OCC DERM INTRO

Occupational dermatitis refers to skin conditions arising from workplace exposures.
It includes irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), both of which can affect the largest organ of the body—the skin.

Injuries account for over 35% of all occupational diseases.
Breakdown of Causes:
- 82% of cases are due to lacerations.
- 14% are chemical burns.
- Approximately 1 in 1000 workers experience dermatitis annually.
Contact dermatitis is classified into two major types:
- Irritant Contact Dermatitis (ICD): Causative factor is exposure to harmful substances.
- Allergic Contact Dermatitis (ACD): Results from a hypersensitivity reaction.

Dermatitis: Inflammation of the skin presented as erythema, edema, vesicles, and often itching.
Absorption Areas for Chemicals:
- Commonly affected areas include the foot, palm, forearm, back, scalp, face, and scrotum.
Stratum Corneum: The outermost layer of the skin, serves as a barrier but is impermeable to hydrophilic substances.

Prevalence: Accounts for 80-90% of all occupational dermatoses.
Etiology: Results from exposure to irritants that directly damage the skin.
Symptoms:
- Acute: Redness, swelling, crusting, scaling.
- Chronic: Thickening of the skin, lichenification, loss of pigmentation.
Causes: Any substance can cause irritation given high concentration or prolonged exposure.
- Factors such as pH, concentration of agents, and individual predispositions play a role.

Prevalence: Accounts for 20% of occupational skin conditions.
Mechanism: Involves a hypersensitivity reaction to specific antigens after prior sensitization.
Symptoms: Characterized by erythema, edema, vesiculation, and significant itchiness.
Common Allergens:
- Nickel, rubber chemicals (thiuram), and specific medications (e.g., topical corticosteroids).

Highest risk occupations include:
- Agricultural workers.
- Manufacturing workers.
- Poultry and meat packing plant workers.
- Hairdressers and retail clerks.
Younger individuals, males, and those without a history of atopy are at higher risk for ICD, while females are more prone to ACD.

Use of PPE (Personal Protective Equipment):
- Gloves, masks, and barriers to reduce contact with irritants or allergens.
Proper hygiene and skin care measures including:
- Regular hand washing (but avoid excessive washing that can irritate skin).
- Use of barrier creams to protect skin.
- Removal of irritants after exposure to prevent dermatitis.

Diagnostic Criteria for ICD:
- Symptoms such as macular erythema, hyperkeratosis, or fissuring.
- Diagnosis often based on the exclusion of allergic causes (patch testing).
Testing Protocols:
- Skin biopsy for histological examination revealing hyperkeratosis and potential parakeratosis.
- KOH examination to rule out fungal infections.
- Patch testing to identify specific allergens implicated in ACD.

ICD Treatment:
- Topical steroids, immunomodulators, and moisturizers to restore the skin barrier.
- Cessation of exposure to irritants.
ACD Treatment:
- Same as ICD, but may also include antihistamines for itching and further delaying allergic response.
- Systemic treatments for severe reactions include corticosteroids.
Topical therapies such as Tacrolimus or Pimecrolimus may be used, but care must be taken as they may provoke irritation in ICD.

Common causes of occupational skin cancer include ultraviolet light, arsenic exposure, and prolonged contact with certain chemicals.
Types of Skin Cancer:
- Basal Cell Carcinoma (BCC): Typically non-invasive.
- Squamous Cell Carcinoma (SCC): Can be invasive.
- Melanoma: The most aggressive form of skin cancer with a high mortality rate.
Carcinogenic Substances:
- Aromatic amines in hair dyes, silica, and certain hydrocarbons are known contributors to cancer risk.

Understanding the nuances of occupational dermatitis is essential for prevention and management. Addressing factors such as exposure to irritants and allergens significantly impacts overall skin health in occupational settings.