Contact dermatitis in hairdressers, 10 years later: patch-test results in 300 hairdressers (1994 to 2003) and comparison with previous study.

BACKGROUND: In the last 20 years, the hairdressing profession has undergone important modifications, mainly because of a change in the substances and techniques used and improved occupational education. OBJECTIVE: To evaluate the modifications in the hairdressing profession and its actual risk of occupational allergic contact dermatitis (OACD). METHODS: We studied all 300 hairdressers seen in our department from 1994 to 2003 and compared the results with those of a previous study of 379 hairdressers who attended our department from 1980 to 1993. All were patch-tested with the European Standard series and specific hairdressing products. As previously, most of the workers were women (93%), with a mean age (23.7 years) slightly higher than that of the workers in our previous study. RESULTS: We found a significant increase in the frequency of positive patch-test responses (78.3% vs 58.8%) and OACD (58% vs 48.8%) with respect to our previous study. We also observed a significant increase in sensitization to most allergens, including p-phenylenediamine base (54% vs 45.9%), 4-aminobenzene (40.7% vs 31.9%), ammonium thioglycolate (2.7% to 12.3%), ammonium persulfate (7.9% to 14.3%), p-toluenediamine sulfate (6.8% to 15.3%), p-aminodiphenylamine (2.9% to 7.7%), o-nitro-4-phenylenediamine (2.1% to 7.3%), and aminophenols (0% to 9%), whereas a decrease was found in sensitization to Disperse Orange (17% vs 32.7%) and thioglycolic acid (15.3% to 3%). CONCLUSION: The high frequency and increase of sensitizations among hairdressers require urgent measures to improve protective measures and their application.

Allergic contact urticaria from natural rubber latex in healthcare and non-healthcare workers.

To compare the prevalence of natural rubber latex (NRL) sensitization and allergic contact urticaria from NRL in healthcare and non-healthcare workers, we studied all 1171 patients who attended our clinic during 2001 and 2002. Prick testing for NRL and patch testing with European standard series were performed in all patients and an additional rubber series in those who had contact with rubber. Specific immunoglobulin E (IgE) levels against NRL and tropical fruits were measured when prick testing was positive. Sensitization to NRL (positive prick test and specific IgE levels) was much more common in healthcare workers than that in non-healthcare workers, 16.7 versus 2.3%. Among the non-healthcare workers, sensitization to NRL was more common in food handlers (17.1%), construction workers (6.6%), painters (6.2%), hairdressers (5.1%) and cleaners (3.8%). The difference in the prevalence of specific IgE to tropical fruits was not significant. Allergic contact urticaria from NRL was also much more frequent in healthcare workers, 71.4 versus 28.6%. In conclusion, sensitization to NRL and allergic contact urticaria from NRL are more common in healthcare workers, but this is a growing problem in non-healthcare workers and should be investigated in all workers with a history of NRL intolerance or who have contact with NRL.

Occupational allergic contact dermatitis from antioxidant amines in a dental technician.

We describe an 18-year-old dental technician who presented with dry hyperkeratotic lesions on his left palm that were limited to an area that was in contact with a container in which he had prepared the molds for a dental prosthesis. On patch testing, he had a positive reaction to black rubber mix and its components N-cyclohexyl-N'-phenyl-4-phenylenediamine, N,N'-diphenyl-4-phenylenediamine, and N-isopropyl-N'-phenyl-4-phenylenediamine, as well as to a piece of the rubber container. Thin-layer chromatography (TLC) of a piece of the rubber container confirmed the presence of the para-phenylenediamine mix. Results of patch-testing with TLC were positive after 48 and 96 hours. The lesions resolved when the patient stopped using the container. The patient was diagnosed with occupational allergic contact dermatitis. We also review the dermatoses caused by antioxidant amines.

Dermatitis artefacta?

A 35-year-old man presented with a 2-month history of intensely pruritic excoriated and crusted linear lesions on the dorsa of the left hand and left forearm (Fig 1). The patient had worked in construction for 2 years, and his job consisted mainly in covering the facades of buildings with cement. The patient was right-handed and used a black rubber glove as a protective measure only on his left hand (Fig 2). He reported that the lesions resolved partially during holidays and weekends and clearly flared in association with his work. There was no history of atopic dermatitis, drug use, or intolerance to metals, rubber, or fruits. On physical examination, linear excoriations with crusts were observed on the dorsa of the left hand, extending to the ventral and dorsal aspects of the forearm, involving the whole area that was in contact with the glove. Lichenified erythematous plaques and excoriations on the dorsal surface of the metacarpophalangeal joints and scaly lesions on the dorsal surfaces of the fingers were also present. On the palm, only discrete hyperkeratosis was seen. The right hand and forearm were free of lesions. He complained of intense pruritus when wearing the rubber glove and admitted to continuous scratching to relieve his discomfort, inducing the linear and excoriated lesions. Treatment with topical corticosteroids was initiated, with progressive resolution of the lesions.