Transcript DERMATOSIS AKIBAT KERJA - Keluarga IKMA FKMUA 2010

DERMATOSIS AKIBAT
KERJA
Changes in Incidence
(1993 - 1999)
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From 1993 to 1999 there have
been further changes in the
number of cases, incidence
and proportion of occupational
skin diseases. In 1999 BLS
data showed 44,600 total
cases of occupational skin
diseases/disorders, or an
incidence of 49 cases per
100,000. In 1999, 12% of all
occupational illnesses reported
were skin diseases/disorders.
Work time lost
Cost
Sifat agen penyebab
dermatosis :
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Agen fisik : tekanan, gesekan, cuaca dingin,
panas, radiasi ultraviolet, serat mineral.
Agen Biologis : beberapa mikroba, fungi,
parasit kulit dan produk2 nya
Agen kimia, dibagi dalam 4 kelompok :
- iritan primer
- sensitizer
- acnegenic
- photosensitizer
Iritan primer
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Asam , basa, pelarut lemak
Detergen
Garam garam logam
- garam arsen
- garam mercuri
- dll
Sensitizer
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Logam dan garam2nya (kromium, nikel, kobalt)
Senyawa yang berasal dari anilin
( p fenilendiamin, azo dyes )
Derivat nitro aromatik ( trinitrotoluene )
Resin (epoksiresin, formaldehid, vinil, akrilik )
Bahan kimia karet ( vulcanizer)  dimetil
tiuran disulfida
Obat-2an (procain, fenotiazin, klorotiazid,
penisilin,tetrasiklin
Kosmetik, terpentin, tanam2an
Agen acnegenic
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Naftalen
Bifenil khlor
Minyak mineral
Agen photosensitizer
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Antrasen
Pitch
Derivat asam aminobenzoat
Hidrokarbon aromatik klor
Pewarna akridin
Photosensitivity
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Many chemicals need
light to activate and
produce the complete
phototoxin or
photoallergen. The
furocoumarins in limes
produced this vesicular
phototoxic dermatitis in
a bartender who
squeezed limes all
afternoon in direct sun.
Ultraviolet cured
processes
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The technology of
using ultraviolet light
sensitive chemicals is
relatively new in
creating templates for
printing. It is also
being used in the
manufacture of certain
printing inks and in
dentistry. Various
acrylates have been
the sensitizers in this
process.
Mekanisme terjadinya
dermatosis :
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Agen fisik  trauma mekanik langsung ke kulit
Agen kimia
Iritan primer : merusak kulit dengan cara
mengubah PH, denaturasi protein, mengekraksi
lemak, menurunkan daya tahan
Sensitizer/allergi reaksi hipersinsitivitas tipe
lambat
Acnegenic menyumbat kelenjar dan sal, sebacea
 peradangan lokal
Photosensitizer  meningkatkan sensitivitas kulit
terhadap radiasi ultraviolet
Gejala dan tanda
a. D. contact irritant
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Akut ditandai eritema, edema, papula
vesikula  biasanya di tangan, lengan
bawah atau wajah
Kronik ditandai excoriasi, crustae , eksema,
hiperkeratosis
Faktor yang membantu timbulnya contac
iritant adalah ; adanya trauma ( digosok,
digaruk) pakaian, sarung tangan, kulit
kering, kulit sudah dalam kondisi sakit
Contact Dermatitis, Acute
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This arm shows a painful,
acute contact dermatitis
form exposure to the
strong irritant, ethylene
oxide. The arm is
markedly swollen and
shows an acute vesiculobullous dermatitis. A
similar pattern may be
seen on the basis of
contact allergy.
Contact Dermatitis,
Subacute
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This patient developed a
bilateral and symmetric subacute dermatitis from the
rubber accelerator,
mercaptoben zothiazole,
which was leached from the
rubber portion of his work
shoe as a result of sweating.
In this case there is some
edema and erythema with
an eczematous eruption.
Contact Dermatitis,
Chronic
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The hands, wrists and forearms
are the most frequent sites of
involvement in cases of industrial
contact dermatitis. The hands
and wrists of this worker with a
chronic dermatitis show the
effect of long term exposure to a
solvent, in this case kerosene,
which was used for cleaning the
skin. The skin markedly
thickened, hyperpigmented, dry
and fissured, itching is usually a
major symptom.
Chrome hole, fingers
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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.
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, nasal
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When chrome containing
materials are present as
aerosols, painless ulceration
of the nasal mucosa and
septum may occur. With
continues exposure
permanent septal
perforation eventually
results, as in this young
woman who was employed
in chrome plating small
appliance parts.
b. D.contact allergica
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Ada sensitisasi sebelum timbul alergi, agen
sensitisasi bereaksi dengan protein dalam
epidermis membentuk kompleks hapten –
protein  pembentukan antibody
Reaksi hypersensitivas tipe lambat, timbul
setelah 48 – 72 jam
Zat yang biasanya sebagai primary irritant
juga dapat sebagai allergen
Bentuk akut seperti  spt D. contact irritant
akut
Bentuk kronis  timbul likenifikasi , fisura
Contoh kasus D. Contac
allergica
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Dental Assistant
(allergy to glutaraldehyde and neomycin)
Contoh kasus D. contact
allergica
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Optician - non-dominant hand dermatitis
(allergy to ethyl acrylate)
Other Resin System
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This severe allergic
contact dermatitis was
due to a phenolformaldehyde resin.
These resins are used as
bonding agents for
foundry sand, electrical
devices and in molded
and cast plastic articles.
They may also produce
irritant reactions.
Chemical Accelerators in
Rubber
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Allergic contact dermatitis
due to rubber chmicals is
fairly common in industry.
Chemial accelerators that
speed up the vulcanization
raction and antixidants are
the more frequent
allergens. They present a
potential hazard in finishing
goods as well.
Gejala Dermatosis yang
lain
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Acne akibat kerja  hanya menyerang tubuh yang
kontak dengan agen
Lesi mikrotraumatik  disebabkan oleh serat
mineral, ditandai dengan papula kecil keputihan
atau kemerahan pd area yg terpapar
Kanker kulit ( karsinoma squamosa 
hyperkeratosis, papilomatosis
Dermatosis yg menular  zoonotik, dermatofitosis,
kandidiasis, tuberkulosis verukosa
Occupational Acne. Acute,
Oil Folliculitis
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Occupational acne is most
commonly seen in workers
exposed to insoluble cutting oils in
the machine tool trades or in
mechanics exposed to grease and
lubricating oils. This worker
developed folliculitis, sometimes
called oil boils or acne, with
multiple comedones and pustules
on his arms and other covered
areas of his body as a result of
prolonged contact with oil. The
lesions almost never develop from
bacteria present in the oils
Oil Folliculitis Chronic,
Chloracne
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Chlordane is an extremely
refractory type of acne caused
by certain halogenated aromatic
chemicals and can be certain
halogogenated aromatic
chemicals and can be
accompaned by systemic toxicity.
It represents one of the most
sensitive indicators of biologic
response to these chemicals.
Chloracne in this herbicide
production worker involved
almost every follicular orifice on
his face and neck with
comedones, papules and cystlike
lesions.
Depigmentation
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The hands of this
hospital maintenance
worker are
depigmented form
contact with a phenolic
germicidal detergent.
Irritation or
sensitization to the
chemical is not a
prerequisite for the
pigment loss to occur.
This loss of pigment
may be permanent.
Granuloma
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Granulomas represent a focal,
chronic inflammatory reaction.
These granulomas were
produced by beryllium and are
considered to be on a allergic
basis. Non-allergic granulomas
are more common and
represent the skin's response to
inoculated or implanted foreign
materials such as wooden
splinters, plant spines and silica.
Eccrine
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Miliaria represents blockage
of the eccrine sweat ducts
and may occur in workers
who perspire excessively. In
this case of miliaria rubra of
prickly heat, the blockage site
is the granular cell layer of
the epidermis. When more
than 30% of the skin surface
is affected, an individual may
develop thermoregulatory
disorders such as heat
exhaustion.
Tumors
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Skin tumors, such as this
ulcerating squamous cell
carcinoma most frequently arise
after years of occupational
exposure. Malignant tumors may
represent to occupational
carcinogens such as coal tar and
physical agents such as sunlight.
Skin cancer is the commonest
form of cancer. The role played
by occupational factors is
frequently difficult to determine.
Diagnose Dermatosis
akibat kerja
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Gambaran klinis, lokalisasi dan
perjalanan penyakit harus sepenuhnya
sesuai dengan ciri PAK yg pasti
Paparan kerja terhadap agen
berbahaya perlu dipastikan
Ada hubungan waktu paparan dan
timbulnya penyakit
Dermatosis contact allergica  uji
tempel
Uji tempel
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Menempelkan alergen yang dicurigai
dengan kadar yang non iritatif pada
kulit yang tidak terpapar selama 24 –
48 jam
Positif bila timbul dermatosis
ekzematous dibawah tempelan yang
penutup
Kerentanan
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Orang dengan atopi ( eksema,
penyakit kulit alergi dan alergi lainnya)
Penyakit kulit kronik termasuk
hiperhidrosis
Seborea atau iktiosis
Pimentasi abnormal
Lesi kulit prekanker
Penanganan kasus
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Dipindahkan ke area bebas alergen
Kasus D. iritatant, pekerja dipindahkan
sementara dan agen penyebab dikendalikan
Pemindahan kerja sec. Permanen dilakukan
bila pemindahan sementara tidak
menghasilkan penyembuhan yg sempurna
Kondisi prekanker mk. Pekerja harus
dijauhkan dari paparan
Upaya pencegahan
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Allergen kuat, sensitizer, karcinogen
diganti dengan zat yang kurang
berbahaya
Pengendalian secara tehnik ( isolasi
tempat kerja)
Eliminasi kontak dengan kulit
Pakaian pelindung ( apron,sarung
tangan, sepatu boot, penutup wajah)
Upaya pencegahan
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Fasilitas dasar untuk kebersihan diri
(pancuran air untuk mandi bukan bak
mandi)
Kebersihan lingkungan dan house
keeping
- pembuangan air bekas dan sampah
industri
- pembersihan debu
- cara penimbunan dan penyimpanan
barang
Upaya pencegahan
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Diagnose dini Penyakit Dermatosis Akibat
kerja melalui :
Pemeriksaan awal sebelum penempatan
- riwayat medis
- fisik dengan perhatian khusus pada kulit
Pemeriksaan berkala :
- sama spt pem.awal
- uji tempel tdk dianjurkan bagi yg tdk
menunjukan gx
- waktu antara 6 bln – 2 tahun tgt tingkat
paparan
Prognosis
D. iritant , acne, infeksi 
menyembuh sth agen penyebab
dijauhkan
 D. alergi  tgt sifat alergennya dan
bila hanya ditempat kerja dan telah di
hilangkan alergennya  sembuh
sempurna
 allergi + infeksi sekunder 
sembuhnya lama
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