Screening and Monitoring in Occupational Health and Safety
OCT 420 HC
SKIN
By Kylie Stitt and David Freeman
Lecturer: Dr J...
Introduction
Occupational skin disease can be induced by, or aggravated by
exposure to irritant agents in the work environ...
Anatomy of Skin
Epidermis
- superficial layer
- epithelium cells
- varying thickness depending on site
- hair shaft
Dermis...
Function of Skin
Protective barrier
- a protective layer of natural oils to retard moisture evaporation
and to act as a me...
Skin grafting
Split thickness - removal of epidermis from donor site and
positioning graft on burn site
Full thickness - i...
Types of Occupational Skin Disease
Occupational Dermatitis
- Eczema and dermatitis- inflammation of the skin
- Contact der...
Table 1 from Mc Cunney (1994) ch.17 p.
Freeman and Stitt SKIN
CHEMICAL
Irritant Absolute, Immediate first contact inflamma...
Irritant Reaction
 Cause pathological reactions in the skin with
exposure in sufficiently high concentrations and
length ...
Multiple Sensitisations
 Multiple allergens within different products
 Cross sensitisation means that contact dermatitis...
Chronic allergic dermatitis
 Prolonged acute dermatitis and is maintained by repeated
contact with the allergic substance...
Burns
Flame
 In direct contact with a fire, the cause of which could be from
a multitude of sources.
 The length of expo...
Electrical
Herrington (1995) states “Electrical burns are caused by the
conversion of the electrical energy to thermal ene...
Herrington (1995)
Types of burn
First-degree (superficial) burns
• Most commonly caused by the exposure to ultraviolet
rad...
Herrington (1995)
Third-degree (full thickness) burns
• Caused by flame, electrical contact, or immersion in hot
liquids
•...
Herrington (1995)
Mechanical Injury
Callosity
- Hardened skin that forms when the skin is subjected to
constant friction
-...
Goh (1990)
Physical Injury
Heat
- The swelling of the lining of the sweat ducts can obstruct
the entrance of the sweat duc...
Goh (1990)
Radiation effects
- Electromagnetic radiation is dependent on energy level
and dose
- Little or no warning prop...
Adams (1999)
Acute radiodermatitis
- Occupational exposure to ionising radiation is usually
localised
- Acute radiodermati...
Adams (1999)
Ultraviolet light radiation
- Common cause of cancer such as melanoma, and
squamous cell carcinoma.
- Enhance...
Adams (1999)
Irritants and Allergens
Resins
 Acrylic - associated with causing allergic contact
dermatitis in the uncured...
- used in electrical and manufacturing
industries
Goh (1990)
Rubber Chemicals
 Most common skin sensitiser
 Allergic con...
 Cleansers
Goh (1990)
Foodstuffs
 Uncooked food can cause skin reactions
 Occupational dermatitis can be cumulative
 A...
Goh (1990)
Metals
 Skin sensitiser and irritant
 Can cause contact dermatitis
 Nickel - skin sensitiser and can cause c...
Goh (1990)
Freeman and Stitt SKIN 24
Health Risk Assessment
Hazard Identification
- First step in risk assessment
- What is a hazard and what the effects of ex...
References
Adams, R.M. (Ed.). (1999). Occupational Skin Disease (3rd
ed.).
Philadelphia: W.B. Saunders Company
Berger, T.G...
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Screening and Monitoring in Occupational Health and Safety

  1. 1. Screening and Monitoring in Occupational Health and Safety OCT 420 HC SKIN By Kylie Stitt and David Freeman Lecturer: Dr J. Cromie Latrobe University School of Occupational Therapy Freeman and Stitt SKIN 1
  2. 2. Introduction Occupational skin disease can be induced by, or aggravated by exposure to irritant agents in the work environment. Although most occupational skin diseases are not life threatening, they can cause considerable discomfort to the employee. This can have an effect on productivity, employee and team moral as well as business operations. It is important to recognise the effects of occupational skin disease with respect to short and long term effects. Occupational health and safety professionals should be aware of the types, and causes of occupational skin disease as well as preventive measures. Freeman and Stitt SKIN 2
  3. 3. Anatomy of Skin Epidermis - superficial layer - epithelium cells - varying thickness depending on site - hair shaft Dermis - deep layer - connective tissue - blood vessels - lymphatic vessels - nerves - hair shaft - nails Superficial Fascia - layer below the dermis - hair follicle - sweat glands Snell (1986) Freeman and Stitt SKIN 3
  4. 4. Function of Skin Protective barrier - a protective layer of natural oils to retard moisture evaporation and to act as a mechanical shield. Goh (1994) Burns - depth indicates rate of healing and methods of treatment Partial thickness- heal from cells of hair follicle, sebaceous glands, sweat glands, and cells of the edge of the burn Full thickness - deeper than sweat glands will heal slowly from the edges of the burn only - require skin grafting to prevent contracture and increase the rate of healing Freeman and Stitt SKIN 4
  5. 5. Skin grafting Split thickness - removal of epidermis from donor site and positioning graft on burn site Full thickness - involves both the epidermis and the dermis, with the provision of circulation supply at the burn site and within the donor graft to survive. Snell (1986) Freeman and Stitt SKIN 5
  6. 6. Types of Occupational Skin Disease Occupational Dermatitis - Eczema and dermatitis- inflammation of the skin - Contact dermatitis refers to an inflammation that is caused by an external agent - Most commonly these diseases are localised to the hands and forearms and can prevent a person from continuing employment - Occupational dermatitis can be caused by a variety of interactions in the workplace - Many substances encountered in the occupational environment can affect the skin in different ways and cause different types of reactions Freeman and Stitt SKIN 6
  7. 7. Table 1 from Mc Cunney (1994) ch.17 p. Freeman and Stitt SKIN CHEMICAL Irritant Absolute, Immediate first contact inflammatory reaction of the skin – strong bases and acids (potassium chloride, ethylene oxide) Marginal Repeat contact (Kerosene, various cutting fluids) Allergens Contact causing a reaction (epoxy resins, chemicals used in making of rubbers, chromates, nickel) MECHANICAL Friction Calluses, abrasions, lichenification of skin (violinist neck, knuckle pads of carpet layers), Koebner’s phenomenon (development of lesions of psoriasis or lichens planus, in workers predisposed to having either of these skin disorders in traumatised areas of skin) Pressure Blisters, nail dystrophy Vibration Vibration induced white fingers, Raynaud’s Disease (certain types of vibrating equipment) PHYSICAL Heat Burns, sweating (Miliaria, intertriginous rashes) Cold Frostbite, Raynaud’s symptoms Radiation Radiation dermatitis, skin cancers (x-ray exposure), photosensitivity eruptions, phytophotodermatitis (eruptions form contact with plants containing furocoumarin in presence of light. BIOLOGICAL Plants Poison Ivy, oak and sumac (forest fire fighters) Insects Lyme disease from bite of tick in forester) Animal Orf (viral eruption from infected sheep) Microbiological Agents Viruses- herpetic whitlow (herpes simplex of finger in dentists) Bacterial- anthrax (contact with spores in contaminated goat hair) Fungal- Mycobacterium Marinum (fish tank cleaners) Rickettsial- Rocky Mountain spotted fever (tick bite in dog handler) Protozoa- Plazmodium (causing malaria from mosquito bite in laboratory workers) Helminthes- Ancylostoma braziliense (causing cutaneous larva margins, skin eruptions in workers who are exposed to organisms from infected soil) 7
  8. 8. Irritant Reaction  Cause pathological reactions in the skin with exposure in sufficiently high concentrations and length of time  Reactions to irritants can vary greatly between individuals  Some irritants give no visible change on one or two contacts, but can still reduce the defence mechanism of skin Contact Allergy  Involves an altered type of reaction in the skin  The allergy as such does not cause any visible alteration, but the skin can develop dermatitis when it comes into contact with the allergens (sensitisers) to which the allergy has been acquired  The origin of contact allergies can occur after one week of exposure or years and even decades  The allergy is very specific and involves one or a few very similar definitive products  Vary in intensity  The allergy normally remains for the remainder of the person’s life, causing a reaction upon every point of contact. Freeman and Stitt SKIN 8
  9. 9. Multiple Sensitisations  Multiple allergens within different products  Cross sensitisation means that contact dermatitis caused by a primary allergen combined with allergies to chemically similar substances, all of which can cause an outbreak of a dermatitis reaction at contact Phototoxic/Photoallergic Reactions  These forms of reaction only occur where there is contact with an allergic substance and ultra violet light at the same time. Allergic Contact Dermatitis  Can occur after only a single contact  Characterised by redness, itching, swelling, papules, and vesicles  Many factors affect the appearance of dermatitis such as the location and quantity of allergen  The allergens cause skin lesions in a sensitised person and are normally visible 6-48 hours after contact, but can take four to five days to remedy. Freeman and Stitt SKIN 9
  10. 10. Chronic allergic dermatitis  Prolonged acute dermatitis and is maintained by repeated contact with the allergic substance  Irritant and allergic dermatitis is often difficult to distinguish as they can occur at the same time Diagnosis  Patch tests are used to reproduce as allergic reaction on skin with specific products  Bacterial culture test - for blistering or crusting lesions  Conducted by a suitably qualified physician or dermatologist Freeman and Stitt SKIN 10
  11. 11. Burns Flame  In direct contact with a fire, the cause of which could be from a multitude of sources.  The length of exposure and intensity of the heat liberated from the fire will determine the extent of the burn suffered. Chemical Herrington (1995) states that “Chemical burns are uncommon, accounting for only 3% of all burn injuries; however they are responsible for over 30% of burn deaths” (Herrington, 1995, p. 264).  Alkalis are more destructive to human tissue than acids due to the different reactions with the skin and underlying tissue  When chemical exposure is suffered the continuation of exposure will directly affect the extent of the burn wound.  Acid or alkali burns should be treated initially by continuous flushing with copious amounts of running water.  Neutralisation is not recommended, as the heat produced with neutralisation will exacerbate the injury. Herrington (1995) Freeman and Stitt SKIN 11
  12. 12. Electrical Herrington (1995) states “Electrical burns are caused by the conversion of the electrical energy to thermal energy. As the current courses through the body, heat is liberated in proportion to the resistance of the various tissues” (Herrington, 1995, p. 264).  Damage caused by electric current is generally not visible  The majority of the burn damage is to internal tissue, except to the entry and exit point of the current and burns due to associated flame proliferation when an electric arc flashes or heat ignites. Freeman and Stitt SKIN 12
  13. 13. Herrington (1995) Types of burn First-degree (superficial) burns • Most commonly caused by the exposure to ultraviolet radiation or scalding due to hot liquids or surface contact • Injuries generally do not require hospitalisation and are treatable without specialist medical attention • This type of burn should heal within a week or so. Second-degree (partial thickness) burns • Predominately caused by scalding, contact with hot surfaces or flame • Treated as soon as possible by flushing or where possible submerging in cold water as this helps to limit the extent of the burn injury. • Hospitalisation is necessary for this type of injury to ensure appropriate treatment is received, recovery within three to four weeks. Freeman and Stitt SKIN 13
  14. 14. Herrington (1995) Third-degree (full thickness) burns • Caused by flame, electrical contact, or immersion in hot liquids • Affected area has constricted blood flow • Specialist treatment is required • Treatment involves the removal of the affected area and the positioning of grafts Freeman and Stitt SKIN 14
  15. 15. Herrington (1995) Mechanical Injury Callosity - Hardened skin that forms when the skin is subjected to constant friction - Occurs during manual work and can be painful, causing difficulty at work Raynaud’s Phenomenon - The fingertips change colour when exposed to the cold - Discoloration is the result of a vasopastic reaction to cold and in severe cases this can lead to necrosis - Common with workers using vibrating tools such as jackhammers, pneumatic drills and pounding machines. Freeman and Stitt SKIN 15
  16. 16. Goh (1990) Physical Injury Heat - The swelling of the lining of the sweat ducts can obstruct the entrance of the sweat duct leading to sweat retention causing miliaria - Symptoms can be as mild as scaling of the skin, or severe such as itchy popular rashes - Treatment involves changing the environment of the worker to reduce sweating and hygiene Cold - Frostbite and Raynaud’s phenomenon - Environments such as cold rooms and in liquefied gas workers can cause vasoconstriction leading to decreased blood supply to the fingertips with severe damage being tissue damage and necrosis. Freeman and Stitt SKIN 16
  17. 17. Goh (1990) Radiation effects - Electromagnetic radiation is dependent on energy level and dose - Little or no warning properties such as odour or sound. Ionising radiation - Has a high energy level and occurs in waveform such as X-rays - Health impact varies with the type of radiation and intensity - Occurs in industry such as curing plastics, sterilising, medical radiography and therapy, and electronic equipment such as television sets. Freeman and Stitt SKIN 17
  18. 18. Adams (1999) Acute radiodermatitis - Occupational exposure to ionising radiation is usually localised - Acute radiodermatitis affects the skin in stages - Initially, there is blanching of the skin and oedema that reaches a peak at 48 hours after exposure and rapidly subsides. From six to ten days the skin begins to change in colour and texture with considerable pain - Acute radiodermatitis effects the functioning of the sebaceous glands and hair follicles. After months of healing a scar remains present - As the intensity of exposure to radiation increases, the effects become worse, with amputation a possibility. Freeman and Stitt SKIN 18
  19. 19. Adams (1999) Ultraviolet light radiation - Common cause of cancer such as melanoma, and squamous cell carcinoma. - Enhances the skin ageing process and this can lead to skin cancer - Industry use artificial sources of UV radiation, examples include welding and cutting torches, numerous laboratory equipment and electric arc furnaces - Outdoor workers are affected - Personal protection equipment - Some medication can cause photosensitivity reaction effecting toenails and fingernails following exposure to UV radiation Freeman and Stitt SKIN 19
  20. 20. Adams (1999) Irritants and Allergens Resins  Acrylic - associated with causing allergic contact dermatitis in the uncured form - skin irritant and sensitiser  Epoxy - inert form is not a skin sensitiser - can cause dermatitis - used in thermoplastics, prosthetics, and dentures  Polyurethane - skin irritants - dermatitis caused by direct contact - used in prosthetics, adhesives and furniture  Formaldehyde - skin irritant and sensitiser - allergic contact dermatitis possible as formaldehyde is released from the resin Freeman and Stitt SKIN 20
  21. 21. - used in electrical and manufacturing industries Goh (1990) Rubber Chemicals  Most common skin sensitiser  Allergic contact urticaria  Latex gloves can cause dermatitis  Substitutes include plastic gloves Solvents  Skin irritants  Can cause cumulative dermatitis in hands  Used for dissolving substances, degreasing and in inks  Used as cleanser Soaps and Detergents  Skin irritants  Skin sensitiser in fragrances  Can cause contact dermatitis Freeman and Stitt SKIN 21
  22. 22.  Cleansers Goh (1990) Foodstuffs  Uncooked food can cause skin reactions  Occupational dermatitis can be cumulative  Allergic contact dermatitis possible with preservatives and spices  Contact urticaria result of contact with shellfish, fish meat and fruit  Patch test can confirm allergy  Chefs and food handlers Plants and Woods  Irritant and allergic contact dermatitis  Plant dermatitis - lesions on the skin  Wood dermatitis – airborne, exposed skin  Forest workers, florists, gardeners, and horticulturists Freeman and Stitt SKIN 22
  23. 23. Goh (1990) Metals  Skin sensitiser and irritant  Can cause contact dermatitis  Nickel - skin sensitiser and can cause contact dermatitis - jewellery, hairdressing and electronics industries - patch test available to detect nickel  Chromium - not a skin sensitiser - chromate can cause allergic contact dermatitis - dermatitis continues after stopping contact - used in tanning leather and in cement Freeman and Stitt SKIN 23
  24. 24. Goh (1990) Freeman and Stitt SKIN 24
  25. 25. Health Risk Assessment Hazard Identification - First step in risk assessment - What is a hazard and what the effects of exposure on health - Injury type or disease and exposure conditions. Dose Response Assessment - Relationship of dose and the occurrence of an adverse effect - Animal studies and human studies, showing route of exposure, dose type, and the response. Exposure Assessment - Amount of exposure from the environment such as ingestion, absorption, and inhalation. - Duration and estimated dose of exposure is determined to be able to identify current and to anticipate future adverse conditions. Risk Characterisation - Determine the extent of the risk with respect to regulations and legislation. Adams (1999) Freeman and Stitt SKIN 25
  26. 26. References Adams, R.M. (Ed.). (1999). Occupational Skin Disease (3rd ed.). Philadelphia: W.B. Saunders Company Berger, T.G., Elias, P.R., and Wintroub, B.U. (1990). Manual of Therapy For Skin Diseases. New York, U.S.: Churchill Livingstone Dr. Kevin Macdonald. Occupational Physician, B.Med.Sc., M.B.B.S., F.A.F.O.M. Goh, C.L. (1990). Handbook of Occupational Skin Diseases. Singapore: P.G. Publishing Herrington, T and Morse, L. (1995). Occupational Injuries, Evaluation, Management and Prevention. St Louis Missouri, U. S. A.: Mosby, Year Book Incorporated Mc Cunney, R. (1994). A Practical Approach to Occupational and Environmental Medicine (2nd ed.). Boston: Little, Brown and Company Snell, R.S. (1986). Clinical Anatomy for Medical Students (3rd ed.). Boston: Little, Brown and Company Zenz, C., Dickerson, O., and Horvath, E. (Eds.). (1995). Occupational Medicine (3rd ed.). St Louis Missouri, U. S. A.: Mosby, Year Book Incorporated Freeman and Stitt SKIN 26

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