This standard specifies the diagnostic criteria and treatment principles for occupational skin diseases. This standard applies to diseases of the skin and its appendages caused by exposure to harmful factors in occupational activities. Similar skin diseases caused by non-occupational exposure can also refer to this standard. GBZ 18-2002 Occupational Skin Disease Diagnostic Standard (General Principles) GBZ18-2002 Standard Download Decompression Password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ18-2002
Diagnostic Criteria of Occupational Skin Diseases (General Guideline) Issued on April 8, 2002
Ministry of Health of the People's Republic of China
Implementation on June 1, 2002
Article 5.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". In case of any inconsistency between the original standard GB7804-1987 and this standard, this standard shall prevail.
Occupational skin diseases have many pathogenic factors, high incidence, and wide coverage, accounting for a large proportion of occupational diseases. In order to protect the health of occupational contacts, effectively prevent and treat occupational skin diseases, and in accordance with the requirement that the diagnostic standards for occupational diseases should reflect the latest clinical progress, GB7804-87 has been revised. Appendix A of this standard is an informative appendix, and Appendix B and C are normative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Institute of Occupational Health and Poison Control of the Chinese Center for Disease Control and Prevention and the Shanghai Dermatology and Venereology Hospital. Ruijin Hospital of Shanghai Second Medical University participated in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. ..com General principles for the diagnosis of occupational skin diseases
GBZ18-2002
Occupational skin diseases refer to diseases of the skin and its appendages caused by exposure to chemical, physical, biological and other production-related harmful factors in occupational activities.
1 Scope
This standard specifies the general principles for the diagnosis and treatment of occupational skin diseases. This standard applies to diseases of the skin and its appendages caused by exposure to harmful factors in occupational activities. Similar skin diseases caused by non-occupational exposure can also refer to this standard. 2 Normative references
The clauses in the following documents become the clauses of this standard through reference in this standard. For any dated referenced document, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, parties reaching an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For any undated referenced document, the latest version shall apply to this standard.
GBZ106
GB17149.1
3 Diagnostic principles
Diagnostic standards for radiation-induced skin diseases
Diagnostic standards for cosmetic skin diseases and treatment principles General principles Based on a clear history of occupational exposure and clinical manifestations, combined with skin patch tests or other special examination results when necessary, with reference to the investigation of the working environment and the incidence of the same type of work, comprehensive analysis, and exclusion of similar skin diseases caused by non-occupational factors, a diagnosis can be made.
4 Clinical types
Common clinical types and causes of occupational skin diseases are as follows: 4.1 Occupational dermatitis
4.1.1 Contact dermatitis
Irritant and (or) allergic contact dermatitis caused by direct or indirect contact with irritants and (or) allergens 4.1.2 Photocontact dermatitis
Phototoxic or photoallergic contact dermatitis caused by contact with photosensitizers and exposure to sunlight or artificial ultraviolet light sources, 4.1.3 Photoelectric dermatitis
Acute dermatitis caused by contact with artificial ultraviolet light sources (electric welding, etc.). 4.1.4 Radiodermatitis
Acute and chronic dermatitis and skin and mucosal ulcers caused by ionizing radiation (see GBZ106) 4.1.5 Drug eruption dermatitis
Inflammatory reactions of the skin and mucosa caused by contact with chemicals such as trichloroethylene, accompanied by fever and visceral lesions in severe cases. 4.2 Occupational skin pigmentation changes
4.2.1 Occupational melanosis
Chronic skin pigmentation caused by long-term contact with coal tar and mineral oil, rubber products and their additives, certain pigments (dyes) and their intermediates.
4.2.2 Occupational vitiligo
Skin depigmentation spots caused by long-term contact with phenylphenol or alkylphenol compounds. 4.3 Occupational acne
Oil acne caused by contact with coal tar, shale oil, natural petroleum and its high-boiling point fractionation products and asphalt; chloracne caused by contact with certain halogenated aromatic hydrocarbons, polychlorinated phenols and polyvinyl chloride thermal decomposition products. 4.4 Occupational skin ulcers
"Bird's eye ulcers" caused by contact with compounds such as hexavalent chromium and soluble beryllium salts. 4.5 Occupational infectious skin diseases
Occupational skin damage such as skin anthrax, erysipelas, and milkman's tubercles caused by contact with certain bacteria, viruses and other microorganisms. 4.6 Occupational warts
Flat wart-like, common wart-like and papilloma-like skin lesions caused by long-term contact with asphalt, coal tar, shale oil and high-boiling-point fraction mineral oil, as well as asbestos warts caused by contact with asbestos. 4.7 Occupational hyperkeratosis and fissures
Roughness, thickening and fissures of the skin caused by contact with organic solvents and alkaline substances and mechanical friction. 4.8 Occupational prurigo
Papular urticaria-like lesions caused by biological factors such as mites and cercariae. 4.9 Occupational immersion and erosion
Milky white swelling, wrinkling and erosion of the skin caused by long-term immersion in water. 4.10 Occupational hair changes
Hair abnormalities such as hair breakage or hyperplasia caused by mineral oil, asphalt, etc. 4.11 Occupational nail changes
Nail damage such as fingernails, key nails and nail peeling caused by long-term contact with alkaline substances, mineral oil and physical factors. 4.12 Others
Other occupational skin diseases with a clear causal relationship with occupational exposure, such as skin pain and itching caused by contact with glass fiber, copper scraps and dust or gas of various chemicals; contact urticaria caused by contact with latex gloves, chlorpyrifos, lindane, raw lacquer, etc.; skin tumors such as squamous cell carcinoma and basal cell carcinoma caused by contact with coal tar pitch, coal tar, shale oil, inorganic arsenic and ionizing radiation.
Treatment principles
5.1 Treatment principles
Avoid or reduce contact with pathogenic factors during treatment. 5.1.1
Remove pathogens remaining on the skin in time. Symptomatic treatment according to clinical type and condition. 5.2 Other treatments
Occupational skin diseases generally do not cause loss of labor ability, and can work as usual under enhanced protection conditions. Special cases are handled as follows: 5.2.1 Those with severe allergic reactions or repeated illnesses that do not heal for a long time should change their jobs and arrange work that does not contact allergens. 5.2.2 During the treatment period of acute dermatitis, ulcers and some infectious skin diseases, it is appropriate to rest or temporarily change the type of work. 5.2.3 After the diagnosis of occupational melanosis, occupational vitiligo and occupational skin cancer, the type of work should be changed to leave the disease environment. 5.2.4 For occupational acne with aggregated type or combined with multiple folliculitis and cysts, those who fail to respond to long-term treatment may consider changing the type of work. Instructions for the correct use of this standard
See Appendix A (Informative Appendix), Appendix B and C (Normative Appendix). Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard applies to the diagnosis of occupational skin diseases. All those who meet the clinical types specified in this standard can be diagnosed and treated according to the principles of this standard.
A.2 There are many pathogenic factors for occupational skin diseases, and the clinical types are different. The same pathogenic factor can cause different clinical manifestations, and the same clinical manifestation can be caused by different pathogenic factors. The clinical types specified in this standard are common clinical types of occupational skin diseases, which can basically include occupational skin diseases caused by various reasons. A.3 Occupational drug eruption dermatitis refers to skin lesions such as severe erythema multiforme, bullous epidermal necrolysis or exfoliative dermatitis caused by contact with chemicals such as trichloroethylene, dimethyl thiocarbate, acrylonitrile, methamidophos or dimethoate, which often involve mucous membranes and are accompanied by fever. In severe cases, liver, kidney or other organ damage may occur. It is similar to drug dermatitis caused by certain drugs entering the human body through various routes. Although the incidence of this disease is not high, the condition is often serious and should be taken seriously. A.4 This standard changes the name of "occupational photosensitivity dermatitis" in the original standard to "occupational photocontact dermatitis". Occupational photosensitivity dermatitis belongs to the category of exogenous photosensitivity dermatitis. Exogenous photosensitivity dermatitis refers to the reaction after exposure to certain external photosensitizers and light, and is divided into photocontact dermatitis and photochemical drug eruption according to the different ways in which photosensitizers reach the skin. Photocontact dermatitis refers to an inflammatory reaction caused by skin exposure to photosensitizers (such as asphalt, coal tar, onions, chlorpromazine and other industrial chemicals) and local exposure to sunlight: photochemical drug eruption refers to an inflammatory reaction caused by internal photosensitizers (such as promethazine, sulfonamides, nalidixic acid, norfloxacin, psoralea corylifolia, white chlorpheniramine, etc.) and skin exposure to sunlight. Both can be divided into phototoxicity and photoallergy according to the pathogenesis. Since various photosensitizers from the occupational environment are exogenous photosensitizers, the main way they invade the body during occupational activities is through skin contact. Therefore, this standard renamed the "occupational photosensitivity dermatitis" in the original standard as "occupational light contact dermatitis". A.5 Skin patch test is an important means of diagnosing allergic contact dermatitis, but a comprehensive analysis must be made in combination with occupational contact history, clinical manifestations, on-site investigation data, etc. to make a correct judgment. Appendix B of this standard is based on the original standard and is formulated with reference to international standards such as the International Contact Dermatitis Collaboration Group (ICDRG), the North American Contact Dermatitis Collaboration Group (NACDG), the European Standard (European Standard) and the screening allergen series of GB17149.1-1997, combined with the current specific situation in my country.
A.6 Other special examinations specified in the diagnostic principles refer to open patch test, light patch test, skin tissue pathology examination, trichophyton examination, fungal microscopy and culture, etc., and if necessary, chemical substances and their metabolites can be tested. A.7 Occupational skin diseases should be differentiated from non-occupational skin diseases. The initial site of skin lesions of occupational skin diseases is often consistent with the contact site, but its clinical manifestations are often similar to those caused by non-occupational factors, and most of them are non-specific, so occupational history is of decisive significance for diagnosis. For those suspected of occupational dermatitis but with insufficient diagnostic evidence, they can generally be temporarily separated from contact and dynamically observed. If it is repeatedly proved that the disease is cured or significantly improved after separation from contact for more than two times, and relapses or worsens after resuming contact, they can be diagnosed. A.8 Certain chemicals can cause occupational skin diseases and can also be absorbed through the skin, respiratory tract or other routes to cause poisoning. This standard does not include skin manifestations caused by chemical poisoning. A.9 The health examination requirements stipulate that "for jobs prone to skin diseases, physical examinations are required once every 1 to 2 years. During the physical examination, attention should be paid to new skin diseases and whether they are occupational skin diseases should be identified." It mainly refers to the need for correct diagnosis and differential diagnosis of skin damage caused by certain jobs prone to skin diseases. For example: skin melanosis in workers who come into contact with coal tar and petroleum fractionation products, rubber and its additives; white spots in workers who come into contact with phenylphenol and alkylphenol; acne and warty skin in workers who come into contact with coal tar and high-boiling-point fractionated petroleum products; hyperkeratosis and chapped skin in workers who come into contact with organic solvents and alkaline substances.
B.1 Scope of application
Appendix B
(Normative Appendix)
Skin patch test method
This method is only applicable to finding allergens of allergic contact dermatitis caused by contact allergy, not irritant contact dermatitis.
B.2 Test materials and allergen concentration of patch test
B.2.1 Test materials: Use commercial low-sensitivity patch test tape with good closure performance. B.2.2 Allergen concentration of patch test: The concentration that is not irritating to the skin but can induce allergic reactions should be used. For the spot test concentrations of some common industrial chemicals, please refer to Appendix C. The concentrations of allergens that need to be spot tested that are not listed in Appendix C can be determined by referring to relevant materials; if there is no reference, animal experiments can be conducted to determine the lowest irritation concentration, and then skin tests can be conducted with allergens at a concentration lower than this concentration, and healthy people must be used as controls. B.3 Operation steps
B.3.1 Peel off the isolation paper of the spot test tape and place it on the test bench with the chamber facing up. B.3.2 If the test substance is solid or semi-solid, it can be directly added to the chamber, and the amount added is slightly more than half of the chamber volume (about 0.02g); for liquid test substances, filter paper can be soaked (about 0.02ml) and placed in the chamber. B.3.3 Immediately apply the spot test tape with allergens to the normal skin on both sides of the spine from the bottom, and press the chambers lightly one by one to expel air and evenly distribute the test substance. B.3.4 Mark the test site for observation. B.4 Observation and judgment
B.4.1 Observation time
Remove the test tape after 48 hours of application, and use a wet soft paper or cotton swab to clean the residual test material. Make the first observation at an interval of 30 minutes, and make the second and third observations at 72 and 96 hours respectively. If necessary, continue to observe on the 7th day, and pay attention to whether there is a regression reaction.
B.4.2 Determination of reaction degree
IR irritation reaction
NT Not tested
A negative reaction: no reaction on the tested local skin. A questionable reaction: mild erythema on the tested local skin. A weak positive reaction: erythema and infiltration on the tested local skin, with a small amount of papules. A strong positive reaction: erythema, infiltration, papules, and blisters on the tested local skin. Ten Ten Ten Very strong positive reaction: Bullae appear on the local skin of the test subject..comB.4.3 Interpretation of results
B.4.3.1 The patch test results should be judged through continuous dynamic observation and comprehensive analysis. B.4.3.2 If the reaction of "+" or above persists or even worsens during the observation for 72 hours or later, it indicates a positive allergic reaction.
In judging the patch test results, attention should be paid to the differentiation of false positive reactions and false negative reactions. B.4.3.3
Common causes of false positive and false negative reactions False positive reaction
False positive reaction
Concentration is too high Pre-irritation
Angry back
Edgeeffet
Formula reaction
Tape reaction
Precautions
Patch test is not recommended in the acute stage of dermatitis.
Concentration is too low
Improper excipient selection
Poor closure
Short contact time
Immunosuppression caused by drug combination
B.5.2 Subjects should not use corticosteroids 2 weeks before and during the test, and antihistamines should be stopped 3 days before and during the test.
Before the patch test, the significance and possible reactions should be explained to the subjects in order to obtain full cooperation. B.5.3
B.5.4 The test subject must be informed that if a strong reaction occurs, the test substance should be removed immediately. B.5.5
During the test, it is not advisable to bathe, drink alcohol, or rub the test site, and avoid intense exercise. In determining the degree of reaction, false positive or false negative results should be excluded. B.5.6
Excipients should be used as controls. If necessary, normal controls should be used. B.5.7
Appendix C
(Normative Appendix)bzxZ.net
(Standardized Time Record)
Concentrations of Common Allergens and Excipients for Skin Patch Test Chemical Names
Potassium dichromate Cobalt chlorida
Nickel sulphate
Veomycin suifate Penicillin
Streptomycin
Camphor
Chlarpromazine hydrochloride)Benzocaine
Thinerasal
Bulsam of peru
Woolalcohois
Ethyieredianice dihydrochlorideParabensmixMethyl-hydranxyhenzaateEthyl-p-hydroxybenzoatePropyl-p-hydroxyhenzoateButyl-p-hydroxybenzoateBenzyi-p-hydroxybenzoateImidazolidinylurua, Giermall 115Chart 15, Quaternium 15, Chlorallyl methienamine chloride) Bronopol
KatlomCG, 5-Chloro-2-methyl-4-isotiazolin-3-one-2-methyi-4-iscthiazolin-3-n) Formaldehyde (Fornaldchytle)
Sorbic acid (Sorbicacid)
Thiuram mixture (Thiurammix
Dithiothiocyanate, accelerator PTD (Dipen tamethylenethiuramdisultida) Tetramethylthiuram disulfide, accelerator TMTD (Tetramethylthiuramdisulride) Unified tetramethylthiuram, accelerator TMTM (Tetramethylthiurammonosulfide) Diisopropylthiuram, accelerator TFD (Tctraethylthiuramdisuifide) Black rubber mixture (Blackrubbertnix, PPDmix) N-cyclohexyl-V-phenyl-p-undiamine, antioxidant 40110 (N-Cyelohexyl-N'-phenyl -p-phenylenediamine, CPPD) N-isopropyl-V-phenyl-p-phenylenediamine, antioxidant 4010NA (N-Isopropyl-N'-phenyl-p-phenylenediamine, IPPD) N,N-amino-p-phenylamine, antioxidant PPD (NN-Diphenyl-p-phenylenedianine, DPPD) Carba mixture (Carba mix)
1.3-diphenylguanidine, accelerator D (1.3-Diphenylguanidine, DPG) ethyl disulfide hydrogen acid, accelerator 7Dc (Zinediethylditaiacarbamate) concentration%
Excipients
Fan Shangsuo
Feng Shilin
Fan Shilin
Zhengwangshui
Zhengwonshui
Children's Work School
Fan Zhuqiu
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Chemical Name
Zinc Tri-thiocarbamate, Accelerator BZ Mercaptan Mixture (Mereaptnmix)
(Zinc Dibutyldithiocaroamate) N-cyclohexylbenzothiazyl sulfenamide, accelerator CZ (N-Cycloexylbenzothiazyl sulfenamide, CBS) disulfide, accelerator DM (Dibenzothiazyldisulfide, MBTS) 2-Mcrcaptohenvothiazole, accelerator M (2-Mcrcaptohenvothiazole, MBT) Morpholine 1-mercaptobenzothiazole (Mor) Naphthylmix N-phenyl-2-napinthy lamina) N, N'-di-β-banyl-p-benzylamine, antioxidant DNP (NN'-Di-Ji-naphthyl-p-phunyleaedamine), hexamethyltetramine, accelerator II (IIexanethylenetetramina), benzyl-3-tetramine, antioxidant D (Phenyi-B-naphthylamine), vanillin (Vanillin)
Muskambree
Cinnamic aleohol
Cinmamicaidebyce
Hydroxycitromc:lal) Anylcinnamaldchyde, Gtraniol, Lugenal, Isocugunol, Oakmassalsolutg, Machine oil, Gasoline, Epoxy resin, P-tert-Butylphenolformaldehyde resin lormaldehyderesin）Colophany
Tohene
Xylene
Shampoo(Saampoo)
Skin protection cream(Skin protection cream)Hair dye(Hairdye)
Toilet soap
Detergent powder(Detergent powder)
Perfume(Pcifunc)
Lipstick
P-Pheylenediaming
Iydroquinone
Luentincoil
Lyso
Concentration%
Shaping agent| |tt||Every Tudong
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Every Main Lin
Every Ermo
Every Wangmo
Tian Shangx
Every Ten Schools
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Vaseline
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.