Contact Dermatitis.

The Major Occupational

Allergic Skin Diseases

Dr Yusrizal Djam’an Saleh SpP.FCCP

 BATASAN
• Penyakit kulit akibat kerja, ialah setiap
penyakit kulit yg disebabkan oleh
pekerjaan atau lingkungan kerja (faktor
risiko mekanik, fisik, kimia, biologik &
psikologik)
 INTRODUCTION
• Contact dermatitis, both irritant and
allergic, is the major cause for
occupational skin disease in many
industrial and agricultural workers.
• Needs to be addressed early in the
disease process for proper diagnosis,
management and control of the disease
activity.
 DEFINITION
• Contact dermatitis is a general term
applied to acute or chronic inflammatory
reaction to substances that come in
contact with the skin.
• There are two main types of contact
dermatitis, the irritant contact dermatitis
and the allergic contact dermatitis. These
constitute the major occupational allergic
skin diseases.
 Contact Irritant Dermatitis

• caused by chemical, physical or biological

(plants, animals) irritants.
• The acute form of the irritant contact
dermatitis occurs following a single
exposure to the offending agent, which is
toxic to the skin.
• Severe reactions may cause the skin to
slough off, producing deep necrotic ulcers.
• The severity of the irritant reaction in CID
(contact irritant dermatitis) is dependent
upon the concentration of the chemical
irritant.
• Certain levels of the concentrate produces
CID, lower strengths does not.
 Allergic Contact Dermatitis

• Immunological reaction caused by the

interaction of an antigen with the
antibodies produced against the antigen.
• For ACD (allergic contact dermatitis) to
occur a previous exposure and
sensitization to the antigen (allergy
producing substance) is required.
• This sensitization requires 7-21 days to
occur.
• If the individual is again exposed to the
same allergen, within a period of 12-24
hours, an antigen-antibody reaction occurs
in the skin, which causes the inflammatory
changes seen in allergic contact
dermatitis.
• This type of allergic reaction is known as
the cell mediated or delayed
hypersensitivity reaction.
 How to Differentiate Between the Contact
Irritant Dermatitis and Allergic Contact
Dermatitis?

• Contact irritant dermatitis is dose

dependent: higher the amount of irritant,
stronger the reaction.
• Allergic contact dermatitis is not dose
dependent; once the individual is
sensitized, even minute quantities can
produce allergic reaction on the skin.
• As contact irritant dermatitis is a toxic reaction, it
involves only the area of contact with the irritant.
The margins are sharply defined; the reaction
does not extend beyond.
• In allergic contact dermatitis, the reaction can
occur outside area of contact, even in remote
areas of the body which never came in contact
with the allergen. Thus generalized allergic
reaction is possibly in ACD.
• Anyone can get contact irritant dermatitis, but
only sensitized individuals get allergic contact
dermatitis.
 I. Dermatitis, Irritant Contact

• Occupational irritant contact dermatitis is

an inflammation caused by substances
found in the workplace that come in direct
contact with the skin.
• Signs of irritant contact dermatitis include
redness of the skin, blisters, scales or
crusts. These symptoms do not
necessarily occur at the same time or in all
cases.
 How does irritant contact
dermatitis develop?
• after a short, heavy exposure or a repeated or
prolonged, low exposure to a substance.
• an accidental contact with a strong irritant
causes immediate blisters. Contact with a mild
irritant may only produce redness of the skin.
• However, if the irritation continues, small lesions
or sores appear on the reddened area;
afterwards crusts and scales form.
• The skin damage usually heals a few weeks
after exposure ends if no complications have
arisen (e.g., no infections occurred).
• During the body's defensive response phase, a
person may experience pain, warmth, redness
and swelling in the irritated area.
• Minimal skin damage, as in the thickening of the
inner layer of the skin, will not be visible.
• However, when the damage is severe, the skin
shows signs of chapping, scaling, and blistering.
Some skin cells also die.
• Typically, an irritant reaction develops within a
few hours from exposure and is at its worst after
approximately twenty-four hours.
 What are factors contributing to
irritant contact dermatitis?
• the chemical properties of the substance (for example, is
it an acid, an alkali, or a salt),
• the amount and concentration of chemical coming in
contact with the skin, and the length and frequency of
the exposure.
• Hereditary factors influence the variety of reactions seen
in different persons when exposed to the same irritan.
• The penetration of substances varies over different body
regions, some substances penetrate the face and the
upper back more quickly than the arms.
• Environmental factors play a significant role.
For example, hot, humid workplaces
Table 2
 How is it recognized?
• No single test can reliably identify irritants in
specific cases.
• The best approach is to identify the conditions of
exposure by discussing the victim's employment.
The information to be gathered includes a
detailed list of all chemicals in the individual's
working environment; a detailed description of all
processes involved in a day's work; and any
information about other workers, if any, who
have similar skin problems.
 How is it treated?
• may be treated with compresses, creams,
ointments and skin cleansers.
• In general, people should protect their skin
from physical trauma, chemical irritation,
excessive sunlight, wind, and rapid
temperature changes while the dermatitis
is active.
 How common is it?
• Skin disorders comprise more than 35
percent of all occupationally related
diseases.
• Among all occupational dermatitis, irritant
contact dermatitis accounts for about 80
percent.
 What are the preventive
measures?
Can be avoided by the following measures:
• personal hygiene
• substitution of a less harmful substance
• enclosure of the process
• automation of the work procedures
• local exhaust ventilation systems
• good housekeeping
• education
• protective clothing
• barrier creams, skin cleansers
• convenient washing facilities
 II. Dermatitis, Allergic Contact

• local inflammation of the skin.

• Symptoms of inflammation are itching, pain,
redness, swelling, and the formation of small
blisters or wheals (itchy, red circles with a white
centre) on the skin. The inflammation is caused
by an allergy or irritation as a result of
substances found in the workplace that come
into direct contact with the skin. Approximately
3,000 substances are recognized as contact
allergens yet only 25 of these substances are
responsible for almost half the cases of allergic
contact dermatitis (ACD).
• This inflammation is usually confined to
the site of contact with the allergen, but in
severe cases it may spread to cover large
areas of the body. It usually starts within
twelve hours from exposure and is at its
worst after three or four days. It slowly
improves in about seven days. The allergic
sensitization may remain with the
individual through life. If there is no further
contact with the allergen, the level of
sensitivity may gradually decline.
 What are the contributing
factors?
• The most common factors are pre-existing skin
conditions such as irritant contact dermatitis.
Cuts or scratches, also.
• The chemical nature of the substance is
important (for example, whether it is an acid, an
alkali, or a salt), as are the amount and
concentration that comes into contact with the
skin, and the length and frequency of the
exposure.
• Important individual factors include the
resistance of the skin, which increases with age.
Hereditary factors influence the variety of
reactions in different persons exposed to the
same allergen.
• Environmental factors hot workplaces cause
sweating, which can dissolve some types of
industrial chemical powders, increasing their
toxicity for the skin. But sweating may also
provide a protective function because it may
dilute or "wash out" substances. Dry air can
cause chapping of the skin, increasing the
possibility of allergies.
What occupations are at risk?
 How is it recognized?
• Evaluation begins with a discussion of the person's
employment, and requires a detailed description of all
the processes involved in a typical day's work. It also
requires a detailed list of all chemicals in the individual's
working environment, and knowledge of whether other
workers are affected.
• Diagnosis of allergic contact dermatitis is confirmed by
patch test. Minute amounts of suspected substances are
applied to the skin, usually on the upper back.
Inflammation at the site of application indicates that the
person is allergic to a specific substance.
 How common is it?
• According to some US statistics, skin
disorders comprise more than thirty-five
percent of all occupationally related
diseases.
• Among all cases of occupational
dermatitis, allergic contact dermatitis
accounts for about twenty percent.
 What are the preventive
measures?
Occupational allergic contact dermatitis can be
avoided by;
• personal hygiene,
• engineering control methods,
• good housekeeping, and
• personal protection.
Personal hygiene, including hand washing, is
very important to prevent contact dermatitis, but
workers should be aware that excessive hand
washing with soap and detergents can also
damage the skin.
 How is it treated?
• Sensitized workers should avoid further
exposure to the allergen. This alone is an
effective remedy. Allergic contact dermatitis may
be treated with anti-inflammatory drugs, and with
ointments and skin cleansers.
• In general, the affected skin should be protected
from physical trauma, excessive sunlight, wind,
and rapid temperature changes while the
dermatitis is active.
 TATA CARA DIAGNOSIS
PENYAKIT KULIT AKIBAT KERJA
DASAR:
Keputusan Menteri Tenaga Kerja dan
Transmigrasi RI
KEP.79/MEN/2003
Pedoman Diagnosis dan Penilaian Cacat
Karena Kecelakaan dan Penyakit Akibat
Kerja
Tanggal 21 Maret 2003
 I. BATASAN
• Penyakit kulit akibat kerja, ialah setiap
penyakit kulit yg disebabkan oleh
pekerjaan atau lingkungan kerja (faktor
risiko mekanik, fisik, kimia, biologik &
psikologik)
Kelainan yg terjadi dapat berupa :
– Dermatitis kontak
– Dermatitis kontak fotosensitifitas
– Acne
– Infeksi kulit (bakteri, virus, jamur, infestasi
parasit)
– Neoplasma pada kulit
– Kelainan pigmentasi kulit
– Dll
•
 II. DIAGNOSIS
• Identifikasi
• Assesment potensial hazards ditempat kerja
• Pemeriksaan penderita
• Evaluasi  PAK ?

A.Anamnesis
1. Keluhan
2. Riwayat pekerjaan sekarang (lama &
jenis hazard).
3. Riwayat pekerjaan sebelumnya (lama &
jenis hazard)

Dibandingkan dg catatan medik sebelum

bekerja di perusahaan (“pre-employment
medical check up”)

4. Riwayat penyakit keluarga

5. Riwayat perjalanan penyakit

- Waktu kejadian?
- Rasa gatal?
- Perbaikan selama cuti
- Pengobatan yg pernah / telah didapat?
B. Pemeriksaan fisik
1. Inspeksi
- Pemeriksaan seluruh badan termasuk
lipatan kulit, misal lipat paha, celah
antar jari
- Kondisi higiene umum
- Lokasi kelainan

2. Palpasi

3. Pemeriksaan dengan kaca pembesar

C. Pemeriksaan penunjang
1. Pemeriksaan laboratorium
1.1. Pemeriksaan hasil kerokan kulit
dengan KOH 20% (pemeriksaan
jamur)

1.2. Tes serologi untuk sifilis :

- VDR ≤ ¼ bukan sifilis (bukan
pada pasien berisiko tinggi)
- VDR > ¼ kemungkinan sifilis 
rujuk kespesialis kulit & kelamin
1.3. Kelainan kulit.
karena HIV  Western Blot, atau
Elisa 3x dengan metoda berbeda atau
ke laboratorium rujukan

2. Pemeriksaan dengan Lampu Wood

2.1. Untuk perubahan warna kulit berupa
hipo atau hiper pigmentasi tanpa disertai
radang
2.2. Pemeriksaan psoriasis versicolor 
Khusus
3. Histopatologi : Khusus untuk
neoplasma kulit

4. Uji tempel, ada 2 (dua) cara :

4.1. Uji tempel terbuka, terutama untuk
bahan iritan (bahan mudah menguap,
bahan yg dicurigai iritan dioleskan
dibelakang telinga & dievaluasi 24 jam
kemudian)
4.2. Uji tempel tertutup; dilakukan baik untuk
alergen standar atau bukan standar
(pengenceran 1/1000-1/100). Lokasi
penempelan di punggung atau lengan atas
bagian lateral. Setelah alergen dioleskan
48 jam lalu dibuka. Setelah terbuka 15
menit kemudian dievaluasi
III. URAIAN PENILAIAN CACAT
• Sesuai dg peraturan perundang-undangan
yg berlaku, cacat bidang penyakit kulit sulit
diperhitungkan terhadap penurunan
kemampuan kerja & tidak tercakup dalam
lampiran Peraturan Pemerintah No.14
tahun 1993
TERIMA KASIH