 Digunakan untuk kelainan pada kulit akibat eksposur

terhadap iritan di lingkungan kerja

 Efek dapat berupa kemerahan saja sampai pada
gatal, kulit melepuh, terbakar dan tumor
 Kulit merupakan organ terbesar dari tubuh, dengan
fungsi:
 daya tahan pertama thd iritan, bakteri, fungi, dll.
 menerima sensasi panas, dingin, tekstur, dll.
 mengatur temperatur tubuh: menguapkan gas,
uap, sekresi minyak, asam pelindung, membuat
pigmen thd matahari
 luasnya: 2 m2, tebal dari 0,5mm sampai 3-4 mm
 JAMUR,
BAKTERI,
FISIKA. KIMIA

ALERGIK/
IRITAN/ ZAT KIMIA,
DERMATITIS
SENSITISER/ BIOLOGI

ZAT KIMIA
API
 HELM PEWARNA

IKAT KEPALA
K RI M RA MB UT K ACA M ATA KACAMATA
TETES MATA/TELINGA
MINYAK
PENCUKUR
M I N YAK WA NG I WANGI OBAT-
K ERA H

MINYAK WANGI OBATAN

PAKAIAN

G ELAN G JAM TANGAN

M EJA

IKAT PI N GG AN G
KUNCI/KOIN PINGGANG
B AN PI N GG ANG

K URS I

S EPATU B UT
KOREK API
SEPATU/KAUS KAKI
OB AT

Gambar 4.5. Tampak Depan Laki-laki Gambar 4.6. Tampak Belakang Laki-laki

P EWA R N A
B AN D O
JEPIT RAMBUT
GULUNGAN CAT K UK U
RAMBUT K A C A M A TA

K O S M ET I K
BANDO O B AT- O B ATA N
LOSION
PENGERITING
KERAH
RAMBUT
P E R H IA S A N
PERHIASAN PA R F U M

TALI BRA
TA L I B R A
PENJEPIT RESLETING PA K A I A N
BRA
JA M T AN G A N
D EO D O R A N

GELANG SARUNG
TANGAN

DUDUKAN TOILET IK AT P I N G G A N G PA K A I A N D A L A M

S T O C K IN G/
KAUSKAKI
KAUS KAKI
OBAT-OBATAN

S E P AT U

Gambar 4.7. Tampak Depan Perempuan Gambar 4.8.Tampak Belakang Perempuan

 Zat kimia

Tenaga mekanis

Zat fisis

Racun tumbuhan

Zat biologis
 Dari golongan zat kimia organik dan anorganik
 Zat organik kebanyakan merupakan sensitizers
 Zat anorganik kebanyakan merupakan primary iritan
 Kontak langsung dengan kulit
 Oral
immersing hands (sometimes legs)
into chemicals

direct handling of contaminated workpieces

 contact with contaminated surfaces (eg
workbench, tools, clothing and containers)

splashing (eg when liquid or powdery

chemicals are mixed or handled
in deposits in the air (eg cement dust)
 Iritan primer

Penyumbat pori

Sensitiser
 Menyebabkan dermatitis karena kontak langsung 
‘dermatitis kontak’
 80% dari kasus di industri
 Contoh:
 HNO3, H2SO4, NaOH: cepat membakar kulit
 Deterjen, sabun kuat, pelarut ‘sedang’: iritasi ringan,
eksposur berulang  iritasi berat
 karet, plastik, lem, resin (terutama epoxy resin),
pelumas: melekat pada kulit menyebabkan iritasi
primer atau sensitisasi  selain melekat, mengeras
pada kulit  kulit jadi peka terhadap iritan/radang
Dermatitis kontak Alergik
(sarung tangan karet)
Dermatitis kontak alergik (semen)
 Berupa minyak, wax  black heads/acne yang disebut
dermatitis kulit
 Sering terbawa pakaian kerja dan terbawa ke rumah 
dapat mengena keluarga pekerja
 Zat kimia yang menyebabkan kelainan kulit seperti
alergi timbul setelah beberapa kali eksposur  reaksi
delayed dan multiple
 Disebut ‘dermatitis sensitisasi’
 Sekali orang tersensitisasi  eksposur sedikit juga
sudah menyebabkan efek parah dan kelainan dapat
menjalar ke seluruh tubuh  orang tidak dapat
bekerja di tempat yang sama
 Contoh: epoxy resin hardener, pewarna azo, derivat
coal tar, pollen, antibiotik, dll.
 Zat kimia yang menstimulir sel kulit tumbuh berlebih:
epitelioma, papilioma, polip, dan kanker  coal tar
dan minyak mentah
 Skin Sensitizer

Kanker
Iritasi
 Friksi, tekanan  kulit melepuh
 Sumbatan oleh glass wool dan rockwool
 Iritasi atau alergi  gatal-gatal, terluka, melepuh
 Melepuh

Kulit mengeras
 Suhu ekstrim
 Sinar matahari, UV, IM, sinar-X, dll.
 Efek yang timbul: iritasi/sensitisasi, perubahan warna,
gatal, pedih, luka bakar, melepuh, dan kanker
 Tanaman beracun:
poison ivy  alergi
 Bunga beracun
 Efek: kulit memerah dan
gatal
 Bakteri, jamur, parasit dan tungau
 Didapat di daerah pertanian, bakery,
sayur, dan buah-buahan

BEDAKAN DERMATITIS INDUSTRIAL

DENGAN BUKAN INDUSTRIAL SEPERTI
AKIBAT KOSMETIKA, OBAT,
INSEKTISIDA, DLL.
 Deterjen dan pelarut keratin
 Desikator, zat higroskopis, anhidrida
 Protein precipitants
 Hidrolitik, elektrolitik
 Pengoksidasi
 Derivatif nitro yang toksik
 Keratogenik, neoplastik
 Agent biologis
 Alergi, protein anafilaktik
 Pereduksi
 Deterjen dan pelarut keratin
 minyak alami kulit dan sel kulit larut  kulit menjadi kering dan
mudah terinfeksi

 contoh: alkali, terpentin, alkohol, dan sabun

 Desikator, zat higroskopis, anhidrida
 menyerap air dari kulit  kulit kering dan panas
 contoh: SO2=, PO4=, H2SO4, dll.
 Protein precipitants
 menyebabkan koagulasi protein, kulit mengeras
 contoh: garam logam berat, HgCl, asam tanat, asam pikrik, fenol, UV,
formaldehid, dll.
 Hidrolitik, elektrolitik
 bereaksi dengan air di kulit, terjadi iritasi, panas keluar
selama reaksi berlangsung
 contoh: gas mustard, NH4NO3

 Pengoksidasi
 bereaksi dengan hidrogen  O terbebas  oksidasi
 contoh: FeCl2, H2O2, As, chromat, permanganat, ozon, dan
amonia
 Derivatif nitro yang toksik
 melarutkan kulit
 contoh: TNT, DNT, fenol, kresol, tetryl, asam pikrat
 Keratogenik, neoplastik
 sel kulit tumbuh berlebih  kanker
 As, tar, naftilamin, dll.
 Agent biologis
 mikroba, parasit  infeksi
 Alergi, protein anafilaktik
 reaksi antigen-antibodi dengan membentuk histamin  alergi
 contoh: tepung, pollen, dll.
 Pereduksi
 membentuk hidrogen bebas  reduksi
 contoh: asam salisilat, asam oksalat, hidrokarbon alifatik, fenol, naftol,
hidrokarbon-aromatik
sub-acute dermatitis from the rubber contact dermatitis form exposure to the
accelerator, mercaptoben zothiazole strong irritant, ethylene oxide
 The skin contact with an irritant results in itchy rash within
minutes to an hour.
 They disappear within twenty-four hours, usually within a
few hours.
 Contact urticaria is also known as nettle rash or hives. It is
typified by the wheal (swellings) and flare at the site of
contact.
 The affected person may suffer from itching, tingling or
burning sensations.
 There are other types of urticaria. This includes immune
sensitised reaction and happens in people who have
previously become sensitised to a causative agent (eg latex
protein in rubber gloves). This type of reaction is also
called ACD.
 Acne is an inflammatory disorder of the sebaceous glands. The
skin eruptions from acne may be mild, involving exposed areas
of the body, or severe covering of all the body.
 Occupational acne includes oil acne, coal-tar acne, and
chloracne.
 Others types are related to cosmetics, heat/cold and
mechanical forces.
 The incidence of oil acne has declined in recent years
because of decreased use of neat cutting oils. Better
performing oils and improved health and safety
standards in the workplace helped this decline further.
 The eruptions resulting from oil acne are called oil
boils. When the exposure is prolonged, skin cancer,
such as cancer of the scrotum, may develop.
 Oil acne amongst oil workers is rare because there are
fewer opportunities for prolonged contact with crude
oil or the heavier oil fractions.
 Chloracne results from exposure to certain halogenated
aromatic hydrocarbons (eg polychlorinated biphenyles (PCBc)).
 Individual lesions of chloracne consist primarily of blackheads,
whiteheads and cysts.
 Choracne occurs mainly on exposed areas of the skin, but
following regular exposure, lesions may appear in other regions
especially the genital, groin and axillae areas of the body.
 Chloracne usually begins several weeks or months after the
exposure and new lesions may appear even when exposure
stops, because there may still be traces of the contaminants in
the follicular areas of the skin.
 Coal-tar acne is associated with coal tar-based products and may
be aggravated by light/UV.
 Skin and eyes are vulnerable and it will cause increased
pigmentation as well as acne-related symptoms (eg skin
eruptions, blackheads).
 Skin pigmentation disorders cause the skin to appear lighter or darker
than normal.
 Pigmentary disorders can be due to hazardous agents found in the
workplace (eg: UV, X-rays), environment (eg Sun rays) or ones
genetic makeup or reaction to medicines and food.
 A number of chemicals used at work can cause depigmentaion

Hyperpigmentation by kerosene
 Exposure to radiation can lead to skin cancer, most
commonly this comes from exposure to the sun. Therefore
outside workers are particularly at risk.
 People who are exposed ionising and non-ionising radiation
may be susceptible to work related cancers.
 Some chemicals can cause cancer on the skin, others may
contribute to cancers found in other parts of the body.
 The use of unrefined mineral oils has in the past led to skin
cancer affecting the exposed skin of the hands and
forearms.
 Oil-soaked clothing and oily rags kept in overalls caused
scrotal cancer.
 The use of refined oils together with changes in work
practice and improved personal hygiene have reduced this
risk.
 Chemicals like Mobca is used in the manufacture of
polyurethane products. It can get through the skin and may
cause cancer in other parts of the body.
 Penyebab
 zat kimia, konsentrasi pekat, temperatur
ekstrim tinggi, lama kontak dengan kulit
 Klasifikasi luka bakar:
 tingkat I (first degree burn): merah, panas,
gatal, sakit, rasa terbakar
 tingkat II (second degree burn): sangat
sakit,
melepuh, merah, basah (terbakar lebih
dalam)
 mudah kena infeksi
 tingkat III (third degree burn): kulit dan
karingan bawah kulit habis terbakar
Burn degree
 2

3
 agriculture/horticulture;
 catering and food processing;
 chemicals;
 cleaning;
 construction;
 engineering;
 hairdressing/beauty care;
 health care;
 offshore;
 printing;
 rubber.
 S
E
1'R N
Y SI MANIFESTATIONS OF IRRITATING
AGENT/IRITANT IRR TYPICAL OCCUPATION
TI ACTION ON THE SKIN
ITA Z
NT E
R

ACIDS
manufacturing acetat rayon, printing, dying,
acetic X Dermatitis & ulcers hat makers

nitric acid worker, ekectroplaters, metal

refineries, acid dippers, nitrators, soda
nitric X Severe skin burn & ulcers makers

corrosive action on skin, severe inflammation Nitrator, pickers (metal), acid dippers,
sulfuric X of mucous membranes chemical manufacturing

Ulcers ('chrome holes') on skin, inflammation platers, manufacturing chemicals and

chromic X X and perforation of nasal septum dyestuff

ALKALIS
Sodium hydroxide makers, bleacher, soap
Severe burning of kin, deep-seated persistent and dye makers, petroleum
sodium hydroxide X ulcers, loss of fingernails refiners,mercerizers, tannery worker

sodium silicate X Thickening of skin, ulcers on fingers bleacher, manufacturing cardboard boxes
Electroplaters, case hardening, extraction
sodium or potassium cyanide X Blisters, ulcers of gold

Arsenic & its compounds
SALTS OR ELEMENTS
Darkening of skin, perforation of nasal
septum, ephitelioma, formation of hornt
growth of tissue on palm, ezcema around
mounth and nose (possible loss of nails and
X X hair)
Artificaial leather makers, carroter (felt
hats), manufaturing insecticides, glass
industry and vermicides, manufacturing
artificial flowers, calico printing

Explosive manufacturing, silver and gold

extractors, manufactoring electrical
Corrosion and irrtation of skin, 'mercurial appliances and scientific equipment, hat
Mercury compounds X X eczema' making

Zinc chloride X Ulcers of skin and nasal septum Manufaturing chemical and dyestuffs

AGENT/IRITANT
Acetone
Benzene and its homologues
(toluene and xylene)
Terpentine
Chlorinated compounds
Dinitrochlorobenzene
Nitro and nitroso compound
Petroleum oil
Tar (coal)
Including chemicals handled in sye
manufacturing
Metal dichromated, amicdol,
quinone, para aminophenol, etc.
SE
1'RY N
IRR SI MANIFESTATIONS OF IRRITATING
TYPICAL OCCUPATION
ITA TI ACTION ON THE SKIN
NT ZE R
S
O
L
V Spray painters, celluloid industry, artificial silk
E and leather workers, acetylene workers,
N lacquer and varnish makers, electrical
X Dry (defatted) skin
T equipment manufacturing
S Chemical, rubber, and artificial letaher
X Dry (defatted) skin manufacturing, dry cleaning
X X Red or blistered skin, eczema Painters, furniture polisher, lacquuerers
SOME DYES INTERMEDIATES
X Blisterlike eruptions X Dye manufaturing
X Blisterlike eruptions Dye manufaturing
X Red skin and eczeme Dye manufaturing
eruptions
ACNE
PRODUCERS
X Petroleum workers, machinists, mechanics
Inflammation of hair follicle, acne, skin
ulcers, boils, malignant tumor Tar manufacturing, roofing paper, felt, and
X X Acne, eczema, and malignant tumors pitch, road building and repairing
DYES
X Red skin, blisterlike eruptions Dye worker
PHOTO DEVELOPERS
X Red skin, blisterlike eruptions Photo developers
 S
E
1'R N
Y
SI MANIFESTATIONS OF IRRITATING
AGENT/IRITANT IRR TYPICAL OCCUPATION
TI ACTION ON THE SKIN
ITA Z
NT
E
R

RUBBER ACCELATORS AND ANTI OXIDANTS

Hexamethylenetetra-mine, para
phenylenediamine, pada
nitrosodimethylaniline, and phenyl Itchy skin, dermatitis - usually called'rubber Rubber workers, such as compound mixers
naphthylamine (B) X itch' and calender and mill operators

SOAP AND SOAP POWDER

Eczema, blisterlike eruptions, chronic Soap manufacturing, dishwashers, scrub-
containing an excess of free alkalis X ancesses women, soda fountain clerks

INSECTICIDES

Arsenic X Red skin, blisters Manufacturing and appling insencticides

OILS
Cashew nut oil X Severe dermatitis as blisters Handlers of unprocessed cashew nuts
Cutting oils-oil emulsion or soluble
oil mixtures X Oil acne, inflammation of hair follicle Machinists

RESINS
Acute dermatitis, 'shagreen skin', acne,
Coal tar products such as pitch and inflammation around hair follicle, Manufacturing various coal tar products,
asphalt X X ephiteliomaous cancer, eczema, ulcers road making, gas manufacturers

EXPLOSIVE
Chlorates, nitrates, mercury
fulminate, tetryl, lead styphnate,
TNT, amatol, DNT, dinitrophenil,
etc. X Red skin, papular eruptions, severe irritations Explosive manufacturing, shell loading
 CEGAH KONTAK

Ada beberapa cara pencegahan yang dapat dilakukan,

yaitu:
• Kontrol teknik
• Pendidikan
• Tes penempatan kerja
• Klinik dan tempat perawatan
Kontrol Teknik
Merencanakan proses industri yang sedapat mungkin
menghindari/mengurangi kontak langsung pekerja
dengan bahan-bahan yang digunakan.

Pendidikan
Para pekerja harus diberi informasi tentang bahan-
bahan yang berbahaya bagi kulit, yang sering
digunakan dan bagi mereka harus ditanamkan
pengertian untuk menghindari kontak langsung dengan
bahan-bahan tersebut.
Higiene Menjaga kebersihan tubuh merupakan salah
satu
pencegahan terbaik untuk mengurangi kerusakan pada kulit
dan sebaliknya jika bekerja memakai pakaian kerja
Alat perlindungan
Seperti: - sarung tangan karet - penutup muka
- sepatu boot - cream pelindung
- kaca mata - sabun basa
Tujuannya untuk mengurangi kontak langsung antara bahan
dengan kulit.

Test penerapan pekerja

Test ini bertujuan untuk mengetahui kondisi kulit pekerja
sehingga dapat disesuaikan dengan lingkungan kerja yang
akan dihadapinya.
Pemeriksaan sebelum kerja  riwayat alergi
Faktor penentu: warna kulit, kesehatan, kulit
bermunyak.kering, banyak berkeringat,
jenis kelamin, diet
 Klinik dan tempat perawatan
Deteksi dini: pemeriksaan periodik, lapor diri
Supervisi: perawatan oleh perawat
Pekerja yang mengalami kerusakan pada kulitnya harus
segera dikirim ke klinik untuk mendapatkan pertolongan,
sehingga mencegah kerusakan yang lebih parah.

 Isolasi-substitusi bahan/proses

 APD
 Sarung tangan
 Baju, sepatu
 Kebersihan APD
 Cream pelindung terhadap iritan
 berbasis sabun, larut air
 repellent pelarut, dasar oli/gum  seperti memberi
sarung tangan yang tidak tampak. Efektif terhadap
pelarut, mempermudah menghilangkan cat, dll.
 repellent air, lanolin, petroleun jelly, ethyl cellulose
atau silicone yang memberi selaput yang tahan air
 tipe khusus: campuran zat khusus misalnya
terhadap fotosensitizers sun-exposure, poison ivy,
insekta, dll.
 Efek:
 Kekurangan cairan  dehidrasi, shock,
sakit sekali/pingsan
 Infeksi
 P3K:Bilas dengan air:
 mata  fountain, badan  shower
 Tutup/lindungi luka
 Bila shock  infus
 Bila ada hazardous information sheet

siapkan antidotum, beri antidotum
 Flush area immediately with large quantities of fresh water, using an
installed deluge shower or hose, if available. Avoid excessive water
pressure. Continue to flush the area for at least 15 minutes while
removing the clothes, including shoes, socks, and jewelry. Dry lime
powder (alkali burns) creates a corrosive substance when mixed
with water; keep the powder dry and remove it by brushing it
from the skin. Acid burns caused by phenol (carbolic acid), should be
washed with alcohol. Then wash the area with large quantities of water.
If alcohol is not available, flush the area with large quantities of water.
Cover chemical burns with a sterile dressing.
 Material Safety Data Sheet (MSDS) for the chemical.
 Flush the eyes with fresh water immediately using an installed
emergency eye/face bath or hose on low pressure for at least 20
minutes. Ask casualty to remove contact lenses. Use your hands to
keep the eyelids open. Never use a neutralizing agent, mineral oil, or
other material in the eyes.
 Monitor the airway, breathing, and circulation (ABCs).
 Warning - Do not attempt to neutralize any chemical unless you
are sure what it is and what substance will effectively neutralize
it. Further damage may be done by a neutralizing agent that is
too strong or incorrect. Do not apply creams or other materials
to chemical burns.
 Treat for shock - Keep the casualty comfortable and warm
enough to maintain normal body temperature.
 Request medical assistance for all chemical burns. If possible,
before transport, notify medical personnel of the name and
other pertinent information about the chemical involved,
location of the burn, and percentage of the body area affected.
Send the container to medical personnel with the casualty.
 For every task undertaken at your workplace, know what products or
substances are being used or generated.
 Find out what are the health and safety hazards associated with each of
the substance or product used or generated. Find out whether these
substances carry warnings signs and hazard information on dangers to
the skin. You can find these on product labels and/or in Safety Data
Sheets. SDS must be provided by the supplier of the chemical.
 Frequent contact with water (wet working) is a major cause of WRD.
Some substances (eg: formaldehyde in metal working fluids) may be
generated during work and can cause WRD. Take account of wet work
and substances generated during work in the next step.
 Find out which of your employees are exposed to these substances, how
does their skin come into contact, for how long and the frequency.
 Find out what control measure you have in place.
 Based on these make a judgement whether your employees
are at risk of getting work related dermatitis.
 If there is a risk of WRD, can you get rid of the chemical
altogether? This is the best and simplest solution.
 If you cannot get rid of the offending chemical, can you able
to replace it with a less harmful chemical. Seek the advice
of your Trade Association.
 Introduce process controls so that skin does not come into
contact with the chemical. If the contact is by immersion, or
splash find a solution that would provide a safe working
distance (SWD) between the chemical and the skin.
 If the exposure is due to dust, vapour in the air, install a
ventilated enclosure or provide local exhaust ventilation.
Consult “COSHH Essentials”. It is likely to provide a suitable
engineering control for your task.
 If you have provided all the above controls and you consider that skin
exposure could not be prevented altogether, then provide chemical
protective gloves and coverall as appropriate. Selection of gloves is a
complicated process. Always seek the help of your chemical supplier or
a reputable PPE supplier.
 Make sure employees: have been taught on safe working practices; use
the controls provided; have been trained to correctly use process
equipment and PPE; know how to check their skin for signs of
dermatitis; understand the benefits and limitations of skin care
creams.
 Provide mild skin cleaning cream that will do the job and washing
facilities with hot and cold water.
 Tell employees to clean their hands before consuming drinks and food
or before wearing gloves.
 Ensure pre and post work creams are used.
 Seek the help of occupational health professionals if you suspect that
you may have dermatitis problem at your workplace.
 Put in place a management system that checks that all of these actions
are carried out in practice.
You should take particular care if you have:
 fair or freckled skin that doesn’t tan, or goes red or
burns before it tans;
 red or fair hair and light coloured eyes;
 a large number of moles.

In the short term, even mild reddening of the skin from

sun exposure is a sign of damage. Sunburn can blister
the skin and make it peel.
Longer term problems can arise. Too much sun speeds up
ageing of the skin, making it leathery, mottled and
wrinkled. The most serious effect is an increased
chance of developing skin cancer.
 Keep your top on.
 Wear a hat with a brim or a flap that covers the ears and the
back of the neck.
 Stay in the shade whenever possible, during your breaks
and especially at lunch time.
 Use a high factor sunscreen of at least SPF15 on any
exposed skin.
 Drink plenty of water to avoid dehydration.
 Check your skin regularly for any unusual moles or spots.
See a doctor promptly if you find anything that is changing
in shape, size or colour, itching or bleeding.