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| Block 5: Occupational Sin Disease Cases |
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| Block 5: Occupational Sin Disease Cases |
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Please work on the cases and write down your answers so that you can discuss them at the tutorial session and/or remotely as an interblock exercise.
A chicken abattoir worker involved in packing of carcasses presents with vesicles of the hands and feet of 4 months duration. He has only shown a partial response to topical steroids.
From the vesicles on the in-step of the foot Trichophyton metagrophytes was cultured.
A pharmaceutical company worker who collects and boxes analgesic powder, complains of itchy red patches that come and go, despite his cap, mask and cotton overalls.
Discuss the differential diagnosis for the presentation as described in the history.
On examination a patient had mild facial acne and chronic urticaria.
A zinc metal sprayer complains of itchy red papules of the lower leg of 6 months duration. There is a definite relationship to work, with lesions clearing over the Christmas period. The patient uses a variety of personal protective equipment items including boots, hoods, gloves, earplugs and overalls.
Discuss the differential diagnosis for this patient’s presentation.
The picture shown here is representative of the lesions found on the patient.
On examination that patient was found to have folliculitis of the lower legs and buttock. Staphylococcus aureus was grown from a pus swap taken from one of the lesions. Patch tests were negative.
A council worker responsible for waste water treatment presented with intermittent itchy vesicles and scaling of the hands of 2 years duration. He used gloves at work and had a partial response to topical steroids.
His clinical presentation was that of acute weeping eczema.
The patient was considered to have acute on chronic dermatitis and patch tests showed a 2+ reaction to potassium dichromate and a 1+ reaction to caine mix.
The patient returns at follow up with a sludge chromate level from the Municipality showing that chromate is within acceptable limits.
Mrs SS is a machinist in an underwear factory. She presented with red, scaly, itchy, fissured hands and itchy vesicles, redness and scale, of recent onset, of the body and limbs. Her hand problem had gradually worsened and become persistent. The body and limbs had only recently been involved. She had a partial response to topical steroids.
On examination she had classic contact dermatitis of the hands with an eczematous generalised eruption compatible with autoeczematisation. Patch tests revealed a 2+ reaction to nickel sulphate and to mercapto mix.
(See the accompanying slide, which is an example of rubber allergy)
A spray-painter presents with red, scaly, itchy, fissured hands and forearms. He has always used respiratory protection but it was only recently that skin protection was introduced. There has been only a partial response to topical steroids.
On examination he had classic acute on chronic contact dermatitis of the forearms and hands. Patch testing revealed 2+ positive reactions to epoxy resin and turpentine peroxide.
A seafood processor presented with itchy, red vesicular patches of the hands of 4 months duration. She had been using gloves and had only a partial response to topical steroids and removal from the workplace.
These hands are representative of those of the patient’s.
Clinically the patient had contact dermatitis. RAST tests to cod fish, tuna, shrimp and seafood mix, were negative. She had a 1+ positive patch test to prawns.
This patient suffered significant scarring following a major burn. Symptoms related to the scars were limitations of movement and most particularly itching.
A nursing sister presents with dry, itchy, red, scaly and fissured fingers of several years’ duration. The first three fingers of the right hand are especially involved.
