Cellular phone dermatitis with chromate allergy

BACKGROUND

A patient with allergic contact dermatitis caused by hexavalent chromium plating on a cellular phone has already been reported.

OBJECTIVES

This study described the clinical characteristics and results of patch tests in 8 patients with contact dermatitis possibly caused by handling a cellular phone.

PATIENTS

The 8 patients were 4 males and 4 females aged from 14 to 54 years. They each noticed skin eruptions after 9-25 days of using a cellular phone. All patients had erythema, and 7 had papules on the hemilateral auricle or in the preauricular region. Three of 8 patients had a history of metal allergy. Chromate, aluminium and acrylnitrile-butadiene-styrene copolymer were used as plating on the cellular phones used by these patients.

METHODS

Closed patch tests and photopatch tests were performed using metal standard antigens.

RESULTS

The patch test was positive for 0.5, 0.1 and 0.05% potassium dichromate in all 8 patients. The photopatch test showed the same results. One patient was positive for 2% cobalt chloride and one for 5% nickel sulfate.

CONCLUSION

It is important to consider the possibility of contact dermatitis due to a cellular phone, possibly caused by chromate, when the patients have erythema and papules on the hemilateral auricle or in the preauricular region.

Lung cancer mortality among chromate production workers

AIMS

To assess mortality in 1997 among 493 former workers of a US chromate production plant employed for at least one year between 1940 and 1972.

METHODS

Cohort members were followed for mortality to 31 December 1997. Standardised mortality ratios (SMRs) were calculated for selected cause specific categories of death including lung cancer. Lung cancer mortality was investigated further by calculation of SMRs stratified by year of hire, duration of employment, time since hire, and categories of cumulative exposure to Cr(VI).

RESULTS

Including 51 deaths due to lung cancer, 303 deaths occurred. SMRs were significantly increased for all causes combined (SMR = 129), all cancers combined (SMR = 155), and lung cancer (SMR = 241). A trend test showed a strong relation between lung cancer mortality and cumulative hexavalent exposure. Lung cancer mortality was increased for the highest cumulative exposure categories (> or =1.05 to <2.70 mg/m(3)-years, SMR = 365; > or =2.70 to 23 mg/m(3)-years, SMR = 463), but not for the first three exposure groups. Significantly increased SMRs were also found for year of hire before 1960, 20 or more years of exposed employment, and latency of 20 or more years.

CONCLUSIONS

The finding of an increased risk of lung cancer mortality associated with Cr(VI) exposure is consistent with previous reports. Stratified analysis of lung cancer mortality by cumulative exposure suggests a possible threshold effect, as risk is significantly increased only at exposure levels over 1.05 mg/m(3)-years. Though a threshold is consistent with published toxicological evidence, this finding must be interpreted cautiously because the data are also consistent with a linear dose response.

Decreasing allergic contact dermatitis frequency through dermatotoxicologic and epidemiologic based intervention?

Allergic contact dermatitis (ACD) affects millions of people worldwide. In an attempt to decrease the incidence of contact dermatitis, several countries have implemented legislations to reduce the population's exposure to known sensitizers. To determine whether these legislations have been effective, we reviewed several studies examining trends in patch test reactivity before and after implementation of these legislations. Common sensitizers studied include nickel, gluceryl monothioglycolate fragrances, chromate, and thiuram. Overall, the evidence suggests a decreasing trend of ACD with appropriate formulation changes, however some of the data may be confounded by biases, and additionally, exposure to the sensitizer may still exist via non-compliance to regulations by small manufacturers. In the future population based studies should be conducted to more accurately assess trends in ACD.

An ultrastructural study of chronic chromate hand dermatitis

Occupational chromate dermatitis is one of the most common occupational diseases, predominantly causing hand eruptions. The ultrastructural manifestations of this condition have not been previously described. In this study, 7 cases of chronic occupational chromate hand dermatitis were investigated. Biopsies were taken from palmar skin and examined using light and electron microscopy. The ultrastructural features of chronic chromate dermatitis are similar to those of acute inflammatory dermatoses, even in the absence of clinical or histological features of an acute inflammatory process. Most changes are probably mechanical in nature and are a result of increasing intercellular oedema. Several features of chronic chromate dermatitis are common to other inflammatory dermatoses, including the presence of marked intercellular oedema of the lower epidermal keratinocytes, the formation of intracellular vacuoles in cells of the lower epidermis and the presence of milder ultrastructural changes in the midepidermis. The study has documented the presence of dendritic, spindle-shaped granular cells in the upper dermis, which have not previously been described in chromate dermatitis. The epidermis in chromate dermatitis appears to have fewer desmosomes when compared with other forms of dermatitis.

Potential hazards of hexavalent chromate in our drinking water

A consideration of the consequences of human exposure to hexavalent Cr in the drinking water has been compiled. Since there is an absence of adequate human data on this subject the problem has been analyzed not only from human and animal studies but also from a mechanistic point of view. This treatise has been inspired by recent reviews and speculations that suggest that we may safely drink hexavalent Cr in great excess of the current EPA and states drinking water standards of 50-100 ppb.

Workers' understanding of chemical risks: electroplating case study

BACKGROUND

There is limited research concerning how small companies in particular, respond to health and safety messages.

AIMS

To understand individuals' knowledge and beliefs about chemical risks and to compare these with those of experts.

METHODS

The use of chromic acid in particular, and also other chemicals associated with chrome plating were studied. All chromium plating firms were based in the West Midlands. The methodology involved initial face to face interviews (n = 21) with chromium platers, structured questionnaires (n = 84) to test the prevalence of beliefs identified in the interviews, an expert questionnaire, and a workshop to discuss findings. The responses of platers were compared with those of occupational health and safety experts.

RESULTS

Although chromium platers appeared to understand the short term adverse effects of the chemicals to which they are exposed, their understanding of long term, or chronic effects appeared to be incomplete. They had good knowledge of acute effects based primarily on experience. Platers were aware of the hazardous nature of the chemicals with which they work, but did not draw distinction between the terms "hazards" and "risks". They had difficulties articulating the effects of the chemicals and how exposure might occur; although it is inappropriate to equate this with lack of knowledge. A significant minority of platers displayed deficiencies in understanding key technical terms used in Safety Data Sheets.

CONCLUSIONS

This study provides a method which can be used to gain some understanding of workers' knowledge and beliefs about risks that they are exposed to in the workplace. The study also identifies gaps between the platers' knowledge and beliefs and those of experts. New risk information needs to be designed which addresses the information needs of platers using language that they understand.

Effects of chromic acid exposure on immunological parameters among electroplating workers

OBJECTIVE

To investigate the immunological parameters of chromic acid exposure among electroplating workers.

METHODS

Forty-six subjects were selected from five electroplating plants in central Taiwan. Each subject was interviewed by questionnaire, and urine chromium (urine-Cr) concentration was assessed. Immunological parameters were evaluated by interleukin (IL-2, IL-4, IL-6, IL-8, IL-10, TNF-alpha, IFN-gamma) and levels of lymphocyte subsets (T-cell, B-cell, T4, T8 and T4/T8).

RESULTS

Levels of IL-6 and IL-8 significantly increased in subjects with high urine Cr concentration, but TNF-alpha levels decreased. IL-2, IL-4, IL-10 and IFN-gamma were undetected. Flow cytometry was used to determine levels of lymphocyte subsets: only B-cells percentage had a negative correlation with urine-Cr. Smoking was an important factor that influenced levels of lymphocyte subsets.

CONCLUSION

Exposure to Cr has a detrimental effect on the immune system, so it is evident that worker exposure to chromic acid in the electroplating workplace must be reduced to a minimum.

Frequent microsatellite instability in lung cancer from chromate-exposed workers

Although chromium has been the most extensively investigated metal with respect to mutagenicity and carcinogenicity, its genetic effects in humans are only partly understood. Our previous study demonstrated that lung cancer from chromate-exposed workers infrequently (20%) displayed p53 gene mutations as well as a particular mutation pattern. In the present study, we examined the replication error (RER) and loss of heterozygosity (LOH) in 38 lung cancers from 28 chromate-exposed workers (chromate lung cancer group) and in 26 lung cancer patients without chromate exposure (non-chromate lung cancer group), using six microsatellite markers containing CA repeats: D3S647 (3p23), D3S966 (3p21.3), D3S1289 (3p21.1), D5S346 (5q21-q22), D9S161 (9p21), and TP53 (17p13.1). The RER phenotype was defined as the presence of microsatellite instability (MSI) at two or more loci. Thirty (78.9%) of 38 tumors in the chromate lung cancer group exhibited RER. In contrast, only four (15.4%) of 26 tumors in the non-chromate lung cancer group exhibited RER. The frequency of RER in the chromate lung cancer group was significantly higher than that in the non-chromate lung cancer group (P < 0.0001). By contrast, the frequency of LOH at 3p, 5q, 9p, and 17p loci in tumors with chromate exposure was not significantly different from that in tumors without chromate exposure. In the chromate lung cancer group, the period of chromate exposure in workers with RER (24.5 +/- 6.7 yr) was significantly longer than that in workers without RER (17.0 +/- 3.5 yr) (P = 0.0046). In addition, a longer period of chromate exposure was associated with a tendency toward a higher frequency of MSI. This finding suggests that MSI may play a role in chromium-induced carcinogenesis. In addition to our previous study of p53 mutations, the present findings suggest that the carcinogenic mechanism of chromate lung cancer may differ from that of non-chromate lung cancer.

Genotoxicity of nitroso compounds and sodium dichromate in a model combining organ cultures of human nasal epithelia and the comet assay

Genotoxic effects of xenobiotics are a possible step in tumor initiation in the mucosa of the upper aerodigestive tract. Using the comet assay, detecting genotoxicity in human tissue has been restricted to single incubations in vitro, but in vivo most xenobiotics harm their target in a repetitive or chronic manner. Therefore, we propose a model, which provides repetitive incubations in human upper aerodigestive tract mucosa cultures. Samples of human inferior nasal turbinate mucosa (n = 25) were cultured according to a modified version of a technique originally described by Steinsvåg. On day 1 fresh samples and on days 7, 9 and 11 organ cultures were incubated with N-nitrosodiethylamine (NDEA), sodium dichromate (Na2Cr2O7) and N'-methyl-N-nitro-N-nitrosoguanidine (MNNG). Mucosa samples and organ cultures, respectively, underwent a modified comet assay on days 1, 7 and 11. Genotoxicity could be shown for NDEA, Na2Cr2O7 and MNNG on days 1, 7 and 11. Duration of tissue culture and repetitive incubations did not significantly influence the results for NDEA. Nevertheless, Na2Cr2O7 and MNNG caused higher genotoxic effects on cultures subjected to the comet assay on day 11. This model may help to assess genotoxic hazards posed by environmental pollutants that have a cumulative character in repetitive or chronic exposure in vivo.

Occupational cancer genetics: infrequent ras oncogenes point mutations in lung cancer samples from chromate workers

BACKGROUND

Chromium carcinogenicity and mutagenicity are no longer disputed. However, although chromium has various genetic effects that induce cancer, its mechanism of inducing lung cancer in humans is still not fully understood. p53, a tumor suppressor gene, was found to be infrequently mutated in samples of lung cancer in workers with long occupational exposure to chromium, suggesting other cancer-related genes to be targeted in such tumors.

METHODS

To assess the contribution of the ras oncogenes in the pathogenesis of chromate-related lung cancer, we studied point mutations at the critical positions of codons 12, 13, and 61 of the Ha-ras and Ki-ras oncogenes in 38 lung cancer samples derived from Japanese patients who worked in the chromate industry for long periods. We used both radioactive isotope and non-radioisotope PCR-SSCP techniques.

RESULTS

The results of this study demonstrated that activation of ras genes due to point mutations in chromate-related lung cancer is a rare event.

CONCLUSIONS

Ras oncogenes activated by point mutations do not have a major role in the process of tumorigenesis of chromate-related lung cancer.

[Occupational diseases caused by chromium and its compounds]

The present paper demonstrates by documentary evidence occupational diseases caused by chromium and its compounds. Perforations of the nasal septum were diagnosed in 20 males and 9 females, the last one in 1980. Most of them worked in chromium-plating shops. Other diseases, including bronchial asthma, allergic rhinitis, and contact allergic eczemas, were examined in 1985-1999. Bronchial asthma was reported in a textile dyer who was in contact with chromium dyes for 32 years and two allergic rhinitides (a welder and an electroplater) were reported in 1987 as "other damage to health resulting from work." Out of 103 contact allergic eczemas, only 24 diseases, i.e. less than one quarter, were healed in 1999. Improvements were observed in 59 of them and 20 diseases persist. There was an exceptional finding of a chromium ulcer (pigeonneaux) on the lower extremity of a builder.

Multiple effects of chromate on the photosynthetic apparatus of Spirodela polyrhiza as probed by OJIP chlorophyll a fluorescence measurements

Chromate (Cr) decreases the growth of Spirodela polyrhiza. The fronds lost their pigments. The O2 evolution was also decreased. The Cr effect was found to be dose dependent. The toxic effects of Cr have further been studied on the photosynthetic activity of Spirodela polyrhiza by means of the chlorophyll a (Chl a) fluorescence transient O-J-I-P. The Chl a fluorescence transients were recorded in vivo with high time resolution and analyzed according to the JIP-test which can quantify the photosystem II behavior. Cr treated plants show a decrease in yield for primary photochemistry, phi Po. The performance index of PSII, PIABS, which is the combination of the indexes of three independent parameters, (1) the total number of active reaction centers per absorption (RC/ABS), (2) yield of primary photochemistry (phi Po) and (3) efficiency with which a trapped exciton can move an electron into the electron transport chain (psi 0), decreased due to Cr treatment. Chromate sensitivity varies within plant populations. In summary Cr affects several targets of PSII. More specifically, the main targets of Cr, according to the JIP-test, can be listed as a decrease in the number of active reaction centers and damage to the oxygen-evolving complex.

Workplace protection factors--supplied air hood

Several organizations list assigned protection factors. For supplied air hoods, the value of the assigned protection factors varies from <10 to 2,000 depending on the organization. Workplace protection factors (WPFs) of a supplied air hood were measured during aircraft sanding and painting operations on several types of aircraft to evaluate whether the American National Standard Z88.2 (1992) assigned protection factor of 1,000 was realistic. The primary contaminant during these activities is strontium chromate. Samples collected inside the hood show that employees during sanding and painting operations were not exposed to strontium. The respirator performed adequately. This study is consistent with other simulated and WPF studies in that the ANSI Z88.2 WPF of 1,000 is supported.

Repeated exposures to cobalt or chromate on the hands of patients with hand eczema and contact allergy to that metal

The present study aimed at evaluating the effects of daily repeated exposures to low cobalt or chromate concentrations on the hands of patients with hand eczema and cobalt or chromate allergy. For 2 weeks, the patients immersed a finger for 10 min daily into the appropriate metal salt solution in water. During the 1st week, this was a 10 or 50 mg/l cobalt concentration or a 10 mg/l chromate concentration, and, during the 2nd week, a 100 or 200 mg/l cobalt concentration or a 100 mg/l chromate concentration. This regimen elicited a flare of hand eczema only in the chromate-exposed chromate-sensitive patients. During the exposure period, accumulation of cobalt or chromate in the nail was demonstrated. Standardization of chemical methods of quantification of skin exposure to allergens, combined with experimental exposure studies in patients with specific contact allergy, will increase the possibility of providing evidence-based medicine in the area of allergic contact dermatitis in the future.

Frequent cyclin D1 expression in chromate-induced lung cancers

Ex-chromate workers are frequently afflicted with lung cancers, especially central-type squamous cell carcinomas (SCCs) of the lung. However, little is known about the molecular and cellular biologic characteristics of chromate-induced lung cancers. We investigated expression of cyclin D1, bcl-2, and p53 proteins in chromate-induced lung cancers by immunohistochemistry, compared with those in lung cancers from nonexposed individuals and those in individuals with pneumoconiosis. Of 19 chromate-induced lung cancers, 16 tumors were SCCs, including 11 central and 5 peripheral types. Eleven (69%) of 16 chromate SCCs showed cyclin D1 expression. In contrast, cyclin D1 expression was observed in only 3 (12%) of 26 SCCs from nonexposed individuals and 6 (16%) of 37 SCCs that developed in patients with pneumoconiosis, respectively. The frequency of cyclin D1 expression proved to be significantly higher in chromate-induced SCCs than in SCCs from nonexposed individuals and from those with pneumoconiosis (P < .001). When comparisons were extended to all histologic types of lung cancer, cyclin D1 expression was observed significantly more often in chromate-induced lung cancers than in lung cancers from nonexposed subjects and those from patients with pneumoconiosis (11 [58%] of 19 v 5 [10%] of 52, P < .001, and 7 [11%] of 63, P < .001, respectively). Frequencies of bcl-2 and p53 expression were not significantly different among lung cancers from ex-chromate workers, nonexposed individuals and those with pneumoconiosis. The current study suggests that cyclin D1 expression may be involved in the development of chromate-induced lung cancers, although its underlying mechanism remains to be determined.

Chromic acid burns: early aggressive excision is the best method to prevent systemic toxicity

Chromium poisoning can occur from the cutaneous absorption of chromium from burns that are as small as 1% of the total body surface area. In this case report, we describe a patient with 10% total body surface area burns caused by hot chromic acid. The amount of chromium removed by peritoneal dialysis and the amount of chromium in the urine were estimated, as well as the chromium content in the excised skin, serum, and red blood cells. The extent of chromium load from this type of injury and subsequent risk of systemic poisoning is not predictable, and we therefore believe that systemic toxicity is best prevented by early excision of the burned skin.

Lichen planus with involvement of all twenty nails and the oral mucous membrane

A 57-year-old man had had deformities of all ten fingernails for one and a half years before presentation and deformities of all ten toenails for the previous six months. The surfaces of the nails were rough, with excessive longitudinal striations. The bases of the nails were slightly hypertrophic, and the tips were atrophic and itchy. A longitudinal nail biopsy including the nail matrix revealed the typical histology of lichen planus. Reticulated pigmentation, maceration, and erosion on the buccal mucous membrane were also discovered. Histological analysis of the buccal mucous membrane revealed lichen planus intermingled with eosinophils. Immunological blood analysis revealed elevated CD4+ T cells and CD4/CD8 ratio. He worked as a tinsmith and had dental metal. The metal series patch test revealed positive reactions to chromate and tin. Treatment with systemic steroids was quite effective in treating the nail lesions.

Mortality among aircraft manufacturing workers

OBJECTIVES

To evaluate the risk of cancer and other diseases among workers engaged in aircraft manufacturing and potentially exposed to compounds containing chromate, trichloroethylene (TCE), perchloroethylene (PCE), and mixed solvents.

METHODS

A retrospective cohort mortality study was conducted of workers employed for at least 1 year at a large aircraft manufacturing facility in California on or after 1 January 1960. The mortality experience of these workers was determined by examination of national, state, and company records to the end of 1996. Standardised mortality ratios (SMRs) were evaluated comparing the observed numbers of deaths among workers with those expected in the general population adjusting for age, sex, race, and calendar year. The SMRs for 40 cause of death categories were computed for the total cohort and for subgroups defined by sex, race, position in the factory, work duration, year of first employment, latency, and broad occupational groups. Factory job titles were classified as to likely use of chemicals, and internal Poisson regression analyses were used to compute mortality risk ratios for categories of years of exposure to chromate, TCE, PCE, and mixed solvents, with unexposed factory workers serving as referents.

RESULTS

The study cohort comprised 77,965 workers who accrued nearly 1.9 million person-years of follow up (mean 24.2 years). Mortality follow up, estimated as 99% complete, showed that 20,236 workers had died by 31 December 1996, with cause of death obtained for 98%. Workers experienced low overall mortality (all causes of death SMR 0.83) and low cancer mortality (SMR 0.90). No significant increases in risk were found for any of the 40 specific cause of death categories, whereas for several causes the numbers of deaths were significantly below expectation. Analyses by occupational group and specific job titles showed no remarkable mortality patterns. Factory workers estimated to have been routinely exposed to chromate were not at increased risk of total cancer (SMR 0.93) or of lung cancer (SMR 1.02). Workers routinely exposed to TCE, PCE, or a mixture of solvents also were not at increased risk of total cancer (SMRs 0.86, 1.07, and 0.89, respectively), and the numbers of deaths for specific cancer sites were close to expected values. Slight to moderately increased rates of non-Hodgkin's lymphoma were found among workers exposed to TCE or PCE, but none was significant. A significant increase in testicular cancer was found among those with exposure to mixed solvents, but the excess was based on only six deaths and could not be linked to any particular solvent or job activity. Internal cohort analyses showed no significant trends of increased risk for any cancer with increasing years of exposure to chromate or solvents.

CONCLUSIONS

The results from this large scale cohort study of workers followed up for over 3 decades provide no clear evidence that occupational exposures at the aircraft manufacturing factory resulted in increases in the risk of death from cancer or other diseases. Our findings support previous studies of aircraft workers in which cancer risks were generally at or below expected levels.

Dermatoses in cement workers in southern Taiwan

Construction workers are known to have occupational dermatoses. The prevalence of such dermatoses was unknown in Taiwanese construction workers. The objective of this study was to determine the work exposure, prevalence of skin manifestations, and sensitivity to common contact allergens in cement workers of southern Taiwan. A total of 1147 current regular cement workers were telephone-interviewed about skin problems during the past 12 months, work exposure, and personal protection. Among those interviewed, 166 were examined and patch tested with common contact allergens. A high % of cement workers reported skin problems in the past 12 months. More men (13.9%) reported skin problems possibly related to work than women (5.4%). Prevalence was associated with lower use of gloves, duration of work as cement worker, and more time in jobs involving direct manual handling of cement, especially tiling. A high % of dermatitis was noted in the 166 workers examined, which correlated with reported skin problems. On patch testing, construction workers had a high frequency of sensitivity to chromate. Sensitivity to chromate or cobalt was associated with reported skin problems, or dorsal hand dermatitis on examination. These workers' dermatitis was under-diagnosed and inadequately managed. It is concluded that cement workers in southern Taiwan had a high prevalence of skin problems related to cement use. Protective measures, work practice, and physician education should be improved to prevent or manage such problems.

Effects of smoking, aromatic amines, and chromates on CD4+ and CD8+ T lymphocytes in male workers

To investigate effects of smoking, aromatic amines (AAs), and chromates (CRs) on T lymphocyte subpopulations, we measured CD3+, CD4+, and CD8+ T lymphocytes in the peripheral blood of 33 nonexposed workers, 25 AA-use workers, 27 AA-production workers, and 19 CR workers (all subjects were males). The number of CD4+ T lymphocytes in smokers of nonexposed workers was significantly larger than that of the nonsmokers; also, the numbers of CD4+ and CD3+ T lymphocytes in smokers of each group of AA-production and AA-use workers were significantly larger than those in nonsmokers. Number of CD4+ and CD3+ T lymphocytes in nonsmokers of AA-production and CR workers were significantly smaller than those in nonsmokers of nonexposed workers; the number of CD8+ T lymphocytes in nonsmokers of CR workers was significantly smaller than that in nonsmokers of nonexposed workers. The cross-sectional study suggests that (1) smoking increases CD4+ (and CD3+) T lymphocytes in all categories of workers except for CR workers; (2) exposure to CRs and AAs decreases CD4+ (and CD3+) T lymphocytes; (3) the magnitude of decrease in CD4+ T lymphocytes is large among CR workers, intermediate among AA-production workers, and small among AA-use workers regardless of smoking status; and (4) exposure to CRs also decreases CD8+ T lymphocytes.

Contact sensitivity to chromate: comparison at a London contact dermatitis clinic over a 10-year period

It has been argued that for chromate sensitivity to be reduced, then ferrous sulfate should be added to cement. This has not yet been done in the UK. To explore this further, we have looked at the comparative sensitization rates of patients attending the St. John's Institute of Dermatology Contact Dermatitis Clinic between the years 1982-3 and 1992-3. Patch-test-positive rates for females were not significantly different between the 2 populations studied (1982-3, 1.59% and 1992-3, 1.99% p NS). Similarly, there was no significantly different rate between the males (1982-3, 3.99% and 1992-3, 4.25% p NS) in the same time period. There was no difference in the distribution of eczema in chromate-positive subjects, nor of cobalt co-sensitization, a crude indicator of sensitization via cement. This work demonstrates no appreciable difference in the frequency of chromate sensitivity between the early 1980s and 1990s in London. Adding ferrous sulfate to cement may help to lower the frequency in the future.