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DERMATOSIS AKIBAT
KERJA
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Changes in Incidence
(1993 - 1999) From 1993 to 1999 there have
been further changes in thenumber of cases, incidenceand proportion of occupational
skin diseases. In 1999 BLSdata showed 44,600 totalcases of occupational skindiseases/disorders, or anincidence of 49 cases per100,000. In 1999, 12% of alloccupational illnesses reportedwere skin diseases/disorders.
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Work time lost
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Cost
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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
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Iritan primer
Asam , basa, pelarut lemak
Detergen
Garam garam logam
- garam arsen
- garam mercuri- dll
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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) dimetiltiuran disulfida
Obat-2an (procain, fenotiazin, klorotiazid,penisilin,tetrasiklin
Kosmetik, terpentin, tanam2an
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Agen acnegenic
Naftalen
Bifenil khlor
Minyak mineral
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Photosensitivity
Many chemicals needlight to activate andproduce the complete
phototoxin orphotoallergen. Thefurocoumarins in limesproduced this vesicularphototoxic dermatitis in
a bartender whosqueezed limes all
afternoon in direct sun.
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Ultraviolet cured
processes The technology of
using ultraviolet lightsensitive chemicals is
relatively new increating templates forprinting. It is alsobeing used in themanufacture of certain
printing inks and indentistry. Variousacrylates have beenthe sensitizers in thisprocess.
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Mekanisme terjadinyadermatosis :
Agen fisik trauma mekanik langsung ke kulit
Agen kimia
Iritan primer : merusak kulit dengan cara
mengubah PH, denaturasi protein, mengekraksilemak, menurunkan daya tahan
Sensitizer/allergi reaksi hipersinsitivitas tipelambat
Acnegenic menyumbat kelenjar dan sal, sebacea peradangan lokal
Photosensitizer meningkatkan sensitivitas kulitterhadap radiasi ultraviolet
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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 contaciritant adalah ; adanya trauma ( digosok,digaruk) pakaian, sarung tangan, kulitkering, kulit sudah dalam kondisi sakit
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Contact Dermatitis, Acute
This arm shows a painful,acute contact dermatitisform exposure to the
strong irritant, ethyleneoxide. The arm ismarkedly swollen andshows an acute vesiculo-
bullous dermatitis. Asimilar pattern may beseen on the basis ofcontact allergy.
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Contact Dermatitis,
Subacute This patient developed a
bilateral and symmetric sub-acute dermatitis from the
rubber accelerator,mercaptoben zothiazole,which was leached from therubber portion of his work
shoe as a result of sweating.In this case there is someedema and erythema withan eczematous eruption.
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Contact Dermatitis,
Chronic The hands, wrists and forearms
are the most frequent sites ofinvolvement in cases of industrialcontact dermatitis. The handsand wrists of this worker with achronic dermatitis show theeffect of long term exposure to asolvent, in this case kerosene,which was used for cleaning the
skin. The skin markedlythickened, hyperpigmented, dryand fissured, itching is usually amajor symptom.
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Chrome hole, fingers
Chromic acid and alkaline chromate areagents commonly encountered in thetanning and electroplating industries.These substances have a corrosiveaction when they enter the skin througha minor nick or break in the
integument. This results in theformation of chronic, ulcerative lesionsknown as "chrome holes". Typically, thelesions are found on fingers, hands orforearms. "Chrome holes" also occur onthe dorsal surfaces of the feet whenchrome salts have been allowed topermeate boots or shoes. The lesions
are usually painless and persist formany months before spontaneouslyhealing with permanent atrophic scar.Identical lesions can also be producedby arsenic or zinc salts but these areless frequently encountered.
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Chromic acid and alkaline chromate are agentscommonly encountered in the tanning and electroplatingindustries.
These substances have a corrosive action when theyenter the skin through a minor nick or break in theintegument. This results in the formation of chronic,ulcerative lesions known as "chrome holes".
Typically, the lesions are found on fingers, hands orforearms. "Chrome holes" also occur on the dorsalsurfaces of the feet when chrome salts have been allowedto permeate boots or shoes.
The lesions are usually painless and persist for many
months before spontaneously healing with permanentatrophic scar.
Identical lesions can also be produced by arsenic orzinc salts but these are less frequently encountered.
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Chrome hole, nasal
When chrome containingmaterials are present asaerosols, painless ulcerationof the nasal mucosa andseptum may occur. Withcontinues exposurepermanent septalperforation eventuallyresults, as in this young
woman who was employedin chrome plating smallappliance parts.
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b. D.contact allergica Ada sensitisasi sebelum timbul alergi, agen
sensitisasi bereaksi dengan protein dalamepidermis membentuk kompleks hapten protein pembentukan antibody
Reaksi hypersensitivas tipe lambat, timbulsetelah 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
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Contoh kasus D. Contac
allergica Dental Assistant
(allergy to glutaraldehyde and neomycin)
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Contoh kasus D. contact
allergica Optician - non-dominant hand dermatitis
(allergy to ethyl acrylate)
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Other Resin System
This severe allergiccontact dermatitis wasdue to a phenol-
formaldehyde resin.These resins are used asbonding agents forfoundry sand, electrical
devices and in moldedand cast plastic articles.They may also produceirritant reactions.
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Chemical Accelerators in
Rubber Allergic contact dermatitis
due to rubber chmicals isfairly common in industry.
Chemial accelerators thatspeed up the vulcanizationraction and antixidants arethe more frequent
allergens. They present apotential hazard in finishinggoods as well.
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Gejala Dermatosis yang
lain Acne akibat kerja hanya menyerang tubuh yang
kontak dengan agen
Lesi mikrotraumatik disebabkan oleh seratmineral, ditandai dengan papula kecil keputihanatau kemerahan pd area yg terpapar
Kanker kulit ( karsinoma squamosa
hyperkeratosis, papilomatosis
Dermatosis yg menular zoonotik, dermatofitosis,kandidiasis, tuberkulosis verukosa
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Occupational Acne. Acute,
Oil Folliculitis Occupational acne is most
commonly seen in workersexposed to insoluble cutting oils inthe machine tool trades or in
mechanics exposed to grease andlubricating oils. This workerdeveloped folliculitis, sometimescalled oil boils or acne, withmultiple comedones and pustuleson his arms and other covered
areas of his body as a result ofprolonged contact with oil. Thelesions almost never develop frombacteria present in the oils
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Oil Folliculitis Chronic,
Chloracne Chlordane is an extremely
refractory type of acne causedby certain halogenated aromaticchemicals and can be certain
halogogenated aromaticchemicals and can beaccompaned by systemictoxicity. It represents one of themost sensitive indicators ofbiologic response to these
chemicals. Chloracne in thisherbicide production workerinvolved almost every follicularorifice on his face and neck withcomedones, papules and cystlikelesions.
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Depigmentation
The hands of thishospital maintenanceworker are
depigmented formcontact with a phenolicgermicidal detergent.Irritation orsensitization to the
chemical is not aprerequisite for thepigment loss to occur.This loss of pigmentmay be permanent.
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Granuloma
Granulomas represent a focal,chronic inflammatory reaction.These granulomas wereproduced by beryllium and areconsidered to be on a allergicbasis. Non-allergic granulomasare more common andrepresent the skin's response toinoculated or implanted foreign
materials such as woodensplinters, plant spines and silica.
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Eccrine
Miliaria represents blockageof the eccrine sweat ductsand may occur in workerswho perspire excessively. In
this case of miliaria rubra ofprickly heat, the blockage siteis the granular cell layer ofthe epidermis. When morethan 30% of the skin surfaceis affected, an individual maydevelop thermoregulatorydisorders such as heatexhaustion.
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Tumors
Skin tumors, such as thisulcerating squamous cellcarcinoma most frequently ariseafter years of occupationalexposure. Malignant tumors mayrepresent to occupationalcarcinogens such as coal tar andphysical agents such as sunlight.Skin cancer is the commonestform of cancer. The role played
by occupational factors isfrequently difficult to determine.
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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 dantimbulnya penyakit
Dermatosis contact allergica ujitempel
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Uji tempel Menempelkan alergen yang dicurigai
dengan kadar yang non iritatif padakulit yang tidak terpapar selama 24
48 jam Positif bila timbul dermatosis
ekzematous dibawah tempelan yang
penutup
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Kerentanan
Orang dengan atopi ( eksema,penyakit kulit alergi dan alergi lainnya)
Penyakit kulit kronik termasukhiperhidrosis
Seborea atau iktiosis
Pimentasi abnormal
Lesi kulit prekanker
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Penanganan kasus
Dipindahkan ke area bebas alergen
Kasus D. iritatant, pekerja dipindahkansementara dan agen penyebab dikendalikan
Pemindahan kerja sec. Permanen dilakukanbila pemindahan sementara tidakmenghasilkan penyembuhan yg sempurna
Kondisi prekanker mk. Pekerja harusdijauhkan dari paparan
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Upaya pencegahan
Allergen kuat, sensitizer, karcinogendiganti dengan zat yang kurang
berbahaya Pengendalian secara tehnik ( isolasi
tempat kerja)
Eliminasi kontak dengan kulit Pakaian pelindung ( apron,sarung
tangan, sepatu boot, penutup wajah)
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Upaya pencegahan
Fasilitas dasar untuk kebersihan diri(pancuran air untuk mandi bukan bak
mandi) Kebersihan lingkungan dan house
keeping
- pembuangan air bekas dan sampahindustri
- pembersihan debu
- cara penimbunan dan penyimpanan
barang
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Upaya pencegahan
Diagnose dini Penyakit Dermatosis Akibatkerja 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 tdkmenunjukan gx
- waktu antara 6 bln 2 tahun tgt tingkatpaparan
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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 sembuhsempurna
allergi + infeksi sekunder
sembuhnya lama
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