,c c||cc|ccs O ccc,c|cctc |c|c cvc sc :c|tc c sc cccssc|c cvcs |,ccccs c |uccctc c cc|c|c cvccc sc :c|tcs cc cu||c +00 ctc ,uc sc tc|c cctc.c c ,uc tcc c cc|c :c| cutc||.ccAteno: no use cloreto de clcio, pois ele irritante para o tecidoRecomendaes teis em casos de queimadurasOuc|cucs s|,|cs c c scuc cu ctc 0 cct|ctcs c |cctc ,cc sc |cvccs cc cuc ccctc ctc |utcs c |stc cc :c ,css|vc| usc cc,csscs :|cs `cc usc c|c O usc c ||ctctcs vcsc||c cstc||` ,cc sc ut|| ||u|c c ,css|||||cc c csscccctc ictc,c c ,uc|cuc c scuc cu cc c.c cstc|| sc ,csscc |ccc| ctc ctc|ctc c|cc cs,cc|c||.cc c |cuvc c |ccc| usc u cc|cs|cc c |cc ,ctcc|cO|scvcccccs,uc|cucss|,|cstc|cccsc|ucccccccccucsscccs sc ,uc|,uc tctcctc Ouc|cucs c scuc cu cvc ccc|c cu|ccs ctc cuc cc,|ctc iv|tc c,c cs |c||cs ccsc |c,c c,|ctc cs,ctccc |c||c cc` csvc.|cc cc ct|c suc ,c|c |cvc c |ccc| c c|c cssc ,c|c cc|c c vc ct|ccc c c|c c ,uc :c sc cstcccc |sc ccc cc ct|||ct|cc sc cccssc|cOuc|cucscvcsccccvccsvcstcs,uc|ccsc,cc|ctcct|:|,ucscc ,uccc|cc|scctctcccccctc,uc,cu.|ucs|csccs\c|:|,ucsccv|t|c cstc cs,|cc vc,c sc |c c|u ||c,uc|c c sc cccssc|c :ccc cs,|cccc |ccc c |ccc u|c c ccc ,uc|cc cc |ccc cstc|| c u|c icv|cc|c ccccc ,cc uc u|cc c cccc|c`cs ,uc|cucs ,c cctcs ,u||ccs ,cccc c scu|tc cc|cicvc c ccc ct||c cc cuc c c|