Occupational skin diseases

Occupational skin diseases are contracted primarily as a result of an exposure arising from work activity and are the second most common employer-reported occupational disorder. The most common manifestations include irritant contact dermatitis, occupational acne, and latex allergy. Other occupational diseases covered elsewhere include: asbestosis, mesothelioma, and silicosis. For precancerous skin diseases, see “Precancerous skin lesions.”

• Second most common cause of occupational disorders (15–20% of all reported occupational diseases) ^[1]
• 75% of patients with occupational contact dermatitis develop chronic skin disease ^[1]

• Definition: a localized, inflammatory skin reaction caused by a direct cytotoxic effect of a causal agent
• Epidemiology: most common cause of occupational skin disease
• Etiology
  • Heavy metals
  • Strong acids and alkalis
  • Water, soaps, detergents
  • Solvents, synthetic oils
  • Latex gloves
  • Extreme temperatures (e.g., thermal burns, sunburn, cold injury)
• Clinical features
  • Acute manifestations: erythema, edema, and vesicular rash
  • Chronic manifestations: xerosis, scaling, lichenification, hyperkeratosis, and fissuring
  • The skin lesions are typically limited to the area of exposure.
  • Pruritus and/or pain can occur
• Differential diagnoses
  • Allergic contact dermatitis (see table on “Irritant vs. allergic contact dermatitis” below)
  • Atopic dermatitis
  • Seborrheic dermatitis

• Treatment
  • Avoidance of causative agents
  • If local acute reaction: wet dressings with saline solution, moisturizers, and topical corticosteroids
  • If chronic dermatitis: corticosteroid ointments and emollients
  • If severe or widespread: oral corticosteroids

Reference:^[2]

• Definition: a skin condition caused by clogging of hair follicles with dead skin cells and/or sebum
• Classification
  • Oil acne
    • Most common form of occupational acne
    • Seen frequently in mechanics
    • Oil exposure → reactive follicular hyperkeratosis → open comedones (blackheads) → folliculitis and microcystic lesions
  • Chloracne
    • Most serious form of occupational acne
    • Caused by halogenated aromatic hydrocarbons penetrating the skin
    • Closed comedones, yellowish cysts, and scarring
    • The nose is typically spared.
• Treatment: topical benzoyl peroxide and retinoic acid

• Definition: a type I or type IV hypersensitivity to latex-based products (e.g., exam gloves, condoms)
• Epidemiology: ∼ 8–12% of health care workers are affected ^[3]
• Etiology: latex (particularly in rubber gloves)
• Pathophysiology
  • Immediate hypersensitivity (type I HSR): preformed IgE antibodies coating mast cells and basophils are crosslinked by contact with antigen (usually latex allergens) → cell degranulation → release of histamine and other inflammatory mediators.(e.g., leukotrienes, prostaglandins) → vasodilatation, increased capillary permeability, smooth muscle contraction, and inflammatory cell chemotaxis ^[4]
    OR
  • Delayed-type hypersensitivity (type IV HSR): contact of antigens (usually chemicals used during glove manufactoring such as benzothiazoles or amines) with presensitized T lymphocytes ^[5]
    • Presensitized CD4+ T cells recognize antigens on antigen-presenting cells → release of inflammatory cytokines → activation of macrophages
    • Presensitized CD8+ T cells recognize antigens on somatic cells → cell-mediated cytotoxicity
• Clinical features
  • Urticaria in the areas of contact
  • Rhinitis and asthma (dyspnea) caused by allergens in the air
  • Anaphylactic shock
• Treatment: allergen avoidance