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Digunakan untuk kelainan pada kulit akibat eksposur
terhadap iritan di lingkungan kerja Efek dapat berupa kemerahan saja sampai pada
gatal, kulit melepuh, terbakar dan tumor Kulit merupakan p organ g terbesar dari tubuh, dengan g
fungsi: daya tahan pertama thd iritan, bakteri, fungi, dll. menerima sensasi panas, dingin, tekstur, dll. mengatur temperatur tubuh: menguapkan gas, uap, sekresi minyak, asam pelindung, membuat pigmen thd matahari luasnya: 2 m2, tebal dari 0,5mm sampai 3-4 mm
Zat kimia Tenaga mekanis Zat fisis Racun tumbuhan Zat biologis
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Dari golongan zat kimia organik dan anorganik
Kontak langsung dengan kulit
Zat organik kebanyakan merupakan sensitizers
Oral
Zat anorganik kebanyakan merupakan primary iritan
immersing hands (sometimes legs) into chemicals
direct handling of contaminated workpieces
contact with contaminated surfaces (eg workbench, tools, clothing and containers)
in deposits in the air (eg cement dust)
splashing (eg when liquid or powdery chemicals are mixed or handled
Menyebabkan dermatitis karena kontak langsung
Iritan primer Penyumbat pori
‘dermatitis kontak’ 80% dari kasus di industri Contoh: HNO3, H2SO4, NaOH: cepat membakar kulit Deterjen, Deterjen sabun kuat kuat, pelarut ‘sedang’: sedang : iritasi ringan ringan,
eksposur berulang iritasi berat
karet, plastik, lem, resin (terutama epoxy resin),
pelumas: melekat pada kulit menyebabkan iritasi primer atau sensitisasi selain melekat, mengeras pada kulit kulit jadi peka terhadap iritan/radang
Sensitiser
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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 seperti
alergi timbul setelah beberapa kali eksposur reaksi delayed dan multiple Disebut ‘dermatitis sensitisasi’ Sekali orang tersensitisasi eksposur sedikit juga sudah menyebabkan efek parah dan kelainan dapat menjalar ke seluruh tubuh orang tidak dapat bekerja di tempat yang sama Contoh: epoxy resin hardener, pewarna azo, derivat coal tar, pollen, antibiotik, dll. Zat kimia yang menstimulir sel kulit tumbuh berlebih: epitelioma, papilioma, polip, dan kanker coal tar dan minyak mentah
Friksi, tekanan kulit melepuh Sumbatan oleh glass wool dan rockwool Iritasi atau alergi gatal-gatal, terluka, melepuh
Skin Sensitizer
Kanker Iritasi
Melepuh Suhu ekstrim Sinar matahari, UV, IM, sinar-X, dll. Efek yang timbul: iritasi/sensitisasi, perubahan warna,
gatal, pedih, luka bakar, melepuh, dan kanker
Kulit mengeras
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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.
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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
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
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 g p 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.
Keratogenik, neoplastik sel kulit tumbuh berlebih kanker As, tar, naftilamin, dll.
Agent biologis mikroba, parasit infeksi Alergi, protein anafilaktik 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
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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 yp y ( g ) 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.
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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) 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 b off chemicals h i l usedd att workk can cause ddepigmentaion i t i
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 radiation may be susceptible to work related cancers. 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, temperatur
ekstrim tinggi, lama kontak dengan kulit Klasifikasi luka bakar: tingkat I (first degree burn): merah merah, panas 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 dan karingan bawah kulit habis terbakar
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2
1
3
Burn degree
AGENT/IRITANT
1'R Y IRR ITA NT
S E N SI TI Z E R
MANIFESTATIONS OF IRRITATING ACTION ON THE SKIN
agriculture/horticulture; catering and food processing; chemicals; cleaning; construction; engineering; i i hairdressing/beauty care; health care; offshore; printing; rubber.
TYPICAL OCCUPATION AGENT/IRITANT
1'RY IRR ITA NT
SE N SI TI ZE R
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
Ulcers ('chrome holes') on skin, inflammation and perforation of nasal septum
platers, manufacturing chemicals and dyestuff
X
ALKALIS
sodium hydroxide
X
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
Mercury compounds
X
Zinc chloride
X
X
X
Acetone
X
Benzene and its homologues (toluene and xylene)
X
Terpentine
X
Dry (defatted) skin
Spray painters, celluloid industry, artificial silk and leather workers, acetylene workers, lacquer and varnish makers, electrical equipment manufacturing
Dry (defatted) skin
Chemical, rubber, and artificial letaher manufacturing, dry cleaning
X
Red or blistered skin, eczema
Painters, furniture polisher, lacquuerers
X
Blisterlike eruptions
Dye manufaturing
X
Blisterlike eruptions
Dye manufaturing
X
Red skin and eczeme eruptions
Dye manufaturing
SOME DYES INTERMEDIATES Chlorinated compounds Dinitrochlorobenzene
Sodium hydroxide makers, bleacher, soap and dye makers, petroleum refiners,mercerizers, tannery worker
Severe burning of kin, deep-seated persistent ulcers, loss of fingernails
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)
TYPICAL OCCUPATION
SOLVENTS
ACIDS acetic
MANIFESTATIONS OF IRRITATING ACTION ON THE SKIN
X
Nitro and nitroso compound
ACNE PRODUCERS Petroleum oil
X
Tar (coal)
X
X
Inflammation of hair follicle, acne, skin ulcers, boils, malignant tumor
Petroleum workers, machinists, mechanics
Acne, eczema, and malignant tumors
Tar manufacturing, roofing paper, felt, and pitch, road building and repairing
DYES Artificaial leather makers, carroter (felt hats), manufaturing insecticides, glass industry and vermicides, manufacturing artificial flowers, calico printing
Including chemicals handled in sye manufacturing
Corrosion and irrtation of skin, 'mercurial eczema'
Explosive manufacturing, silver and gold extractors, manufactoring electrical appliances and scientific equipment, hat making
Metal dichromated, amicdol, quinone, para aminophenol, etc.
Ulcers of skin and nasal septum
Manufaturing chemical and dyestuffs
X
Red skin, blisterlike eruptions
Dye worker
PHOTO DEVELOPERS X
Red skin, blisterlike eruptions
Photo developers
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AGENT/IRITANT
1'R Y IRR ITA NT
S E N SI TI Z E R
MANIFESTATIONS OF IRRITATING ACTION ON THE SKIN
TYPICAL OCCUPATION
CEGAH KONTAK
RUBBER ACCELATORS AND ANTI OXIDANTS Hexamethylenetetra-mine, para phenylenediamine, pada nitrosodimethylaniline, and phenyl naphthylamine (B)
X
Itchy skin, dermatitis - usually called'rubber itch'
containing an excess of free alkalis
X
Eczema, blisterlike eruptions, chronic ancesses
Rubber workers, such as compound mixers and calender and mill operators
SOAP AND SOAP POWDER Soap manufacturing, dishwashers, scrubwomen, 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
X
Acute dermatitis, 'shagreen skin', acne, inflammation around hair follicle, ephiteliomaous cancer, eczema, ulcers
RESINS Coal tar products such as pitch and asphalt
X
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
Kontrol Teknik Merencanakan proses industri yang sedapat mungkin menghindari/mengurangi kontak langsung pekerja dengan bahan-bahan yang digunakan. Pendidikan Para pekerja harus diberi informasi tentang bahanbahan yyangg berbahaya y bagi g kulit,, yyang g sering g digunakan dan bagi mereka harus ditanamkan pengertian untuk menghindari kontak langsung dengan bahan-bahan tersebut.
Higiene Menjaga kebersihan tubuh merupakan salah satu pencegahan terbaik untuk mengurangi kerusakan pada kulit dan sebaliknya jika bekerja memakai pakaian kerja
Klinik dan tempat perawatan Deteksi dini: pemeriksaan periodik, lapor diri Supervisi: perawatan oleh perawat Pekerja yang mengalami kerusakan pada kulitnya harus segera dikirim ke klinik untuk mendapatkan pertolongan segera dikirim ke klinik untuk mendapatkan pertolongan, sehingga mencegah kerusakan yang lebih parah.
Isolasi‐substitusi bahan/proses APD
Ada beberapa cara pencegahan yang dapat dilakukan, yaitu: • Kontrol teknik • Pendidikan • Tes penempatan kerja • Klinik dan tempat perawatan
Alat perlindungan Seperti: - sarung tangan karet - penutup muka - sepatu boot - cream pelindung - kaca mata - sabun basa Tujuannya untuk mengurangi kontak langsung antara bahan dengan kulit. Test penerapan pekerja Test ini bertujuan untuk mengetahui kondisi kulit pekerja sehingga dapat disesuaikan dengan lingkungan kerja yang akan dihadapinya. Pemeriksaan sebelum kerja riwayat alergi Faktor penentu: warna kulit, kesehatan, kulit bermunyak.kering, banyak berkeringat, jenis kelamin, diet
Sarung tangan Baju, sepatu Kebersihan APD Cream pelindung terhadap iritan berbasis sabun, larut air repellent pelarut, dasar oli/gum seperti memberi sarung tangan t yang tidak tid k tampak. t k Efektif Ef ktif terhadap t h d pelarut, mempermudah menghilangkan cat, dll. repellent air, lanolin, petroleun jelly, ethyl cellulose atau silicone yang memberi selaput yang tahan air tipe khusus: campuran zat khusus misalnya terhadap fotosensitizers sun-exposure, poison ivy, insekta, dll.
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Efek: Kekurangan cairan dehidrasi, shock,
sakit sekali/pingsan Infeksi P3K P3K:Bilas Bil d dengan air: i 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 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.
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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 Sh Sheets. SDS must be provided by the supplier of the chemical. SDS b id d b h li f h h i l 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 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.
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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
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