136 Questions
What is the primary cause of occupational skin diseases?
Direct exposure to an exogenous agent
Which type of occupational contact dermatitis is a reaction to a substance by a type IV, delayed hypersensitivity reaction?
Allergic contact dermatitis
Who is at higher risk for irritant contact dermatitis?
People with compromised skin barrier
What is the category that irritant contact dermatitis and allergic contact dermatitis fall under?
Occupational skin diseases
What percentage of occupational skin diseases is comprised of occupational contact dermatitis?
90% to 95%
What kind of reaction causes irritant contact dermatitis?
Nonimmunologic reaction
What type of reaction is allergic contact dermatitis?
Type IV, delayed hypersensitivity reaction
What is the primary category of skin conditions caused or aggravated by workplace factors?
Occupational contact dermatitis
Which type of occupational contact dermatitis arises from direct exposure to an exogenous agent?
Irritant contact dermatitis
What is the primary cause of irritant contact dermatitis?
Wet work tasks and exposure to soaps
How soon can the effects of irritant contact dermatitis become visible?
Within minutes to a few hours
What is the difference in clinical presentation between severe acute and chronic irritant contact dermatitis?
Severe acute response may present with necrosis, whereas chronic lesions often present with lichenification, scaling, hyperpigmentation, or fissuring
Why is there no readily available diagnostic test for irritant contact dermatitis?
A careful history and the patient’s clinical presentation are usually sufficient for diagnosis
What is the unique variant predominantly seen in elderly individuals with a history of extensive usage of soaps and cleansing products?
Asteatotic dermatitis
Which type of occupational contact dermatitis arises from direct exposure to an exogenous agent like tars and greases?
Pustular and acneiform ICD
What syndrome is characterized by eczematous lesions, delayed healing, and persistent condition due to continued use of irritants?
Irritant contact dermatitis
In which weather conditions does asteatotic dermatitis mainly occur?
Low-humidity, winter months
What is the characteristic of the subjective irritant contact dermatitis?
Sensation of burning or stinging without visible cutaneous irritation
What should be done when warranted for patients with asteatotic dermatitis?
Replace harsh soaps with an appropriate soap
What is the characteristic phenomenon associated with acute irritant contact dermatitis?
Decrescendo phenomenon
What is a possible symptom of acute irritant contact dermatitis?
Pain due to fissuring of the hyperkeratotic skin
What is a characteristic feature of traumatic irritant contact dermatitis?
Arising after acute skin trauma
What type of exposure can lead to cumulative irritant contact dermatitis?
Frequent repetition of one agitating factor
What may lead to earlier development of cumulative irritant contact dermatitis in patients with sensitive skin?
Decreased irritant threshold
Which type of occupational contact dermatitis is associated with hardening of the skin and may progress to cumulative irritant dermatitis?
Irritant reaction contact dermatitis
What type of reaction is allergic contact dermatitis characterized by?
Transient increase of symptom intensity despite removal of the allergen (Crescendo phenomenon)
What is the most common occupational exposure leading to irritant contact dermatitis?
Exposure to soap, petroleum products, cutting oils and coolants
What is the characteristic of the clinical presentation of severe acute irritant contact dermatitis?
Necrosis or ulceration
Where are the most commonly involved sites for irritant contact dermatitis?
Hands
Which type of skin reaction is characterized by the lack of objective clinical signs but individuals complain of a sensation of burning or stinging after contact with certain chemicals?
Subjective ICD
In which weather conditions does asteatotic dermatitis mainly occur?
Low-humidity, winter months
What is the primary characteristic of pustular and acneiform ICD resulting from exposure to specific irritants?
Sterile and transient pustules
What is the defining characteristic of acute irritant contact dermatitis?
Symptoms confined to areas where the irritant damages the skin
What may lead to the earlier development of cumulative irritant contact dermatitis?
Repetitive subthreshold insults to the skin
What is the primary cause of traumatic irritant contact dermatitis?
Lacerations and burns
What is a characteristic feature of cumulative irritant contact dermatitis?
Pruritus and pain due to fissuring of the skin
What distinguishes acute allergic contact dermatitis from acute irritant contact dermatitis?
Crescendo phenomenon after removal of allergen
What distinguishes cumulative irritant contact dermatitis from acute irritant contact dermatitis in terms of lesions?
Less sharply demarcated lesions
Which category of workers is at risk for irritant reaction contact dermatitis?
Hairdressers, bartenders Metal workers
What are some common manifestations of both irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD)?
Pruritus, pain, erythema, and swelling
Which profession is reported to be one of the most commonly affected with identified allergens causing occupational contact dermatitis?
Machinists
What are some major occupational contact allergens listed in the text?
Nickel, rubber accelerators, fragrances
Which type of contact urticaria is caused by a wide array of agents in exposed individuals who develop a reaction without previous sensitization?
Nonimmunologic contact urticaria
Which type of contact urticaria is the most common and remains localized, and is less severe than immunologic contact urticaria (ICU) reactions?
Nonimmunologic contact urticaria
What type of hypersensitivity reaction is immunologic contact urticaria (ICU)?
Type I
Which type of reaction is mediated by allergen-specific immunoglobulin E (IgE) and seen in individuals previously exposed to the specific agent?
Immunologic contact urticaria
What can inhibit nonimmunologic contact urticaria (NICU) reactions?
Oral or topical nonsteroidal anti-inflammatory medications
Which of the following substances can cause a type IV hypersensitivity reaction (ie, ACD) and accounts for the majority of allergic reactions to natural rubber latex (NRL)?
Ammonium persulfate
Apart from health care workers, which occupation is commonly affected by immunologic contact urticaria from natural rubber latex (NRL)?
Kitchen workers
What is the prototypical example of immunologic contact urticaria?
Latex gloves
What is capable of eliciting an immunologic contact urticaria response and is the second most common cause of it?
Food
What does ammonium persulfate in bleaching hair boosters typically cause in terms of skin reaction?
Hives and itching
What type of reaction may occur with substances that produce a contact urticaria and a generalized histamine-type reaction but lack a direct or immunologic basis for the reaction?
Nonimmunologic contact urticaria (NICU)
What skin condition can develop in machinists exposed to industrial or cutting oils?
Acne
Which chemical exposure is associated with a notable form of acne called chloracne?
2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)
What is the primary characteristic of chloracne from chemical exposures?
Closed comedones and straw-colored cysts on the face
What is the term for the skin disorder caused by prolonged pressure from computer use?
Computer palms and Mousing callus
Which type of workers are at greater risk of suffering from vibration-induced white finger?
Construction workers
What is the term for the skin condition that may develop in housewives and slaughterhouse workers due to repetitive pressure on the distal finger tips?
Onycholysis
What skin disorder may result from working with fiberglass and cause a pruritic eruption resembling scabies?
Mechanical irritant dermatitis
What is the term for the painful vascular spasms in the fingers and hands induced by vibration-producing tools?
Vibration-induced white finger
What may cause mechanical irritant dermatitis from delicate hairs or hairs with barbs?
Plants
What may athletes develop due to repetitive trauma while running or shearing forces from quick changes in directional movements?
Black heel
What can create changes ranging from calluses and blisters to myositis, tenosynovitis, osseous injury, nerve damage, lacerations, shearing of tissue, or abrasions?
Friction, pressure, pounding, and vibration of the skin
What may develop in musicians due to chronic rubbing specific to the instrument being played?
harpist’s finger, fiddler’s neck, guitar nipple, cellist’s chest, flautist’s chin
What type of hairs can induce mechanical irritant dermatitis?
Trichromes and glochids
What is the primary cause of irritation in mechanical irritant dermatitis?
Mechanical action of the oxalate crystal
What may farmers and construction workers develop in hot environments due to chronic rubbing with clothing?
Miliaria
What skin condition may be aggravated by heat exposure, especially in individuals with preexisting conditions like rosacea and herpes simplex?
Acne vulgaris
Which occupation is associated with the highest incidence rates for all burn injuries?
Welders
What skin disorder may result from working with fiberglass and cause a pruritic eruption resembling scabies?
Lichen planus
What is the primary cause for all types of skin cancer to include melanoma, squamous cell carcinoma, and basal cell carcinoma?
UV radiation
Which workers are at high risk of harmful UV exposure and development of skin cancer due to their outdoor work?
Outdoor workers
What is the potential for increased UV exposure by as much as 2 to 3 times at cruising altitude for pilots and cabin crew?
Higher elevation
What is the aim of primary skin cancer prevention in outdoor workers?
Limiting UV radiation exposure
What are three successful measures in the prevention of skin cancer in outdoor workers?
Regular use of sunscreen, protection from direct UV radiation by suitable clothing, and changes in behavior with awareness of health and diseases
What does ionizing radiation, such as X-rays, primarily cause in terms of skin cancer?
Squamous cell carcinoma
What is a characteristic manifestation of higher doses of acute exposure to ionizing radiation?
Blistering and hemorrhage
What is characterized by long induction periods, often decades, with the first manifestations often not seen until many years after the occupational exposure?
Occupational skin cancers
Which group of workers is at risk for Staphylococci and Streptococci infections according to the text?
Farm workers
What are the occupations at risk for infections that can affect worker productivity and ultimately the employer?
Construction workers
In addition to health care workers, which other group is mentioned as being at risk for Staphylococci and Streptococci infections?
Hairdressers
Which infectious agents are still observed in at-risk occupational groups such as military personnel and forestry workers?
Staphylococcus and Streptococcus
Which occupational group is most at risk for acquiring pseudocowpox (Milker Nodule)?
Veterinarians and farmers
Which occupational group is known to be affected by Butcher wart virus (HPV-7)?
Butchers and meat handlers
Which type of workers are at risk of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV?
Health care workers
What is the occupational group most at risk for developing complications due to handling animals with pseudocowpox and milker nodule?
Farmers and fresh meat handlers
Which occupational group is known to be affected by the controversial nature of the risk of nasopharyngeal HPV?
Gynecologists
Which occupational group is at risk for the 3 bloodborne viruses HBV, HCV, and HIV?
Health care workers
Which bacterium is responsible for fish tank granuloma?
Mycobacterium marinum
Which occupation is most at risk for fish tank granuloma?
Fishermen
Which bacterium causes erysipeloid, an acute infection usually associated with occupational exposure?
Erysipelothrix rhusiopathiae
What is the causative organism of pitted keratolysis, a dermatologic condition affecting the plantar skin?
Corynebacterium species
Who is at highest risk for brucellosis, a worldwide zoonosis primarily affecting animals?
Slaughterhouse workers
What is the primary method of contracting brucellosis?
Ingestion of infected milk or milk products
What is the characteristic feature of pitted keratolysis?
Malodor
Which bacterium causes anthrax, predominantly a cutaneous infection found in certain occupations?
Bacillus anthracis
Which of the following occupations is at increased risk for Erysipeloid (Fish-Handler Disease)?
All of the above
Which occupational group is at risk for developing tinea pedis due to their work environment?
Athletes
What is the most common form of tularemia presentation?
Ulceroglandular form
Which occupational group is at risk for developing candida skin infections due to their work?
Bartenders
Which occupation is at risk of sporotrichosis due to the potential inoculation of Sporothrix schenckii via puncture wounds from thorns, splinters, sticks, and sphagnum moss?
Gardeners
Which occupational group is at risk for developing orf (ecthyma contagiosum) through contact with infected animals or fomites?
Farmers, Sheep workers, and Veterinarians
Which occupational group is at increased risk of tularemia, particularly for the pneumonic form of the disease?
Landscapers
What is the gold standard in diagnosing Allergic Contact Dermatitis (ACD)?
Patch testing
Which commercially available kit consists of 3 adhesive panels of 35 allergens and allergen mixes that are reported to be responsible for the majority of cases of ACD?
TRUE Test®
What is the basic principle when conducting patch testing for occupational skin diseases?
Never test an unknown substance or known irritants
Which group of workers may require testing products from the workplace during patch testing for occupational skin diseases?
Workers from various professions
What is the primary focus of managing occupational skin disorders?
Identifying the specific cause and outlining steps to avoid exposure
Which factor is NOT mentioned as a potential risk factor for occupational skin disorders?
Diet and exercise habits
What is the last resort for prevention of occupational skin disorders mentioned in the text?
Topical barriers and protective clothing
What may be recommended when beryllium sensitization is initially suspected?
Temporary or permanent work restriction
What is the primary role of employers in mitigating hazards related to occupational skin disorders?
Working with employees to mitigate hazards through the hierarchy of controls
What is the preferred approach if elimination or substitution of hazards is unrealistic?
Implementing administrative controls to decrease exposure time
What has been associated with increased risk of allergic contact dermatitis according to the text?
Mutations in the filaggrin gene affecting skin barrier functions
What skin condition is known to increase susceptibility to irritants but not to allergens?
Atopic dermatitis
Which group has been reported to have reduced reactivity to irritants based on age?
Older individuals
What has been suggested as a role in developing allergic contact dermatitis?
Mutations in genes encoding metabolic enzymes
What has been linked to an increased risk of developing occupational skin disorders according to the text?
Frequent handwashing and occlusive glove use at work
What has been found to affect skin barrier functions and contribute to the development of atopic dermatitis and potential susceptibility towards contact dermatitis?
Maceration from wet work conditions
Who should perform patch testing for allergic contact dermatitis (ACD)?
A trained provider with access to a wide range of allergens
What is the purpose of skin prick testing (SPT)?
To identify IgE-mediated immediate hypersensitivity reactions
What does the radioallergosorbent test (RAST) measure?
Serum-specific IgE
What method is commonly used to detect exposure to arsenic in the blood?
Blood biomonitoring
What is important when measuring arsenic in the urine for detecting exposure?
Requesting speciation to determine organic versus inorganic arsenic
What is the purpose of the beryllium lymphocyte proliferation test (Be-LPT)?
To identify sensitization to beryllium
What is the recommended alternative to the radioallergosorbent test (RAST) for diagnosing allergy?
Enzyme-linked immunosorbent assay (ELISA)
What can skin scraping with potassium hydroxide (KOH) preparation be used for?
Diagnosing nonstandardized allergens
Which diagnostic test may be employed particularly for certain occupational exposures?
Blood biomonitoring
What can scratch testing and scratch-chamber testing be used for?
Nonstandardized allergens testing
What is the highest prevalence of reported dermatitis in occupational categories according to the Standard Occupational Classification?
Life, physical, and social sciences
What can limit hazardous exposures but may increase permeation and penetration of irritants and allergens if used improperly?
Personal protective equipment (PPE)
In health risk assessments, what is the initial step to identify workplace hazards?
Hazard identification
What do Safety Data Sheets (SDSs) legally require for hazardous chemicals?
Hazard identification
What helps delineate relative threshold concentrations of an exposure that results in adverse health effects?
Doseresponse relationship
What is usually performed for monitoring since certain toxic substances have legal permissible exposure limits (PELs) enforced by OSHA?
Exposure assessment
Study Notes
Occupational Skin Diseases
- The primary cause of occupational skin diseases is occupational contact dermatitis.
- Occupational contact dermatitis can be categorized into two types: irritant contact dermatitis and allergic contact dermatitis.
Irritant Contact Dermatitis (ICD)
- Irritant contact dermatitis is a non-immunologic reaction caused by direct exposure to an exogenous agent.
- The primary cause of irritant contact dermatitis is the disruption of the skin's natural barrier function.
- ICD can occur immediately or within hours of exposure, and the effects can become visible within a few hours.
- Clinical presentation of severe acute ICD includes erythema, edema, and bullae, while chronic ICD presents as dryness, scaling, and fissuring.
- ICD can be further categorized into acute, cumulative, traumatic, and subjective types.
Allergic Contact Dermatitis (ACD)
- Allergic contact dermatitis is a type IV hypersensitivity reaction caused by a substance that evokes an allergic response.
- The primary cause of allergic contact dermatitis is the reaction to a substance by a type IV, delayed hypersensitivity reaction.
- ACD is characterized by an eczematous reaction, and the symptoms can take hours or days to develop.
Occupational Contact Dermatitis
- Occupational contact dermatitis accounts for approximately 90% of occupational skin diseases.
- Workers in certain occupations, such as healthcare workers, hairdressers, and food handlers, are at higher risk for irritant contact dermatitis.
- Certain substances, such as soaps, detergents, and chemicals, can cause occupational contact dermatitis.
Other Occupational Skin Conditions
- Asteatotic dermatitis is a condition that mainly occurs in dry weather conditions and is characterized by dry, scaly skin.
- Traumatic irritant contact dermatitis is caused by mechanical irritation, such as friction or pressure.
- Cumulative irritant contact dermatitis occurs due to repeated exposure to irritants and is characterized by dryness, scaling, and fissuring.
- Pustular and acneiform ICD results from exposure to specific irritants and is characterized by the formation of pustules and acne-like lesions.
Contact Urticaria
- Contact urticaria is a skin reaction that occurs within minutes to hours of exposure to an allergen or irritant.
- Immunologic contact urticaria (ICU) is caused by a type I hypersensitivity reaction, while nonimmunologic contact urticaria (NICU) is caused by the release of histamine and other mediators.
Skin Cancer
- Skin cancer is a major occupational health concern, particularly for outdoor workers.
- The primary cause of skin cancer is exposure to UV radiation.
- Outdoor workers, such as construction workers, farmers, and pilots, are at high risk for skin cancer due to their increased exposure to UV radiation.
Infectious Diseases
- Certain occupations, such as healthcare workers, military personnel, and forestry workers, are at risk for infectious diseases such as Staphylococci and Streptococci infections.
- Workers in certain industries, such as agriculture and construction, are at risk for bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV.
- Fish tank granuloma and erysipeloid are occupational infections that can affect workers in certain industries.
Test your knowledge about occupational contact dermatitis, a common type of occupational skin disease caused by exposure to workplace factors. Learn about the etiology and pathophysiology of this condition.
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