An 18-year-old man has facial and upper back lesions that have waxed and waned for the past 6 years. On physical examination, there are 0.3- to 0.9-cm comedones, erythematous papules, nodules, and pustules most numerous on the lower face and posterior upper trunk. Other family members have been affected by this condition at a similar age. The lesions worsen during a 5-day cruise to the Adriatic. Which of the following organisms is most likely to play a key role in the pathogenesis of these lesions?

Group A β-hemolytic streptococcus

Which of the following statements is not correct regarding sebaceous cyst?

Treatment is incision and drainage

Found on hairy areas of the body

A hospital implements a policy to reduce occupational hand dermatitis in healthcare workers. They propose: (A) Switching from latex to nitrile gloves, (B) Installing alcohol-based hand rub dispensers, (C) Providing emollients, (D) Reducing glove use frequency. Synthesize the best evidence-based strategy.

Implement A, B, and C; avoiding D as it compromises infection control

Implement all four measures as glove occlusion worsens dermatitis

Implement only A and C to reduce costs

Focus only on B and C as glove material is not the primary issue

Evaluate the following scenario: A 38-year-old worker in an electronics manufacturing unit develops hand dermatitis. Initial patch testing shows multiple positive reactions to metals (nickel, cobalt, chromium). Despite workplace modifications and protective equipment, the dermatitis persists. Re-evaluation reveals positive patch test to colophony. What is the best strategic approach?

Colophony in soldering flux is the relevant occupational allergen; the metal sensitivities may be cross-reactions or co-sensitization

The persistent dermatitis indicates evolution to chronic actinic dermatitis

All positive reactions are equally relevant and complete job change is mandatory

The multiple sensitivities indicate systemic contact dermatitis requiring systemic therapy

Occupational Acne for FMGE: High-Yield Dermatology Lessons

Acneiform eruption from workplace chemical exposure.
Causative Agents:
- Oils (mineral, cutting).
- Coal tar (pitch, creosote).
- Halogenated hydrocarbons (dioxins, PCBs) → Chloracne.
Features: Comedones, papules, pustules, cysts on exposed areas.
Key: Remove exposure; treat like acne vulgaris.

⭐ Occupational acne is a specific form of acneiform eruption directly caused by workplace exposure to certain chemicals.

Occupational Acne - Workplace Culprits

📌 Oily Tars Halt Complexions (Oils, Tars, Halogenated compounds)

Oils: Insoluble cutting oils, mineral oils, petroleum derivatives.
- Mechanism: Direct follicular occlusion, potent comedogenicity.
Tars: Coal tar, pitch, creosote.
- Mechanism: Induce follicular hyperkeratosis; may cause photosensitivity.
Halogenated Aromatic Hydrocarbons: Dioxins (TCDD), Polychlorinated Biphenyls (PCBs), Chloronaphthalenes.
- Mechanism: Alter sebaceous gland function (metaplasia), severe follicular hyperkeratosis, inflammation.
- Result: Chloracne.
⭐ Chloracne, caused by halogenated aromatic hydrocarbons (e.g., dioxins, PCBs), is the most severe and persistent form of occupational acne.
Others:
- Heavy greases, waxes, chlorinated paraffins.
- Persistent friction/pressure (acne mechanica).

Occupational acne on back

Occupational Acne - Spotting Job Acne

Caused by workplace exposure to acnegenic agents. Key types include:

Type	Morphology	Distribution
Oil Acne	Comedones (open/closed), papules, pustules, cysts. Monomorphic.	Exposed areas (face, arms), clothing-covered (thighs, buttocks).
Tar Acne	Prominent comedones, papules, pustules.	Exposed areas (face, V-neck, forearms, scrotum).
Chloracne	Straw-colored cysts, open comedones, nodules. Less inflammation.	Malar, retroauricular, axillae, groin. Spares nose.

⭐ Lesions in occupational acne are typically monomorphic (e.g., predominantly comedones in oil acne) and often found on exposed areas and sites of friction with contaminated clothing.

Occupational Acne - Confirming the Cause

⭐ A meticulous occupational history detailing exposures, temporal relationship of symptoms to work, and improvement away from work is paramount for diagnosis.

Diagnostic Steps:
1. Occupational History: Identify workplace exposures (oils, tars, halogens), tasks, symptom link to work.
2. Clinical Exam: Note lesion morphology (comedones, inflammatory lesions) and distribution (exposed/occluded sites).
3. Patch Testing: Rarely needed; for suspected allergic component.
4. Rule out DDx. (See below)

Key Differential Diagnoses:
- Acne vulgaris (compare onset, distribution)
- Rosacea (no comedones, flushing)
- Bacterial folliculitis (monomorphic, itchy)
- Steroid acne (monomorphic, steroid history)
- Drug-induced acne (medication link)

Occupational Acne - Workplace Skin Shield

Caused by workplace exposure to oils, tars, greases, or chlorinated hydrocarbons (chloracne). Presents with comedones, papules, pustules, cysts on exposed or friction-prone areas.

Management:
- Prevention: 📌 SHIELD
  - Substitute hazards
  - Hygiene (frequent washing)
  - Isolate process
  - Engineering controls (ventilation)
  - Learn (educate workers)
  - Don PPE (gloves, aprons)
- Treatment:
  - Remove from exposure.
  - Topical: retinoids, antibiotics.
  - Systemic: antibiotics; isotretinoin (severe/chloracne).

⭐ Primary prevention through elimination/substitution of causative agents, engineering controls, and appropriate personal protective equipment (PPE) is the most effective strategy.

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High‑Yield Points - ⚡ Biggest Takeaways

Occupational acne arises from workplace contact with comedogenic agents like oils, tars, and cutting fluids.

Chloracne, a severe type, is from chlorinated hydrocarbons (dioxins, PCBs), presenting with straw-colored cysts.

Lesions appear in areas of direct contact with irritants, like forearms and face.

Key features: comedones (blackheads, whiteheads), inflammatory papules, and pustules.

Removing exposure to the causative agent is crucial for management.

Prevention includes protective gear and strict workplace hygiene practices.

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