Industrial airborne irritant or allergic contact dermatitis

Review of refractory ceramic fiber (RCF) toxicity, epidemiology and occupational exposure

This literature review on refractory ceramic fibers (RCF) summarizes relevant information on manufacturing, processing, applications, occupational exposure, toxicology and epidemiology studies. Rodent toxicology studies conducted in the 1980s showed that RCF caused fibrosis, lung cancer and mesothelioma. Interpretation of these studies was difficult for various reasons (e.g. overload in chronic inhalation bioassays), but spurred the development of a comprehensive product stewardship program under EPA and later OSHA oversight. Epidemiology studies (both morbidity and mortality) were undertaken to learn more about possible health effects resulting from occupational exposure. No chronic animal bioassay studies on RCF have been conducted since the 1980s. The results of the ongoing epidemiology studies confirm that occupational exposure to RCF is associated with the development of pleural plaques and minor decrements in lung function, but no interstitial fibrosis or incremental lung cancer. Evidence supporting a finding that urinary tumors are associated with RCF exposure remains, but is weaker. One reported, but unconfirmed, mesothelioma was found in an individual with prior occupational asbestos exposure. An elevated SMR for leukemia was found, but was absent in the highly exposed group and has not been observed in studies of other mineral fibers. The industry will continue the product stewardship program including the mortality study.

Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy

The International Contact Dermatitis Research Group proposes a classification for the clinical presentation of contact allergy. The classification is based primarily on the mode of clinical presentation. The categories are direct exposure/contact dermatitis, mimicking or exacerbation of preexisting eczema, multifactorial dermatitis including allergic contact dermatitis, by proxy, mimicking angioedema, airborne contact dermatitis, photo-induced contact dermatitis, systemic contact dermatitis, noneczematous contact dermatitis, contact urticaria, protein contact dermatitis, respiratory/mucosal symptoms, oral contact dermatitis, erythroderma/exfoliative dermatitis, minor forms of presentation, and extracutaneous manifestations.

Review of Non-Respiratory, Non-Cancer Physical Health Conditions from Exposure to the World Trade Center Disaster

After the World Trade Center attacks on 11 September 2001 (9/11), multiple cohorts were developed to monitor the health outcomes of exposure. Respiratory and cancer effects have been covered at length. This current study sought to review the literature on other physical conditions associated with 9/11-exposure. Researchers searched seven databases for literature published in English from 2002 to October 2017, coded, and included articles for health condition outcome, population, 9/11-exposures, and comorbidity. Of the 322 titles and abstracts screened, 30 studies met inclusion criteria, and of these, 28 were from three cohorts: the World Trade Center Health Registry, Fire Department of New York, and World Trade Center Health Consortium. Most studies focused on rescue and recovery workers. While many of the findings were consistent across different populations and supported by objective measures, some of the less studied conditions need additional research to substantiate current findings. In the 16 years after 9/11, longitudinal cohorts have been essential in investigating the health consequences of 9/11-exposure. Longitudinal studies will be vital in furthering our understanding of these emerging conditions, as well as treatment effectiveness.

The dermal toxicity of cement

Cement and concrete are products used widely in the construction sector, with a traditional perception that any hazards that they have are limited to dermatitis in a small number of workers. In some cases, employers and builders do not think that concrete is a chemical. However, contact dermatitis is one of the most frequently reported health problems among construction workers. A review of the available literature suggests that cement has constituents that produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients such as chromium). These findings indicate that cement and concrete should be treated as hazardous materials, and that workers handling such products should reduce exposure wherever possible. Initiatives to reduce the chromium content of cement have been shown to be successful in reducing the incidence of allergic dermatitis, although the irritant form remains.

Environmental airborne contact dermatoses

This chapter is complementary to Chapter 4 published in the same series. Airborne contact dermatitis (ABCD) is considered a prototype in the field of environmental dermatology. It is often underestimated in most textbooks of general dermatology, despite its frequent occurrence in daily life. ABCD may be irritant, allergic, phototoxic, or photoallergic. Airborne contact urticaria is another example. A particular clinical aspect is the "head and neck dermatitis", which occurs in atopic adult patients. Occupational ABCD represents a most difficult issue in terms of diagnostic procedures. It is obvious that non-occupational ABCD cases involve similar problems, usually easier to solve, and our comments refer to both conditions. Two examples of potentially airborne skin infections (e.g., anthrax and Ebola virus hemorrhagic fever) are also described because they are closely related to the same problematics. A new example of airborne irritant contact dermatitis, not reported so far, is linked with the use of continuous airway pressure in the treatment of obstructive sleep apnea.

Prevalence of dermatitis in the working population, United States, 2010 National Health Interview Survey

BACKGROUND

Prevalence patterns of dermatitis among workers offer clues about risk factors and targets for prevention, but population-based estimates of the burden of dermatitis among US workers are lacking.

METHODS

Data from an occupational health supplement to the 2010 National Health Interview Survey (NHIS-OHS) were used to estimate the prevalence of dermatitis overall and by demographic characteristics and industry and occupation (I&O) of current/recent employment.

RESULTS

Data were available for 27,157 adults, including 17,524 current/recent workers. The overall prevalence rate of dermatitis among current/recent workers was 9.8% (range among I&O groups: 5.5-15.4%), representing approximately 15.2 million workers with dermatitis. The highest prevalence rates were among I&O groups related to health care. Overall, 5.6% of dermatitis cases among workers (9.2% among healthcare workers) were attributed to work by health professionals.

CONCLUSIONS

Dermatitis affected over 15 million US workers in 2010, and its prevalence varied by demographic characteristics and industry and occupation of employment. The prevalence rate of work-related dermatitis based on the NHIS-OHS was approximately 100-fold higher than incidence rates based on the Bureau of Labor Statistics' Survey of Occupational Illness and Injury.

Self-reported skin rash or irritation symptoms among World Trade Center Health Registry participants

OBJECTIVES

We described self-reported skin rash 2 to 3 and 5 to 6 years after 9/11 and examined its association with exposures to 9/11 dust/debris.

METHODS

We analyzed a longitudinal study of New York City World Trade Center Health Registry participants who resided or worked in Lower Manhattan or worked in rescue/recovery in two surveys (W1 and W2).

RESULTS

Among 42,025 participants, 12% reported post-9/11 skin rash at W1, 6% both times, 16% at W2. Among participants without posttraumatic stress disorder or psychological distress, W1 self-reported post-9/11 skin rash was associated with intense dust cloud exposure (adjusted odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.3 to 1.9), home/workplace damage (adjusted OR = 1.8; 95% CI, 1.4 to 2.3), and working more than 90 days (adjusted OR = 1.7; 95% CI, 1.3 to 2.2) or 31 to 90 days (adjusted OR = 1.6; 95% CI, 1.3 to 2.1) at the World Trade Center site.

CONCLUSIONS

Post-9/11 skin rash may be related to acute and long-term exposure to dust, though subjectivity of skin symptoms may bias findings.

Airborne irritant contact dermatitis and conjunctivitis after occupational exposure to chlorothalonil in textiles

Chlorothalonil (tetrachloro-1,3-benzenedicarbonitrile, CAS 1897-45-6) is a pesticide that has been on the market for many years. It is used as a fungicide in agriculture, horticulture, and floriculture; as a wood preservative; and in paint. We report an epidemic of airborne irritant contact dermatitis, conjunctivitis, and upper airway complaints among seamstresses in a Portuguese trailer tent factory, which we attribute to chlorothalonil. All exposed workers had work-related skin symptoms. After patch testing, we showed that none of these were of allergic origin. Instead of allergic reactions, we noticed a delayed type of irritation after 72 hr to chlorothalonil and to the textile extracts containing high concentrations of chlorothalonil. Although allergic and irritant contact dermatitis from chlorothalonil has been described before, this is, as far as we know, the first time that a delayed type of dermatitis, conjunctivitis, and upper airway irritation after exposure to chlorothalonil in tent-cloth is described.

Airborne irritant contact dermatitis due to synthetic fibres from an air-conditioning filter

We describe 8 cases of occupational airborne irritant contact dermatitis in intensive care unit (ICU) employees caused by synthetic (polypropylene and polyethylene) fibres from an air-conditioning filter. Not until a workplace investigation was conducted, was it possible to clarify the unusual sequence of events. High filter pressure in the intensive care air-conditioning system, maintained to establish an outward airflow and prevent microorganisms from entering the ward, probably caused fibres from the filter to become airborne. Upon contact with air-exposed skin, fibres subsequently provoked skin irritation. Test periods in the ICU with varying filter pressures, in an attempt to improve environmental conditions, led to even higher filter pressure levels and more complaints. The sometimes-very-low humidity might have contributed to development of skin irritation. The fact that most patients recovered quickly after treatment with emollients and changing the filters made it most likely that the airborne dermatitis was of an irritant nature.

Occupational irritant contact dermatitis from synthetic mineral fibres according to Finnish statistics

Synthetic mineral fibres (i.e. man-made vitreous fibres, MMVF) are classified into glass filament, mineral wool (glass wool, rock wool and slag wool), refractory ceramic fibres, and fibres for special purposes. This paper analyses the data on occupational irritant contact dermatitis (ICD) caused by MMVF during 1990-99 in Finland according to the Finnish Register of Occupational Diseases (FROD). A total of 63 cases from MMVF were reported. 56 were diagnosed as ICD, and 2 as allergic contact dermatitis, both from rock wool. 53 out of 63 cases were due to mineral wool or glass filaments; half of the cases, according to a rough estimate, were due to mineral wool and a half due to glass filaments used in lamination work. Carpenters, building workers and insulation workers have the highest risk of ICD from mineral wool. 4 cases in carpenters, 4 in building workers and 2 in insulation workers were reported from MMVF. For every 100 000 employed workers, only 1.6 cases of ICD in carpenters, 2.7 in building workers and 9.1 in insulation workers were annually due to MMVF, respectively. Mineral wool used in construction work, insulation, etc., cannot be considered to be a common cause of occupationally induced ICD. However, information on harmful skin effects of MMVF is useful to exposed persons in the prevention of the effects.

Eyelid dermatitis

Cosmetic alteration of a patient's orbital skin is a common reason for professional consultation. This review presents the differential diagnosis and recommended evaluation of inflamed eyelids. To better understand the diseases, each is individually addressed clinically, pathogenetically, and therapeutically. It is critical to recognize the lesions correctly and to have full knowledge of the putative clinical disease process. An algorithm for an appropriate work-up for each disease is offered. With this background, a successful therapeutic response can be anticipated.

Irritant contact dermatitis. Clues to causes, clinical characteristics, and control

Skin irritation can cause poorly defined nonimmunologic cutaneous changes that may cause diagnostic confusion. Clinical signs include vesicles, papules, bullae, erythema, edema, scaling, and lichenification. In some patients, this condition, termed irritant contact dermatitis, is indistinguishable from endogenous, dyshidrotic, nummular, and atopic dermatitis. Irritant contact dermatitis has only a few typical characteristics. The diagnosis is generally based on clinical appearance, history and, when indicated, diagnostic patch testing to rule out an allergic component. Elimination of the offending agent and protection from further exposure are important in both diagnosis and management. The dermatitis usually heals once the irritant is eliminated, and reexposure should be minimized for weeks to months, if not permanently.

Airborne irritant contact dermatitis from metal dust adhering to semisynthetic working suits

2 workers at an aircraft factory were employed in a plasma sparying unit. Soon after they were equipped with new semisynthetic working suits, they started to complain of pruritic eruptions after heavy exposure to metal dust. They noted that the dust was not as easily blown off the clothes by pressurized air as previously. Clinical findings consisted of discrete macular and papular lesions, partly follicular, on the ventral and medial thighs. Atopy score, IgE level and a standard series of prick tests ruled out atopic disposition. Patch tests revealed no reactions. A diagnosis of occupational airborne irritant contact dermatitis from metal dust was therefore made. To elucidate the role of the working suit, extensive physical investigations of the physical properties of the textile were performed. Microscopic pictures at low magnification showed more dust particles on the semisynthetic working suit, compared to the former pure cotton suit. This impression could not be confirmed by particle count because of too uneven particle distribution at higher magnification. Hairiness of the 2 textiles was low and ruled out irritation by the semisynthetic textile itself. No difference in electrostatic properties between the 2 working suits could be established either. Both textiles showed high static electrical propensity. When use of the semisynthetic overall was discontinued, the patients reported no recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Occupational skin hazards from synthetic plastics

Epoxy and acrylic resins have numerous industrial applications but are also widely used in the household environment. These compounds are presently one of the most important sources of occupational contact dermatitis. Contact sensitization to epoxy resins is usually caused by the resin itself but hardeners or other additives, such as reactive diluents, plasticizers, fillers and pigments, can occasionally be responsible. Since completely cured epoxy resins are not sensitizers, epoxy resin sensitization is always due to the presence, in the final polymer, of uncured allergenic low molecular weight oligomers. Acrylates are now considered the fourth most common cause of contact sensitization due to resins. Unpolymerized monomers of acrylic compounds are known to be responsible for the contact allergy. Accelerators, inhibitors and catalysts, which are usually added to the acrylates to promote the polymerization process, can also sensitize. Both allergic and irritant contact dermatitis may be caused by exposure to epoxy or acrylic resins and their additives. Contact urticaria, allergic or irritant airborne contact dermatitis caused by volatile compounds, onychia and paronychia can also occur. From January of 1984 to May of 1992 we detected 39 cases of occupational allergic contact dermatitis to epoxy resin system substances and 11 cases of occupational contact sensitization to acrylic compounds. In our experience, the electronics industry as well as paint and glue related activities were the most important sources of epoxy sensitization. Dental materials and anaerobic sealants were found to be the most frequent acrylate sensitizers.

Airborne contact dermatitis: an update

This review is an update of a previously published one on airborne-induced contact dermatoses. Because reports in the literature often omit the term 'airborne', 12 volumes of Contact Dermatitis (July 1985-April 1991) were screened, and the cases cited were classified as to history, lesion locations, causative agents, and other factors. The number of reports of airborne dermatoses has increased considerably in recent years.

Facial dermatitis caused by chlorothalonil in a paint

A case of acute facial dermatitis caused by staying in a summer cottage is described. Patch testing revealed contact allergy to the paint På Trä Lasur, and to chlorothalonil. Chlorothalonil was used as a pesticide in the paint. Chemical analyses using high-performance liquid chromatography and gas chromatography/mass spectrometry were performed to reveal the purity of the chlorothalonil. Chlorothalonil has earlier been described as a contact allergen, sometimes causing facial dermatitis. The reason for localization to the face has not before been discussed. It is now suggested that it might be due to the high vapour pressure of chlorothalonil. It is concluded that products containing chlorothalonil are unsuitable for indoor use.

Antibody production in rats after long-term exposure to formaldehyde

Sprague-Dawley rats were vaccinated with pneumococcal polysaccharide antigens and tetanus toxoid to evaluate the immunologic effects of long-term formaldehyde exposure. The antibody response to vaccination was measured 3 to 4 weeks later by enzyme-linked immunosorbent assay. An IgG response to pneumococcal polysaccharides and to tetanus toxoid was found in both the formaldehyde-exposed group and a control group of rats not exposed to formaldehyde. The IgM response to tetanus toxoid was significant in both groups but neither group showed a significant IgM response to pneumococcal polysaccharides. There were thus no signs of impaired B-cell function in rats exposed to a high concentration (12.6 ppm) of formaldehyde for nearly 2 years.