Occupational dermatoses are a large group of skin diseases associated with industrial activity. The clinical manifestations of occupational dermatoses are diverse, correspond to the clinic of analogous diseases that do not have a professional component. It can be dermatitis, eczema, vitiligo, vasculitis, porphyria, lichen, keratosis, urticaria. The diagnosis is based on anamnesis, statement of the fact of occupational harm, clinical picture, analysis of working conditions at work, skin tests and immunological testing. The treatment of occupational dermatoses is identical to their non-professional counterparts.
General information
Occupational dermatoses are a number of skin diseases caused by the complex influence of exogenous factors on the body of patients and arising as a result of professionally harmful working conditions. The prevalence of pathological processes and their sexual and age distribution depend on the presence of certain industries in the region and the composition of employees of enterprises. There are age limits that are determined by the working age. The first to deal with the problem of occupational skin diseases began in the United States, where in 1928 the Federal Public Health Service established the Dermatosis Research Department, which today is the Dermatological Department of the Occupational Health Program.
In the structure of dermatological morbidity, occupational skin diseases account for about 1%, whereas among all occupational pathology they are assigned from 35% to 80%. Most of all, occupational pathology is provided by enterprises of mechanical engineering and metalworking (21%), chemical (19%) and woodworking (9%) industries, construction business (9%). Today, there is an increase in the incidence of profdermatoses everywhere. This is probably due to the widespread use of chemical fertilizers in agriculture, the development of the microbiological industry and the synthesis of new substances with pathogenic effects on the skin, which determines the relevance of the topic at the present stage.
Causes
Triggers of occupational pathology are known and are divided into three types: chemical (92%), physico-mechanical (2%), infectious and parasitic (6%). According to the nature of contact with the dermis, chemicals are divided into irritating, photo-provoking and allergizing. Irritants include concentrated compounds such as alkalis, acids and salts, as well as solvents, fuel oil and technical oils that are weaker in their action. The category of photoprovocators includes refined petroleum products and medicines. Sensitizing agents can be contact and non-contact. Physical and mechanical provoking factors are heat, cold, rays and current. Microorganisms constitute an infectious-parasitic group.
The mechanism of development of occupational pathology depends not only on the action of the trigger, but also on the state of the patient’s body. Exogenous factors capable of combining with dermal proteins, having penetrated into the cell membrane by transdermal absorption, form an allergen depot. In response to this, an antigen-antibody reaction of a delayed type occurs in the skin. Some of the T-lymphocytes that trigger proliferative processes in lymphoid cells are activated. In parallel, the active production of mediators and prostaglandins begins. T-suppressors and T-helpers join the process. At the molecular level, the organization of cells involved in the development of the allergic process is disrupted, which is visually manifested by hyperemia, edema, rash, peeling and wetting of the skin with the addition of coccoid infection.
The penetration of a pathological antigen through the digestive tract or respiratory tract leads to an immediate type of allergy. The development of the pathological process is aggravated by endogenous factors: the state of the digestive tract, hormonal disorders, stress, local infection, skin disorders. Depending on the aggressiveness, the amount of pathogenic onset and the duration of its action on the skin or mucous membranes, one or another profdermatosis occurs.
Classification
Modern dermatologists focus on the etiological classification of profdermatoses, distinguishing three groups:
- Skin diseases resulting from the patient’s industrial contact with chemicals: epidermoses, dermatitis, folliculitis, toxicoderma, eczematous manifestations, melanodermia, vasculitis, vitiligo, lichen, porphyria, onychia, paronychia, urticaria rashes, burns, Quincke’s edema, photodermatoses, dermatoconiosis.
- Skin diseases developed as a result of the patient’s industrial contact with physical and mechanical factors: temperature, radiation, mechanical skin inflammation, chills, calluses, electrical trauma.
- Skin diseases resulting from the patient’s industrial contact with microorganisms: erysipeloid, tuberculosis, syphilitic infection, dermatozoonosis, anthrax, skin lesions in milkmaids, candidiasis.
Symptoms
Each type of occupational pathology has its own characteristics, which are determined by the nature of irritating agents in production. Improvement of the sanitary and hygienic situation, automation of the workflow and testing of irritants contribute to the transformation of acute forms of diseases into chronic ones, since they do not exclude a pathological allergen from the working cycle, but only weaken its effect, prolonging the skin response time.
Clinical manifestations of occupational dermatoses are no different from the symptoms of similar non-professional pathologies. More often than others, acute contact inflammation of the dermis develops with the development of erythema and serous bulls at the site of the introduction of a pathological allergen, accompanied by a feeling of heat and burning. Elimination of the root cause leads to rapid relief of inflammation. In second place is occupational eczema, clinically identical to the true one, its only distinguishing feature is the presence of a history of occupational hazard.
Occupational angiopathies that have arisen when working with varnishes and paints resemble Raynaud’s disease: paresthesia, cyanosis of the hands and feet, pallor of the skin. Over time, osteoporosis, endarteritis, osteolysis, toxic hepatitis occur. Vasculitis in contact with aromatic carbohydrates is manifested by hemorrhages, anemia and hemolytic syndrome. Phytoallergens cause occupational vasculitis with the phenomena of asthmoid bronchitis. Work related to the manufacture of medicines stimulates the development of allergic reactions up to anaphylactic shock.
Occupational vitiligo develops in contact with synthetic resins and acrylic compounds, accompanied by the appearance of flaky erythemas on the back and upper extremities with the outcome in the foci of depigmentation. Elimination of the cause promotes repigmentation. Heavy metal salts lead to a violation of porphyrin metabolism, the skin manifestations of which are characterized by bullous rashes with an outcome in the scars, skin dyschromia, increased dermis pattern, the appearance of cheilitis, hypertrichosis and onychodystrophy.
Professional red lichen planus is a dermatosis of photographers, accompanied by lichenoid rashes after contact with color film developers. Occupational atopy is caused by barn mites of the grain complex, characterized by dermatitis on the background of rhinitis, conjunctivitis and asthmoid bronchitis. Borrelious spirochete causes specific acrodermatitis of employees of sawmills, forestry, apiaries and fishing farms.
Diagnostics
The primary diagnosis is made by a dermatologist on the basis of anamnesis, establishing the fact of the patient’s contact with industrial hazards, clinical manifestations of the disease (primary rashes occur at the site of the introduction of a professionally harmful substance into the skin, the timing of occurrence coincides with the timing of work), analysis of such morbidity at the enterprise and identification of similar pathology in other workers.
The final clinical diagnosis is established by a professional pathologist based on the interpretation of the results of a complete laboratory and clinical examination of the patient using additional special methods. First of all, skin tests are carried out to identify the suspected irritant (prick test, drip and scarification tests), skin PH-metry, bacterioscopy, vitropression and Wood lamp examination are performed. They make a sample of Nikolsky, a sample of Yadasson, a sample of Tzanka, determine the symptom of Kebner.
Immunological testing is carried out (RTML, RSAL – samples of specific migration and agglomeration of leukocytes, RSPB – specific reaction with basophils, NST – test – reaction with neutrophils, Shelley reaction with solutions of industrial allergens). There are special developments for determining profdermatoses at an early stage – these are studies of the activity of chemicals used in production. Differentiate profdermatoses with their non-professional counterparts, verruciform epidermodysplasia, papillomas, dermatomycosis and candidiasis.
Treatment and prevention
The therapy of occupational dermatoses is carried out similarly to the treatment of non-professional dermatoses, provides for the mandatory elimination of the irritant that caused pathological skin changes and the solution of employment problems. Prevention consists in using special ointments and overalls to protect the skin from dangerous substances, improving the production cycle and its automation, improving working conditions, installing sanitary and hygienic modules, regular sanitary control of industrial premises, special selection of workers for industries with occupational hazards (testing with skin samples), conducting occupational examinations, medical examinations. The prognosis when eliminating the provoking factor is favorable. Of great importance is the examination of the ability to work with further employment.