DERMATOSIS AKIBAT DERMATOSIS AKIBAT KERJAKERJA

Changes in Incidence Changes in Incidence (1993 - 1999)(1993 - 1999)

From 1993 to 1999 there From 1993 to 1999 there have been further changes have been further changes in the number of cases, in the number of cases, incidence and proportion of incidence and proportion of occupational skin diseases. occupational skin diseases. In 1999 BLS data showed In 1999 BLS data showed 44,600 total cases of 44,600 total cases of occupational skin occupational skin diseases/disorders, or an diseases/disorders, or an incidence of 49 cases per incidence of 49 cases per 100,000. In 1999, 12% of 100,000. In 1999, 12% of all occupational illnesses all occupational illnesses reported were skin reported were skin diseases/disorders. diseases/disorders.

Work time lostWork time lost

CostCost

Sifat agen penyebab Sifat agen penyebab dermatosis :dermatosis : Agen fisik : tekanan, gesekan, cuaca Agen fisik : tekanan, gesekan, cuaca

dingin, panas, radiasi ultraviolet, serat dingin, panas, radiasi ultraviolet, serat mineral.mineral.

Agen Biologis : beberapa mikroba, fungi, Agen Biologis : beberapa mikroba, fungi, parasit kulit dan produk2 nyaparasit kulit dan produk2 nya

Agen kimia, dibagi dalam 4 kelompok :Agen kimia, dibagi dalam 4 kelompok : - iritan primer- iritan primer - sensitizer- sensitizer - acnegenic- acnegenic - photosensitizer- photosensitizer

Iritan primer Iritan primer Asam , basa, pelarut lemakAsam , basa, pelarut lemak DetergenDetergen Garam garam logam Garam garam logam - garam arsen- garam arsen - garam mercuri- garam mercuri - dll- dll

SensitizerSensitizer Logam dan garam2nya (kromium, nikel, Logam dan garam2nya (kromium, nikel,

kobalt)kobalt) Senyawa yang berasal dari anilin Senyawa yang berasal dari anilin ( p fenilendiamin, azo dyes )( p fenilendiamin, azo dyes ) Derivat nitro aromatik ( trinitrotoluene )Derivat nitro aromatik ( trinitrotoluene ) Resin (epoksiresin, formaldehid, vinil, akrilik )Resin (epoksiresin, formaldehid, vinil, akrilik ) Bahan kimia karet ( vulcanizer) Bahan kimia karet ( vulcanizer) dimetil dimetil

tiuran disulfidatiuran disulfida Obat-2an (procain, fenotiazin, klorotiazid, Obat-2an (procain, fenotiazin, klorotiazid,

penisilin,tetrasiklinpenisilin,tetrasiklin Kosmetik, terpentin, tanam2anKosmetik, terpentin, tanam2an

Agen acnegenicAgen acnegenic

NaftalenNaftalen Bifenil khlorBifenil khlor Minyak mineralMinyak mineral

Agen photosensitizerAgen photosensitizer AntrasenAntrasen PitchPitch Derivat asam aminobenzoatDerivat asam aminobenzoat Hidrokarbon aromatik klorHidrokarbon aromatik klor Pewarna akridinPewarna akridin

PhotosensitivityPhotosensitivity Many chemicals need Many chemicals need

light to activate and light to activate and produce the complete produce the complete phototoxin or phototoxin or photoallergen. The photoallergen. The furocoumarins in limes furocoumarins in limes produced this produced this vesicular phototoxic vesicular phototoxic dermatitis in a dermatitis in a bartender who bartender who squeezed limes all squeezed limes all afternoon in direct afternoon in direct sunsun. .

Ultraviolet cured Ultraviolet cured processes processes

The technology of The technology of using ultraviolet light using ultraviolet light sensitive chemicals is sensitive chemicals is relatively new in relatively new in creating templates for creating templates for printing. It is also printing. It is also being used in the being used in the manufacture of certain manufacture of certain printing inks and in printing inks and in dentistry. Various dentistry. Various acrylates have been acrylates have been the sensitizers in this the sensitizers in this process. process.

Mekanisme terjadinya Mekanisme terjadinya dermatosis :dermatosis : Agen fisik Agen fisik trauma mekanik langsung ke kulit trauma mekanik langsung ke kulit Agen kimiaAgen kimia Iritan primer : merusak kulit dengan cara Iritan primer : merusak kulit dengan cara

mengubah PH, denaturasi protein, mengubah PH, denaturasi protein, mengekraksi lemak, menurunkan daya tahan mengekraksi lemak, menurunkan daya tahan

Sensitizer/allergiSensitizer/allergi reaksi hipersinsitivitas tipe reaksi hipersinsitivitas tipe lambatlambat

AcnegenicAcnegenic menyumbat kelenjar dan sal, menyumbat kelenjar dan sal, sebacea sebacea peradangan lokal peradangan lokal

Photosensitizer Photosensitizer meningkatkan sensitivitas meningkatkan sensitivitas kulit terhadap radiasi ultravioletkulit terhadap radiasi ultraviolet

Gejala dan tandaGejala dan tandaa. D. contact irritanta. D. contact irritant- Akut ditandai eritema, edema, papula Akut ditandai eritema, edema, papula

vesikula vesikula biasanya di tangan, lengan biasanya di tangan, lengan bawah atau wajah bawah atau wajah

- Kronik ditandai excoriasi, crustae , Kronik ditandai excoriasi, crustae , eksema, hiperkeratosiseksema, hiperkeratosis

- Faktor yang membantu timbulnya contac Faktor yang membantu timbulnya contac iritant adalah ; adanya trauma ( digosok, iritant adalah ; adanya trauma ( digosok, digaruk) pakaian, sarung tangan, kulit digaruk) pakaian, sarung tangan, kulit kering, kulit sudah dalam kondisi sakitkering, kulit sudah dalam kondisi sakit

Contact Dermatitis, Contact Dermatitis, AcuteAcute

This arm shows a painful, This arm shows a painful, acute contact dermatitis acute contact dermatitis form exposure to the form exposure to the strong irritant, ethylene strong irritant, ethylene oxide. The arm is oxide. The arm is markedly swollen and markedly swollen and shows an acute vesiculo-shows an acute vesiculo-bullous dermatitis. A bullous dermatitis. A similar pattern may be similar pattern may be seen on the basis of seen on the basis of contact allergy.contact allergy.

Contact Dermatitis, Contact Dermatitis, SubacuteSubacute

This patient developed a This patient developed a bilateral and symmetric bilateral and symmetric sub-acute dermatitis from sub-acute dermatitis from the rubber accelerator, the rubber accelerator, mercaptoben zothiazole, mercaptoben zothiazole, which was leached from the which was leached from the rubber portion of his work rubber portion of his work shoe as a result of shoe as a result of sweating. In this case there sweating. In this case there is some edema and is some edema and erythema with an erythema with an eczematous eruption. eczematous eruption.

Contact Dermatitis, Contact Dermatitis, ChronicChronic

The hands, wrists and forearms The hands, wrists and forearms are the most frequent sites of are the most frequent sites of involvement in cases of involvement in cases of industrial contact dermatitis. industrial contact dermatitis. The hands and wrists of this The hands and wrists of this worker with a chronic worker with a chronic dermatitis show the effect of dermatitis show the effect of long term exposure to a long term exposure to a solvent, in this case kerosene, solvent, in this case kerosene, which was used for cleaning the which was used for cleaning the skin. The skin markedly skin. The skin markedly thickened, hyperpigmented, dry thickened, hyperpigmented, dry and fissured, itching is usually a and fissured, itching is usually a major symptom. major symptom.

Chrome hole, fingersChrome hole, fingers Chromic acid and alkaline chromate Chromic acid and alkaline chromate

are agents commonly encountered in are agents commonly encountered in the tanning and electroplating the tanning and electroplating industries. These substances have a industries. These substances have a corrosive action when they enter the corrosive action when they enter the skin through a minor nick or break in skin through a minor nick or break in the integument. This results in the the integument. This results in the formation of chronic, ulcerative formation of chronic, ulcerative lesions known as "chrome holes". lesions known as "chrome holes". Typically, the lesions are found on Typically, the lesions are found on fingers, hands or forearms. "Chrome fingers, hands or forearms. "Chrome holes" also occur on the dorsal holes" also occur on the dorsal surfaces of the feet when chrome surfaces of the feet when chrome salts have been allowed to permeate salts have been allowed to permeate boots or shoes. The lesions are boots or shoes. The lesions are usually painless and persist for many usually painless and persist for many months before spontaneously months before spontaneously healing with permanent atrophic healing with permanent atrophic scar. Identical lesions can also be scar. Identical lesions can also be produced by arsenic or zinc salts but produced by arsenic or zinc salts but these are less frequently these are less frequently encountered. encountered.

Chromic acid and alkaline chromate are agents commonly encountered in the tanning and electroplating industries. These substances have a corrosive action when they enter the skin through a minor nick or break in the integument. This results in the formation of chronic, ulcerative lesions known as "chrome holes". Typically, the lesions are found on fingers, hands or forearms. "Chrome holes" also occur on the dorsal surfaces of the feet when chrome salts have been allowed to permeate boots or shoes. The lesions are usually painless and persist for many months before spontaneously healing with permanent atrophic scar. Identical lesions can also be produced by arsenic or zinc salts but these are less frequently encountered.

Chrome hole, nasalChrome hole, nasal When chrome containing When chrome containing

materials are present as materials are present as aerosols, painless aerosols, painless ulceration of the nasal ulceration of the nasal mucosa and septum may mucosa and septum may occur. With continues occur. With continues exposure permanent exposure permanent septal perforation septal perforation eventually results, as in eventually results, as in this young woman who this young woman who was employed in chrome was employed in chrome plating small appliance plating small appliance parts. parts.

b. D.contact allergicab. D.contact allergica Ada sensitisasi sebelum timbul alergi, agen Ada sensitisasi sebelum timbul alergi, agen

sensitisasi bereaksi dengan protein dalam sensitisasi bereaksi dengan protein dalam epidermis membentuk kompleks hapten – epidermis membentuk kompleks hapten – protein protein pembentukan antibody pembentukan antibody

Reaksi hypersensitivas tipe lambat, timbul Reaksi hypersensitivas tipe lambat, timbul setelah 48 – 72 jam setelah 48 – 72 jam

Zat yang biasanya sebagai primary irritant Zat yang biasanya sebagai primary irritant juga dapat sebagai allergenjuga dapat sebagai allergen

Bentuk akut seperti Bentuk akut seperti spt D. contact irritant spt D. contact irritant akutakut

Bentuk kronis Bentuk kronis timbul likenifikasi , fisura timbul likenifikasi , fisura

Contoh kasus D. Contoh kasus D. Contac allergica Contac allergica Dental Assistant Dental Assistant

(allergy to glutaraldehyde and neomycin)(allergy to glutaraldehyde and neomycin)

Contoh kasus D. Contoh kasus D. contact allergicacontact allergica Optician - non-dominant hand Optician - non-dominant hand

dermatitisdermatitis(allergy to ethyl acrylate)(allergy to ethyl acrylate)

Other Resin System Other Resin System This severe allergic This severe allergic

contact dermatitis was contact dermatitis was due to a phenol-due to a phenol-formaldehyde resin. formaldehyde resin. These resins are used These resins are used as bonding agents for as bonding agents for foundry sand, electrical foundry sand, electrical devices and in molded devices and in molded and cast plastic articles. and cast plastic articles. They may also produce They may also produce irritant reactions. irritant reactions.

Chemical Accelerators Chemical Accelerators in Rubber in Rubber

Allergic contact dermatitis Allergic contact dermatitis due to rubber chmicals is due to rubber chmicals is fairly common in industry. fairly common in industry. Chemial accelerators that Chemial accelerators that speed up the speed up the vulcanization raction and vulcanization raction and antixidants are the more antixidants are the more frequent allergens. They frequent allergens. They present a potential present a potential hazard in finishing goods hazard in finishing goods as well. as well.

Gejala Dermatosis Gejala Dermatosis yang lainyang lain Acne akibat kerja Acne akibat kerja hanya menyerang tubuh hanya menyerang tubuh

yang kontak dengan agenyang kontak dengan agen Lesi mikrotraumatik Lesi mikrotraumatik disebabkan oleh serat disebabkan oleh serat

mineral, ditandai dengan papula kecil mineral, ditandai dengan papula kecil keputihan atau kemerahan pd area yg terpaparkeputihan atau kemerahan pd area yg terpapar

Kanker kulit ( karsinoma squamosa Kanker kulit ( karsinoma squamosa hyperkeratosis, papilomatosishyperkeratosis, papilomatosis

Dermatosis yg menular Dermatosis yg menular zoonotik, zoonotik, dermatofitosis, kandidiasis, tuberkulosis dermatofitosis, kandidiasis, tuberkulosis verukosaverukosa

Occupational Acne. Occupational Acne. Acute, Oil FolliculitisAcute, Oil Folliculitis

Occupational acne is most Occupational acne is most commonly seen in workers commonly seen in workers exposed to insoluble cutting oils exposed to insoluble cutting oils in the machine tool trades or in in the machine tool trades or in mechanics exposed to grease mechanics exposed to grease and lubricating oils. This worker and lubricating oils. This worker developed folliculitis, developed folliculitis, sometimes called oil boils or sometimes called oil boils or acne, with multiple comedones acne, with multiple comedones and pustules on his arms and and pustules on his arms and other covered areas of his body other covered areas of his body as a result of prolonged contact as a result of prolonged contact with oil. The lesions almost with oil. The lesions almost never develop from bacteria never develop from bacteria present in the oilspresent in the oils

Oil Folliculitis Chronic, Oil Folliculitis Chronic, ChloracneChloracne

Chlordane is an extremely Chlordane is an extremely refractory type of acne caused refractory type of acne caused by certain halogenated by certain halogenated aromatic chemicals and can be aromatic chemicals and can be certain halogogenated aromatic certain halogogenated aromatic chemicals and can be chemicals and can be accompaned by systemic accompaned by systemic toxicity. It represents one of the toxicity. It represents one of the most sensitive indicators of most sensitive indicators of biologic response to these biologic response to these chemicals. Chloracne in this chemicals. Chloracne in this herbicide production worker herbicide production worker involved almost every follicular involved almost every follicular orifice on his face and neck with orifice on his face and neck with comedones, papules and comedones, papules and cystlike lesions. cystlike lesions.

DepigmentationDepigmentation The hands of this The hands of this

hospital maintenance hospital maintenance worker are worker are depigmented form depigmented form contact with a contact with a phenolic germicidal phenolic germicidal detergent. Irritation or detergent. Irritation or sensitization to the sensitization to the chemical is not a chemical is not a prerequisite for the prerequisite for the pigment loss to occur. pigment loss to occur. This loss of pigment This loss of pigment may be permanent. may be permanent.

GranulomaGranuloma Granulomas represent a Granulomas represent a

focal, chronic inflammatory focal, chronic inflammatory reaction. These granulomas reaction. These granulomas were produced by beryllium were produced by beryllium and are considered to be on and are considered to be on a allergic basis. Non-allergic a allergic basis. Non-allergic granulomas are more granulomas are more common and represent the common and represent the skin's response to skin's response to inoculated or implanted inoculated or implanted foreign materials such as foreign materials such as wooden splinters, plant wooden splinters, plant spines and silica.spines and silica.

Eccrine Eccrine Miliaria represents Miliaria represents

blockage of the eccrine blockage of the eccrine sweat ducts and may sweat ducts and may occur in workers who occur in workers who perspire excessively. In perspire excessively. In this case of miliaria rubra this case of miliaria rubra of prickly heat, the of prickly heat, the blockage site is the blockage site is the granular cell layer of the granular cell layer of the epidermis. When more epidermis. When more than 30% of the skin than 30% of the skin surface is affected, an surface is affected, an individual may develop individual may develop thermoregulatory thermoregulatory disorders such as heat disorders such as heat exhaustion. exhaustion.

TumorsTumors Skin tumorsSkin tumors, such as this , such as this

ulcerating squamous cell ulcerating squamous cell carcinoma most frequently carcinoma most frequently arise after years of arise after years of occupational exposure. occupational exposure. Malignant tumorsMalignant tumors may may represent to occupational represent to occupational carcinogenscarcinogens such as such as coal tarcoal tar and and physical agentsphysical agents such such as as sunlightsunlight. Skin cancer is the . Skin cancer is the commonest form of cancer. commonest form of cancer. The role played by The role played by occupational factors is occupational factors is frequently difficult to frequently difficult to determine. determine.

Diagnose Dermatosis Diagnose Dermatosis akibat kerjaakibat kerja Gambaran klinis, lokalisasi dan Gambaran klinis, lokalisasi dan

perjalanan penyakit harus sepenuhnya perjalanan penyakit harus sepenuhnya sesuai dengan ciri PAK yg pastisesuai dengan ciri PAK yg pasti

Paparan kerja terhadap agen Paparan kerja terhadap agen berbahaya perlu dipastikanberbahaya perlu dipastikan

Ada hubungan waktu paparan dan Ada hubungan waktu paparan dan timbulnya penyakittimbulnya penyakit

Dermatosis contact allergica Dermatosis contact allergica uji uji tempeltempel

Uji tempelUji tempel Menempelkan alergen yang Menempelkan alergen yang

dicurigai dengan kadar yang non dicurigai dengan kadar yang non iritatif pada kulit yang tidak iritatif pada kulit yang tidak terpapar selama 24 – 48 jam terpapar selama 24 – 48 jam

Positif bila timbul dermatosis Positif bila timbul dermatosis ekzematous dibawah tempelan ekzematous dibawah tempelan yang penutupyang penutup

KerentananKerentanan Orang dengan atopi ( eksema, Orang dengan atopi ( eksema,

penyakit kulit alergi dan alergi penyakit kulit alergi dan alergi lainnya)lainnya)

Penyakit kulit kronik termasuk Penyakit kulit kronik termasuk hiperhidrosishiperhidrosis

Seborea atau iktiosisSeborea atau iktiosis Pimentasi abnormalPimentasi abnormal Lesi kulit prekankerLesi kulit prekanker

Penanganan kasusPenanganan kasus

Dipindahkan ke area bebas alergenDipindahkan ke area bebas alergen Kasus D. iritatant, pekerja dipindahkan Kasus D. iritatant, pekerja dipindahkan

sementara dan agen penyebab sementara dan agen penyebab dikendalikandikendalikan

Pemindahan kerja sec. Permanen dilakukan Pemindahan kerja sec. Permanen dilakukan bila pemindahan sementara tidak bila pemindahan sementara tidak menghasilkan penyembuhan yg sempurnamenghasilkan penyembuhan yg sempurna

Kondisi prekanker mk. Pekerja harus Kondisi prekanker mk. Pekerja harus dijauhkan dari paparandijauhkan dari paparan

Upaya pencegahanUpaya pencegahan Allergen kuat, sensitizer, karcinogen Allergen kuat, sensitizer, karcinogen

diganti dengan zat yang kurang diganti dengan zat yang kurang berbahayaberbahaya

Pengendalian secara tehnik ( isolasi Pengendalian secara tehnik ( isolasi tempat kerja)tempat kerja)

Eliminasi kontak dengan kulitEliminasi kontak dengan kulit Pakaian pelindung ( apron,sarung Pakaian pelindung ( apron,sarung

tangan, sepatu boot, penutup wajah)tangan, sepatu boot, penutup wajah)

Upaya pencegahanUpaya pencegahan Fasilitas dasar untuk kebersihan diri Fasilitas dasar untuk kebersihan diri

(pancuran air untuk mandi bukan bak mandi)(pancuran air untuk mandi bukan bak mandi) Kebersihan lingkungan dan house keepingKebersihan lingkungan dan house keeping - pembuangan air bekas dan sampah industri- pembuangan air bekas dan sampah industri - pembersihan debu- pembersihan debu - cara penimbunan dan penyimpanan barang- cara penimbunan dan penyimpanan barang Penggunaan SPF 15 untuk melindungi Penggunaan SPF 15 untuk melindungi

Sinar .matahariSinar .matahari

Upaya pencegahanUpaya pencegahan Diagnose dini Penyakit Dermatosis Akibat kerja Diagnose dini Penyakit Dermatosis Akibat kerja

melalui :melalui : Pemeriksaan awal sebelum penempatanPemeriksaan awal sebelum penempatan - riwayat medis- riwayat medis - fisik dengan perhatian khusus pada kulit - fisik dengan perhatian khusus pada kulit Pemeriksaan berkala : Pemeriksaan berkala : - sama spt pem.awal - sama spt pem.awal - uji tempel tdk dianjurkan bagi yg tdk menunjukan - uji tempel tdk dianjurkan bagi yg tdk menunjukan

gxgx - waktu antara 6 bln – 2 tahun tgt tingkat paparan - waktu antara 6 bln – 2 tahun tgt tingkat paparan ditempat kerjaditempat kerja

PrognosisPrognosis D. iritant , acne, infeksi D. iritant , acne, infeksi menyembuh menyembuh

sth agen penyebab dijauhkansth agen penyebab dijauhkan D. alergi D. alergi tgt sifat alergennya dan tgt sifat alergennya dan

bila hanya ditempat kerja dan telah di bila hanya ditempat kerja dan telah di hilangkan alergennya hilangkan alergennya sembuh sembuh sempurnasempurna

allergi + infeksi sekunder allergi + infeksi sekunder sembuhnya lamasembuhnya lama