Cutaneous reactivity of the hands in nickel-sensitive patients with hand eczema

Occupational exposure to nickel, cobalt, and chromium in the Lithuanian hard metal industry

BACKGROUND

Metalworkers are said to have heavy exposure to metals, but the amount of released metal ions from alloys and deposition on the hands is unknown.

OBJECTIVE

To analyze nickel, cobalt, and chromium in vitro release to the artificial sweat from nails and wire made of different alloys, and to test metal deposition on the fingers of metalworkers.

MATERIAL AND METHODS

Six different samples of nails and wire were kept in artificial sweat for 24 hours and one week, respectively. The metal release was determined by atomic absorption spectrometry (AAS). Eighty-eight consecutive metal plant workers immersed their index fingers and thumbs in separate laboratory tubes filled with deionized water for 2 minutes. The sample analysis for metals was carried out with an inductively coupled plasma mass spectrometer (ICP-MS).

RESULTS

The average released concentration of Ni was 0.0012 μg/cm² , for Co it was 0.0007 μg/cm² , and for Cr 0.0037 μg/cm² after 24 hours and 0.0135, 0.0029, and 0.0042 μg/cm² , respectively, after 1 week. There was a statistically significant increase in released concentration of Ni during one week: 0.0012 μg/cm² vs 0.0135 μg/cm² (P = .04). Medians of the detected Co amount on fingers reflected a statistically significant difference between workplaces: 0.004 μg/cm² for metalworkers vs 0.001 μg/cm² for office staff (P = .04).

CONCLUSION

Nickel (Ni), cobalt (Co), and chromium (Cr) can be released in different concentrations from nails and wire. Detected Ni and Cr levels can elicit dermatitis in already sensitized patients. Co can be extracted from alloys even if not mentioned on material safety data sheets. The finger immersion technique was used for cobalt and chromium detection on fingers for the first time.

Release of nickel from coins and deposition onto skin from coin handling--comparing euro coins and SEK

BACKGROUND

Nickel exposure is the most common cause of contact allergy. The role of contact with nickel-containing coins has been controversial.

OBJECTIVES

To compare the release of nickel from 1 and 2 EUR coins (both composed of two alloys: Cu 75%, Zn 20%, Ni 5% and Cu 75%, Ni 25%) and Swedish 1 SEK coin (alloy: Cu 75%, Ni 25%) and to assess the deposition of nickel onto skin by coin handling.

METHODS

Nickel release was determined by immersion in artificial sweat (2 min, 1 hr, 24 hr, and 1 week). Deposition of nickel onto the skin was assessed in three subjects after 1-hr handling of 2 EUR and 1 SEK coins. Samples (n = 48) were taken from fingers and palms by acid wipe sampling and analysed by inductively coupled plasma mass spectrometry.

RESULTS

Amounts of nickel released by 1 week from 1 SEK, 1 EUR, and 2 EUR coins were 121, 86, and 99 microg/cm(2), respectively. Corresponding 2 min values were 0.11, 0.25, and 0.22 microg/cm(2). Nickel was deposited onto the skin by 1 hr coin handling (range 0.09-4.1 microg/cm(2)), the largest amounts were on fingers; similar amounts of nickel were deposited from 1 SEK and 2 EUR coins.

CONCLUSIONS

Nickel is released from 1 and 2 EUR and 1 SEK coins at similar amounts. Nickel is deposited onto skin at substantial and similar amounts by coin handling. Acid wipe sampling is suitable for studies of skin exposure to nickel and in risk assessment.

[Metallurgical differentiation of cobalt-chromium alloys for implants]

BACKGROUND

Cobalt Chromium alloys are used in cemented total hip or knee arthroplasty as well as in metal-on-metal bearings in total hip arthroplasty. An increasing number of publications report about (allergic) reactions to wear particles of Cobalt Chromium alloys. Reactions to nickel are more frequent in comparison to Cobalt or Chromium particles. It is well known that different kinds of Cobalt Chromium alloys contain different amounts of alloying elements; nevertheless. The aim of the current work was to compare the different Cobalt Chromium alloys according to ASTM F or ISO standards in respect to the different alloying elements.

MATERIAL AND METHODS

Co28Cr6Mo casting alloys according to ASTM F 75 or ISO 5832-4 as well as forging alloy types according to ASTM F 799 and ISO 5832 such as Co20Cr15W10Ni, Co35Ni20Cr, Fe40Co20Cr10Ni, Co20Cr20Ni, and Co28Cr6Mo were analyzed in respect to their element content of Co, Cr, Ni, Mo, Fe, W, and Mn.

RESULTS

In 1935 the Cobalt based alloy "Vitallium" Co30Cr5Mo basically used in the aircraft industry was introduced into medicine. The chemical composition of this alloy based on Cobalt showed 30 wt.% Chromium and 5 wt.% Molybdenum. The differentiation using alloy names showed no Nickel information in single alloy names.

CONCLUSION

The information given about different alloys can lead to an unprecise evaluation of histopathological findings in respect to alloys or alloying constituents. Therefore, implant manufacturers should give the exact information about the alloys used and adhere to European law, Euronorm 93/42/EWG.

Experimental nickel elicitation thresholds - a review focusing on occluded nickel exposure

Nickel (Ni) is the most frequent cause of contact allergy among the female population. This makes it interesting to examine thresholds for elicitation under different conditions. Even though Ni exposure may be open, occluded, penetrating or oral, most dose-response studies in the literature concern single occluded application. The aims of this study were to assess thresholds of response by making a statistical analysis of available dose-response studies with single occluded exposure and comparing the results to thresholds from other modes of exposure. 8 occluded Ni dose-response studies were selected based on statistical considerations. The statistical analysis showed that 5% of a sensitized population react to 0.44 microg Ni/cm2 and 10% react to 1.04 microg Ni/cm2. In another study with a single open application, 7.8% of sensitized persons responded to a dose x6 higher than the dose to which 10% reacted in occluded exposure. When combining the exposure to Ni with an irritant, divagating results were found, although the literature shows evidence of an augmented response when combining exposure to an allergen and an irritant. The thresholds of penetrating exposure were found to be lower than the thresholds of single occluded exposure. Comparisons of different kind of exposures across studies are difficult, because of differences in the studies, although a comparison could be made by a study that compares the different exposures within the same individuals at the same time.

Influence of a detergent on skin response to methyldibromo glutaronitrile in sensitized individuals

The present study was undertaken to evaluate the combined effect of the preservative methyldibromo glutaronitrile (MDBGN) and sodium lauryl sulfate (SLS) on the elicitation response of allergic contact dermatitis. 20 volunteers with contact allergy to MDBGN were patch tested with 5 concentrations (10, 50, 100, 500 and 1000 p.p.m.) of MDBGN alone and in combination with 0.25% SLS on the upper arms for 24 h. Skin reactions were evaluated by clinical scoring, and data were evaluated by logistic dose-response models. Additionally, evaluation of skin reactions was performed by measurement of transepidermal water loss (TEWL) and skin colour. Measurements were obtained at baseline and at D3 and D7. As evaluated by clinical assessment, allergic reactions to MDBGN were elicited at lower concentrations when applied in combination with SLS than when applied alone. The response was augmented by a factor of 6.4. An increased response to combined exposure to SLS and MDBGN as compared with MDBGN alone was confirmed by TEWL and colour measurements. Effects of exposure time and concentration of the detergent are discussed. In conclusion, an augmented response was found after concurrent application of MDBGN and SLS. The response was augmented by a factor of 6.4, with confidence limits of 2.8-14.6 (P < 0.0001). This result is important in relation to the determination of threshold values and the risk assessment of contact allergens in consumer and industrial products, where allergens are often present in combination with surfactants.

Basal electrical impedance in relation to sodium lauryl sulphate-induced skin reactions - a comparison of patients with eczema and healthy controls

BACKGROUND

Identification of subjects at risk for contact dermatitis by screening tests is desirable in order to adjust the preventive measures to individual skin susceptibility. The present study aimed to examine the effects of basic physiological features, such as baseline electrical impedance (IMP) and transepidermal water loss (TEWL), on reactivity to sodium lauryl sulphate (SLS).

METHODS

On the basis of two previous studies, we re-evaluated the experimental irritant skin reactions (50 microL of 2% SLS in large Finn Chambers for 24 h) on the volar forearms of 29 patients with eczema and 19 healthy controls.

RESULTS

We found definite differences in the baseline values of IMP, between the patients and the controls. Moreover, patients with eczema showed higher TEWL and lower MIX values on day 3 after exposure to SLS, which may indicate differences in SLS reactivity. After the study, the biophysical parameters of the eczema patients did not return to baseline, which suggests that their skin heals more slowly than that of normal subjects.

CONCLUSIONS

Our findings indicate that the IMP technique may help to 'detect' chemically vulnerable skin. However, more studies are needed to determine the value of the basal electrical impedance parameters in assessing the risk of developing irritant contact dermatitis.

Nickel, chromium and cobalt in consumer products: revisiting safe levels in the new millennium

The transition metals nickel (Ni), chromium (Cr) and cobalt (Co) are common causes of allergic contact dermatitis (ACD). Given the high frequency with which these allergens can be associated with hand eczema in those responsible for domestic work, it has been suggested that contamination of household consumer products with these metals may be of relevance to the causation/chronicity of hand dermatitis. Dose-response studies using 48 h occlusive patch test conditions in sensitized individuals show that >/=90% of sensitized patients fail to react below 1 p.p.m., even on irritated skin. Assessment under more realistic exposure conditions has shown that in the presence of irritants and/or following repeated exposures, such individuals rarely react to levels below 10 p.p.m. On the basis of this information, it was recommended a decade ago that household (and other consumer) products should not contain more than 5 p.p.m. of each of Ni, Cr or Co and that, for an even greater degree of protection, the ultimate target level should be 1 p.p.m. The data generated since the original recommendations were made serve to reinforce the validity of these recommendations. Indeed, it is our view that typically the level of each of these transition metals should not normally exceed 1 p.p.m. Then, where consumer products meet this guideline fully, modern quantitative risk assessment shows clearly that elicitation of ACD is highly improbable, and the chance of the induction of sensitization is even lower.

The fragrance hand immersion study - an experimental model simulating real-life exposure for allergic contact dermatitis on the hands

Recently, we showed that 10 x 2% of consecutively patch-tested hand eczema patients had a positive patch test to a selection of fragrances containing fragrances relevant to hand exposure. In this study, we used repeated skin exposure to a patch test-positive fragrance allergen in patients previously diagnosed with hand eczema to explore whether immersion of fingers in a solution with or without the patch-test-positive fragrance allergen would cause or exacerbate hand eczema on the exposed finger. The study was double blinded and randomized. All participants had a positive patch test to either hydroxycitronellal or Lyral (hydroxyisohexyl 3-cyclohexene carboxaldehyde). Each participant immersed a finger from each hand, once a day, in a solution containing the fragrance allergen or placebo. During the first 2 weeks, the concentration of fragrance allergen in the solution was low (approximately 10 p.p.m.), whilst during the following 2 weeks, the concentration was relatively high (approximately 250 p.p.m.), imitating real-life exposure to a household product like dishwashing liquid diluted in water and the undiluted product, respectively. Evaluation was made using a clinical scale and laser Doppler flow meter. 3 of 15 hand eczema patients developed eczema on the finger immersed in the fragrance-containing solution, 3 of 15 on the placebo finger and 3 of 15 on both fingers. Using this experimental exposure model simulating real-life exposure, we found no association between immersion of a finger in a solution containing fragrance and development of clinically visible eczema on the finger in 15 participants previously diagnosed with hand eczema and with a positive patch test to the fragrance in question.

Clinical manifestations of hand eczema compared by etiologic classification and irritation reactivity to SLS

Hand eczema is a common skin disease. Because of its variable etiologies and clinical manifestations, it is difficult to determine the etiology from the clinical manifestation. Among the contact allergens, nickel is the most common. Patients with hand eczema and a nickel allergy have a poorer prognosis than patients without a nickel allergy. The reason is still uncertain; suggestions include persistent exposure to nickel or a weak skin barrier. The purpose of our study was to identify the characteristic clinical manifestations by etiology and to compare the skin barrier state between patients with nickel allergies and those without them. Ninety-three patients were classified into 4 types; irritation contact type, allergic contact type, atopic type and mixed type. After the sodium lauryl sulfate (SLS) test to compare the skin barrier state, visual score and transepidermal water loss (TEWL) were measured and analyzed statistically. From this study, it was not possible to ascertain a statistical difference, however a few characteristic clinical manifestations according to etiology can be stated. There was no difference in the visual scoring system or the TEWL after the SLS irritation test between the nickel-allergy group and the non-allergy group. Therefore, we believe that the poor prognosis of hand eczema with nickel allergy may be due to the nickel allergy itself rather than skin barrier state.

Factors affecting thresholds in allergic contact dermatitis: safety and regulatory considerations

Although it is now well understood that thresholds exist for both the induction and the elicitation of allergic responses, such as those of allergic contact dermatitis, it must also be appreciated that for any given allergen, these thresholds are not absolute values. They will vary between individuals, and according to the conditions of exposure to the allergen. Therefore, it is necessary for the purposes both of risk assessment and regulatory toxicology to appreciate the variables involved and to adopt strategies that incorporate this understanding. In this short article, the nature of thresholds in allergic contact dermatitis and the factors affecting them are reviewed. In particular, thresholds will vary according to whether skin exposure is transient or prolonged, open or occluded and single or repeated. The condition of the skin, the presence of inflammation and the matrix in which a chemical sensitizer comes into contact with the skin also are important. However, the scale of these variables frequently is quantifiable. Thus, recommendations can be made concerning how these considerations can be embraced by those responsible for safety evaluation and for the shaping of regulations for skin sensitizing chemicals/formulations.

Altered serum cytokine and immunoglobulin levels in the workers exposed to antimony

1 Antimony (Sb), an industrial and environmental toxicant, is known to cause dermatitis and pulmonary inflammations, but the immunomodulatory effects of environmental or occupational exposure to Sb have not been reported. To initiate investigation of Sb-induced alterations of the immune system, the concentrations of the IgG subclasses, IgE, interleukin-2, interferon-gamma, and interleukin-4 in sera obtained from workers exposed to Sb through antimony trioxide manufacture were determined and compared with those of control subjects. 2 The serum levels of IgG1, an immunoglobulin involved in host defense against many microbial infections, were significantly lower in the sera of Sb-exposed individuals than the controls. The serum concentrations of IgE, an immunoglobulin mediating allergic hypersensitivity, also were lower in the Sb-exposed workers than the controls. In addition, the levels of interleukin-2 and interferon-gamma, multifunctional cytokines for T-cell mediated immunity, were lowered in the factory workers. 3 A significant positive correlation between IgG4 and urine Sb levels was found among the Sb-exposed workers, indicating a possible role of IgG4 in Sb-mediated pulmonary or skin pathogenesis. 4 The present study provides the first report on immune alterations induced by occupational exposure to Sb and suggests that Sb exposure disturbs immunohomeostasis in humans observed as a function of aberrant serum cytokine and immunoglobulin levels, which could influence health.

Effects of repeated skin exposure to low nickel concentrations: a model for allergic contact dermatitis to nickel on the hands

We studied the effects of repeated daily exposure to low nickel concentrations on the hands of patients with hand eczema and nickel allergy. The concentrations used were chosen to represent the range of trace to moderate occupational nickel exposure. The study was double-blinded and placebo controlled. Patients immersed a finger for 10 min daily into a 10-p.p.m. nickel concentration in water for the first week, and during the second week into a 100-p.p.m. nickel concentration. This regimen significantly increased (P = 0.05) local vesicle formation and blood flow (P = 0.03) as compared with a group of patients who immersed a finger into water. The nickel concentrations used also provoked significant inflammatory skin changes on sodium lauryl sulphate (SLS)-treated forearm skin of the patients, whereas inflammatory skin changes were not observed in healthy volunteers without hand eczema and nickel allergy, either on normal or on SLS-treated forearm skin. The present study strongly suggests that the changes observed were specific to nickel exposure. Standardized methods to assess trace to moderate nickel exposure on the hands, and the associated effects in nickel-sensitized subjects, are needed.