Case Reports 2 patients developed airborne allergic contact dermatitis from dibutylthiourea (DBTU... more Case Reports 2 patients developed airborne allergic contact dermatitis from dibutylthiourea (DBTU) (Table 1). Patch testing, prick testing and scoring were performed as previously described (1), DBTU being obtained from Trolab, Hermal, Germany. Patient no. 1 had worked for 5 months when he developed patchy dermatitis of the face. Within a week, the dermatitis spread to the whole face and the neck. Later, he developed dermatitis on the hands and forearms. The dermatitis cleared when he was off the job, and relapsed after as little as 1 day back at work. The patient worked as a polyurethane (PU) machine operator and used a DBTU-containing paint remover (Stripper 100, Oy Trans-Meri Ab, Helsinki, Finland), as often as 1¿ an hour, to remove PU from the coil used to mix the polyurethane. Patient no. 2 developed dermatitis first on her eyelids,
l. Palacios J, Fuller W E, Blaylock W K. Immunological capabilities of patients with atopic derma... more l. Palacios J, Fuller W E, Blaylock W K. Immunological capabilities of patients with atopic dermatitis. J Invest Dermatol 1966: 487: 484--490. 2. Hawes G E, Struyk L, Van den Elsen P J. Differential usage ofT cell receptor V gene segments in CD4+ and CD8+ subsets ofT lymphocyttes in monozygotic twins. J Immmuno/1993: I50: 2033-2045. 3. Kaltoft K, Pedersen C B, Hansen B H, Lemonidis A S, Contact Dermatitis 1997: 36: 53
work, and a clear exacerbation, with itching, when resuming work. A fresh biopsy showed a diffuse... more work, and a clear exacerbation, with itching, when resuming work. A fresh biopsy showed a diffuse dense infiltrate (Fig.2). The epidermis showed crusting with parakeratosis and some areas of spongiosis. At higher magnification, the infiltrate showed a few eosinophils among many small lymphocytes, with irregular nuclei. There were also a very few large cells with wide amphophilic cytoplasms and large nuclei with nucleoli. Immunohistochemical investigation demonstrated the prevalence of OPD4+ cells, with a high incidence of CD4+ T lymphocytes (CD4/CD8 ratio 4:1) and sparse nests of CD20+ cells. In a paraffine-embedded specimen, the predominant elements were CD30-. There were also many APC SlOO+ cells. Because the clinical appearance, histologic and immunohistochemical features raised the possibility of a lymphomatoid-like contact dermatitis, we patch tested the patient. He was negative to the standard series (including cobalt chloride 1% pet.), but patch testing him with polyester and epoxy resin components showed positivity to cobalt naphthenate 2% pet. ( + + 02/ + + 04). 20 control subjects were also patch tested, with negative results.
Between 1974 and 1992. we were consulted by 4 patients (an orthodontist. 2 dental technicians and... more Between 1974 and 1992. we were consulted by 4 patients (an orthodontist. 2 dental technicians and a denial worker trained in‐house) who had developed occupational allergic contact dermatitis from working with denial prostheses. All patients had positive allergic patch test reactions to methyl methacrylate (MMA). the acrylate which is the most widely used in work with prostheses. All but the orthodontist also reacted to dimethacrylates. which are used in cross‐linked dental prostheses. The last patient, investigated in 1992. had been exposed mainly to light‐cured acrylics, which are similar in composition to dental composite resins. These acrylics, only recently introduced into prosthetic work, contain more potent acrylic sensilizers than MMA. Accordingly, dental personnel working with prostheses may face a higher risk of sensitization than previously. To detect cases of occupational allergic contact dermatitis, we suggest that patients working with dental prosiheses should be patch tested with MMA, 2‐hydroxyethyi methacrylate. dimeihacrylates. epoxy acrylates and urethane acrylates.
Background: Mono(meth)acrylates (monoacrylates and monomethacrylates) are moderate to strong sens... more Background: Mono(meth)acrylates (monoacrylates and monomethacrylates) are moderate to strong sensitizers. They are used in the production of a great variety of polymers, including nail cosmetics. Objective: A patient who became occupationally sensitized to photobonded sculptured nails is reported. Detailed patch testing and analyses of the patient's nail cosmetics containing mono(meth)acrylates clarified the cause of her hand and face dermatitis. The current knowledge on mono(meth)acrylates in nail cosmetics is also reviewed. Methods: Patch testings with conventional methods, including patch testing with the patient's own substances, were performed. The patient's nail cosmetics suspected of containing mono(meth)acrylates were analyzed with gas chromatography/mass spectrometry analysis. Results: In the (meth)acrylate series, 15 of the 31 (meth)acrylate compounds tested gave an allergic reaction: 2 acrylates, 5 methacrylates, 3 dimethacrylates, and 5 diacrylates. Epoxy diacrylates, cyanoacrylate, triacrylates, and methacrylic acid were negative. Three of seven of her own nail cosmetic preparations contained mono(meth)acrylates as revealed by the gas chromatography/mass spectrometry analysis, and these also gave allergic patch test reactions, namely, the nail liquid, nail hardener, and UV-cured nail gel. Conclusion: The patient probably had been sensitized to the following (meth)acrylate compounds from her nail cosmetics: tripropylene glycol diacrylate and methyl acrylate from her photobonded nail gel; ethyl methacrylate, triethylene glycol dimethacrylate, and methyl methacrylate from her nail liquid; and butyl methacrylate from her nail hardener. She was probably also sensitized to the rare sensitizer aliphatic urethane diacrylate, but the source was not verified. Because nail cosmetics containing mono(meth)acrylates are strong sensitizers, both the workers and the customers should be aware of their sensitizing capacity; they should use no-touch techniques regarding the skin before the mono(meth)acrylates are polymerized.
7. Greig D E. Another isothiazolinone source. Contact Dermatitis 1991: 25: 201–202. 8. Damstra R ... more 7. Greig D E. Another isothiazolinone source. Contact Dermatitis 1991: 25: 201–202. 8. Damstra R J, Van Vloten W A, Van Ginkel C J W. Allergic contact dermatitis from the preservative 1,2-benzisothiazolin-3-one (1,2-BIT, Proxel): a case report, its prevalence in those occupationally at risk and its relationship to allergy to its analogue Kathon CG. Contact Dermatitis 1992: 27: 105–109. 9. Chew A-L, Maibach H I. 1,2-benzisothiazolin-3-one (Proxel): irritant or allergen? Contact Dermatitis 1997: 36: 131– 136. 10. Andersen K E, Rycroft R J G. Recommended patch test concentrations for preservatives, biocides and antimicrobials. Contact Dermatitis 1991: 25: 1–18. 11. Freeman S. Allergic contact dermatitis due to 1,2-benzisothiazolin-3-one in gum arabic. Contact Dermatitis 1984: 11: 146–149.
Thiourea compounds are mainly used as accelerators in the rubber industry, but also in other indu... more Thiourea compounds are mainly used as accelerators in the rubber industry, but also in other industries, e.g., as antioxidants in the graphics industry. Thiourea compounds may provoke allergic contact dermatitis, although the number of reported cases is relatively low. During 1985–1991, we had 5 patients with allergic patch test reactions caused by thiourea compounds. 1 of our patients had to use a knee brace after an occupational accident. He developed allergic contact dermatitis caused by the knee brace, probably because he had become sensitized to diethylthiourea. 2 patients were probably sensitized by diphenylthiourea in neoprene gloves. A florist had an allergic patch test reaction to diphenylthiourea and might have been sensitized by fungicides or pesticides, which break down into thioureas. It is often difficult, however, to detect the source of thiourea compound sensitization. If the patient has contact dermatitis and has been exposed to products that may contain thiourea compounds (or compounds that break down into thiourea compounds), such as rubber, PVC plastic or adhesive, diazo paper, paints or glue remover, anticorrosive agents, fungicides or pesticides, patch testing with a series of thiourea compounds needs to be performed. If patch testing with thiourea compounds is not performed, allergic contact dermatitis caused by thiourea compounds is not likely to be diagnosed.
Very little is known about allergic contact dermatitis (ACD) from preimpregnated epoxy products (... more Very little is known about allergic contact dermatitis (ACD) from preimpregnated epoxy products (prepregs). To describe a patient with occupational ACD from prepregs, and report new quantitative data on the content of prepregs. A laminator developed work-related vesicular hand dermatitis. He worked in an aircraft plant assembling aircraft parts, being exposed to preimpregnated carbon fiber and fiberglass sheets (prepregs), and epoxy adhesive tapes and foams. Triglycidyl-p-aminophenol (TGPAP; 1-0.25%, 2+; 0.05%, 1+) and tetraglycidyl-4,4'-methylene dianiline (TGMDA; 1%, 3+; 0.5-0.05%, 2+) provoked allergic patch test reactions, whereas o-diglycidyl phthalate was negative (1-0.05% pet) and standard epoxy provoked a weak (?+) reaction. Six prepreg products provoking allergic patch test reactions were analyzed for their TGPAP, TGMDA and diglycidyl ether of bisphenol A (DGEBA) content using gas and liquid chromatographic methods, showing up to 10% of TGPAP, 19% of TGMDA and 5% of DGEBA in the prepregs. An epoxy primer contained 61% of TGPAP. TGPAP and TGMDA caused occupational ACD. These chemicals need to be used when patch testing patients are exposed to prepregs, because patch testing with DGEBA may be negative.
Hand protection entails many problems. There is a wide variety of individual differences in the t... more Hand protection entails many problems. There is a wide variety of individual differences in the types of skin among human beings, and an even wider variety of chemicals to be handled and working methods to be learned in various workplaces. There are great differences in the degree of experience and education among job applicants and thus in their ability to understand the importance of instructions on safe working methods and the use of personal protective equipment. Therefore, proper employee selection is an important and demanding task for occupational health care personnel and dermatologists. Despite these complexities, an appropriate means of hand protection is essential in the prevention of many skin disorders and injuries.
Case Reports 2 patients developed airborne allergic contact dermatitis from dibutylthiourea (DBTU... more Case Reports 2 patients developed airborne allergic contact dermatitis from dibutylthiourea (DBTU) (Table 1). Patch testing, prick testing and scoring were performed as previously described (1), DBTU being obtained from Trolab, Hermal, Germany. Patient no. 1 had worked for 5 months when he developed patchy dermatitis of the face. Within a week, the dermatitis spread to the whole face and the neck. Later, he developed dermatitis on the hands and forearms. The dermatitis cleared when he was off the job, and relapsed after as little as 1 day back at work. The patient worked as a polyurethane (PU) machine operator and used a DBTU-containing paint remover (Stripper 100, Oy Trans-Meri Ab, Helsinki, Finland), as often as 1¿ an hour, to remove PU from the coil used to mix the polyurethane. Patient no. 2 developed dermatitis first on her eyelids,
l. Palacios J, Fuller W E, Blaylock W K. Immunological capabilities of patients with atopic derma... more l. Palacios J, Fuller W E, Blaylock W K. Immunological capabilities of patients with atopic dermatitis. J Invest Dermatol 1966: 487: 484--490. 2. Hawes G E, Struyk L, Van den Elsen P J. Differential usage ofT cell receptor V gene segments in CD4+ and CD8+ subsets ofT lymphocyttes in monozygotic twins. J Immmuno/1993: I50: 2033-2045. 3. Kaltoft K, Pedersen C B, Hansen B H, Lemonidis A S, Contact Dermatitis 1997: 36: 53
work, and a clear exacerbation, with itching, when resuming work. A fresh biopsy showed a diffuse... more work, and a clear exacerbation, with itching, when resuming work. A fresh biopsy showed a diffuse dense infiltrate (Fig.2). The epidermis showed crusting with parakeratosis and some areas of spongiosis. At higher magnification, the infiltrate showed a few eosinophils among many small lymphocytes, with irregular nuclei. There were also a very few large cells with wide amphophilic cytoplasms and large nuclei with nucleoli. Immunohistochemical investigation demonstrated the prevalence of OPD4+ cells, with a high incidence of CD4+ T lymphocytes (CD4/CD8 ratio 4:1) and sparse nests of CD20+ cells. In a paraffine-embedded specimen, the predominant elements were CD30-. There were also many APC SlOO+ cells. Because the clinical appearance, histologic and immunohistochemical features raised the possibility of a lymphomatoid-like contact dermatitis, we patch tested the patient. He was negative to the standard series (including cobalt chloride 1% pet.), but patch testing him with polyester and epoxy resin components showed positivity to cobalt naphthenate 2% pet. ( + + 02/ + + 04). 20 control subjects were also patch tested, with negative results.
Between 1974 and 1992. we were consulted by 4 patients (an orthodontist. 2 dental technicians and... more Between 1974 and 1992. we were consulted by 4 patients (an orthodontist. 2 dental technicians and a denial worker trained in‐house) who had developed occupational allergic contact dermatitis from working with denial prostheses. All patients had positive allergic patch test reactions to methyl methacrylate (MMA). the acrylate which is the most widely used in work with prostheses. All but the orthodontist also reacted to dimethacrylates. which are used in cross‐linked dental prostheses. The last patient, investigated in 1992. had been exposed mainly to light‐cured acrylics, which are similar in composition to dental composite resins. These acrylics, only recently introduced into prosthetic work, contain more potent acrylic sensilizers than MMA. Accordingly, dental personnel working with prostheses may face a higher risk of sensitization than previously. To detect cases of occupational allergic contact dermatitis, we suggest that patients working with dental prosiheses should be patch tested with MMA, 2‐hydroxyethyi methacrylate. dimeihacrylates. epoxy acrylates and urethane acrylates.
Background: Mono(meth)acrylates (monoacrylates and monomethacrylates) are moderate to strong sens... more Background: Mono(meth)acrylates (monoacrylates and monomethacrylates) are moderate to strong sensitizers. They are used in the production of a great variety of polymers, including nail cosmetics. Objective: A patient who became occupationally sensitized to photobonded sculptured nails is reported. Detailed patch testing and analyses of the patient's nail cosmetics containing mono(meth)acrylates clarified the cause of her hand and face dermatitis. The current knowledge on mono(meth)acrylates in nail cosmetics is also reviewed. Methods: Patch testings with conventional methods, including patch testing with the patient's own substances, were performed. The patient's nail cosmetics suspected of containing mono(meth)acrylates were analyzed with gas chromatography/mass spectrometry analysis. Results: In the (meth)acrylate series, 15 of the 31 (meth)acrylate compounds tested gave an allergic reaction: 2 acrylates, 5 methacrylates, 3 dimethacrylates, and 5 diacrylates. Epoxy diacrylates, cyanoacrylate, triacrylates, and methacrylic acid were negative. Three of seven of her own nail cosmetic preparations contained mono(meth)acrylates as revealed by the gas chromatography/mass spectrometry analysis, and these also gave allergic patch test reactions, namely, the nail liquid, nail hardener, and UV-cured nail gel. Conclusion: The patient probably had been sensitized to the following (meth)acrylate compounds from her nail cosmetics: tripropylene glycol diacrylate and methyl acrylate from her photobonded nail gel; ethyl methacrylate, triethylene glycol dimethacrylate, and methyl methacrylate from her nail liquid; and butyl methacrylate from her nail hardener. She was probably also sensitized to the rare sensitizer aliphatic urethane diacrylate, but the source was not verified. Because nail cosmetics containing mono(meth)acrylates are strong sensitizers, both the workers and the customers should be aware of their sensitizing capacity; they should use no-touch techniques regarding the skin before the mono(meth)acrylates are polymerized.
7. Greig D E. Another isothiazolinone source. Contact Dermatitis 1991: 25: 201–202. 8. Damstra R ... more 7. Greig D E. Another isothiazolinone source. Contact Dermatitis 1991: 25: 201–202. 8. Damstra R J, Van Vloten W A, Van Ginkel C J W. Allergic contact dermatitis from the preservative 1,2-benzisothiazolin-3-one (1,2-BIT, Proxel): a case report, its prevalence in those occupationally at risk and its relationship to allergy to its analogue Kathon CG. Contact Dermatitis 1992: 27: 105–109. 9. Chew A-L, Maibach H I. 1,2-benzisothiazolin-3-one (Proxel): irritant or allergen? Contact Dermatitis 1997: 36: 131– 136. 10. Andersen K E, Rycroft R J G. Recommended patch test concentrations for preservatives, biocides and antimicrobials. Contact Dermatitis 1991: 25: 1–18. 11. Freeman S. Allergic contact dermatitis due to 1,2-benzisothiazolin-3-one in gum arabic. Contact Dermatitis 1984: 11: 146–149.
Thiourea compounds are mainly used as accelerators in the rubber industry, but also in other indu... more Thiourea compounds are mainly used as accelerators in the rubber industry, but also in other industries, e.g., as antioxidants in the graphics industry. Thiourea compounds may provoke allergic contact dermatitis, although the number of reported cases is relatively low. During 1985–1991, we had 5 patients with allergic patch test reactions caused by thiourea compounds. 1 of our patients had to use a knee brace after an occupational accident. He developed allergic contact dermatitis caused by the knee brace, probably because he had become sensitized to diethylthiourea. 2 patients were probably sensitized by diphenylthiourea in neoprene gloves. A florist had an allergic patch test reaction to diphenylthiourea and might have been sensitized by fungicides or pesticides, which break down into thioureas. It is often difficult, however, to detect the source of thiourea compound sensitization. If the patient has contact dermatitis and has been exposed to products that may contain thiourea compounds (or compounds that break down into thiourea compounds), such as rubber, PVC plastic or adhesive, diazo paper, paints or glue remover, anticorrosive agents, fungicides or pesticides, patch testing with a series of thiourea compounds needs to be performed. If patch testing with thiourea compounds is not performed, allergic contact dermatitis caused by thiourea compounds is not likely to be diagnosed.
Very little is known about allergic contact dermatitis (ACD) from preimpregnated epoxy products (... more Very little is known about allergic contact dermatitis (ACD) from preimpregnated epoxy products (prepregs). To describe a patient with occupational ACD from prepregs, and report new quantitative data on the content of prepregs. A laminator developed work-related vesicular hand dermatitis. He worked in an aircraft plant assembling aircraft parts, being exposed to preimpregnated carbon fiber and fiberglass sheets (prepregs), and epoxy adhesive tapes and foams. Triglycidyl-p-aminophenol (TGPAP; 1-0.25%, 2+; 0.05%, 1+) and tetraglycidyl-4,4'-methylene dianiline (TGMDA; 1%, 3+; 0.5-0.05%, 2+) provoked allergic patch test reactions, whereas o-diglycidyl phthalate was negative (1-0.05% pet) and standard epoxy provoked a weak (?+) reaction. Six prepreg products provoking allergic patch test reactions were analyzed for their TGPAP, TGMDA and diglycidyl ether of bisphenol A (DGEBA) content using gas and liquid chromatographic methods, showing up to 10% of TGPAP, 19% of TGMDA and 5% of DGEBA in the prepregs. An epoxy primer contained 61% of TGPAP. TGPAP and TGMDA caused occupational ACD. These chemicals need to be used when patch testing patients are exposed to prepregs, because patch testing with DGEBA may be negative.
Hand protection entails many problems. There is a wide variety of individual differences in the t... more Hand protection entails many problems. There is a wide variety of individual differences in the types of skin among human beings, and an even wider variety of chemicals to be handled and working methods to be learned in various workplaces. There are great differences in the degree of experience and education among job applicants and thus in their ability to understand the importance of instructions on safe working methods and the use of personal protective equipment. Therefore, proper employee selection is an important and demanding task for occupational health care personnel and dermatologists. Despite these complexities, an appropriate means of hand protection is essential in the prevention of many skin disorders and injuries.
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