Occupational dermatosis among sanders in the furniture industry

The prevalence of occupational skin disease was found to be 3.8% in a study of 479 sanders in the furniture-making industry in Singapore. 17 species of wood imported from South East Asia were used. The most common dermatoses from wood dust were pruritus (1.6%), irritant contact dermatitis (1.6%) and xerosis (1.4%). 2 sanders had miliaria. None had allergic contact dermatitis from wood dust. The arms and trunk were the most common site for pruritus and dermatitis from wood dust. It appeared that the woods commonly used in the furniture making industry are weak sensitizers. Appropriate preventive measures against irritant dermatitis such as dust control, protective clothing, and good personal hygiene should be adequate to prevent occupational dermatoses among the sanders.     

Textile dermatitis in patients with contact sensitization in Israel: a 4-year prospective study

BACKGROUND: The exact incidence of textile dermatitis is unknown because of the lack of controlled epidemiological studies. Nevertheless, the increasing frequency of contact dermatitis to clothing has been demonstrated, thus indicating the importance of further investigations in this field. OBJECTIVE: To analyse the results from a 4-year prospective study of the clinical and aetiological features of contact dermatitis to textiles in Israel. We also aimed to assess the frequency and relevance of sensitization to textile dyes and resins in these patients. METHODS: Six hundred and forty-four patients (441 female and 203 male), referred for the investigation of contact dermatitis, and suspected of having textile allergic contact dermatitis (ACD), were studied. All patients were patch tested with the standard series (TRUE Tests), textile colour and finish series (TCFS) clothing extracts and pieces of garment in some cases. Readings were performed on days 2, 3 and in many patients also on day 7. RESULTS: Eighty-three patients (12.9%) had an allergic reactions to a dye and/or resin allergen. Of them, 43 (51.8%) had positive patch tests to the textile dye allergens, 28 (33.7%) to the formaldehyde and textile finish resins and 12 (14.4%) to allergens from both groups. The highest incidence of sensitization from the dye group allergens was due to Disperse Blue (DB) 124 (30.6%), DB 106 (27.0%) and DB 85 (8.1%) and from the resin group to melamine formaldehyde and ethyleneurea melamine formaldehyde (20.7% each) and urea formaldehyde (18.3%). Present relevance of the patch tests was found in 81.4% of the cases. Concomitant sensitization with allergens from the standard series included nickel sulphate, potassium dichromate, formaldehyde, rubber additives and others. Although chronic dermatitis was the typical clinical presentation, less frequent forms such as purpuric, hyperpigmented and papulopustular lesions and atypical forms such as erythema multiforme-like, nummular-like lesions, lichenification and erythrodermia were observed in 24.4% of the cases. The atypical manifestations were provoked by sensitization to dye allergens and never to resins. Along with the typical distribution in areas of friction on the trunk and extremities, less frequent areas including the hands, face, genital area and the soles were affected too. CONCLUSIONS: In view of the increasing frequency of contact dermatitis to clothing, the clinical assessment should include awareness of the classical as well as the unusual and atypical clinical forms and locations of ACD to textiles, for they are not infrequent. Although dyes and among them DB 106 and DB 124 are the most frequent allergens inducing textile dermatitis, concomitant testing with allergens from the textile dyes and resin groups is recommended when investigating patients with textile dermatitis.     

Dermatitis in bulb growers

A damaged skin forms a health hazard in flower-bulb growers as it enables higher permeation rates For pesticides than normal skin. Therefore, an investigation was performed into the skin condition of 103 bulb growers and 49 controls. Contact dermatitis of the hands was of the same order (11 and 10%) in both groups. However, minor signs of dermatitis were seen more often in bulb growers (30 versus 8%, p <0.05). Most growers had contact with narcissus sap during the investigation. This irritant sap, as well as many other skin contacts with irritants such as hyacinth dust and pesticides, seemed to be responsible for many skin complaints. Contact serialization was suspected in 19 growers and 3 controls. Patch tests showed that contact sensitization existed to pesticides in probably 10, and to flower-bulb extracts in 4 growers. Reactions to propachlor were not regarded as very reliable as the test concentration seemed to be marginally irritant. There were only a few allergic reactions to narcissus (3) and tulip (2) and none to hyacinth. This investigation showed that minor irritant contact dermatitis was frequent in bulb growers, and indicated that contact sensitization to pesticides and bulbs seemed to be a less frequent but important cause of dermatitis.     

Atypical and unusual clinical manifestations of contact dermatitis to clothing (textile contact dermatitis): case presentation and review of the literature

Although the exact incidence of textile contact dermatitis is unknown, recent studies demonstrate that contact dermatitis produced by allergic or irritant reactions to clothing not only is more frequent than previously thought but also increasing. The clinical features of contact dermatitis (CD) caused by clothing may resemble common allergic contact dermatitis or may have atypical presentations. We report on several cases of clothing-induced contact dermatitis with atypical clinical presentations.     

Lyngbya dermatitis (toxic seaweed dermatitis)

Lyngbya dermatitis is an irritant contact dermatitis caused by the blue-green alga (or cyanobacterium), Lyngbya majuscula, commonly found in tropical and temperate waters worldwide. Lesions generally appear in a bathing suit distribution minutes to hours after exposure, initially with itching or burning, evolving into a blistering eruption which eventually desquamates leaving bright red, tender erosions that resolve spontaneously in about a week. Our case is of a 13-year-old female that presented with haphazard clusters of reddish-brown vesicles and papules on her abdomen one day after swimming in rough surf conditions on the shores of Oahu, Hawaii. Histopathological examination revealed an acute irritant contact dermatitis consistent with Lyngbya dermatitis. L. majuscule, with its wealth of biologically active compounds, should be a consideration in any patient presenting with an acute irritant contact dermatitis following temperate saltwater exposure.     

Skin irritant reactivity following experimental cumulative irritant contact dermatitis

Despite the frequency of irritant contact dermatitis, very little is known about the duration of barrier function impairment following cumulative irritant contact dermatitis. We studied post-irritation irritant reactivity by assessing the response to SLS irritation in previously irritated sites. Cumulative irritant contact dermatitis was induced on the forearms of 15 volunteers aged 18 to 50 years by repeated occluded application of 0.5% SLS I h per day over 3 weeks. 3, 6 and 9 weeks later, previously irritated and unirritated control sites were challenged with 2% SLS under occlusion for 23 h. Irritation was assessed by visual scoring, transepidermal water loss (TEWL) as an indicator of epidermal barrier function, and capacitance as a parameter of epidermal water content. While no difference in irritant reactivity between pre-irritated and unirritated sites was observed 3 weeks following irritant contact dermatitis, there was a significant hyporeactivity of previously irritated skin as expressed by clinical scores, TEWL and capacitance at 6 and 9 weeks. Our results indicate that epidermal barrier function remains altered even 9 weeks after cumulative irritant contact dermatitis. With regard to patch testing, post-irritation hyporeactivity might be a cause of false-negative tests on previously irritated sites.     

Contact dermatitis from dielectric fluids in electrodischarge machining

We report an outbreak of irritant contact dermatitis in the aerospace industry from electrodischarge machining (EDM). 20 workers doing EDM developed irritant contact dermatitis from the dielectric fluid used in EDM, a form of precision metal machining that is widely used in mould making and precision engineering. Dielectric fluid contains hydrocarbons that are aromatic, paraffinic or naphthenic and are skin irritants. Irritant contact dermatitis from dielectric fluid has not been reported previously. EDM will become more widespread and occupational dermatitis from dielectric fluid is likely to become more prevalent in the future. Our experience was that irritant contact dermatitis from dielectric fluid can be prevented by simple preventive measures such as personal hygiene and health education.     

Industrial airborne irritant or allergic contact dermatitis

Industrial airborne irritant or allergic contact dermatitis is commonly observed in many factories. Examples of airborne irritants include fibres (such as fibreglass or rockwool), various kinds of dust particles (such as cement, slag, sludge, insulating foam, wood chips), acids and alkalis, gasses and vapours. Airborne contact allergens are unequivocally numerous. The clinical symptoms of both irritant and allergic airborne contact dermatitis are reviewed.     

Eyelid dermatitis: experience in 203 cases

Allergic contact dermatitis has been considered the most common of the many dermatologic conditions found with eyelid dermatitis. This is a retrospective study of 203 patients who presented with persistent or recurrent eyelid dermatitis with or without dermatitis elsewhere. Almost all underwent patch testing and, when indicated, radioallergosorbent test, skin prick and intradermal tests, and in many cases, usage tests as part of the workup. Relevant allergic contact dermatitis was found in 151 of 203 patients (74.%): 46 (23.%) had protein contact dermatitis, but only 7% had protein contact dermatitis without concurrent allergic contact dermatitis. Less than 1% had irritant dermatitis alone. Twenty-three patients had atopic eczema, of whom 16 also had allergic contact dermatitis, protein contact dermatitis, or both. Other conditions included seborrheic dermatitis (n = 11), psoriasis (n = 7), dry eyes (n = 9), and dermatomyositis or overlapping connective tissue disease (n = 7). Important sources of contact sensitivity include cosmetics, metals, topical medications including corticosteroids, eye medications, dust mites, animal dander, and artificial nails; only 5 cases were caused by nail lacquer. Eyelid dermatitis is a multifaceted clinical problem, but in this group of patients, allergic contact dermatitis was a common cause, even among those with atopic eczema.     

Clues to an accurate diagnosis of contact dermatitis

An accurate diagnosis of allergic contact dermatitis can be achieved by a combination of historical, morphologic, and diagnostic steps. Clues in the history and physical examination can point to an irritant as the source of contact dermatitis. While irritants and allergens share many common features both immunologically and clinically, there are grounds for the distinction. Knowledge of occupational factors is necessary to assess the source of contact dermatitis. A common pitfall is the failure to appreciate the role of endogenous factors in the clinical presentation and overall care of the dermatitis patient. A comprehensive assessment of the patient's environment will lead to appropriate patch tests being applied and a correct diagnosis being reached.     

Nonanoic acid--an experimental irritant

Irritant contact dermatitis is defined as a non-immunological skin reaction following exposure to various chemical, mechanical and physical factors. It is known that the skin response to irritants depends on the irritant applied and differs between chemically different irritants. Sodium lauryl sulfate (SLS) is an anionic detergent and the most frequently used substance in experimental irritant contact dermatitis. In 1980, it was suggested that nonanoic acid (NNA) could be used as a positive control when patch testing. Since then, NNA has been used as an experimental irritant in several studies and has been used as a chemically different substance compared to SLS. The present article presents a review of the application of NNA in studies on skin irritancy and experimental irritant contact dermatitis.     

P53Hand contact dermatitis in jewellwery 2 cases

The production of jewellery is currently mostly industrial and the jewellers perform only one or two stages in the manufacturing process. The jewellers make jewellery by hand in small workshops and are more polyvalent: they shape the metal with pliers or hand tools or cast it in moulds, assemble the individual parts with glues, carve metal, diamonds and other stones, clean metals with soaps and ultrasonic baths. The occupational dermatitis is of irritant nature (acid and alkalis in metal cleaners, soaps, detergents, metal dust, abrasions from polishing wheels and emery paper, heat, adhesives, etc) and allergic nature (potassium dichromate, 2‐mercaptobenzothiazole, ammoniated mercury, carba mix, epoxy resin, mercapto mix, formaldehyde, nickel, colophony). We report the cases of two jewellers working in workshops. A 47 year old atopic woman already known for a sensitivity to metals (nickel, potassium dichromate and cobalt) developed recurrent vesiculo‐pustular erythematous lesions of both palms with occasional infections treated with systemic antibiotics and topical steroids. Patch tests were performed for the European standard series, woods, and personal series. There were positive + reactions at 96 h to colophony, palladium, and personal waxes. Information obtained through the manufacturer revealed colophony in the waxes frequently used by jewellers to fix the precious stones to woods and metal allowing the stones to be carved. A 47 years old atopic man working as a jeweller for 32 years developed recurrent eczematous lesions of the fingers of the right hand. Patch tests were performed for the European standard series, preservatives, plastics, acrylates and personals series and were positive + + at 96 h for urea formaldehyde, diethylenetriamine, araldite hardener and the soap used to clean the jewels. Uncommonly this contact allergy is not due to the epoxy resins themselves but to the hardener. The urea formaldehyde and the diethylenetriamine are in fact used as epoxy resins hardeners. There were no reactions to the araldite resin but there was one to its hardener. In conclusion we report two unusual cases of hand contact dermatitis in jewellers. Because jewellers are exposed to a variety of substances, to detect the allergens the inquiry must be accurate and extensive patch testing may be required. Common allergens are compounds of uncommon substances and tools and uncommon allergens are compounds of well‐known sensitizers.     

Immunopathological and ultrastructural findings in human allergic and irritant contact dermatitis

The histopathological features of allergic contact dermatitis were compared with those of irritant contact dermatitis in a group of 17 subjects. Each patient received simultaneous patch tests of a known allergen and a standardized irritant (benzalkonium chloride). The cellular changes occurring between 3 h and 7 days after patch test application were studied by light and electron microscopy and immunocytochemistry. No differences were observed between the induced allergic contact dermatitis (ACD) and the irritant contact dermatitis (ICD), either in the responding cell types or the sequence of cellular events. Both reactions showed a predominantly T lymphocyte infiltrate with no polymorphonuclear leukocyte involvement. Apposition of Langerhans cells to lymphocytes in the epidermis was seen in both types of response. Considerable variability in the intensity of reaction to irritant and allergen occurred within individuals. There was no statistically significant difference between the intensity of the reactions to the irritant and the allergen.     

Irritant cutaneous reactions to N-methyl-2-pyrrolidone (NMP)

Several workers in a small electrotechnical company in Norway experienced irritant reactions of the skin after a few days of working with the solvent N-methyl-2-pyrrolidone (NMP). Due to concern about the health risk of commonly-used organic solvents, the company had chosen to use NMP when one of its products had to be treated with a solvent. After 2 days of work with NMP, 10 of the 12 involved workers displayed acute irritant contact dermatitis of the hands. According to published reports, NMP is not considered to be particularly irritant to the skin. The Safety Data Sheet of a Norwegian sales firm contained no information on cutaneous hazards, but the Safety Data Sheet of an American producer of NMP stated the risk of severe dermatitis upon prolonged contact. NMP seems to be more irritant to the human skin than reported thus far.     

Occupational contact dermatitis in the pharmaceutical industry

Occupation-induced skin reactions are not infrequently observed in the pharmaceutical industry. Workers may come in contact with irritant substances and also with chemically reactive intermediates or drugs that may be potential sensitizers. The skin lesions can be located at the site of contact, usually the hands, although airborne reactions on exposed and even nonexposed areas (eg, by particles trapped under clothing) are not uncommon. Generalized reactions may occur due to inhalation or transcutaneous absorption. An accidental exposure to a highly allergenic compound may cause a chemical burn, followed by primary sensitization and allergic contact dermatitis. The pharmaceutical contact allergens belong to many different pharmacologic classes. If several cases of contact dermatitis occur in multiple individuals in the same company, then the working conditions are implicated and should be changed to prevent their recurrence. Measures to be taken include dust control, installation of closed filter equipment, and keeping the workers informed about the potential risks associated with the manipulation of the chemicals.     

Occupational dermatoses from exposure to epoxy resin compounds in a ski factory

Of 22 workers in a ski factory, occupational allergic contact dermatitis was found in 8. 6 were sensitive to epoxy resin compounds, i.e. epoxy resins, hardeners or diluents. I to cobalt in glass-fiber reinforcements, and I to formaldehyde in a urea–formaldehyde glue and a lacquer. 4 workers had irritant contact dermatitis from epoxy resin compounds, lacquers, sanding dust. or glass-fiber dust. 3 had contact allergy from a new sensitizer, diethyleneglycol diglycidyl ether, in a reactive diluent. Immediate transfer of workers sensitized to epoxy resin from epoxy exposure prevents aggravation of their dermatitis and broadening of the sensitization to epoxy hardeners, diluents and other compounds.     

Dynamic patterns of allergic patch test reactions to 10 European standard allergens

In an epidemiological study of occupational dermatitis in 5 different show factories, 246 workers were interviewed, examined and patch tested using standard and occupational patch test series. The prevalence of occupational contact dermatitis was 14.6% (36/246): 8.1% (20/246) irritant contact dermatitis (OACD). Among the latter, the most common occupational allergens were p-tert-butylphenol-formaldehyde resin and mercaptobenzothiazole. 6% (15/246) presented with hyperkeratosis of the fingertips, while 3.2% (8/246) reported prutitus sine materia (PSM) present only during working hours. 2 workers presented with vitiligo-like leukodermic patches on the backs of their hands and on their forearms. Some jobs were more frequently associated with skin complaints. In the assembly department, OACD was most frequent (11.4%), attributed to contact with adhesives and, to a lesser degree, with rubber and leather, OICD caused by contact with the solvents contained in adhesives and varnishes was probably caused by the dust present in the working environment was reported by 33.3% of the workers in the sole-cutting and scraping departments. Hyperkeratosis of the fingertips, as a reaction to the continuous trauma of leather on the skin, was observed most frequently (41.6%) in the sole-cutting department.     

Occupational irritant and allergic contact dermatitis among healthcare workers

Contact dermatitis is the most frequent occupational dermatosis and non-specific irritants in addition to specific Type IV sensitization are involved. We reviewed our database for data from 1994 to 1998 and selected 360 consecutive patients working in healthcare environments and experiencing contact dermatitis at their hands, wrists and forearms. We found that allergic contact dermatitis and irritant contact dermatitis were considered to be work-related in 16.5% (72/436) and 44.4% (194/436) of diagnoses, respectively. Occupational irritant contact dermatitis is due to exposure to a wide range of irritants in the workplace, such as soaps, solvents, cleansers and protective gloves, which conspire to remove the surface lipid layer and/or produce cellular damage. In this study the major relevant aetiological agents that induced occupational allergic contact dermatitis were: nickel sulphate (41 patch positivities), components of disinfectants [glutaraldehyde (5) and benzalkonium chloride (7)] and rubber chemicals [thiuram mix (15), carba mix (9) and tetramethylthiuram monosulphide (6)]. The best treatment for allergic contact dermatitis is to avoid those allergens causing the rash. Whenever this is not possible, contact with them needs to be reduced using properly selected protective gloves. Finally, subjects with atopic dermatitis should avoid 'wet work' and contact with irritants, because atopic dermatitis is significantly associated with irritant contact dermatitis.     

Predictive testing of metalworking fluids: a comparison of 2 cumulative human irritation models and correlation with epidemiological data

Metalworking fluids (MWF) have been reported as being an important cause of irritant contact dermatitis in metal workers. Our purpose was to determine whether the irritancy of different MWF assessed by 2 different types of predictive human in vivo tests could be compared with epidemiological data, 3 water-based MWF were tested in the same panel of subjects. Reactions were assessed by a visual score (VS), evaporimetry to evaluate the transepidermal water loss (TEWL) and chromametry to quantify erythema. Test 1 : MWF were applied with Finn Chambers on the volunteers' mid-back, removed after 1 day of exposure, and reapplied for a further 2 days Test 2 : Cumulative irritant contact dermatitis was induced using a repetitive irritation test for 2 weeks (omitting weekends) for 6 h per day. We observed an increase in VS, TEWL, and erythema for all MWF, with the same irritancy ranking in both test models. Differentiation of the substances was better in the D1/D3 test. The experimental results partially correlated with the epidemiological data, Considering the shorter application time and the better discrimination of irritancy, we prefer the D1/D3 model as a predictive test of MWF irritancy. Our results might aid development of a Standardized test to reduce cumulative skin irritation in metal workers.