Contact dermatitis among decorators and enamellers in hand-made ceramic decorations

Occupational contact dermatitis to nickel: experience of the British dermatologists (EPIDERM) and occupational physicians (OPRA) surveillance schemes

AIMS

To examine, from occupational surveillance reporting data, whether scheme reporters considered nickel exposure to play a role in occupational contact dermatitis (OCD) in the UK.

METHODS

Data on occupational skin disease in the UK are collected by two occupational disease surveillance schemes, EPIDERM and OPRA. Cases of OCD believed to have relevant nickel exposure reported to EPIDERM or OPRA from February 1993 to January 1999 were studied.

RESULTS

An estimate of 1190 cases of occupational contact dermatitis thought to have relevant nickel exposure (12% of total estimated OCD) was derived from reports by dermatologists, an average of 198 per year. The highest incidence rates were seen in hairdressers (23.9/100 000 workers/year), bar staff (4.7), chefs and cooks (4.4), retail cash and checkout operators (2.8), and catering assistants (2.5). From May 1994 to January 1999, 158 cases of nickel associated dermatitis (1.9% of total OCD cases) were estimated; the most frequently reported occupations were electronic assemblers, nurses, sales assistants, and general assemblers. From July 1997 to January 1999, 547 positive patch tests to nickel were reported; in 195 cases (36%), nickel was felt to be a relevant occupational allergen (for example, coin handling). In hairdressers, nurses, cooks, and beauticians, nickel was usually considered, if relevant at all, to be only one of several causes of dermatitis.

CONCLUSIONS

Up to 12% of total estimated cases of OCD were thought to be due in part to nickel. Results suggest that nickel hypersensitivity is one of several contributors to OCD in subjects with multiple occupational exposures. Coin handling may be a source of OCD to nickel.

Nickel dermatitis: how much nickel is safe?

The Nickel Directive will become law in the countries of the European Union in 1996. This directive states that the concentration of nickel in post assemblies (used after ear piercing) may not exceed 0.05%, that products which come into direct and prolonged contact with the skin, e.g. earrings, watchstraps or zippers, may not release greater than 0.5 microgram/cm2/week, and that nickel release from coated products will not exceed this level after 2 years of normal use. The data relating to the threshold for reacting to nickel and the levels of nickel release from nickel-containing objects, are considered in this review. Although the level of 0.5 microgram/cm2/week is one below which a minority of nickel-allergic subjects will react, it is not safe in every nickel-sensitive individual. This level of nickel release is currently exceeded by many nickel-containing alloys and jewelery items that are made from high-sulfur stainless steel, and manufacturers are going to have to change the composition of jewelery to comply with the directive.