DERMATOSIS AKIBAT KERJA

BIMA URAMANDA
AKADEMI KEPERAWATAN
DHARMA WACANA
Changes in Incidence
(1993 - 1999)
• 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 :
• 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
• Asam , basa, pelarut lemak
• Detergen
• Garam garam logam
- garam arsen
- garam mercuri
- dll
 Sensitizer
• 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

• Naftalen
• Bifenil khlor
• Minyak mineral
 Agen photosensitizer
• Antrasen
• Pitch
• Derivat asam aminobenzoat
• Hidrokarbon aromatik klor
• Pewarna akridin
Photosensitivity
• 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
• 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 :
• 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
- 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
• 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
vesiculo-bullous dermatitis.
A similar pattern may be
seen on the basis of contact
allergy.
Contact Dermatitis, Subacute
• This patient developed a
bilateral and symmetric sub-
acute 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
• 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
• 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
• 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
• 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
• Dental Assistant
(allergy to glutaraldehyde and neomycin)
 Contoh kasus D. contact allergica
• Optician - non-dominant hand dermatitis
(allergy to ethyl acrylate)
Other Resin System
• This severe allergic contact
dermatitis was due to a
phenol-formaldehyde 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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

• 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
• 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
• 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
 Penggunaan SPF 15 untuk melindungi
Sinar .matahari
 Upaya pencegahan
• 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
ditempat kerja
 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