Contact dermatitis case study

Skin diseases are the second most common form of occupational disease with contact dermatitis accounting for 10 to 15% of all occupational illnesses with an annual associated cost of at least 1 billion [7], Although irritant dermatitis accounts for the majority of cases of contact dermatitis, studies have reported that contact allergies are relevant in between 20 to 50% of contact dermatitis cases [8], In 2003 there were 49 cases of occupational skin disease reported for every 100,000 workers in private... 

The recent Burden of Skin Disease study, a joint project of the American Academy of Dermatology Association and the Society of Investigative Dermatology, found that the third most common skin ailment was contact dermatitis. According to this study, 72 million Americans had contact dermatitis in 2004 which resulted in 1.4 billion in direct costs and almost 500 million in indirect costs due to lost productivity.83 A review of 1993 BLS data showed that of 60,200 cases of occupational skin diseases, 12,613 (21%) resulted in one or more days away from work.70 The mean time away from work was 3 days, but 17% lost workday cases had over 11 days away from work. Of those with days away from work, 70% had a diagnosis of dermatitis. In 2001, of the 38,900 skin disease cases, 6,051 (16%) resulted in days away from work, with a median of 3 days lost.68 Of these, 78% had dermatitis. A study of 235 Canadian workers with oc-... 

Contact dermatitis has been reported in Japanese women who worked in a greenhouse where benomyl had been used. Eruptions on the backs of the hands and on the forearms consisted of redness and edema. Cases of dermal sensitization have also been reported. In animal studies benomyl has low acute toxicity. The oral LDso for rats was greater than lOg/kg, and the dermal LDso in rabbits was also greater than lOg/kg. There was mild irritation when benomyl was placed on the skin of the rabbit or in the rabbit eye. 

In another case study, a small polyurethane molding plant employing poor hygienic techniques in which a number of employees developed contact dermatitis was described. Three employees were examined. Patch testing in two of these revealed positive reactions suggesting allergic sensitization to an HMDI and to the catalyst methylenedianiline. 

A retrospective study was performed of 3851 patients who presented at a clinic with suspected allergic contact dermatitis over a 5-year period. Workup of each case included standard patch tests for delayed-type sensitivity. Of the 3851 patients, 145 had type IV allergies to one or more rubber constituents. Five of the 145 were positive to MBT. 

Prolonged contact between toluene and human skin may cause nonallergic contact dermatitis. Human exposure to toluene also causes nervous system symptoms and signs and excessive exposure may cause adverse effects on the kidney and liver. Adverse effects on the nervous system have been observed in experimental animals. In studies of spontaneous abortion, perinatal mortality and congenital malformations in humans, the numbers of cases were small and the mothers had also been exposed to other substances. Embryotoxicity that generally occurs concurrently with maternal toxicity has been seen in some studies in mice and rats but not rabbits (lARC, 1989a). 

Other cases of erythema multiforme-like contact dermatitis after topical budesonide have been reported (SEDA-21, 415 186). In a large case-control study, potential cases of... 

Sosted H, Agner T, Andersen KE, Menne T. 55 cases of allergic reactions to hair dye a descriptive, consumer complaint-based study. Contact Dermatitis 2002 47(5) 299-303. 

Thiamine hydrochloride, and possibly its intermediates such as thiothiamide, can cause allergic contact dermatitis (3,4). A prospective study of the toxicity of parenteral thiamine hydrochloride in a large group of patients showed adverse reactions in only 1.1% of the cases, mainly in the form of local irritation. Only one out of the 11 adverse reaction cases was serious (5). 

Maltol is generally regarded as an essentially nontoxic and nonirritant material. In animal feeding studies, it has been shown to be well tolerated with no adverse toxic, reproductive, or embryogenic effects observed in rats and dogs fed daily intakes of up to 200 mg/kg of maltol, for 2 years.The WHO has set an acceptable daily intake for maltol at up to 1 mg/kg body-weight. A case of allergic contact dermatitis, attributed to the use of maltol in a lip ointment, has been reported. 

Many case studies have shown that exposure to piperazine results in allergic contact dermatitis and occupational asthma. A recent study of 93 patients exposed dermally to a 1% piperazine solution showed 3.2% positive reactions. At a piperazine production facility, 10% of the current and former factory workers were diagnosed with occupational asthma. 

Information concerning metallic mercury exists primarily for the inhalation route of exposure in humans and animals (see Figure 2-8). Human data exist for all categories of effect following inhalation exposure to metallic mercury vapor. The results from inhalation studies in animals have been reported for all end points except immunological and genotoxic effects, and cancer. With the exception of case studies on contact dermatitis and neurological effects after acute and occupational dermal exposure to metallic mercury in humans, no studies were located for either the oral or dermal routes of exposure for either humans or animals. 

Exposure to Asteraceous plants may also result in the development of contact dermatitis. One Serbian study has indicated that it is not unusual to detect sensitization to chamomile (Chamomilla recutita), arnica (Arnica montana), tansy (Tanacetum vulgare), and feverfew (Tanacetum parthenium) (Jovanovic et al., 2004). Contact dermatitis, along with asthma and rhinitis, may also accompany occupational exposure to chamomile (Rudzki et al., 2003) and contact dermatitis to feverfew (Hausen, 1981). Similarly, chamomile in cosmetic products can also be a cause of dermatitis (Paulsen, 2002 Rycroft, 2003). Because chamomile-containing products, particularly in shampoos and other OTC products, are so widespread, the linkage to these types of adverse events are likely underreported. Also, use of royal jelly, a thick mixture of honey, pollen, and their allergens, has been associated with several cases of bronchospasm, and topical application of concentrated forms of bee pollen (propalis) to contact dermatitis (Perharic, 1993). Milk thistle has also been known to cause urticaria (De Smet, 2004). 

There is no established evidence (epidemiological or experimental) for carcinogenicity caused by exposure to Cr(III) or Cr(0) compounds (113, 117). However, allergic contact dermatitis due to occupational exposure to Cr(lll) (primarily in the leather tanning industry) is relatively common (144—146). The safety of oral intake of Cr(III) in food supplements has also been questioned (Section IV.D) (5). A concern about the safety of the use of Cr(0) in stainless steel body implants (e.g., artificial joints or fracture fixation plates) was raised following at least one reported case of bone cancer caused by corrosion of the implant (147). In vitro studies have shown that the corrosion of Cr alloys in human semm leads to Cr(III) binding to serum proteins (148). Such corrosion can also release another possible carcinogen, Ni(II) (149). This problem should be overcome by the use of Ti alloys (free of Cr or Ni), which were introduced as an alternative 10-15 years ago (150). 

HEMA is a known contact allergen [70,71], but despite this there do not seem to have been any reports of dermatitis among dental personnel, either dentists or then-assistants [61]. Latex gloves are inadequate to protect the skin because they are permeable to HEMA [79]. The volatility HEMA may also cause problems with these materials, and inhalation of the vapour should be avoided [61]. There are anecdotal reports of dental personnel developing allergies to resin-modified glass-ionomers, but again there seem to be no detailed reports or case studies in the literature about this. 

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