| disease | Industrial Skin Disease |
In the process of industrial labor production, damage caused by certain harmful factors acting on the skin, mucous membranes, or appendages is called industrial skin disease or industrial dermatitis.
bubble_chart Etiology
Disease cause: It is relatively complex. Common causes can be divided into three major categories:
(1) Chemical factors are the primary cause of occupational skin diseases, accounting for approximately 95% of cases. Various organic acids, alkalis, inorganic acids, alkalis, heavy metals and their salts, organic solvents, etc., can trigger reactions. Common examples include: (1) Dyes and their intermediates. (2) Developers. (3) Rubber and anti-aging agents. (4) Natural and synthetic resins. (5) Pesticides. (6) Medications. (7) Certain plants. (8) Metals and their salts. These substances can induce allergic reactions or act as primary irritants leading to the onset of the disease.
(2) Physical factors include mechanical friction and pressure, effects of temperature and humidity, as well as exposure to sunlight, ultraviolet rays, and radiation.
(3) Biological factors involve certain plants such as Mongolian snakegourd root, sap, fruits, insect toxins and bites, animal feathers, and certain pathogens, all of which can contribute to the disease.
In addition to the above factors, the onset of the disease is closely related to the patient’s age, gender, individual constitution, hygiene habits and physiological state, protective measures, and seasonal influences.
bubble_chart Clinical Manifestations
Due to differences in the cause of the disease, the nature and concentration of the contact substance, duration and method of contact, as well as individual reactivity, the clinical symptoms can vary significantly. Common types of damage include:
(2) **Acne Folliculitis Type**: Symptoms are similar to common acne, but the rash appears in different areas. Besides the face, it can occur on the back of the hands, forearms, chest wall, buttocks, and other friction-prone areas. It is more common in young workers and those with a seborrheic constitution. Workers frequently exposed to coal tar, asphalt, paraffin, diesel, or machine oil are prone to this condition. These oils can cause hyperkeratosis of the follicular openings, leading to obstructed sebum excretion and subsequent lesions. Cases caused by oils are also called "oil acne."
(3) **Skin and Mucous Membrane Ulcer Type**: Caused by exposure to highly concentrated, strongly corrosive chemicals, such as strong acids, strong alkalis, or certain metal salts. Strong acids dehydrate tissues, causing coagulative necrosis of the skin or mucous membranes, while strong alkalis dissolve tissue proteins, leading to ulcers. For example, sodium fluoride, hydrofluoric acid, and potassium dichromate may not cause immediate pain upon contact, making them easy to overlook. However, within hours, they can form small, round or oval ulcers with neat, raised edges, covered by dry gray scabs—these are referred to as "bird's-eye ulcers." Long-term inhalation of chromic acid vapors can cause perforation of the nasal septum.
(4) **Skin Pigmentation Changes**: Long-term exposure (including vapor inhalation) to coal tar and petroleum hydrocarbons can cause skin melanosis. Frequent contact with photosensitive substances like asphalt and tar on exposed areas such as the face, neck, and back of the hands can lead to photosensitive dermatitis, often leaving post-inflammatory hyperpigmentation. Conversely, long-term exposure to rubber antioxidants, hydroquinone monobenzyl ether, or hydroquinone can cause skin hypopigmentation.
(6) **Hand Skin Dryness and Rhagades**: Long-term exposure to dust, gasoline, kerosene, toluene, or alkaline substances can dehydrate and dry the skin. Persistent mechanical irritation can cause roughness, thickening, hardening, or rhagades on the palms.
(7) **Hair and Nail Changes**: Long-term exposure to thallium, arsenic, or radiation can cause hair loss. Chronic contact with calcium oxide, weak alkalis, or mineral oils may lead to flattened or spoon-shaped nails. Frequent exposure to bleaching powder can make nails brittle, thin, and discolored.
(8) **Infections and Insect Bites**: Untreated skin injuries can lead to secondary bacterial infections. Exposure to certain chemicals like cyanides, bromides, or aniline can cause pustular eruptions. Other conditions, such as erysipeloid, glanders, or milker's nodules, are seen in workers of specific occupations. Mite bites can cause grain itch.
(9) **Cutaneous Pruritus**: Exposure to fiberglass, enamel powder, copper dust, or certain chemical dusts can cause cutaneous pruritus.
(10) **Others**: Contact with certain antibiotics or phenylenediamine can cause urticaria. Prolonged immersion in water can lead to maceration and erosive dermatitis.
**Occupational Stigmata**: Certain distinctive skin changes caused by occupational factors. These changes generally do not affect work capacity or overall health but can sometimes indicate the nature of the work. Examples include calluses from prolonged friction or pressure, telangiectasia from working in high-temperature environments, thinning and softening of nails due to long-term water exposure, skin staining from contact with colored substances, or occupational soiling from dust. Under certain conditions, occupational stigmata may evolve into occupational skin diseases.
Conduct a comprehensive analysis based on the following points:
(1) Occupational history: Inquire about the length of employment, job type, and whether the individual has an allergic constitution. Understand the nature of the contact substances, the mode of contact, and the temporal relationship with the onset of symptoms. Determine whether there were any such skin lesions before starting work and the incidence of similar conditions among coworkers in the same workshop.
(2) Morphology and location of skin lesions: Most skin lesions are nonspecific, but some have distinctive features, such as "bird's-eye ulcers," which can aid in diagnosis.
(3) Patch testing: This is a commonly used examination method to determine whether a patient has an allergic reaction to a specific substance.
(4) On-site investigation: Conduct an in-depth visit to the workshop to understand the production environment, substances contacted, operational methods, implementation of protective measures, and personal hygiene conditions, providing crucial data for diagnosis.
Prevention and Control:
In terms of prevention, focus on the following points:
(1) Improve production equipment and working conditions by mechanizing and sealing the production equipment, which is the most fundamental measure. If these requirements cannot be met temporarily, ventilation and dust-proof facilities in the workshop should be enhanced, and operating procedures must be strictly followed.
(2) Improve the production environment by maintaining workshop cleanliness and hygiene. After work, shower and change clothes, paying attention to personal hygiene.
(3) Strengthen personal protection by wearing work clothes and protective goggles as per operating procedures, and applying protective ointment when necessary.
(4) Enhance publicity and improve health care organizations to continuously raise workers' health knowledge levels and ensure regular health care work.
Treatment: Essentially the same as contact dermatitis. First, identify the disease-causing factors and avoid contact with allergens. Provide symptomatic treatment promptly after onset. Temporarily suspending work when necessary plays a decisive role in treatment. For local treatment, select mild, protective medications based on the principles of topical drug use.
[Efficacy Evaluation]
Epidemiology
