Digunakan untuk kelainan pada kulit akibat eksposurterhadap iritan di lingkungan kerja

Efek dapat berupa kemerahan saja sampai padagatal, kulit melepuh, terbakar dan tumor

Kulit merupakan organ terbesar dari tubuh, denganfungsi:

daya tahan pertama thd iritan, bakteri, fungi, dll.

menerima sensasi panas, dingin, tekstur, dll.

mengatur temperatur tubuh: menguapkan gas, uap, sekresi minyak, asam pelindung, membuatpigmen thd matahari

luasnya: 2 m2, tebal dari 0,5mm sampai 3-4 mm

Zat kimia

Tenaga mekanis

Zat fisis

Racun tumbuhan

Zat biologis

Dari golongan zat kimia organik dan anorganik

Zat organik kebanyakan merupakan sensitizers

Zat anorganik kebanyakan merupakan primary iritan

Kontak langsung dengan kulit

Oral

immersing hands (sometimes legs)

into chemicals

direct handling of contaminated workpieces

splashing (eg when liquid or powdery

chemicals are mixed or handled

contact with contaminated surfaces (eg

workbench, tools, clothing and containers)

in deposits in the air (eg cement dust)

Iritan primer

Penyumbat pori

Sensitiser

Menyebabkan dermatitis karena kontak langsung ‘dermatitis kontak’

80% dari kasus di industri

Contoh: HNO3, H2SO4, NaOH: cepat membakar kulit Deterjen, sabun kuat, pelarut ‘sedang’: iritasi ringan,

eksposur berulang iritasi berat karet, plastik, lem, resin (terutama epoxy resin),

pelumas: melekat pada kulit menyebabkan iritasiprimer atau sensitisasi selain melekat, mengeraspada kulit kulit jadi peka terhadap iritan/radang

Berupa minyak, wax black heads/acne yang disebut

dermatitis kulit

Sering terbawa pakaian kerja dan terbawa ke rumah

dapat mengena keluarga pekerja

Zat kimia yang menyebabkan kelainan kulit sepertialergi timbul setelah beberapa kali eksposur reaksidelayed dan multiple

Disebut ‘dermatitis sensitisasi’

Sekali orang tersensitisasi eksposur sedikit jugasudah menyebabkan efek parah dan kelainan dapatmenjalar ke seluruh tubuh orang tidak dapatbekerja di tempat yang sama

Contoh: epoxy resin hardener, pewarna azo, derivatcoal tar, pollen, antibiotik, dll.

Zat kimia yang menstimulir sel kulit tumbuh berlebih: epitelioma, papilioma, polip, dan kanker coal tar dan minyak mentah

Iritasi

Skin Sensitizer

Kanker

Friksi, tekanan kulit melepuh

Sumbatan oleh glass wool dan rockwool

Iritasi atau alergi gatal-gatal, terluka, melepuh

Melepuh

Kulit mengeras

Suhu ekstrim

Sinar matahari, UV, IM, sinar-X, dll.

Efek yang timbul: iritasi/sensitisasi, perubahan warna,

gatal, pedih, luka bakar, melepuh, dan kanker

Tanaman beracun:

poison ivy alergi

Bunga beracun

Efek: kulit memerah dan

gatal

Bakteri, jamur, parasit dan tungau

Didapat di daerah pertanian, bakery,

sayur, dan buah-buahan

BEDAKAN DERMATITIS INDUSTRIAL

DENGAN BUKAN INDUSTRIAL SEPERTI

AKIBAT KOSMETIKA, OBAT,

INSEKTISIDA, DLL.

Deterjen dan pelarut keratin

Desikator, zat higroskopis, anhidrida

Protein precipitants

Hidrolitik, elektrolitik

Pengoksidasi

Derivatif nitro yang toksik

Keratogenik, neoplastik

Agent biologis

Alergi, protein anafilaktik

Pereduksi

Deterjen dan pelarut keratin

minyak alami kulit dan sel kulit larut kulit menjadi kering dan

mudah terinfeksi

contoh: alkali, terpentin, alkohol, dan sabun

Desikator, zat higroskopis, anhidrida

menyerap air dari kulit kulit kering dan panas

contoh: SO2=, PO4=, H2SO4, dll.

Protein precipitants

menyebabkan koagulasi protein, kulit mengeras

contoh: garam logam berat, HgCl, asam tanat, asam pikrik, fenol, UV,

formaldehid, dll.

Hidrolitik, elektrolitik

bereaksi dengan air di kulit, terjadi iritasi, panas keluar

selama reaksi berlangsung

contoh: gas mustard, NH4NO3

Pengoksidasi

bereaksi dengan hidrogen O terbebas oksidasi

contoh: FeCl2, H2O2, As, chromat, permanganat, ozon, dan

amonia

Derivatif nitro yang toksik melarutkan kulit

contoh: TNT, DNT, fenol, kresol, tetryl, asam pikrat

Keratogenik, neoplastik

sel kulit tumbuh berlebih kanker As, tar, naftilamin, dll.

Agent biologis

mikroba, parasit infeksi

Alergi, protein anafilaktik

reaksi antigen-antibodi dengan membentuk histamin alergi contoh: tepung, pollen, dll.

Pereduksi

membentuk hidrogen bebas reduksi contoh: asam salisilat, asam oksalat, hidrokarbon alifatik, fenol, naftol,

hidrokarbon-aromatik

sub-acute dermatitis from the rubber

accelerator, mercaptoben zothiazole

contact dermatitis form exposure to the

strong irritant, ethylene oxide

The skin contact with an irritant results in itchy rash within minutes to an hour.

They disappear within twenty-four hours, usually within a few hours.

Contact urticaria is also known as nettle rash or hives. It is typified by the wheal (swellings) and flare at the site of contact.

The affected person may suffer from itching, tingling or burning sensations.

There are other types of urticaria. This includes immune sensitised reaction and happens in people who have previously become sensitised to a causative agent (eg latex protein in rubber gloves). This type of reaction is also called ACD.

Acne is an inflammatory disorder of the sebaceous glands. The skin eruptions from acne may be mild, involving exposed areas of the body, or severe covering of all the body.

Occupational acne includes oil acne, coal-tar acne, and chloracne.

Others types are related to cosmetics, heat/cold and mechanical forces.

The incidence of oil acne has declined in recent years because of decreased use of neat cutting oils. Better performing oils and improved health and safety standards in the workplace helped this decline further.

The eruptions resulting from oil acne are called oil boils. When the exposure is prolonged, skin cancer, such as cancer of the scrotum, may develop.

Oil acne amongst oil workers is rare because there are fewer opportunities for prolonged contact with crude oil or the heavier oil fractions.

Chloracne results from exposure to certain halogenated aromatic hydrocarbons (eg polychlorinated biphenyles (PCBc)).

Individual lesions of chloracne consist primarily of blackheads, whiteheads and cysts.

Choracne occurs mainly on exposed areas of the skin, but following regular exposure, lesions may appear in other regions especially the genital, groin and axillae areas of the body.

Chloracne usually begins several weeks or months after the exposure and new lesions may appear even when exposure stops, because there may still be traces of the contaminants in the follicular areas of the skin.

Coal-tar acne is associated with coal tar-based products and may

be aggravated by light/UV.

Skin and eyes are vulnerable and it will cause increased

pigmentation as well as acne-related symptoms (eg skin eruptions, blackheads).

Skin pigmentation disorders cause the skin to appear lighter or darker than normal.

Pigmentary disorders can be due to hazardous agents found in the workplace (eg: UV, X-rays), environment (eg Sun rays) or ones genetic makeup or reaction to medicines and food.

A number of chemicals used at work can cause depigmentaion

Hyperpigmentation by kerosene

Exposure to radiation can lead to skin cancer, most commonly this comes from exposure to the sun. Therefore outside workers are particularly at risk.

People who are exposed ionising and non-ionising radiationmay be susceptible to work related cancers.

Some chemicals can cause cancer on the skin, others may contribute to cancers found in other parts of the body.

The use of unrefined mineral oils has in the past led to skin cancer affecting the exposed skin of the hands and forearms.

Oil-soaked clothing and oily rags kept in overalls caused

scrotal cancer.

The use of refined oils together with changes in work

practice and improved personal hygiene have reduced this

risk.

Chemicals like Mobca is used in the manufacture of

polyurethane products. It can get through the skin and may

cause cancer in other parts of the body.

Penyebab

zat kimia, konsentrasi pekat, temperaturekstrim tinggi, lama kontak dengan kulit

Klasifikasi luka bakar:

tingkat I (first degree burn): merah, panas, gatal, sakit, rasa terbakar

tingkat II (second degree burn): sangat sakit, melepuh, merah, basah (terbakar lebih dalam) mudah kena infeksi

tingkat III (third degree burn): kulit dankaringan bawah kulit habis terbakar

Burn degree

1

2

3

agriculture/horticulture;

catering and food processing;

chemicals;

cleaning;

construction;

engineering;

hairdressing/beauty care;

health care;

offshore;

printing;

rubber.

AGENT/IRITANT

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MANIFESTATIONS OF IRRITATING

ACTION ON THE SKIN TYPICAL OCCUPATION

ACIDS

acetic X Dermatitis & ulcers

manufacturing acetat rayon, printing, dying,

hat makers

nitric X Severe skin burn & ulcers

nitric acid worker, ekectroplaters, metal

refineries, acid dippers, nitrators, soda

makers

sulfuric X

corrosive action on skin, severe inflammation

of mucous membranes

Nitrator, pickers (metal), acid dippers,

chemical manufacturing

chromic X X

Ulcers ('chrome holes') on skin, inflammation

and perforation of nasal septum

platers, manufacturing chemicals and

dyestuff

ALKALIS

sodium hydroxide X

Severe burning of kin, deep-seated persistent

ulcers, loss of fingernails

Sodium hydroxide makers, bleacher, soap

and dye makers, petroleum

refiners,mercerizers, tannery worker

sodium silicate X Thickening of skin, ulcers on fingers bleacher, manufacturing cardboard boxes

sodium or potassium cyanide X Blisters, ulcers

Electroplaters, case hardening, extraction

of gold

SALTS OR ELEMENTS

Arsenic & its compounds X X

Darkening of skin, perforation of nasal

septum, ephitelioma, formation of hornt

growth of tissue on palm, ezcema around

mounth and nose (possible loss of nails and

hair)

Artificaial leather makers, carroter (felt

hats), manufaturing insecticides, glass

industry and vermicides, manufacturing

artificial flowers, calico printing

Mercury compounds X X

Corrosion and irrtation of skin, 'mercurial

eczema'

Explosive manufacturing, silver and gold

extractors, manufactoring electrical

appliances and scientific equipment, hat

making

Zinc chloride X Ulcers of skin and nasal septum Manufaturing chemical and dyestuffs

AGENT/IRITANT

1'RY IRRITANT

SENSITIZER

MANIFESTATIONS OF IRRITATING ACTION ON THE SKIN

TYPICAL OCCUPATION

SOLVENTS

Acetone X Dry (defatted) skin

Spray painters, celluloid industry, artificial silk and leather workers, acetylene workers, lacquer and varnish makers, electrical equipment manufacturing

Benzene and its homologues (toluene and xylene) X Dry (defatted) skin

Chemical, rubber, and artificial letaher manufacturing, dry cleaning

Terpentine X X Red or blistered skin, eczema Painters, furniture polisher, lacquuerers

SOME DYES INTERMEDIATES

Chlorinated compounds X Blisterlike eruptions Dye manufaturing

Dinitrochlorobenzene X X Blisterlike eruptions Dye manufaturing

Nitro and nitroso compound X Red skin and eczeme eruptions Dye manufaturing

ACNE PRODUCERS

Petroleum oil XInflammation of hair follicle, acne, skin ulcers, boils, malignant tumor Petroleum workers, machinists, mechanics

Tar (coal) X X Acne, eczema, and malignant tumorsTar manufacturing, roofing paper, felt, and pitch, road building and repairing

DYES

Including chemicals handled in sye manufacturing X Red skin, blisterlike eruptions Dye worker

PHOTO DEVELOPERS

Metal dichromated, amicdol, quinone, para aminophenol, etc. X Red skin, blisterlike eruptions Photo developers

AGENT/IRITANT

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MANIFESTATIONS OF IRRITATING

ACTION ON THE SKIN TYPICAL OCCUPATION

RUBBER ACCELATORS AND ANTI OXIDANTS

Hexamethylenetetra-mine, para

phenylenediamine, pada

nitrosodimethylaniline, and phenyl

naphthylamine (B) X

Itchy skin, dermatitis - usually called'rubber

itch'

Rubber workers, such as compound mixers

and calender and mill operators

SOAP AND SOAP POWDER

containing an excess of free alkalis X

Eczema, blisterlike eruptions, chronic

ancesses

Soap manufacturing, dishwashers, scrub-

women, soda fountain clerks

INSECTICIDES

Arsenic X Red skin, blisters Manufacturing and appling insencticides

OILS

Cashew nut oil X Severe dermatitis as blisters Handlers of unprocessed cashew nuts

Cutting oils-oil emulsion or soluble

oil mixtures X Oil acne, inflammation of hair follicle Machinists

RESINS

Coal tar products such as pitch and

asphalt X X

Acute dermatitis, 'shagreen skin', acne,

inflammation around hair follicle,

ephiteliomaous cancer, eczema, ulcers

Manufacturing various coal tar products,

road making, gas manufacturers

EXPLOSIVE

Chlorates, nitrates, mercury

fulminate, tetryl, lead styphnate,

TNT, amatol, DNT, dinitrophenil,

etc. X Red skin, papular eruptions, severe irritations Explosive manufacturing, shell loading

CEGAH KONTAK

Pemeriksaan sebelum kerja riwayat alergi

Faktor penentu: warna kulit, kesehatan, kulitbermunyak.kering, banyak berkeringat, jeniskelamin, diet

Higiene memelihara kebersihan: sabun

Deteksi dini: pemeriksaan periodik, lapor diri

Supervisi: perawatan oleh perawat

Isolasi-substitusi bahan/proses: LEV, GV

APD

Sarung tangan

Baju, sepatu

Kebersihan APD

Cream pelindung terhadap iritan berbasis sabun, larut air repellent pelarut, dasar oli/gum seperti memberi

sarung tangan yang tidak tampak. Efektif terhadappelarut, mempermudah menghilangkan cat, dll.

repellent air, lanolin, petroleun jelly, ethyl cellulose atau silicone yang memberi selaput yang tahan air

tipe khusus: campuran zat khusus misalnyaterhadap fotosensitizers sun-exposure, poison ivy, insekta, dll.

Efek: Kekurangan cairan dehidrasi, shock,

sakit sekali/pingsan Infeksi

P3K:Bilas dengan air: mata fountain, badan shower Tutup/lindungi luka Bila shock infus Bila ada hazardous information sheet

siapkan antidotum, beri antidotum

Flush area immediately with large quantities of fresh water, using an installed deluge shower or hose, if available. Avoid excessive water pressure. Continue to flush the area for at least 15 minutes while removing the clothes, including shoes, socks, and jewelry. Dry lime powder (alkali burns) creates a corrosive substance when mixed with water; keep the powder dry and remove it by brushing it from the skin. Acid burns caused by phenol (carbolic acid), should be washed with alcohol. Then wash the area with large quantities of water. If alcohol is not available, flush the area with large quantities of water. Cover chemical burns with a sterile dressing.

Material Safety Data Sheet (MSDS) for the chemical.

Flush the eyes with fresh water immediately using an installed emergency eye/face bath or hose on low pressure for at least 20 minutes. Ask casualty to remove contact lenses. Use your hands to keep the eyelids open. Never use a neutralizing agent, mineral oil, or other material in the eyes.

Monitor the airway, breathing, and circulation (ABCs).

Warning - Do not attempt to neutralize any chemical unless you are sure what it is and what substance will effectively neutralize it. Further damage may be done by a neutralizing agent that is too strong or incorrect. Do not apply creams or other materials to chemical burns.

Treat for shock - Keep the casualty comfortable and warm enough to maintain normal body temperature.

Request medical assistance for all chemical burns. If possible, before transport, notify medical personnel of the name and other pertinent information about the chemical involved, location of the burn, and percentage of the body area affected. Send the container to medical personnel with the casualty.

For every task undertaken at your workplace, know what products or substances are being used or generated.

Find out what are the health and safety hazards associated with each of the substance or product used or generated. Find out whether these substances carry warnings signs and hazard information on dangers to the skin. You can find these on product labels and/or in Safety Data Sheets. SDS must be provided by the supplier of the chemical.

Frequent contact with water (wet working) is a major cause of WRD. Some substances (eg: formaldehyde in metal working fluids) may be generated during work and can cause WRD. Take account of wet work and substances generated during work in the next step.

Find out which of your employees are exposed to these substances, how does their skin come into contact, for how long and the frequency.

Find out what control measure you have in place. Based on these make a judgement whether your employees

are at risk of getting work related dermatitis. If there is a risk of WRD, can you get rid of the chemical

altogether? This is the best and simplest solution. If you cannot get rid of the offending chemical, can you able

to replace it with a less harmful chemical. Seek the advice of your Trade Association.

Introduce process controls so that skin does not come into

contact with the chemical. If the contact is by immersion, or

splash find a solution that would provide a safe working

distance (SWD) between the chemical and the skin.

If the exposure is due to dust, vapour in the air, install a ventilated enclosure or provide local exhaust ventilation. Consult “COSHH Essentials”. It is likely to provide a suitable engineering control for your task.

If you have provided all the above controls and you consider that skin exposure could not be prevented altogether, then provide chemical protective gloves and coverall as appropriate. Selection of gloves is a complicated process. Always seek the help of your chemical supplier or a reputable PPE supplier.

Make sure employees: have been taught on safe working practices; use the controls provided; have been trained to correctly use process equipment and PPE; know how to check their skin for signs of dermatitis; understand the benefits and limitations of skin care creams.

Provide mild skin cleaning cream that will do the job and washing facilities with hot and cold water.

Tell employees to clean their hands before consuming drinks and food or before wearing gloves.

Ensure pre and post work creams are used.

Seek the help of occupational health professionals if you suspect that you may have dermatitis problem at your workplace.

Put in place a management system that checks that all of these actions are carried out in practice.

You should take particular care if you have: fair or freckled skin that doesn’t tan, or goes red or

burns before it tans; red or fair hair and light coloured eyes; a large number of moles.

In the short term, even mild reddening of the skin from sun exposure is a sign of damage. Sunburn can blister the skin and make it peel.

Longer term problems can arise. Too much sun speeds up ageing of the skin, making it leathery, mottled and wrinkled. The most serious effect is an increased chance of developing skin cancer.

Keep your top on. Wear a hat with a brim or a flap that covers the ears and the

back of the neck. Stay in the shade whenever possible, during your breaks

and especially at lunch time. Use a high factor sunscreen of at least SPF15 on any

exposed skin. Drink plenty of water to avoid dehydration. Check your skin regularly for any unusual moles or spots.

See a doctor promptly if you find anything that is changing in shape, size or colour, itching or bleeding.

SELAMAT UTS