Water, soap, and hand-disinfectant exposure during the COVID-19 pandemic and self-reported hand eczema in frontline workers: A cross-sectional study.

BACKGROUND: During the COVID-19 pandemic, increased hand hygiene practices were implemented. Impaired skin health on the hands among healthcare workers has been reported previously. Knowledge of how worker in other occupations have been affected is scarce. OBJECTIVES: To investigate self-reported hand water-, and soap exposure and use of hand disinfectants, and hand eczema (HE) in frontline workers outside the hospital setting and in IT personnel during the COVID-19 pandemic. METHODS: In this cross-sectional study, a questionnaire was sent out between 1 March and 30 April in 2021, to 6060 randomly selected individuals representing six occupational groups. RESULTS: A significant increase in water exposure and hand disinfectant use was shown: Relative position (RP) 19; 95% confidence interval (CI) 0.17-0.21 and RP = 0.38: 95% CI 0.36-0.41, respectively. Newly debuted HE was reported by 7.4% of the population, more frequently among frontline workers (8.6%) compared to IT personnel (4.9%). CONCLUSIONS: Water and soap exposure and use of hand disinfectants increased during COVID-19 pandemic, which may increase the risk of hand eczema. This highlights the importance of communication and implementation of preventive measures to protect the skin barrier also in occupations other than healthcare workers.

Cobalt nanoparticles cause allergic contact dermatitis in humans.

BACKGROUND: Cobalt (Co) causes allergic contact dermatitis (ACD) and the emerging use of Co nanoparticles (CoNPs) warrants gaining further insight into its potential to elicit ACD in sensitized individuals. OBJECTIVES: The aims of the study were to clarify to what extent CoNPs may elicit ACD responses in participants with Co contact allergy, and to evaluate whether the nanoparticles cause a distinct immune response compared with cobalt chloride (CoCl2) in the skin reactions. METHODS: Fourteen individuals with Co contact allergy were exposed to CoNPs, CoCl2, a Co-containing hard-metal disc (positive control), and an empty test chamber (negative control) by patch testing. Allergic responses were evaluated clinically by a dermatologist at Days 2, 4 and 7. At Day 2, patch-test chambers were removed, and remaining test-substance and skin-wipe samples were collected for inductive-coupled plasma mass spectrometry (ICP-MS) analysis. Additionally, skin biopsies were taken from patch-test reactions at Day 4 for quantitative real-time polymerase chain reaction analysis, histopathology and ICP-MS analysis of Co skin penetration. RESULTS: Patch testing with CoNPs elicited allergic reactions in Co-sensitized individuals. At all timepoints, clinical assessment revealed significantly lower frequencies of positive patch-test reactions to CoNPs compared with CoCl2 or to the positive control. CoNPs elicited comparable immune responses to CoCl2. Chemical analysis of Co residues in patch-test filters, and on skin, shows lower doses for CoNPs compared with CoCl2. CONCLUSIONS: CoNPs potently elicit immune responses in Co-sensitized individuals. Even though patch testing with CoNPs resulted in a lower skin dose than CoCl2, identical immunological profiles were present. Further research is needed to identify the potential harm of CoNPs to human health.

Safety data sheets as an information pathway on hazards of occupationally used cleaning agents.

To investigate consistency and accessibility of asthma and skin allergy hazard information in safety data sheets (SDSs) for cleaning agents on the Swedish market, we compiled a database of 504 SDSs and 351 therein declared ingredients. Labelling of products was compared to that of ingredients according to harmonised classification. For each ingredient, also notified classification and three additional sources on sensitising properties were compared. Product labelling most frequently indicated corrosion and irritation hazards. Only 3% of products were labelled as skin sensitisers and none as asthmagens. According to harmonised classification, 9% of products contained skin sensitisers, using other information sources increased the number to 46%. While 2% of products contained respiratory sensitisers according to harmonised classification, the number increased to 17% when using other information sources. Furthermore, sensitisers were declared across several sections of the SDSs, hampering easy access of such information. In conclusion, there are inconsistencies in hazard identification of cleaning agents and their ingredients. Hence, SDSs may not altogether fulfil its hazard information role. Improved criteria for identifying sensitisers and respiratory irritants are warranted. Additionally, we argue that all ingredients should be listed in section 3 regardless of concentration, to facilitate access of information about sensitising properties.

Nickel penetration into stratum corneum in FLG null carriers-A human experimental study.

BACKGROUND: The filaggrin gene (FLG) plays a role in skin diseases, with the skin barrier function being impaired in FLG null carriers. The role of FLG status in relation to nickel penetration into the skin remains unclear. OBJECTIVES: To elucidate the association between FLG status and nickel penetration into stratum corneum (SC) in individuals without self-reported history of nickel allergy. METHODS: Forty participants (23 FLG wt and 17 FLG null) were exposed to a nickel solution (80 µg/cm2 ) which was applied onto 2 × 2 cm on their left forearm. After 4 h, the area was tape-stripped with 10 consecutive tapes. Nickel in each tape was quantified using inductively coupled plasma mass spectrometry. RESULTS: The average recovered nickel dose was 35%-48%. A tendency towards lower recovery was seen in FLG null carriers compared to FLG wt carriers, and lower recovery in those with history of skin and/or respiratory symptoms compared to those without such history. This was however not statistically significant. CONCLUSION: FLG null carriers had less nickel recovered by tape strips compared with FLG wt carriers and, compared with individuals without a history of skin and/or respiratory symptoms, indicating higher nickel penetration into SC for FLG null carriers, but further studies are needed.

A novel approach to monitor skin permeation of metals in vitro.

How metals permeate skin is poorly understood. Risk assessments tend to take default approaches to account for the dermal route, often using numbers of questionable relevance. Moreover, simultaneous exposure to multiple metals may affect the permeation of individual metals. To investigate this, we developed an experimental setup where receptor medium circulates directly from a conventional diffusion cell for in vitro skin absorption into an inductively coupled plasma mass spectrometer (ICP-MS), enabling continuous measurement of metal concentration. Full-thickness piglet skin was used as diffusion barrier, artificial sweat as donor medium and phosphate buffered saline as receptor medium. Percutaneous absorption from donor medium containing 2 mmol/L of nickel, cobalt, or chromium or all three combined was monitored for 2 h. Metals retained in skin were quantified post-exposure. Percutaneous absorption of nickel was faster in single than in combined exposure; for cobalt and chromium no such difference was apparent. Similar amounts of the three metals were retained in skin after single exposure, and retention was consistently higher for each metal after combined exposure. This study provides proof-of-concept for a method that reliably detects concentration changes in physiologically relevant medium. It may shed light on skin absorption and permeation kinetics of metals and risks associated with metal exposure.

Nickel deposition and penetration into the stratum corneum after short metallic nickel contact: An experimental study.

BACKGROUND: Knowledge about the skin deposition and penetration of nickel into the stratum corneum (SC) after short contact with metallic items is limited. OBJECTIVE: To quantify nickel skin deposition and penetration into the SC after short contact with metallic nickel. METHODS: Sixteen nickel-allergic participants and 10 controls were exposed to 3 pure nickel discs and 1 aluminium disc on each volar forearm for 3 × 10 minutes. Before exposure, 1 forearm was irritated with 0.5% sodium lauryl sulfate under 24-hour occlusion. Immediately, as well as 24 and 72 hours after metallic disc exposure, outer SC layers were removed with adhesive tapes and the nickel content was measured. RESULTS: Nickel deposition and SC penetration capable of eliciting allergic nickel dermatitis were found immediately and after 24 hours. Significantly higher nickel amounts were found on normal skin and in the SC of nickel-allergic participants than in controls both immediately and after 24 hours, and on irritated skin immediately after exposure. CONCLUSIONS: Nickel deposition and SC penetration is considerable after nickel skin exposure of 3 × 10 minutes. Combined with the allergic responses resulting from the same exposures reported previously, this study highlights that short skin exposure to nickel-releasing items may cause allergic nickel dermatitis.

Neglected exposure route: cobalt on skin and its associations with urinary cobalt levels.

OBJECTIVES: Cobalt (Co) exposure is associated with adverse health effects including skin sensitisation, asthma and interstitial lung fibrosis. Exposure to Co in industrial settings is often assessed using air samples or biomonitoring in urine. Skin exposure is rarely measured. Aim of this study was to quantify and compare the importance of Co skin exposure and respiratory exposure in determining urinary Co concentrations. METHODS: Co skin exposure was measured in 76 hard metal workers by acid wipe sampling before and at the end of work shifts. Spot urine was collected during a 24-hour period from the start of a shift. Respiratory exposure was measured by personal inhalable dust sampling during a shift in 30 workers. Co was analysed by inductively coupled plasma mass spectrometry. RESULTS: Quantile regression modelling showed that a doubling of Co on skin before or at the end of shift increased the median urinary concentration of Co by 70% (p<0.001) or 32% (p<0.001), respectively. A doubling of Co in air increased median urinary Co by 38% (p<0.001). Co skin exposures were still significantly associated with urinary Co after excluding a group of workers with high respiratory exposure (33%, p=0.021 and 17%, p=0.002). CONCLUSIONS: The results indicate an association between Co skin exposure and urinary Co concentrations. This should be considered when using urinary Co as a biomarker of exposure.

Contamination of skin and surfaces by cobalt in the hard metal industry.

BACKGROUND: It is well known that hard metal workers have historically been affected by contact allergy to cobalt. Knowledge is sparse about occupational skin exposure to cobalt, in terms of skin doses and sources of exposure, which could be used to improve protection of workers. OBJECTIVES: To improve knowledge about skin doses and sources of skin exposure to cobalt within hard metal production, thereby facilitating better protection of workers. METHODS: Forty workers were sampled on the index finger by acid wipe sampling after 2 hours of work. The samples were analysed with inductively coupled plasma mass spectrometry. Cobalt spot testing was performed in the work environment. RESULTS: The highest skin doses were found among raw material workers. Skin doses among other production workers were also significant. Most office workers had low, but measurable, levels of cobalt on the skin. Glove use varied between workers. Cobalt was found on production equipment, on items in the canteen area, and on handles and buttons throughout the company. CONCLUSIONS: Cobalt skin doses were prominent, and originated from contact with raw materials, sintered materials, and contaminated surfaces. Cobalt was present on surfaces outside production areas. Companies need to identify and reduce skin exposure for protection of workers.

Development, validation and testing of a skin sampling method for assessment of metal exposure.

BACKGROUND: Nickel, cobalt and chromium are frequent skin sensitizers. Skin exposure results in eczema in sensitized individuals, the risk being related to the skin dose. OBJECTIVES: To develop a self-sampling method for quantification of skin exposure to metals, to validate the method, and to assess its feasibility. METHODS: Defined metal doses (0.01-5 µg) were applied to the fingers of 5 participants. Skin areas (2 cm2 ) were sampled with 1% HNO3 , either as 0.1 ml on a swab, or as 0.5 ml on a wipe. Furthermore, 17 participants performed self-sampling by swab after 2 h of leisure activity. Samples were extracted in 1% HNO3 and analysed by inductively coupled plasma mass spectrometry. RESULTS: The sampling efficiency by swab was 46%, as compared with 93% for acid wipe sampling, for all tested doses. Most metal from the skin dose was detected in the first swab (33-43%). Despite lower sampling efficiency by swab, skin doses of metals following 2 h of leisure activity without hand washing were quantified in all participants, and ranged from 0.0016 to 0.15 µg/cm2 , from 0.00014 to -0.0020 µg/cm2 and from 0.00048 to -0.027 µg/cm2 for nickel, cobalt, and chromium, respectively. CONCLUSIONS: The results indicate a future potential of skin sampling by swab to detect and monitor metals on skin by self-sampling. This will contribute to better knowledge of metal skin exposure among dermatitis patients, workers, and the general population.

Testing in artificial sweat - Is less more? Comparison of metal release in two different artificial sweat solutions.

Metal release from materials immersed in artificial sweat can function as a measure of potential skin exposure. Several artificial sweat models exist that, to various degree, mimic realistic conditions. Study objective was to evaluate metal release from previously examined and well characterized materials in two different artificial sweat solutions; a comprehensive sweat model intended for use within research, based on the composition of human sweat; and the artificial sweat, EN1811, intended for testing compliance with the nickel restriction in REACH. The aim was to better understand whether there are advantages using either of the sweat solutions in bio-elution testing of materials. Metal release in two different artificial sweat solutions was compared for discs of a white gold alloy and two hard metals, and a rock drilling insert of tungsten carbide at 1 h, 24 h, 1 week and 1 month. The released amount of metal was analysed by means of inductively coupled plasma mass spectrometry. Similar levels of released metals were measured from test materials in the two different artificial sweat solutions. For purposes in relation to legislations, it was concluded that a metal release test using a simple artificial sweat composition may provide results that sufficiently indicate the degree of metal release at skin contact.

Nickel on the market: a baseline survey of articles in 'prolonged contact' with skin.

BACKGROUND: In April 2014, the European Chemicals Agency defined the concept of 'prolonged contact with skin' as used in the EU nickel restriction. OBJECTIVES: To establish a baseline of nickel-releasing items on the Swedish market conforming with the EU nickel restriction according to the definition of 'prolonged contact' with the skin. METHODS: We performed a limited market survey in Stockholm, Sweden. Items with metallic parts that come into contact with the skin, except those explicitly mentioned in the legal text, were chosen. The dimethylglyoxime (DMG) test was used to evaluate nickel release. RESULTS: One hundred and forty-one items belonging to one of three categories - accessories, utensils for needlework, painting and writing (called utensils), and electronic devices - were tested in the study. Forty-four percent of all items were DMG test-positive (releasing nickel), and 9% gave a doubtful DMG test result. CONCLUSIONS: The large proportion of nickel-releasing items in the present study shows clearly that broader parts of industry need to take action to prevent nickel allergy. The high proportion of DMG test-positive items indicates that there is still much work to be done to reduce the nickel exposure of the population.

Cobalt allergy: suitable test concentration, and concomitant reactivity to nickel and chromium.

BACKGROUND: Cobalt allergy is frequent, but knowledge about exposure is limited. The patch test concentration and relevance of positive reactions are sometimes questioned. OBJECTIVES: To assess the suitability of cobalt 1% versus 0.5% for patch testing, and to analyse the co-occurrence of allergy to cobalt, chromium, and nickel. MATERIALS AND METHODS: Consecutive dermatitis patients (n = 656) were patch tested with cobalt chloride 0.5% and 1%, potassium dichromate 0.5%, and nickel sulfate 5%, all in petrolatum. Reactions were assessed on day (D)3, and on D6 or D7, and the reactivity and development of reactions were analysed. RESULTS: Allergy to any metal was shown in 31% of patients, allergy to cobalt in 14%, allergy to chromium in 7%, and allergy to nickel in 20%. A significant proportion (37%) of cobalt allergy cases were missed by cobalt 0.5% versus 1%, whereas the reactivity profiles were similar. Cobalt allergy was solitary, without concomitant allergy to chromium or nickel, in 50% of patients. CONCLUSIONS: Cobalt chloride 1% pet. is more suitable for patch testing than 0.5%. Solitary cobalt allergy is as frequent as concomitant allergy to cobalt and nickel or chromium. Sources of skin exposure to metals need to be identified for prevention of contact allergy. This is, owing to large knowledge gaps, particularly demanding for cobalt.

Allergy risks with laptop computers - nickel and cobalt release.

BACKGROUND: Laptop computers may release nickel and cobalt when they come into contact with skin. Few computer brands have been studied. OBJECTIVES: To evaluate nickel and cobalt release from laptop computers belonging to several brands by using spot tests, and to quantify the release from one new computer by using artificial sweat solution. METHODS: Nickel and cobalt spot tests were used on the lid and wrist supports of 31 laptop computers representing five brands. The same surfaces were tested on all computers. In addition, one new computer was bought and dismantled for release tests in artificial sweat according to the standard method described in EN1811. RESULTS: Thirty-nine per cent of the laptop computers were nickel spot test-positive, and 6% were positive for cobalt. The nickel on the surface could be worn off by consecutive spot testing of the same surface. The release test in artificial sweat of one computer showed that nickel and cobalt were released, although in low concentrations. CONCLUSIONS: As they constitute a potential source of skin exposure to metals, laptop computers should qualify as objects to be included within the restriction of nickel in REACH, following the definition of 'prolonged skin contact'. Skin contact resulting from laptop use may contribute to an accumulated skin dose of nickel that can be problematic for sensitized individuals.

Snapshot of cobalt, chromium and nickel exposure in dental technicians.

BACKGROUND: It is not fully understood where and how people are exposed to sensitizing metals. Much can be learnt from studying occupational settings where metals are handled. OBJECTIVES: To quantify cobalt (Co), chromium (Cr) and nickel (Ni) exposure on the skin and in the air, and urine levels, in dental technicians working with tools and alloys that may result in skin and respiratory exposure. METHODS: The metal skin dose was quantified with acid wipe sampling in dental technicians (n = 13). Air exposure was monitored by personal air sampling. Spot urine samples were collected for 24 h. Metals were analysed with inductively coupled plasma mass spectrometry. RESULTS: Before work, Co was detected on the skin of 10 participants (0.00025-0.0039 µg/cm2 ), and Cr (0.00051-0.011 µg/cm2 ) and Ni (0.0062-0.15 µg/cm2 ) on the skin of all participants. After a 2-h period without hand washing, CoCr-exposed participants had more Co on the skin (p = 0.004) than non-CoCr-exposed participants. Co was found in 10 air samples (0.22-155 µg/m3 ), Cr in nine (0.43-71 µg/m3 ), and Ni in four (0.48-3.7 µg/m3 ). Metal urine concentrations were considered to be normal. CONCLUSIONS: Dental technicians were exposed to Co, Cr and Ni on the skin and through the air, which was not reflected in the urine concentrations in this study. Cobalt skin doses may potentially elicit allergic contact dermatitis and cause sensitization.

Elicitation threshold of cobalt chloride: analysis of patch test dose-response studies.

BACKGROUND: Cobalt is a strong skin sensitizer (grade 5 of 5 in the guinea-pig maximization test) that is used in various industrial and consumer applications. To prevent sensitization to cobalt and elicitation of allergic cobalt dermatitis, information about the elicitation threshold level of cobalt is important. OBJECTIVE: To identify the dermatitis elicitation threshold levels in cobalt-allergic individuals. MATERIALS AND METHODS: Published patch test dose-response studies were reviewed to determine the elicitation dose (ED) levels in dermatitis patients with a previous positive patch test reaction to cobalt. A logistic dose-response model was applied to data collected from the published literature to estimate ED values. The 95% confidence interval (CI) for the ratio of mean doses that can elicit a reaction in 10% (ED(10)) of a population was calculated with Fieller's method. RESULTS: On the basis of five included studies, the ED10 values of aqueous cobalt chloride ranged between 0.0663 and 1.95 µg cobalt/cm(2), corresponding to 30.8-259 ppm. CONCLUSIONS: Our analysis provides an overview of the doses of cobalt that are required to elicit allergic cobalt contactdermatitis in sensitized individuals, and thereby the basis for future prevention of cobalt allergy.

Cobalt skin dose resulting from short and repetitive contact with hard metals.

BACKGROUND: Many daily contacts with metallic items are short and repetitive, and result in metal release; material, sweat, friction and wear may all be important. OBJECTIVES: To study cobalt release and skin deposition as a result of many short and repetitive contacts with two cobalt-containing materials. MATERIALS/METHODS: Study participants (n = 5) handled two types of hard metal disc (Co 6% and Co 15% Cr 0.6%) for 30 min. Deposited cobalt skin doses were measured with acid wipe sampling and chemical analysis. Cobalt release from the hard metal discs in artificial sweat was measured under conditions simulating those present during the handling of discs. RESULTS: Average cobalt skin doses from discs containing 6% Co and 15% Co 0.6% Cr were 1.1 µg/cm(2) [standard deviation (SD) 0.4 µg/cm(2) ] and 0.7 µg/cm(2) (SD 0.5 µg/cm(2) ), respectively. More cobalt was released from hard metal discs containing 6% Co [11.4 µg/cm(2) (SD 1.2 µg/cm(2) )] than from discs containing 15% Co 0.6% Cr [4.8 µg/cm(2) (SD 0.6 µg/cm(2) )]. 10% to 15% of the potentially available cobalt was deposited on the skin during handling. CONCLUSIONS: It is likely that the cobalt deposited as a result of short and repetitive contact with hard metals may cause harm. Research regarding cobalt exposure, metal release and the deposition of skin-sensitizing metals resulting from short and repetitive contact is needed for a better understanding of the allergy risk.

Cobalt, nickel and chromium release from dental tools and alloys.

BACKGROUND: Cobalt-chromium alloys are used as casting alloys by dental technicians when producing dental prostheses and implants. Skin exposure and metal release from alloys and tools used by the dental technicians have not been studied previously. OBJECTIVES: To study the release of cobalt, nickel and chromium from alloys and tools that come into contact with the skin of dental technicians. METHODS: Cobalt and nickel release from tools and alloys was tested with the cobalt spot test and the dimethylglyoxime test for nickel. Also, the release of cobalt, nickel and chromium in artificial sweat (EN1811) at different time-points was assessed. Analysis was performed with inductively coupled plasma-mass spectrometry. RESULTS: Sixty-one tools were spot tested; 20% released nickel and 23% released cobalt. Twenty-one tools and five dental alloys were immersed in artificial sweat. All tools released cobalt, nickel and chromium. The ranges were 0.0047-820, 0.0051-10 and 0.010-160 µg/cm(2) /week for cobalt, nickel and chromium, respectively. All dental alloys released cobalt in artificial sweat, with a range of 0.0010-17 µg/cm(2) /week, and they also released nickel and chromium at low concentrations. CONCLUSIONS: Sensitizing metals are released from tools and alloys used by dental technicians. This may cause contact allergy and hand eczema.

Inflammation-related proteins in blood after dermal exposure to some common chemicals depend on the skin barrier gene filaggrin - a human experimental study.

Filaggrin (FLG), a skin barrier protein, is associated with higher dermal uptake of some chemicals in carriers of loss-of-function (null) mutations. This study investigates FLG mutations and systemic effects following dermal exposure to chemicals. Individuals (n = 23 FLG null, n = 31 FLG wt) were simultaneously exposed to pyrimethanil, pyrene, oxybenzone, and nickel ions for 4 h. Pre- and post-exposure, 25-hydroxyvitamin D3 (25(OH)D3, LC-MS/MS) and 92 inflammation-related proteins (proximity-extension assay) were measured. FLG null carriers exhibited significantly higher 25(OH)D3 concentrations than wt carriers, both pre- and post-exposure. Eleven proteins differed in abundance post- vs pre-exposure among FLG null carriers, and 22 proteins among wt carriers (three proteins overlapped). Twelve proteins showed median differences (post- vs pre-exposure) between FLG null and wt carriers. Overall, FLG null carriers showed an increase, while FLG wt carriers showed a decrease in inflammation-related proteins. These findings suggest FLG-dependent differences in susceptibility to systemic effects following simultaneous dermal chemical exposure.

The cobalt spot test--further insights into its performance and use.

BACKGROUND: A spot test was recently developed for easy and rapid testing to detect whether cobalt is available on surfaces in contact with skin. OBJECTIVES: To explore the potential use of the cobalt spot test as a tool for skin dose assessment, and to verify the sensitivity under laboratory conditions. METHODS: A cobalt dilution series (cobalt standards mixed with cobalt spot test reagent solution) was prepared to determine the threshold for colour change. Defined doses of cobalt were applied to the fingers of 5 volunteers. Acid wipe sampling was used to measure the recovery of applied cobalt skin doses on one hand, and cobalt-exposed areas on the other hand were spot tested. RESULTS: A weak colour gradient was visible from approximately 1 to 1.5 µg cobalt/ml in the dilution series. For a skin dose of 0.125 µg cobalt/cm(2) , 80% of the cobalt dose was collected by acid wipe sampling. Spot tests gave positive results in all cases (n = 5). CONCLUSIONS: The cobalt spot test can be used to show cobalt on the skin. More experience is needed to understand and describe the most suitable test conditions.

Coin exposure may cause allergic nickel dermatitis: a review.

Nickel is used in coins because the metal has beneficial properties, including price, colour, weight, and corrosion resistance, and also because it is easy to stamp. It has often been claimed that the duration of skin contact with coins is too short to cause nickel release and dermatitis. However, it is well known by dermatologists specialized in occupational skin diseases, and by their nickel-allergic patients, that hand eczema in cashiers and other professionals who handle coins may be caused or aggravated by nickel release from coins. In this review, we present evidence from past studies showing that nickel-containing coins can indeed pose a risk for those who handle them. For protection of the health of consumers, cashiers, and other workers who handle coins, it is suggested that coins without nickel release should be used as a substitute for the high nickel-releasing coins currently in widespread use. The key risk factor in this situation is the ability of metal alloys in coins to release nickel and contaminate the skin after repeated contact from coin handling.