Occupational skin diseases (OSDs) often have considerable medical and occupational consequences. Previous data on prognostic factors have been derived from studies with fairly small sample sizes.
To determine the medical and occupational outcome in 1048 patients diagnosed with OSD at the Finnish Institute of Occupational Health and to identify the prognostic risk factors for the continuation of OSD.
Patients examined in 1994-2001 filled out a follow-up questionnaire 6 months after the diagnosis. Data on atopy, contact allergies, and occupation were analysed.
Six months after the diagnosis the skin disease had healed in 27% of the patients. The OSD had cleared up in 17% of those with no changes at work, and in 34% of those who had changed their job/occupation. The best clearing had occurred in the patients with contact urticaria (35%), whereas the healing of allergic (27%) and irritant (23%) contact dermatitis was similar. The risk factors for continuing occupational contact dermatitis (OCD) were no changes in work, age > 45 years, food-related occupations, respiratory atopy, and male sex.
The healing of OSD was associated with discontinuation of the causative exposure. A change in work and the presence of easily avoidable work-related allergies were associated with a good prognosis.
Contact allergy to plastic gloves is rare. Benzisothiazolinone is a biocide that is mainly used in industrial settings. We first suspected delayed-type contact allergy to benzisothiazolinone from polyvinyl chloride (PVC) gloves in 2004. We looked through our medical records from 1991 to 2005 to find similar cases.
We found a total of 8 patients who are allergic to benzisothiazolinone and who had had exacerbations of their hand dermatitis while using PVC gloves. Patch testing revealed that 3 of them had weak allergic or doubtful reactions to the glove materials. Six of them had used Evercare Soft, Medi-Point, or Derma Grip PVC gloves, which in chemical analysis were shown to contain 9 to 32 ppm of benzisothiazolinone. Seven of the patients worked in dentistry or health care and 1 in farming. All of them had had hand dermatitis for many years.
To our knowledge, there have been no previous reports of contact allergy to antimicrobial agents in plastic gloves. Benzisothiazolinone is widely used as a biocide in the manufacture of disposable PVC gloves. Small amounts of benzisothiazolinone in the gloves may sensitize those who already have hand dermatitis. We recommend that all patients with hand dermatitis while using PVC gloves should be patch tested with benzisothiazolinone.
Late patch test reactions on day (D) 10-14, which on subsequent retesting appear in the normal time schedule on D2-D4, indicate active sensitization due to the patch test. The objective of this study was to report our series of late patch test reactions. We analysed the clinical records of all the patients who had reported late reactions for the date of the late reaction, the results of the first patch tests and retesting. Between January 2002 and February 2006, we had a total of 16 patients with late reactions (>or=D10). 12 of them were retested. Retesting confirmed active sensitization to 1 or more allergens in 11 patients (1.3% of 884 patients patch tested). In these 11 cases, none of the late reactions had clear relevance to the symptoms before its appearance. The commonest allergens were paraphenylenediamine (PPD) in 6 patients (0.72% of 826 PPD tests), elecampane (Inula helenium) and black-eyed Susan (Rudbeckia sp. hybr.) extracts in 3 patients, and 4-aminoazobenzene and Disperse Orange 3 in 2 patients. The late reaction did not generally affect the clinical course. Only 1 patient developed new dermatitis possibly due to active sensitization. Late reactions meeting the classic criteria of active sensitization were relatively common in our series from a special clinic of occupational dermatology.
2-N-octyl-4-isothiazolin-3-one (OIT) is an antimicrobial agent that is mainly used in industrial settings. The objective of the study was to find the significance of OIT contact allergy at our clinic of occupational dermatology. We looked through our patient material from 1991 for allergic reactions to OIT and analysed the clinical records. We found 8 patients with ordinary allergic reactions to OIT and 1 late reaction. 2 workers in the manufacture of paints had occupational allergic contact dermatitis from OIT in biocides. 2 patients were machinists and 3 were female farmers: in these cases, however, we could not find any exposure. A sewing machine operator had patch test reactions to 2 of her mattress textiles, and chemical analysis of them showed 40-50 parts per million OIT. In conclusion, OIT is a rare sensitizer, and its contact allergies occur mainly in paint manufacturing. It is infrequently used in metal-working fluids and possibly sensitizes machinists. Although it is also used in some biocides recommended for use in the textile industry, there are no previous reports of contact allergy in this field. Our sewing machine operator with OIT contact allergy had probably been sensitized from mattress textiles.
The bark of the cinnamon tree is used as a spice; its flavour is from an essential oil containing mainly cinnamal.
To report new cases of occupational allergic contact dermatitis (ACD) from cinnamon and a novel case of airborne cinnamon contact allergy.
We examined the patient material of two dermatological clinics in Helsinki to find cinnamon contact allergic patients and review their clinical records.
We found six patients with delayed contact allergy to cinnamon. In four patients, cinnamon was the main cause of occupational ACD. Three of them had dermatitis on their hands and one patient on the face and neck. In the latter case, the exposure was shown to be airborne. In addition, the fifth patient was occupationally sensitized to cinnamon, but it was not the main cause of his hand dermatitis. In the sixth patient, cinnamon allergy was considered to derive from cross-allergy to fragrances. Five of the patients reacted to cinnamal separately and in fragrance mix I. None of the six patients had immediate-type cinnamon allergy.
Occupational contact allergy to cinnamon is rare but needs to be considered in workers handling foods. Cinnamal is possibly the main allergen in cinnamon.
Lichens are abundant in forests, living on trees, soil, stones and rocks. They contain usnic acid and other lichen acids that are contact allergens. Lichens and liverworts cause woodcutter's dermatitis, eczema that appears in the forest on the bare skin areas, especially in cold and wet weather. Occupational allergic contact dermatitis from lichens occurs in forestry and horticultural workers and in lichen pickers. Lichens can cause immediate allergy, contact urticaria, rhinitis and asthma and probably also photoallergic contact dermatitis. Lichens are used for the manufacture of oak moss absolute, a fragrance constituent. Oak moss absolute contains lichen acids and is one of the commonest contact allergens. Lichen acid allergy develops either from contact with lichens or from fragrances. We describe 4 cases of occupational allergic contact dermatitis from lichens during the past decade: 2 were farmers and 2 gardeners. 3 of them had allergic reactions to fragrance mix and oak moss absolute. Lichen contact allergy is an old, partly forgotten, syndrome that should be remembered for symptoms in contact with barked wood or wood dust.
Tetraglycidyl-4,4'-methylenedianiline (TGMDA) is an aniline epoxy resin used in, for example, resin systems of pre-impregnated composite materials (prepregs) of the aircraft industry. Allergic contact dermatitis caused by TGMDA in prepregs has been described previously.
To report on 9 patients with occupational allergic contact dermatitis caused by TGMDA in epoxy glues used in helicopter assembly.
The patients were examined with patch testing at the Finnish Institute of Occupational Health in 2004-2009. The first patient was diagnosed by testing both components of two epoxy glues from the workplace, and was also tested with glue ingredients, including TGMDA. The following patients were tested with the glues and TGMDA. The resin parts of the glues were analysed for their epoxy compounds, including TGMDA.
All of the patients had a patch test reaction to one or both of the resin parts of the TGMDA-containing glues. Eight of them had a strong allergic reaction to TGMDA, and one had a doubtful reaction to TGMDA. Two of the patients also had an allergic reaction to triglycidyl-p-aminophenol (TGPAP), another aniline epoxy resin, which was not present in the TGMDA-containing glues.
In aircraft industry workers with suspected occupational dermatitis, aniline epoxy resins should be considered and patch tested as possible contact allergens.
Synthetic mineral fibres (i.e. man-made vitreous fibres, MMVF) are classified into glass filament, mineral wool (glass wool, rock wool and slag wool), refractory ceramic fibres, and fibres for special purposes. This paper analyses the data on occupational irritant contact dermatitis (ICD) caused by MMVF during 1990-99 in Finland according to the Finnish Register of Occupational Diseases (FROD). A total of 63 cases from MMVF were reported. 56 were diagnosed as ICD, and 2 as allergic contact dermatitis, both from rock wool. 53 out of 63 cases were due to mineral wool or glass filaments; half of the cases, according to a rough estimate, were due to mineral wool and a half due to glass filaments used in lamination work. Carpenters, building workers and insulation workers have the highest risk of ICD from mineral wool. 4 cases in carpenters, 4 in building workers and 2 in insulation workers were reported from MMVF. For every 100 000 employed workers, only 1.6 cases of ICD in carpenters, 2.7 in building workers and 9.1 in insulation workers were annually due to MMVF, respectively. Mineral wool used in construction work, insulation, etc., cannot be considered to be a common cause of occupationally induced ICD. However, information on harmful skin effects of MMVF is useful to exposed persons in the prevention of the effects.