Contact allergy caused by acrylates in nail cosmetics: A pilot study from Greece

BACKGROUND

The growing popularity of nail techniques based on acrylates has led to a higher frequency of sensitization in both nail technicians and users.

OBJECTIVES

The study aimed to assess cases of allergic contact dermatitis (ACD) caused by acrylates in individuals with occupational or non-occupational exposure to nail techniques.

METHODS

A preliminary study was conducted on 30 patients with ACD caused by acrylates in nail techniques, who were patch tested from September 2022 to March 2023 at the First Department of Dermatology and Venereology of Andreas Syggros Hospital, Athens, Greece.

RESULTS

Thirty female patients with ACD to acrylates were documented (15 users and 15 nail technicians and users). The most common allergens were: 2-hydroxyethyl methacrylate (HEMA), 2-hydroxypropyl methacrylate (HPMA) and ethyleneglycol dimethacrylate (EGDMA), which tested positive in all 30 patients (100.0%). Twenty patients (66.7%) had been exposed to dental procedures involving acrylates, before the onset of ACD. Nail technicians exhibited extensive skin lesions, 40.0% experienced ACD within the first year of work and 13.3% during their professional practice. Three of them (20.0%) had to discontinue their work.

CONCLUSION

Acrylates have been identified as potent allergens, necessitating the implementation of safety measures for the use of these chemicals in nail techniques.

Contact allergy to rubber accelerators in consecutively patch tested Danish eczema patients: A retrospective observational study from 1990 to 2019

BACKGROUND

Rubber accelerators are used in the production of rubber gloves and may cause contact allergy.

OBJECTIVES

To estimate long-term trend and prevalence of contact allergy to rubber accelerators for a 30-year period in Denmark, high-risk occupations, and exposures.

METHODS

Data from all patients with contact dermatitis consecutively patch tested at the department of Skin and Allergy Gentofte hospital with the rubber accelerators from the European baseline series (EBS) from 1990 to 2019, were analysed. Further, patients under suspicion of rubber accelerator contact allergy were additionally patch-tested with rubber accelerators from the specialised rubber series from 2005 to 2019 and these were additional extracted.

RESULTS

The overall prevalence of contact allergy to one or more of the rubber accelerators from the EBS series was 2.7% with a significant decline in the first 12-years, followed by a stable frequency in the past 18-years. Associations with occupational contact dermatitis, hand dermatitis, and leg/foot dermatitis were found. Wet-work occupations were most often affected and gloves the most frequent exposure.

CONCLUSIONS

Contact allergy to one or more of the rubber accelerators from the EBS is frequent and has been unchanged for several decades, which calls for prevention.

Tackling Acrylate Allergy: The Sticky Truth

Acrylates are synthetic thermoplastic resins used in numerous industries since their discovery in the mid-19th century. Known for their versatility in formulating various consumer, health care, and industrial products, acrylates also have come under scrutiny for their potential to cause allergic contact dermatitis (ACD). Allergic contact dermatitis to acrylates previously was largely occupational in nature, but the expanded use of acrylates in products ranging from nail cosmetics to medical devices has increasingly brought this allergy to the general population. Herein, we discuss the chemistry and allergenicity of acrylates and highlight common sources of exposure, clinical presentations, pertinent considerations for patch testing, and tips for the management/prevention of acrylate ACD. We hope to emphasize the shifting trend of exposure sources from the workplace to consumers, underlining the need for increased vigilance from physicians. Collaborative efforts among health care providers and patient education about allergen avoidance strategies are essential to mitigate potential complications arising from acrylate sensitization.

Occupational Exposure of Employees in a Multispecialty Hospital to Factors Causing Contact Dermatitis-A Questionnaire Study

Background and Objectives: Allergic contact dermatitis (ACD) is a serious health and socio-economic problem. Accurate and reliable assessment of exposure to ACD factors in the work environment would increase quality of life and work of employees. The aim of this study was to assess the level of exposure of workers of a multidisciplinary hospital to the factors causing ACD. Material and Methods: The proprietary OSDES-16 questionnaire was used. The effectiveness of the OSDES-16 was confirmed statistically. The study included 230 employees of the medical center in Polanica Zdrój, divided into groups. Results: The differences in the overall assessment of exposure between the individual groups in the OSDES-16 scale were statistically insignificant (p > 0.05). There was no significant correlation between the current workplace and the level of exposure to ACD (p > 0.05). The level of exposure to ACD in the group of employees with work experience in the current position for more than 10 years was significantly higher than those working less than 6 years (p < 0.05). Conclusions: Nurses, midwives and paramedics are the occupational group most exposed to the development of contact allergy related to exposure to factors present in the work environment. The seniority of more than 10 years in the current position was linked with a higher level of occupational exposure.

Prevalence and risk factors for hand eczema among professional hospital cleaners in Denmark: A cross-sectional questionnaire-based study

BACKGROUND

Professional cleaners are commonly affected by hand eczema (HE) due to wet work and exposure to cleaning products in the work environment.

OBJECTIVE

To investigate (1) the prevalence of HE in a group of professional hospital cleaners, (2) the association of HE with various comorbidities and self-reported signs/symptoms of skin lesions and (3) the association of HE with various occupational and personal risk factors in the same population.

METHODS

A cross-sectional questionnaire-based study including all cleaners working in three hospitals in Denmark. The questionnaire was composed of 35 questions. Prevalence is reported using proportions with 95% confidence intervals and compared using difference of proportions and Fisher's exact test.

RESULTS

A total of 122 out of 180 cleaners (response rate = 68%) participated in this study. The self-reported lifetime prevalence of HE among the cleaners was 30.3%, while the 1-year prevalence was 18.9%. HE was significantly associated with a history of atopic diseases. There was a significant correlation between having HE, and self-reported redness and itch of the hands in the last 12 months, as well as the use of hydrochloric acid ≥4 days/week during the last 12 months. Logistic regression analysis found HE significantly associated with washing hands ≥20 times during a working day and a history of atopic dermatitis.

CONCLUSION

Cleaners are at an elevated risk of developing HE. More focus on education/information regarding the prevention and treatment of HE is necessary for the cleaning profession. Self-reported redness and itching of the hands may be a useful prediction of HE in cleaners.

Occupational Skin Dermatitis among Healthcare Workers Associated with the COVID-19 Pandemic: A Review of the Literature

The skin is the outermost layer of the human body and is continually exposed to numerous external stimuli, which can cause unwanted skin irritation. Occupational skin diseases are the most prevalent form of work-related illness and are found in a variety of sectors, particularly healthcare. During the recent COVID-19 pandemic, healthcare professionals experienced a variety of unexpected, unusual occupational skin diseases associated with COVID-19-engaged employment. Because the clinical characteristics of these types of skin inflammation are unique, this review focuses on the characteristics of a large category of occupational workers, namely COVID-19-engaged healthcare professionals. Furthermore, we examined the potential pathogeneses of occupational skin disorders associated with COVID-19-engaged labor, as well as different preventative methods.

[A Case of Occupational Contact Dermatitis Caused by Rubber Gloves]

A 42-year-old man working at a steel mill recognized itching and erythema on the dorsal surfaces of his hands for 2 weeks prior to his first visit to our department. Lichenized erythematous plaques were observed on the dorsal surfaces of his fingers and hands. A patch testing of the rubber part of the gloves showed a positive reaction. We also conducted a patch testing of metals to exclude a possibility of contact dermatitis mediated by metals as occupational materials. The patch testing of metals showed a positive reaction to zinc, which is not an occupational material in his steel mill, but his rubber gloves contained zinc in the rubber accelerators, which might have been the trigger that caused his allergic contact dermatitis. Contact dermatitis is the most common occupational skin disease, and various materials are the causative agents. Allergic reactions to rubber (latex) are classified into type I allergy and type IV allergy. Type IV allergic reaction is observed in rubber accelerators such as thiuram; however, our case showed that zinc allergy could be a possible causative agent in patients with contact dermatitis due to rubber gloves.

[Molecular genetic studies in occupational medicine]

DNA diagnostic techniques aimed at elaborating informative criteria for assessment of the risk for occupational, occupationally induced diseases are extensively used to study the molecular mechanisms involved in the development of occupational diseases in labor medicine. Patients with different forms of occupational bronchopulmonary diseases have been found to have matrix metalloproteinase-1 (MMP-1) gene mutations. In some individuals, a combination of polymorphic variants of MMP-1 and alpha1-proteinase inhibitor genes is characterized by the presence of clinical complications and the concurrence of bronchopulmonary and skin diseases. GSTM1 gene mutation is noted for the earlier onset (up to 5 years), severity, and poor prognosis of allergic dermatoses.

Quality of life and depression in a population of occupational hand eczema patients

Occupational hand eczema (OHE) is the most frequently recognized occupational disease in Denmark, and despite governmental attempts to reduce exposure to harmful occupational allergens, the number of new cases has remained almost unchanged since the mid-1990s. Some studies have indicated that OHE has considerable impact on quality of life (QoL) and may lead to depression. The aims of the study were to determine risk factors for low QoL, the frequency and severity of depression among OHE patients and changes in QoL and depression after 12 months of follow up. The study population, 758 patients, comprised all new recognized cases from the Danish National Board of Industrial Injuries Registry between October 2001 and November 2002. All patients received a questionnaire to determine impairment of QoL and depressive symptoms. A similar follow-up questionnaire was posted after 1 year. The response rate was 82% at baseline and 91% at follow up. The mean Dermatology Life Quality Index total score was 5.5 for all patients and 7.8 for severe OHE cases. Severe OHE cases and lower socioeconomic status were independently associated with low QoL. The prevalence of moderate-to-severe depression was 9%. Only minor changes in QoL and depressive symptoms were found after 12 months of follow up.

Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability

Cutaneous irritant and allergic responses account for the vast majority of cases of occupational contact dermatitis (OCD). Although the pathophysiologic responses to these two different exposures are distinct, the clinical differentiation between chronic cumulative irritant contact dermatitis and allergic contact dermatitis can be difficult and frequently requires patch testing. This article reviews the recommended algorithms that clinicians should utilize to assess whether a worker suffers from OCD. The prevalence of OCD, its predisposing factors (both endogenous and exogenous), and prognosis are discussed in depth. Finally, issues surrounding the assessment of impairment and disability resulting from OCD are summarized.

Eczema herpeticum complicating Parthenium dermatitis

Parthenium dermatitis is one of the most common causes of airborne contact dermatitis in India. Eczema herpeticum has been reported in association with various eczematous conditions, including Parthenium dermatitis. We report a case of eczema herpeticum in association with Parthenium dermatitis. Because Parthenium dermatitis is a common condition in this region, one should be aware of this complication so that appropriate treatment is not delayed.

Sekundäres Lymphödem der Hand infolge rezidivierender Erysipele bei irritativem Kontaktekzem

A 54 year old female hairdresser suffered from occupational irritant contact dermatitis of the hands. As a complication of hand dermatitis, secondary lymphoedema developed following recurrent erysipelas. Fissures occurring in the course of the hand dermatitis presumably enabled entry of streptococci. Treatment of this complication of occupational dermatitis was reimbursed by the Employers Liability Insurance.

Occupational protein contact dermatitis and paronychia from natural rubber latex

Protein contact dermatitis (PCD) is a chronic recurrent dermatitis caused by contact with a proteinaceous material. PCD may also present as paronychia. Here a case of PCD and paronychia from natural rubber latex (NRL) is presented. The correct diagnosis would not have been established if prick testing with NRL had not been performed. This case shows that contact allergy presenting as dermatitis may occur despite negative patch test results. PCD from NRL may be relatively common, although very few cases have been published. This is probably due to the fact that the term contact urticaria is so closely connected to NRL that automatically all cases of type I allergy to NRL are considered contact urticaria, although the clinical picture is a dermatitis, i.e. PCD.

[A case of squamous cell carcinoma that developed on chronic tar dermatosis]

A 79-year-old Japanese man visited our clinic for evaluation of a large tumor on the left wrist and multiple keratotic tumors. He had handled creosote oil, which is a purified product of coal tar production, for 50 years. Physical examinations revealed poikiloderma with multiple hyperkeratotic tumors on the back of his hand and forearm bilaterally, and a cauliflower-like tumor, 80 x 60 x 15 mm in size, on the left wrist. Histopathologically, the large tumor showed a proliferation of atypical squamoid cells with many keratinization foci, indicating well-differentiated squamous cell carcinoma.

[Four cases with latex allergy followed by anaphylaxis to chestnut]

It is well known that patients with latex allergy have cross-reactions to various fruits, which is called a latex fruit syndrome. We report four cases with latex allergy followed by anaphylaxis to chestnut. They are all nurses of our hospital, who has personal history of atopic diseases. There were varieties in the methods of processing chestnut, presence of epicutaneous contact to chestnut, and clinical courses among the cases. All cases had positive skin prick test reactions while only two cases showed specific IgEs measured with AlaSTAT to chestnut. This fact suggests that we have to warn the risk of anaphylaxis even if one had not shown a serum specific IgE. We could follow the clinical courses and study specific IgEs to chestnut and latex in the two cases for more than two years. The titer of specific IgE was increased in the one, who could not avoid eating chestnut and contact to latex, while it was decreased in the other who could avoid the exposure to the antigens. Hevein is one of the panallergens among latex and related fruits. We studied specific IgEs to hevein on these four cases and 12 normal controls. The results showed that the former had significantly higher values of sIgEs to hevein compared to the latter (p < 0.05). We conclude that a patient with latex allergy has a high risk of contact urticaria or even anaphylaxis to the related fruits such as chestnut so that we recommend the patient with latex allergy to avoid them.

Compositae dermatitis

Compositae dermatitis is an allergic contact dermatitis. The most important allergens in the Compositae family are sesquiterpene lactones (SL), which are present in the oleoresin fraction of leaf, stem, flower and possibly pollen. Compositae dermatitis is most frequently seen in middle-aged and elderly people in patterns reflecting airborne or direct contact with the allergens. The pattern typically starts in summer and disappears in the autumn or winter. Repeated exposure over many years may lead to a chronic and, at times, a disseminated pattern. Seasonal variation does not occur in occupational Compositae dermatitis. In addition to the classically described airborne pattern of face, 'V' of neck, hands and forearms, hand dermatitis is now recognized to be an equally common presentation. This variability of clinical features, and the frequent occurrence of atopic dermatitis and contact allergy to one or more compounds, highlights the need for routine patch testing with sesquiterpene lactone mix 0.1% (Thermal, Hamburg, Germany), combined with aimed patch testing with Compositae plants and extracts. Avoidance of the plants and plant extracts of this large family can be difficult due to its widespread occurrence in flower, herb and vegetable gardens, urban and rural weed population and native vegetation. Importantly, Compositae plant extracts are present in many cosmetics, shampoos, herbal creams and ingested herbal remedies and tonics.

Latex hypersensitivity/glove component reaction as a contributing factor to osteomyelitis of the hand: a case report and review of the literature

A patient with a known glove-related allergy/irritation has been diagnosed with osteomyelitis of the left ring finger. The patient's susceptibility to bone and soft tissue infection is due to an open skin fissure and an eczematoid dermatitis due to a work-related glove reaction. This article is presented to alert readers of the Journal of the Louisiana State Medical Society to the possibility of encountering this unusual complication of latex glove wear and to familiarize them with irritant and allergic contact dermatitis. This report is relevant as the incidence of occupational-related glove reactions has risen and continues to rise.

An evaluation of the relationship between 'atopic skin' and skin irritability in metalworker trainees

Skin hyperirritability to irritants as well as atopy are considered to be predisposing factors for contact dermatitis. The aim of the study was to evaluate whether these predictive factors are independent or whether they are so closely related that one could possibly replace the other 205 metalworker trainees underwent skin examination for skin atopy, including standardized questionnaire, clinical examination of the skin and a series of skin irritability tests. These tests included measurements of transepidermal water loss (TEWL) before and after irritation with 3 different irritants: sodium lauryl sulfate (SLS), dimethylsulfoxide (DMSO) and sodium hydroxide (NaOH). The results of the linear regression analysis demonstrate that skin atopy is not associated with increased skin irritability, as assessed by the irritability testing methods presented.

Chloracne in the 1990s

BACKGROUND

Chloracne is a disease associated with toxicity of halogenated compounds used in some industrial processes. A patient affected by chloracne led us to study a total of nine cases from a single factory.

METHODS

We studied the clinical features of nine patients exposed chronically to chlorobenzenes. On all of them blood samples were drawn and biopsies of affected skin and liver were taken. Their work environment was visited and studied.

RESULTS

All nine patients were men and had polymorphic skin lesions, characterized mainly by comedones and cysts. They had chronic conjunctivitis and seven had cysts in the Meibomian glands. All of them had polyneuropathy and liver damage and seven had hypertriglyceridemia. Compounds known to cause chloracne were found in exceedingly high concentrations in the water used in the workplace.

CONCLUSIONS

Every patient exposed to halogenated compounds with the cutaneous manifestations of chloracne should be carefully investigated for systemic complications (such as ophthalmic, neuropathic, hepatic, and lipoprotein abnormalities).

Evaluation of impairment due to work-related skin disease

Evaluation of impairment is an important task for dermatologists who evaluate workers with occupational disease. Familiarity with the American Medical Association's Guides to the Evaluation of Permanent Impairment makes this chore easier. Here, the author discusses the evaluation process and urges readers to familiarize themselves with the Guides.

Contact dermatitis and its relationship to atopy in workers on the Polish State Railways

Clinical examinations, patch tests and prick tests were carried out in a group of railwaymen. Only 3 had both eczema and atopy. Prick tests were positive in a high proportion of subjects, including both those with eczema and controls.

Consequences of having hand eczema

Consequences of hand eczema were studied in 1238 patients who had the diagnosis confirmed in a prevalence study of hand eczema in the population of Gothenburg. It was found that 2/3 of the patients had consulted a doctor on some occasion and 1/5 had been on sick leave for their hand eczema. The mean total time on sick leave was 18.9 weeks, the median 8 weeks. Patients in service occupations reported more periods of sick leave than other occupational groups. Local steroid preparations were used by 1/2 the patients, emollients by 85%. Change of work was reported by 8% and was most common in service occupations. Hairdressers had the highest rate of change. 80% of the patients experienced some kind of disturbance to their social and emotional lives, considered to be caused by the hand eczema. Frequent itching was reported by 1/2 the patients, occasional itching by another 1/3. Comparing different types of hand eczema, allergic contact dermatitis seemed throughout to cause more serious consequences. It is concluded that good care of a hand eczema patient includes attention to the impact of the disease on the patient's total situation.

Contact urticaria caused by Obeche wood (Triplochiton scleroxylon). Report of eight patients

A variety of plant substances may induce contact urticaria and the list of substances responsible for such reactions is increasing. We report eight patients suffering from occupational asthma caused by Obeche wood sawdust. These patients also presented with urticaria when they worked with this wood. Studies revealed immediate positive skin test reactivity to Obeche wood extracts in all patients. The presence of specific IgE antibodies against Obeche wood could also be demonstrated by a reverse ELISA method. Finally, skin provocation tests (rubbing test) on the eight patients evoked a positive reaction within 20 minutes. These findings strongly suggest an IgE-mediated immunologic mechanism as responsible for the patients' urticaria. Obeche wood should be considered a health hazard capable of causing both bronchial asthma and contact urticaria. At the present time, this timber constitutes the most frequently commercially exported African wood. Many individuals, including carpenters and hobbyists, may come into contact with this wood due to the common use of Obeche wood in the "Do it yourself" type of shops.

Erythema multiforme associated with contact dermatitis

A garment worker developed erythema multiforme concurrently with allergic contact dermatitis of the hands. Patch testing revealed sensitivity to nickel (which was present in her scissors) and to paraphenylenediamine (a commercial dye). During the course of the patch-test evaluation, both the hand dermatitis and the erythema multiforme became exacerbated. Later, patch testing to only nickel sulfate resulted in the development of erythema multiforme on the face and hands. The allergic pathogenesis, involving the absorption of an allergen through the skin and resulting in a type III allergic reaction from nickel, is discussed.

[Bronchial asthma due to inhaled chloroplatinate]

Platinum and its compounds have characteristics that make them excellent oxygen sensors, and in recent years they have come to be used in large amounts in the manufacture of internal combustion engines. Recently, there have been detected among workers engaged in making platinum oxygen sensors, dermatitis and bronchial asthma which appear to be ascribable to exposure to chloroplatinate. This is a study of their etiology from the viewpoint of industrial hygiene and clinical medicine. The results obtained are as follows: Platinum-induced allergic disorders developed in a worker who applies about 50% chloroplatinate to zirconia porcelain. Although the concentration of platinum in the air was 2 microgram/m3 or less as determined by ACGIH, the worker was directly exposed to the dried powder of ammonium chloroplatinate with relatively high concentration; while the exposure was intermittent and topical, it resulted in aspiration of the powder. Bronchial asthma observed in 2 of 16 workers (12.5%) was reactive in a skin drop test with 1% chloroplatinate, and typical bronchial asthma was induced in an environmental provocation test carried out in a room where platinum sensors are made. Parameters obtained from periphero-hematological and immuno-serological tests were within the normal range. The main symptoms revealed by physical examination of workers exposed to chloroplatinate contact dermatitis in 11 (78.6%), pharyngeal irritation in 6 (42.9%), nasal obstruction in 2 (14.3%), frequent sneezing, coughing, and sputum in one each.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of atopy in occupational dermatoses

Hayfever was the commonest symptom of atopy among a group of 134 individuals who had been compensated for work-related skin disease in South Carolina. A history of previous eczema and a history of wool intolerance differed significantly between the group with contact dermatitis and the group with other work-related dermatoses. The rôle of atopy figured dramatically among the more serious cases, accounting for 93% of these cases resulting in job loss.