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Dermatology Board Prep > DERM (02) Eczematous Disease > Occupational Dermatoses > Flashcards

Occupational Dermatoses Flashcards

1
Q

what causes the majoirty of occupational dermatoses?

A

Contact Dermatitis

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2
Q

What are the most common causes of ACD in occupational dermatoses?

A

Rubber> nickel>epoxy + resins> aromatic amines

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3
Q

MC cause of occupational irritant ICD?

A

Soaps> wet work> petroleum products> solvents> cutting oils> coolants

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4
Q

History components that lead you to occupational dermatoses?

A

Gets better when away from work, when chronic this is less clear cut. Covered areas are unusual sites of dz onset. Spread to distant sites is more common in ACD.

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5
Q

How do you make the dx of ACD from the workplace?

A

Test with work materials. You can do dilutional series with the testing if unknown substances to confirm that the rxn is allergic rather than irritant

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6
Q

What is a risk factor for ICD?

A

Prior eczema

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7
Q

What are two chemicals that can have a delayed-type chemical burn/irritant rxn?

A

Phenol and hydrofluoric acid

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8
Q

4 strong acids used in the workplace that can cause ICD?

A

sulfuric, nitric, hydrochloric, chromic

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9
Q

What is the mechanism for damage from strong acids?

A

Coagulate skin proteins –> forms barrier that impedes further penetration

hydrofluoric acid though can cause liquefactive necrosis and penetrates down to the bone.

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10
Q

How do you neutralize hydrofluoric acid?

A

calcium gluconate gel

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11
Q

What are some strong alkalis?

A

Sodium, calcium, potassium hydroxide, wet cement, sodium + potassium cyanides

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12
Q

What are alkalis worse than acids?

A

Degradation of lipids + saponification of resulting fatty acids form soaps–> aid penetration of alkalis deeper into skin.

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13
Q

what are some organic and inorganic chemicals that can cause chemical burn?

A

Dichromates, arsenates, phenolic compounds

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14
Q

How do Dichromates, arsenates, phenolic compounds cause damage in the skin?

A

Nerve damage –> anesthesia but rarely in the absence of visible skin damage -Vasoconstriction may lead to the necrosis that occurs–> systemic shock–>renal damage

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15
Q

Some solvents and gasses that can cause ICD?

A

Acrylonitrile, ethylene oxide (sterilize med supplies), carbon disulfide, mustine

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16
Q

What is the treatment for chemicals leading to chemical burns?

A

Initial: irrigation w/ large volumes of water (If insoluble to water, use soap solution) Avoid high pressure (splashes) Hydrofluoric acid: 2.5% calcium gluconate gel Chromic acid: early debridement of necrotic areas

17
Q

What is the problem with latex patch testing?

A

It is not specific, there are lots of false negatives

18
Q

If you have an allergy to peach, what other fruits are you allergic too potentially (cross react)

A

Other Rosaceae fruit (apple, pear, cherry, plum)

19
Q

Biggest causes of contact urticaria?

A

cow dander, latex, food products

20
Q

what risk factors in occupations can lead to SCC/BCC?

A

UV exposure is the key in 95%

Those at risk:

outdoor workers (agriculture and building industries), welders (UV exposure)

Polycyclic hydrocarbons ( tars, pitches, oil fractioning products)

Arsenic in glass production, copper, zinc or lead smelting, pesticide, herbicides and semiconductors

Radiologists, dentists, x-ray tech, radioactive materials

21
Q

What are the clinical findings of occupational acne?

A

Open and closed comedones, non-inflamed nodules and cysts

22
Q

Causes of occupational acne?

A

oils, halogenated polycyclic hydrocarbons, and repeated frictional trauma

23
Q

Most common cause of occupational acne?

A

Oil acne

24
Q

What is the occupational acne called that is caused by friction/truama?

A

Acne mechanica (frictional trauma occludes follicles at sites of pressure)

25
Q

What is acne cosmetica?

A

Caused from things like lanolin, petrolatum, veggie oil you get smalled closed comedones, small papules and pustules

26
Q

What are m/c causes of chloracne?

A

2/2 toxic chemicals and is a cutaneous sign of systemic exposure (chlorinated aromatic hydrocarbons)

2/2 2,3,7,9 tetrachlorodibenzo-p-dioxin (2,3,7,8 TCDD), agent orange, dioxin poisoning (Ukrainian president)

27
Q

Clinical of chloracne?

A

Open comedones more than closed + concentration over malar crescent and behind ears, axilla, scrotum, penis

  • Occurs w/I 2mo of exposure, lasts for years
  • Fades slowly after exposure but severe dz persist for years

Acne 2/2 Halogens

Iodides, bromides, other halogens (iododerma more severe)

28
Q

Treatment for chloracne?

A

avoidance of cause, isotretinoin, topical retinoids

29
Q

What is vibration white finger?

A

Operators of chainsaws, pneumatic tools, hand grinders who work in cold

½ workers can be affected

Pathogenesis

Vibration between 30-300Hz a/w this

Increased activity of the sympathetic nervous system

Smoking contributes

Symptoms

Onset w/I 3 mo to 2.5 years

White patch of skin in response to cold-induced vasospasm (well demarcated)

Decreased sensation 2/2 touch receptors loos of blood supply

Improves with rewarming

Attacks not triggered by the tool

Thumbs usually spared

Grading

Stage 1: fingertips

Stage 2: partial digit

Stage 3: whole digit

Stage 4 trophic changes and ulceration

30
Q

Common infections seen in healthcare workers?

A

herpetic whitlow, scabies, syphilis, AIDS

31
Q

Common infections are seen in farmer/abattoir worker/veterinarian?

A

Orf, Milker’s nodule, brucellosis (parapoxvirus, brucella suis; b abortus; B. melitensis)

32
Q

Common infection seen in farmers, wool sorter, dock worker, butcher?

A

Anthrax (bacillus anthracis) common in cattle, sheep, goats, horses, buffalo, camels

33
Q

Common infection in Fisherman, tropical fish worker, fish market worker?

A

Mycobacterium marinum

34
Q

Common infections in Butcher, abattoir worker, meat and fish packers?

A

Butcher’s warts: HPV 7

impetigo (Staph aureus)

Erysipelas (GAS)

35
Q

Most common infections in a Fisherman, abattoir worker, farmer, butcher, cook, veterinarian?

A

erysipeloid (erysipelothrix rhusiopathiae) in shellfish, fish, birds and mammels (esp pigs).

36
Q

If a fisherman gets cellulitis what must you be worried about potentially?

A

vibrio vulnificus

37
Q

What infections could a farmer and veterinarian get?

A

microsporum canis (from cats, dogs)

M. nanum (pigs)

Trichophyton mentagrophytes (small mammels)

T. Verrucosum (Cattle)

T. Gallinae (chickens)

DERM (02) Eczematous Disease (6 decks)

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