Allergic construction worker

FIGURE 62-5. Allergic contact dermatitis of the hand chromates. Confluent papules, vesicles, erosions, and crusts on the dorsum of the left hand in a construction worker who was allergic to chromates. (From Wolff K, Johnson RA. Eczema/ dermatitis. Fitzpatrick s Color Atlas Synopsis of Clinical Dermatology. 5th ed. New York McGraw-Hill, 2005 27.)... 

The effect of decreasing the concentration of water-soluble chromium in cement from about 10 to below 2 ppm on the incidences of chromium-induced dermatitis was examined among construction workers in Finland (Roto et al. 1996). After 1987, when the decrease occurred, allergic dermatitis caused by chromium in the industry was reduced by 33% from previous levels, whereas irritant contact dermatitis remained unchanged. 

Contact dermatitis can occur from exposure to cement and has been considered an occupational hazard for construction workers (Turk and Rietschel 1993 Roto et al. 1996 Zachariae et al. 1996). The problem develops because chromium(VI)-con-taining residues from blast furnaces are incorporated into cement. Some countries add ferrous sulfate to cement to reduce the amount of soluble hexavalent chromate in the product (Turk and Rietschel 1993 Roto etal. 1996 Zachariae etal. 1996). In the UK, chromium and chromates accounted for 8.1% of the allergic contact dermatitis cases (Meyer et al. 2000). In Finland, chromium causes 5.6% of ACD, with tanners, cast concrete workers, leader goods workers, and metal plating/coating workers being at greatest risk (Kanerva et al. 2000). In Denmark, the chromium(VI) content of 35% of... 

Allergic contact dermatitis due to hexavalent chromium in cement, one of the occupational skin diseases known for a long time, is still the most important contact allergy in construction workers (bricklayers, manufacturers of concrete elements, etc.). However,... 

While Burrows, in 1972, reported that 79% of patients with occupational contact dermatitis fol-lowed-up over 10-13 years still require treatment for their dermatitis (Burrows 1972), a report from Singapore showed total clearance of dermatitis in 72% of their patients after a i-year follow-up. In Sydney, Rosen et al. reported that improvement of occupational contact dermatitis occurred in 74% and 68% of patients with occupational irritant and allergic contact dermatitis followed up over 2-10 years, respectively (Rosen and Freeman 1993). In the United States, Nethercott et al. reported that 63% of workers had clearance of their occupational contact dermatitis when foUowed-up over a 4-year period, and when patients with mild eczema were included, the improvement rate was 81%. In a recent report form Switzerland, where the medical records of 88 construction workers who had occupational dichromate dermatitis... 

Conde-Salazar L, Guimaraens D, Villegas C, et al. (1995) Occupational allergic contact dermatitis in construction workers. Contact Dermatitis 33 226-230... 

Van Putten PB, Coenraads PJ, Nater JP (1984) Hand dermatoses and contact allergic reactions in construction workers exposed to epoxy resins. Contact Dermatitis 10 146-150 Veien NK, Hattel T, Laurberg G (1992) Patch test results from a private dermatologic practice for two periods of 5 years with a... 

Morbidity data on carpenters dermatoses are difficult to obtain, because in the literature carpenters are included as part of the construction-workers group. According to data from the Finnish Register of Occupational Diseases, the annual prevalence of occupational dermatoses was 3.66 cases for every 10,000 construction carpenters in 1989-1997. During the same time period, the prevalence of allergic contact... 

Allergic cement eczema seems to be more severe than irritant cement eczema (see Chap. 71). Construction workers with allergic cement eczema have more frequent episodes of hand eczema and requirements for topical steroid treatment (Avnstorp 1989a). The persistence of allergic cement eczema is not solely caused by exposure to Cr(VI). It is, in part, also associated with daily irritation of the skin by wet cement. If a worker is advised to change occupation or to be retrained, it is therefore essential that the new job should not involve contact with abrasive wet work processes or contact with other irritants such as, for example, cutting oils. 

In Switzerland, construction workers with a declaration of medical inability are not allowed to perform any further work with contact to Cr(VI) or cement. Of a group of construction workers with allergic cement eczema, 72% (63 of 88) healed in the first few years, following strict avoidance of contact with cement and chromium salts (Lips et al. 1996). 

Table 1. Prevalences of irritant and allergic cement eczema construction workers who are exposed to concrete made from cement without the addition of ferrous sulfate...

Among 360 construction workers in Singapore, 3 workers with allergic cement eczema, took five periods of sickness absence due to their hand eczema in 1 year. The total number of lost working days was 53 days. It was concluded that the number of workers requiring sick leave due to occupational dermatoses was low, but that those with the condition required about 2 weeks of leave. Furthermore, allergic cement eczema was the only type of occupational dermatosis causing sickness absence in this factory (Goh 1986). 

Allergic contact dermatitis caused by n-octyl-iso-thiazolinone has been reported in paint-factory workers who had been exposed to the chemical as dye mixers (Thormann 1982 Mathias et al. 1983). It is chemically related to i,2-benzisothiazolin-3-one. One of the seven Swedish construction painters who were patch-test positive to i,2-benzisothiazolin-3-one also reacted to n-octyl-isothiazolinone (Fischer et al. 1995). Cross-allergy between n-octyl-isothiazolinone and chloromethyl-isothiazolinone has not been demonstrated (Emmett et al. 1989). 

Chlorophorin is a prenylated tetrahydroxystilbene of the West African hardwood iroko (Chlorophora excelsa) (72). This wood is durable and resembles teak or oak. It is used for both outdoor and indoor constructions. The wood cannot be varnished or surface treated with lacquer since the chlorophorin, like many other 2- and 4-hydroxysubstituted stilbenes, prevents proper hardening of the polyester. Workers exposed to saw dust of iroko wood develop strong allergic reactions that have been ascribed to the chlorophorin content of the wood (56) (see also Chap. 9.5). 

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