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Contact dermatitis, both irritant and allergic types, are major occupational skin diseases for many industrial and agricultural workers. Irritant contact dermatitis is caused by direct skin exposure to irritating chemicals, producing symptoms like redness, blisters, and scaling. Allergic contact dermatitis involves an immunological reaction to substances the skin was previously sensitized to. Preventive measures include substituting less harmful substances, good hygiene practices, protective equipment, and educating workers.
Contact dermatitis, both irritant and allergic types, are major occupational skin diseases for many industrial and agricultural workers. Irritant contact dermatitis is caused by direct skin exposure to irritating chemicals, producing symptoms like redness, blisters, and scaling. Allergic contact dermatitis involves an immunological reaction to substances the skin was previously sensitized to. Preventive measures include substituting less harmful substances, good hygiene practices, protective equipment, and educating workers.
Contact dermatitis, both irritant and allergic types, are major occupational skin diseases for many industrial and agricultural workers. Irritant contact dermatitis is caused by direct skin exposure to irritating chemicals, producing symptoms like redness, blisters, and scaling. Allergic contact dermatitis involves an immunological reaction to substances the skin was previously sensitized to. Preventive measures include substituting less harmful substances, good hygiene practices, protective equipment, and educating workers.
BATASAN • Penyakit kulit akibat kerja, ialah setiap penyakit kulit yg disebabkan oleh pekerjaan atau lingkungan kerja (faktor risiko mekanik, fisik, kimia, biologik & psikologik) INTRODUCTION • Contact dermatitis, both irritant and allergic, is the major cause for occupational skin disease in many industrial and agricultural workers. • Needs to be addressed early in the disease process for proper diagnosis, management and control of the disease activity. DEFINITION • Contact dermatitis is a general term applied to acute or chronic inflammatory reaction to substances that come in contact with the skin. • There are two main types of contact dermatitis, the irritant contact dermatitis and the allergic contact dermatitis. These constitute the major occupational allergic skin diseases. Contact Irritant Dermatitis
• caused by chemical, physical or biological
(plants, animals) irritants. • The acute form of the irritant contact dermatitis occurs following a single exposure to the offending agent, which is toxic to the skin. • Severe reactions may cause the skin to slough off, producing deep necrotic ulcers. • The severity of the irritant reaction in CID (contact irritant dermatitis) is dependent upon the concentration of the chemical irritant. • Certain levels of the concentrate produces CID, lower strengths does not. Allergic Contact Dermatitis
• Immunological reaction caused by the
interaction of an antigen with the antibodies produced against the antigen. • For ACD (allergic contact dermatitis) to occur a previous exposure and sensitization to the antigen (allergy producing substance) is required. • This sensitization requires 7-21 days to occur. • If the individual is again exposed to the same allergen, within a period of 12-24 hours, an antigen-antibody reaction occurs in the skin, which causes the inflammatory changes seen in allergic contact dermatitis. • This type of allergic reaction is known as the cell mediated or delayed hypersensitivity reaction. How to Differentiate Between the Contact Irritant Dermatitis and Allergic Contact Dermatitis?
• Contact irritant dermatitis is dose
dependent: higher the amount of irritant, stronger the reaction. • Allergic contact dermatitis is not dose dependent; once the individual is sensitized, even minute quantities can produce allergic reaction on the skin. • As contact irritant dermatitis is a toxic reaction, it involves only the area of contact with the irritant. The margins are sharply defined; the reaction does not extend beyond. • In allergic contact dermatitis, the reaction can occur outside area of contact, even in remote areas of the body which never came in contact with the allergen. Thus generalized allergic reaction is possibly in ACD. • Anyone can get contact irritant dermatitis, but only sensitized individuals get allergic contact dermatitis. I. Dermatitis, Irritant Contact
• Occupational irritant contact dermatitis is
an inflammation caused by substances found in the workplace that come in direct contact with the skin. • Signs of irritant contact dermatitis include redness of the skin, blisters, scales or crusts. These symptoms do not necessarily occur at the same time or in all cases. How does irritant contact dermatitis develop? • after a short, heavy exposure or a repeated or prolonged, low exposure to a substance. • an accidental contact with a strong irritant causes immediate blisters. Contact with a mild irritant may only produce redness of the skin. • However, if the irritation continues, small lesions or sores appear on the reddened area; afterwards crusts and scales form. • The skin damage usually heals a few weeks after exposure ends if no complications have arisen (e.g., no infections occurred). • During the body's defensive response phase, a person may experience pain, warmth, redness and swelling in the irritated area. • Minimal skin damage, as in the thickening of the inner layer of the skin, will not be visible. • However, when the damage is severe, the skin shows signs of chapping, scaling, and blistering. Some skin cells also die. • Typically, an irritant reaction develops within a few hours from exposure and is at its worst after approximately twenty-four hours. What are factors contributing to irritant contact dermatitis? • the chemical properties of the substance (for example, is it an acid, an alkali, or a salt), • the amount and concentration of chemical coming in contact with the skin, and the length and frequency of the exposure. • Hereditary factors influence the variety of reactions seen in different persons when exposed to the same irritan. • The penetration of substances varies over different body regions, some substances penetrate the face and the upper back more quickly than the arms. • Environmental factors play a significant role. For example, hot, humid workplaces Table 2 How is it recognized? • No single test can reliably identify irritants in specific cases. • The best approach is to identify the conditions of exposure by discussing the victim's employment. The information to be gathered includes a detailed list of all chemicals in the individual's working environment; a detailed description of all processes involved in a day's work; and any information about other workers, if any, who have similar skin problems. How is it treated? • may be treated with compresses, creams, ointments and skin cleansers. • In general, people should protect their skin from physical trauma, chemical irritation, excessive sunlight, wind, and rapid temperature changes while the dermatitis is active. How common is it? • Skin disorders comprise more than 35 percent of all occupationally related diseases. • Among all occupational dermatitis, irritant contact dermatitis accounts for about 80 percent. What are the preventive measures? Can be avoided by the following measures: • personal hygiene • substitution of a less harmful substance • enclosure of the process • automation of the work procedures • local exhaust ventilation systems • good housekeeping • education • protective clothing • barrier creams, skin cleansers • convenient washing facilities II. Dermatitis, Allergic Contact
• local inflammation of the skin.
• Symptoms of inflammation are itching, pain, redness, swelling, and the formation of small blisters or wheals (itchy, red circles with a white centre) on the skin. The inflammation is caused by an allergy or irritation as a result of substances found in the workplace that come into direct contact with the skin. Approximately 3,000 substances are recognized as contact allergens yet only 25 of these substances are responsible for almost half the cases of allergic contact dermatitis (ACD). • This inflammation is usually confined to the site of contact with the allergen, but in severe cases it may spread to cover large areas of the body. It usually starts within twelve hours from exposure and is at its worst after three or four days. It slowly improves in about seven days. The allergic sensitization may remain with the individual through life. If there is no further contact with the allergen, the level of sensitivity may gradually decline. What are the contributing factors? • The most common factors are pre-existing skin conditions such as irritant contact dermatitis. Cuts or scratches, also. • The chemical nature of the substance is important (for example, whether it is an acid, an alkali, or a salt), as are the amount and concentration that comes into contact with the skin, and the length and frequency of the exposure. • Important individual factors include the resistance of the skin, which increases with age. Hereditary factors influence the variety of reactions in different persons exposed to the same allergen. • Environmental factors hot workplaces cause sweating, which can dissolve some types of industrial chemical powders, increasing their toxicity for the skin. But sweating may also provide a protective function because it may dilute or "wash out" substances. Dry air can cause chapping of the skin, increasing the possibility of allergies. What occupations are at risk? How is it recognized? • Evaluation begins with a discussion of the person's employment, and requires a detailed description of all the processes involved in a typical day's work. It also requires a detailed list of all chemicals in the individual's working environment, and knowledge of whether other workers are affected. • Diagnosis of allergic contact dermatitis is confirmed by patch test. Minute amounts of suspected substances are applied to the skin, usually on the upper back. Inflammation at the site of application indicates that the person is allergic to a specific substance. How common is it? • According to some US statistics, skin disorders comprise more than thirty-five percent of all occupationally related diseases. • Among all cases of occupational dermatitis, allergic contact dermatitis accounts for about twenty percent. What are the preventive measures? Occupational allergic contact dermatitis can be avoided by; • personal hygiene, • engineering control methods, • good housekeeping, and • personal protection. Personal hygiene, including hand washing, is very important to prevent contact dermatitis, but workers should be aware that excessive hand washing with soap and detergents can also damage the skin. How is it treated? • Sensitized workers should avoid further exposure to the allergen. This alone is an effective remedy. Allergic contact dermatitis may be treated with anti-inflammatory drugs, and with ointments and skin cleansers. • In general, the affected skin should be protected from physical trauma, excessive sunlight, wind, and rapid temperature changes while the dermatitis is active. TATA CARA DIAGNOSIS PENYAKIT KULIT AKIBAT KERJA DASAR: Keputusan Menteri Tenaga Kerja dan Transmigrasi RI KEP.79/MEN/2003 Pedoman Diagnosis dan Penilaian Cacat Karena Kecelakaan dan Penyakit Akibat Kerja Tanggal 21 Maret 2003 I. BATASAN • Penyakit kulit akibat kerja, ialah setiap penyakit kulit yg disebabkan oleh pekerjaan atau lingkungan kerja (faktor risiko mekanik, fisik, kimia, biologik & psikologik) Kelainan yg terjadi dapat berupa : – Dermatitis kontak – Dermatitis kontak fotosensitifitas – Acne – Infeksi kulit (bakteri, virus, jamur, infestasi parasit) – Neoplasma pada kulit – Kelainan pigmentasi kulit – Dll • II. DIAGNOSIS • Identifikasi • Assesment potensial hazards ditempat kerja • Pemeriksaan penderita • Evaluasi PAK ?
A.Anamnesis 1. Keluhan 2. Riwayat pekerjaan sekarang (lama & jenis hazard). 3. Riwayat pekerjaan sebelumnya (lama & jenis hazard)
Dibandingkan dg catatan medik sebelum
bekerja di perusahaan (“pre-employment medical check up”)
4. Riwayat penyakit keluarga
5. Riwayat perjalanan penyakit
- Waktu kejadian? - Rasa gatal? - Perbaikan selama cuti - Pengobatan yg pernah / telah didapat? B. Pemeriksaan fisik 1. Inspeksi - Pemeriksaan seluruh badan termasuk lipatan kulit, misal lipat paha, celah antar jari - Kondisi higiene umum - Lokasi kelainan
2. Palpasi
3. Pemeriksaan dengan kaca pembesar
C. Pemeriksaan penunjang 1. Pemeriksaan laboratorium 1.1. Pemeriksaan hasil kerokan kulit dengan KOH 20% (pemeriksaan jamur)
1.2. Tes serologi untuk sifilis :
- VDR ≤ ¼ bukan sifilis (bukan pada pasien berisiko tinggi) - VDR > ¼ kemungkinan sifilis rujuk kespesialis kulit & kelamin 1.3. Kelainan kulit. karena HIV Western Blot, atau Elisa 3x dengan metoda berbeda atau ke laboratorium rujukan
2. Pemeriksaan dengan Lampu Wood
2.1. Untuk perubahan warna kulit berupa hipo atau hiper pigmentasi tanpa disertai radang 2.2. Pemeriksaan psoriasis versicolor Khusus 3. Histopatologi : Khusus untuk neoplasma kulit
4. Uji tempel, ada 2 (dua) cara :
4.1. Uji tempel terbuka, terutama untuk bahan iritan (bahan mudah menguap, bahan yg dicurigai iritan dioleskan dibelakang telinga & dievaluasi 24 jam kemudian) 4.2. Uji tempel tertutup; dilakukan baik untuk alergen standar atau bukan standar (pengenceran 1/1000-1/100). Lokasi penempelan di punggung atau lengan atas bagian lateral. Setelah alergen dioleskan 48 jam lalu dibuka. Setelah terbuka 15 menit kemudian dievaluasi III. URAIAN PENILAIAN CACAT • Sesuai dg peraturan perundang-undangan yg berlaku, cacat bidang penyakit kulit sulit diperhitungkan terhadap penurunan kemampuan kerja & tidak tercakup dalam lampiran Peraturan Pemerintah No.14 tahun 1993 TERIMA KASIH