TREATMENT OF OCCUPATIONAL SKIN DISEASES Antti I. Lauerma, M.D., Ph.D. FIOH

Occupational Skin Diseases Allergic contact dermatitis Irritant contact dermatitis Protein contact dermatitis Contact urticaria Skin infections Acne Cancer Pigment changes

CONTACT DERMATITIS Irritant contact dermatitis and allergic contact dermatitis clinically very similar Impossible to distinguish in histology Cell-mediated immune responses Antigen presenting cells more important in allergic contact dermatitis

TOPICAL TREATMENTS Wet dermatitis - wet treatment –dressings –light creams Dry dermatitis - dry treatment –ointments –petrolatum –oils

WET, BUT HEALING SKIN WET OCCLUDED SKIN

DRY SKIN LESS DRY

TOPICAL CORTICOSTEROIDS Classes I, II, III, IV Side-effects and beneficial effects mediated by same glucocorticosteroid receptor Side-effects: –Atrophy –Systemic effects –Tachyphylaxis –Worsening of acne

TOPICAL CORTICOSTEROID USE Class I: Face, flexures, children, aged people Class II: Body, extremities Class III: Lichenified eczema, psoriasis Class IV: Mycosis fungoides. Lupus erythematosus, resistant eczema

TOPICAL CORTICOSTEROID APPLICATION 1-2 times daily for 3-14 days Pauses between treatments to avoid atrophy New scheme: 2 times daily for 2 weeks and 2 times weekly after that. –Prevents relapses

TOPICAL IMMUNOSUPPRESANTS TACROLIMUS PIMECROLIMUS CYCLOSPORINE All act through calcineurin inhibition

TOPICAL CYCLOSPORINE Not effective Does not penetrate skin in sufficient amounts Not effective on molar basis

TOPICAL TACROLIMUS (PROTOPIC) Effective topically Penetrates skin Efficient on molar basis No skin atrophy Effective in atopic dermatitis and allergic contact dermatitis Effect in irritant contact dermatitis???

TOPICAL PIMECROLIMUS (ELIDEL) Less effective than tacrolimus Effective in face, flexures? Use in children Expensive (150 euros/100 grams) - same price as Protopic

ANTIMICROBIALS Used when secondary infection is suspected Cephalexin or other cephalosporins preferred (act on both staphylococci and streptocci) Penicillin for erysipelas Drug resistance rarely a problem in skin diseases - no need for expensive antibiotics

ANTIPRURITIC MEASURES In dermatitis antihistamines are seldom effective!! Best effect is seen with corticosteroids, immunosuppressants and UV therapy Basic creams help in itching caused by dryness

SYSTEMIC THERAPY Corticosteroids Cyclosporine Azathioprine Antihistamines Doxepin Pentoxiphylline Monoclonal antibodies

PHOTOTHERAPY SUP UVB PUVA Narrow-band UVB Grenz rays PDP

CONTACT ALLERGY AND DIET mg nickel may cause flare-up of nickel allergic contact dermatitis in areas of previous dermatitis Cobalt (1 mg) may cause similar effects Clinical importance is low

CONTACT URTICARIA Antihistamines Corticosteroids Tacrolimus? Doxepin? NSAIDs (nonimmunologic contact urticaria) Epinephrin (anaphylaxis)

Other occupational skin diseases Bacterial and fungal infections: Antibiotics Acne: Isotretinoin, tetracyclines Scabies: Ivermectine Melanodermia: Hydrokinone Leukodermia: Cosmetic Skin cancer: Surgical, PDT, cryotherapy