The%20Skin%20and%20Occupational%20Dermatoses

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The Skin and Occupational Dermatoses

• Industrial Hygiene
• IENG 431
• Dr. Carter Kerk
• Industrial Engineering Department
• SD School of Mines
• Spring 2009

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Assignment

• Read Plog, Chapter 3
• Color ACB Plate 161
• HW3 Pick one of the Case Examples of Control (p.
  79-80)
• Write a 1-2 page analysis of the case
• How did it strike you? What surprised you?
  Categorize the control strategies into the three
  categories.
• Due ?

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Outline The Skin and Occupational Dermatoses

• Function and Anatomy of the Skin
• Causes of Occupational Skin Injuries
• Preventing Occupational Skin Damage

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Introduction

• Skin disorders rank among the top occupational
  injuries reported each year
• 41,400 cases in US in 2006 (BLS)
• Probably an underestimate
• Many skin disorders go unreported

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Function and Anatomy of the Skin

• Skin is a first line of defense for the body
  against attack
• Heat, cold, wetness, dryness, corrosives,
  chemicals, abrasives, sharps, insect bites,
  bacteria, sunlight
• You probably have scars from past attacks

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Skin is an Organ

• Average surface area 2 m2 (21.5 ft2)
• Physical barrier, moisture barrier, organ of
  sensory perception
• 70 feet of sensory nerves per in2
• Heat, cold, pain , pressure
• Helps regulate thermal system
• Sweating, Vasodilation
• Contains blood vessels, hairs, sweat glands, oil
  glands
• Thickness varies from 0.5 (eye lids) to 4 (palms
  of hands) mm

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Three Skin Layers

• Epidermis (Outer Layer)
• Dermis (Middle Layer)
• Subcutaneous (Deep Layer)

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Epidermis (Outer Layer)

• Keratin layer (horny layer or stratum corneum),
  top layer
• Dead, keratin-filled cells, flakes off
• Excellent barrier, except against alkaline
  materials and fat-soluble materials (organic
  solvents)
• Melanocytes pigment producing cells
• Pigment melanin determines hair and skin
  color
• Exposure to UV wavelengths stimulates melanin
  production freckles, suntan, skin thickening
• Low melanin production - albinism
• Langerhans cells (immune system)
• Sites for haptens leading to allergic response

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Exposure to Chemicals

• Some chemicals may cause loss of pigment from
  exposed skin
• Phenolic compounds, germicidal cleaners,
  metalworking fluids, paints, plastic resins
• Interferes with melanin production destruction
  of melanin-containing cells

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Dermis (Middle Layer)

• Much thicker than epidermis
• Contains connective tissue that supports skin,
  gives structure
• Leather goods from animal hides
• Contains blood vessels, nerves, hair follicles,
  some muscle, oil and sweat glands
• Oil produces provides some water repellence,
  maintains moisture, gives skin flexibility
• Folliculitis inflammation or irritation of hair
  follicles

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Subcutaneous (Deep Layer)

• Contains fatty and connective tissue
• Provides cushion
• Provides insulation
• Lower parts of some sweat glands and hair,
  nerves, blood and lymph vessels
• Binds the skin to underlying tissues

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Causes of Occupational Skin Injuries

• Mechanical
• Chemical
• Ultraviolet radiation
• Biological

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Response to Hazardous Materials

• Depends on
• Physical condition of skin
• Environmental conditions (heat/humidity)
• Perspiration layer, pore size
• Amount of moisture in skin
• Amount of pigmentation
• Body location
• Age and gender
• Pre-existing damage or allergies
• Personal hygiene habits

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Mechanical Damage

• Friction resulting in blisters
• Abrasion from rough surfaces
• Physical damage from sharps
• Irritation from small glass fibers
• Burns (mild to severe to fatal)
• Frostbite

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Chemical Damage

• The most common cause of skin damage and disease
• Irritants or sensitizers
• Allergic Contact Dermatitis
• Sensitizing agents producing a response after a
  single or multiple exposure and only in some
  individuals
• Redness, swelling, cracking, immune system
  effects
• Systemic responses (difficulty breathing,
  inflammation of airways, pulmonary edema
• Common chemicals phenol, epoxy, rubber,
  acrylics, nickel, plant resins
• See Plog, Table 3-D

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Irritant Contact Dermatitis

• Difficult to distinguish from allergic contact
  dermatitis
• Caused by exposure to chemicals
• Solvents, acids, bases
• Degreasing solvents dissolve and remove oily
  protection of the skin
• Long-term exposure causes permanent damage
• Chlorinated solvents cause chloracne

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Chemical Damage Cont.

• Occupational Acne
• Oily/greasy compounds may cause acne-like
  eruptions (Water soluble cutting oils, creosote,
  tar)
• Hyperpigmentation
• Darkening of the skin from chronic physical
  irritation (e.g., itching)
• Some chemicals may stimulate the production of
  melanin (thus darkening)
• Tars, arsenic compounds, plant sensitizers
  (poison oak and ivy)
• Corrosive materials (acids and bases)
• Localized damage ranging from erythema (reddening
  of the skin) to open sores and ulcers (e.g.,
  chrome holes)

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Damage from Ultraviolet Radiation

• Sunburn
• Skin cancer incidence has been increasing
• Each year in the US, about 1,000,000 learn they
  have skin cancer
• Some are occupationally-related
• Especially among outdoor workers
• Construction workers, road builders, roofers,
  landscapers, foresters
• Two other reactions phototoxic, photoallergic
• Involve a chemical along with the presence of UV
  radiation

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Phototoxic Reactions

• Involves a chemical along with UV radiation
• Localized areas of tenderness at exposed location
• Example roofer is more easily sunburned on skin
  that has been exposed to hot roofing tar or tar
  fumes

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Photoallergic Reaction

• Involves a chemical along with UV radiation
• Involves the immune system
• Only affects some individuals
• Example bartender who squeezed limes while
  working in the sun

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Biological Agents

• Can affect the skin, producing a systemic effect
  if untreated
• Bacteria, fungi, insects, parasites, poisonous
  plants, snakes, jellyfish
• Urticaria produced by plants and animals,
  causing reddening, swelling, small fluid
  eruptions
• Example natural latex rubber

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Biological Agents, Cont.

• Rocky Mountain spotted fever
• Tick borne illness
• Fever, aches, rash on hands/feet, organ failure,
  death
• Lyme disease
• Tick borne bacteria
• Leaves a small red circle that grows into a
  bulls eye
• Fever, aches, nausea, vomiting, heart effects,
  rarely to death

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Anthrax

• A bacteria that lives in the hair of sheep and
  other animals and can live in soil for many years
• Cutaneous anthrax
• Enters the body through a cut in skin
• Pulmonary anthrax
• Inhalation entry, easily misdiagnosed
• Can be treated with antibiotics

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Tetanus (Lockjaw)

• A bacteria found in soil, dust, manure
• Enters skin through cuts, scratches, puncture
  wounds and attacks nervous system
• Causes severe muscle spasms that may lead to
  death by suffocation
• Get a tetanus shot every 5-10 years

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Evaluation of Occupational Dermatoses

• Diagnosis
• Can be difficult
• Of what trade are you?
• may require a specialist
• Causation
• Can be difficult
• Is it chemical, physical, mechanical, or
  biological?
• Temporal relationship between exposure and onset
  of symptoms
• What about non-occupational exposures?
• Impairment Evaluation (for WC)
• See Plog Table 3-G

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Prevention of Occupational Skin Damage

• Engineering Controls
• Proper planning during design, construction,
  remodeling
• Proper ventilation design is critical
• Substitution of safer materials or safer forms of
  materials
• Raw material a pellet or liquid form will
  produce less dust than a powder
• Process re-design to eliminate or reduce contact
• Consider automation and closed systems
• Proper design of work methods and procedures
• Good housekeeping and 5S/6S
• Dont forget about maintenance and service
  workers
• Make plans for spills and leaks

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Prevention of Occupational Skin Damage (Cont.)

• Administrative Controls
• Training
• personal hygiene (remember lead and ingestion)
• worker rotation
• 29 CFR 1910.141, Sanitation
• Requires all workplaces contain a basin for
  washing, hot and cold running water, soap, clean
  towels or hot air dryers

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Prevention of Occupational Skin Damage (Cont.)

• PPE gloves, aprons, boots, full body suits,
  face shields, goggles, barrier creams
• Provide a barrier meet specifications for
  degradation and permeation
• See Plog Table 3-H Physical Performance Chart
  of Selected Glove Materials
• ANSI/ISEA 105-2000 American National Standard
  for Hand Protection Selection Criteria
• ISEA International Safety Equipment Assoc,
  www.safetyequipment.org

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Reference

• Nims DK. Basics of Industrial Hygiene. John
  Wiley Sons, Inc., 1999.

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Assignment

• Read Plog, Chapter 3
• Color ACB Plate 161
• HW3 Pick one of the Case Examples of Control (p.
  79-80)
• Write a 1-2 page analysis of the case
• How did it strike you? What surprised you?
  Categorize the control strategies into the three
  categories.
• Due ?