Natural moisturising factor constituents in South African nursing students.

BACKGROUND: The majority of South African healthcare workers are Black Africans with dark-pigmented skin. Studies on how the markers of skin barrier function and natural moisturising factor (NMF) compare between dark and light-pigmented skin are limited. Quantifying NMF in a nursing student population during their practical training at university may provide valuable insight into their potential susceptibility to skin conditions associated with low NMF. OBJECTIVES: The objectives of this study were to quantify and compare NMF content of Black African, Mixed Race and White nursing students from their dominant dorsal hand. METHODS: Forty-nine White, 32 Black African and 5 Mixed Race nursing students participated in this study. Tape strip samples were collected from the participants' dominant dorsal hand and NMF content was measured, including histidine (HIS), pyrrolidone carboxylic acid (PCA), trans-urocanic acid (t-UCA) and cis-urocanic acid (c-UCA), as well as cytokines interleukin-1 alpha (IL-1α) and interleukin-1 receptor antagonist (IL-1RA). RESULTS: No statistically significant differences in PCA, t-UCA, c-UCA, IL-1α or IL-1RA were found between Black African and White nursing students. HIS was significantly (p = 0.001) higher in White nursing students when compared to Black African students. The ratio of tot-UCA/HIS was significantly higher in Black Africans (p = 0.0002) when compared to White nursing students. CONCLUSION: No significant differences were established in NMF content between White and Black African nursing students, other than HIS which was significantly higher in White students than in Black African students. Different HIS levels between the racial groups suggest variation in histidase activity which may be related to skin pH and pigmentation. This finding may suggest that nursing students at the beginning of their careers may have similar susceptibility to skin diseases related to NMF.

In vitro skin permeation of potassium hexachloroplatinate and a comparison with potassium tetrachloroplatinate.

Halogenated platinum salts are known respiratory sensitizers in the workplace, and occupational exposure to platinum via the respiratory system and skin has been reported. The aim of this study was to compare the permeability and skin retention of potassium hexachloroplatinate to previously published data of potassium tetrachloroplatinate. Experiments were performed using female Caucasian skin and Franz diffusion cells with the application of 0.3 mg Pt/mL in the donor solution for 24-h. After 8-h of exposure, 1.87 ng/cm2 of Pt was detected in the receptor solution with exposure to potassium hexachloroplatinate, whereas 0.47 ng/cm2 was detected with exposure to potassium tetrachloroplatinate. After 24-h of exposure the Pt retention in the skin was 1861.60 ng/cm2 and 1486.32 ng/cm2 with exposure to potassium hexa- and tetrachloroplatinate respectively. The faster rate of Pt permeation from exposure to potassium hexachloroplatinate was confirmed by the flux and permeability coefficient values. The results indicate a higher permeability and skin retention of Pt when exposed to potassium hexachloroplatinate, confirming a higher risk associated with occupational exposure to this platinum compound relative to potassium tetrachloroplatinate.

Skin and respiratory exposure to soluble lead, cobalt, nickel, copper, arsenic and silver at two South African precious metals refineries.

OBJECTIVES: Precious metals refinery workers are exposed to soluble platinum group metals (PGMs) during PGM-refining but may also be exposed to hazardous non-PGMs (Pb, Co, Ni, Cu, As and Ag) still present in the matte following base metals refining. The aim of this article was to report the skin and respiratory exposure of workers to soluble non-PGMs during PGM-refining. METHODS: Skin and respiratory exposure (of 40 workers at two precious metals refineries) were measured simultaneously over two consecutive shifts. Skin exposure was measured on the palm, wrist, neck and forehead using Ghostwipes™ and respiratory exposure was measured using the MDHS method 46/2 during which soluble metals were extracted using 0.07 M HCl and mechanical agitation, followed by ICP-MS analysis. RESULTS: The geometric means (GM) of average skin exposure to individual soluble metals on all anatomical areas was found in the order Cu (0.018 µg/cm2) > Ni (0.016 µg/cm2) > Pb (0.008 µg/cm2) > Ag (0.006 µg/cm2) > As (0.004 µg/cm2) > Co (0.0008 µg/cm2) with the palm being the highest exposed anatomical area. The order of the GM respiratory exposure was Pb (0.224 µg/m3) > Ag (0.201 µg/m3) > Cu (0.159 µg/m3) > As (0.079 µg/m3) > Ni (0.034 µg/m3) > Co (0.016 µg/m3) with exposure to As exceeding the South African occupational exposure limit (20 µg/m3) during concentrate handling (max 66.174 µg/m3). CONCLUSIONS: Workers were exposed to a mixture of toxic PGM and non-PGMs via the skin and inhalation. Exposure to these metals could lead to the development of diseases, such as contact dermatitis, occupational allergy, or occupational cancer. Non-PGMs must be included in hazardous chemical risk assessments and control strategies implemented at precious metals refineries.

Effectiveness of Personal Protective Equipment in Reducing Skin Exposure to Soluble Platinum.

OBJECTIVES: Various forms of personal protective equipment (PPE), including disposable coveralls and gloves, are used to help reduce skin exposure to soluble platinum in precious metals refineries. We aimed to investigate the effectiveness of PPE in reducing workers' skin exposure to soluble platinum. METHODS: Thirty precious metals refinery workers were divided into two groups according to their use of PPE and related procedures. Group A (n = 13) used disposable coveralls worn over standard overalls along with long-sleeved rubber gloves, while Group B (n = 17) used standard overalls only and surgical nitrile gloves. The skin (palm, wrist, neck, and forehead) and respiratory exposure of these groups to soluble platinum were concurrently measured (using Ghostwipes™ and MDHS 46/2, respectively) along with their urinary platinum excretion. RESULTS: Both groups of workers experienced comparable geometric mean (GM) respiratory exposure to soluble platinum (Group A = 0.744 µg m-3 versus Group B = 0.711 µg m-3) (P = 0.789), but significantly lower skin exposure (average of all measured anatomical areas) was found for Group A (Group A = 0.005 µg cm-2 versus Group B = 0.033 µg cm-2) (P = 0.018). Significantly lower skin exposure was measured on the palm (P = 0.017), wrist (P = 0.017), forehead (P = 0.027) of Group A workers compared with Group B. No significant difference was found for the urinary platinum excretion of the two groups (Group A GM = 0.208 µg g-1 creatinine versus Group B GM = 0.361 µg g-1 creatinine) (P = 0.273). CONCLUSIONS: The use of disposable coveralls and long-sleeved rubber gloves, along with strict usage procedures, proved effective in reducing precious metals refinery workers' skin exposure to soluble platinum.

Skin and respiratory exposure to platinum group metals at two South African precious metals refineries.

OBJECTIVE: Platinum Group Metals (PGMs) are mined and refined together and have the potential to elicit adverse respiratory and skin health effects. The aim of this study was to investigate the simultaneous skin and respiratory exposure of precious metals refinery workers to all six soluble PGMs. METHODS: The simultaneous skin and respiratory exposure to soluble PGMs of forty workers at two precious metals refineries were measured over two consecutive work shifts using Ghostwipes™ and Methods for the Determination of Hazardous Substances method 46/2. Skin exposure was measured on the palm, wrist, neck, and forehead of workers. RESULTS: The highest geometric mean (GM) skin exposure (average of palm, wrist, neck and forehead) was found for soluble Pt (0.008 µg/cm2) [95% confidence interval (CI) 0.005-0.013], followed, in order, by Rh, Ir, Pd, Ru, and Os. Significantly higher concentrations of soluble PGMs were found on the palm and wrist compared to the neck and forehead (p < 0.0001). The highest GM respiratory exposure was found for soluble Pd (0.342 µg/m3 [95% CI 0.163-0.718]) followed, in order, by Pt, Rh, Ru, Ir, and Os. Skin exposure to all soluble PGMs was positively correlated with respiratory exposure (r = 0.466-0.702). CONCLUSION: This is the first study to report skin exposure to all six soluble PGMs. Precious metals refinery workers were exposed to quantifiable concentrations of soluble PGMs via both the skin and inhalation. Exposure via both routes occurred together and control measures should be aimed at reducing both skin and respiratory exposure.

Particle size and metal composition of gouging and lancing fumes.

Metal gouging and lancing liberate particles of an unknown size and composition. Fumes are formed when vaporized materials condense in air, creating fine and ultrafine particles which can agglomerate. Particle sizes may be <1 µm in diameter. Inhalation of this mixture of metal fumes can lead to adverse health effects. This study characterized fumes by particle size fractions and metal composition. As particles may be in the submicron range, the nano-size fraction was included. Randomized, side-by-side area samples of fumes liberated during gouging and lancing were collected. Samplers included the conductive plastic Institute of Occupational Medicine (IOM) samplers (inhalable fraction), GK2.69 stainless steel thoracic cyclones (thoracic fraction), aluminum respirable cyclones (respirable fraction), Nanoparticle Respiratory Deposition (NRD) samplers (nano-size fraction), and open-face filter cassettes (particle size distribution-PSD). Samplers were mounted at a height of between 1.3 m and 1.7 m, in the worst-case scenario area (down-wind). Forty-six samples were collected during gouging and 26 during lancing. Mass concentrations per fraction ranges (excluding nano-size) were found to be 1.27-17.27 mg/m3 (inhalable), 1.83-13.96 mg/m3 (thoracic) and 0.88-15.82 mg/m3 (respirable) for gouging; and 2.34-5.60 mg/m3 (inhalable), 2.82-4.01 mg/m3 (thoracic), and 1.89-3.24 mg/m3 (respirable) for lancing. PSD analysis confirmed the presence of nano-size particles with a mean size of 171.76 (±56.27) nm during gouging and 32.33 (±7.17) nm during lancing. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis of samples indicated the presence of chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), molybdenum (Mo), nickel (Ni), and tin (Sn) in the respective particle size fractions (including nano-size) of both processes. Negative health effects associated with metal inhalation are well known, while nanoparticles' unique properties enable them to cause further detrimental health effects. The nano-size fraction should be included in personal exposure assessments and control measures.

Measurement of transepidermal water loss, stratum corneum hydration and skin surface pH in occupational settings: A review.

BACKGROUND: The skin provides a permeable barrier which may be impaired in occupational settings. Transepidermal water loss (TEWL), stratum corneum hydration (SCH) and skin surface pH (SSpH) have been used in occupational settings to predict early onset of occupational skin diseases, to measure the effectiveness of prevention strategies for occupational skin diseases, and to assess skin condition during exposure. The aim was to compare the findings, identify shortcomings in the methodology and data reporting and furthermore, to make recommendations for future studies. MATERIALS AND METHODS: A literature study was conducted on studies published before December 2018 to provide a review on the measurement of TEWL, SCH and SSpH in occupational settings. RESULTS: TEWL, SCH and SSpH were previously measured in a wide variety of industries. Results between studies were highly variable, due to different study designs and different anatomical positions measured. Not all of the measurement conditions were reported and variations in study objectives led to data being reported and interpreted differently for most studies. CONCLUSION: Incomplete reporting of methodology hinders comparison of bioengineering measurements. No bioengineering method has been proven useful as a predictive tool for occupational skin diseases, however, it is useful in the acute assessment of skin condition. It is recommended that future studies on TEWL, SCH and SSpH adhere to guidelines for occupational settings as far as possible to enable comparison between studies.

Transepidermal water loss, stratum corneum hydration, and skin surface pH of female African and Caucasian nursing students.

BACKGROUND: Conflicting evidence exists on how skin barrier function compares between Africans and Caucasians. This study measured skin barrier function of South African first year nursing students before their practical training started to compare skin barrier function between the racial groups. METHODS: Transepidermal water loss (TEWL), stratum corneum (SC) hydration, and skin surface (SS) pH was measured on female first year nursing students (19 African and 31 Caucasian; age range 18-40 years). Geometric means and ranges were calculated and the influence of anatomical areas and racial differences were evaluated respectively. RESULTS: No significant difference in TEWL was established between the racial groups. SC hydration was significantly lower (P ≤ 0.05) and SS-pH was significantly higher (P ≤ 0.0001) in African nursing students when compared to Caucasians. African nursing students had significantly lower (P ≤ 0.05) SC hydration on their palms when compared to the other anatomical areas. CONCLUSION: Stratum corneum hydration and SS-pH differed significantly between African and Caucasian skin, while no difference was found for TEWL, the primary parameter used to evaluate skin barrier function. Low SC hydration and high SS-pH of African nursing students prior to their practical training, may suggest a higher risk for developing occupational skin diseases.

Urinary excretion of platinum (Pt) following skin and respiratory exposure to soluble Pt at South African precious metals refineries.

Adverse respiratory and skin health effects have been associated with occupational exposure to soluble platinum (Pt). However, the relationship between skin exposure and urinary Pt excretion has not yet been investigated. In this study we examined the relationship between skin and respiratory exposure to soluble Pt and urinary Pt excretion at two South African precious metals refineries. The skin and respiratory exposure to soluble Pt as well as the urinary Pt excretion of forty precious metals refinery workers was assessed simultaneously using Ghostwipes™, Methods for the Determination of Hazardous Substances method 46/2 and spot urine tests, respectively. The geometric mean for skin exposure to soluble Pt on four anatomical positions (palm, wrist, neck and forehead) was 0.008 µg/cm2 [95% confidence interval (CI): 0.005-0.013 µg/cm2], while the geometric mean for respiratory exposure was 0.301 µg/m3 (95%CI: 0.151-0.601 µg/m3) and the geometric mean for urinary Pt excretion was 0.212 µg/g creatinine (95%CI: 0.169-0.265 µg/g creatinine). Partial correlations identified significant positive correlations between skin exposure, respiratory exposure and urinary Pt excretion (r = 0.580 to 0.754). Skin and respiratory exposures to soluble Pt were both positively correlated with urinary Pt excretion, and both exposure routes should be considered when investigating occupational exposure to soluble Pt.

Urinary excretion of platinum from South African precious metals refinery workers.

BACKGROUND: Urinary platinum (Pt) excretion is a reliable biomarker for occupational Pt exposure and has been previously reported for precious metals refinery workers in Europe but not for South Africa, the world's largest producer of Pt. OBJECTIVE: This study aimed to quantify the urinary Pt excretion of South African precious metals refinery workers. METHODS: Spot urine samples were collected from 40 workers (directly and indirectly exposed to Pt) at two South African precious metals refineries on three consecutive mornings prior to their shifts. Urine samples were analysed for Pt using inductively coupled plasma-mass spectrometry and were corrected for creatinine content. RESULTS: The urinary Pt excretion of workers did not differ significantly between sampling days. Urinary Pt excretions ranged from <0.1 to 3.0 µg Pt/g creatinine with a geometric mean of 0.21 µg Pt/g creatinine (95% CI 0.17 to 0.26 µg Pt/g creatinine). The work area (P=0.0006; η2=0.567) and the number of years workers were employed at the refineries (P=0.003; η2=0.261) influenced their urinary Pt excretion according to effect size analyses. Directly exposed workers had significantly higher urinary Pt excretion compared with indirectly exposed workers (P=0.007). CONCLUSION: The urinary Pt excretion of South African precious metals refinery workers reported in this study is comparable with that of seven other studies conducted in precious metals refineries and automotive catalyst plants in Europe. The Pt body burden of workers is predominantly determined by their work area, years of employment in the refineries and whether they are directly or indirectly exposed to Pt.

Occupational Respiratory Exposure to Platinum Group Metals: A Review and Recommendations.

Platinum group metals (PGMs) is a group of metals that include platinum, palladium, rhodium, ruthenium, iridium, and osmium. Occupational respiratory exposure to platinum has been reported since 1945, but studies investigating occupational exposure to palladium, rhodium, ruthenium, iridium, and osmium are scarce. This review provides a summation of the information available on the respiratory exposure to PGMs in various industrial settings, methods used to assess exposure, and the possible adverse health effects resulting from occupational exposure to PGMs. Of these effects, respiratory sensitization caused by soluble PGMs is of most importance. Metallic PGMs have not been shown to cause allergic reactions. This review reiterates that occupational respiratory exposure to PGMs is dependent on the type of industry where exposure takes place, the chemical form (soluble or insoluble) of the PGMs present in the workplace air, and the tasks performed by workers in the specific work areas. Sensitization to soluble platinum is associated with the degree of exposure to soluble platinum compounds, and the highest concentrations of soluble PGMs in workplace air have been reported for precious metals refineries where personal exposures frequently exceed the occupational exposure limit for soluble platinum (2 µg/m3). Additionally, this review emphasizes that personal exposure monitoring is preferred over area monitoring when assessing workers' exposure to PGMs. The legislation applicable to occupational exposure to PGMs is also discussed, and it is highlighted that the occupational exposure limit for soluble platinum has remained unchanged, in most countries, since 1970 and that too few countries have classified PGM compounds as respiratory or skin sensitizers. Finally, recommendations are made to ensure that future investigations are comparable in terms of the type of exposure monitoring (personal or area) conducted, the type of tasks included in the exposure monitoring program, and the format in which results are reported.

The influence of pH on the in vitro permeation of rhodium through human skin.

Workers in precious metals refineries are at risk of exposure to salt compounds of the platinum group metals through inhalation, as well as through the skin. Rhodium salt permeation through the skin has previously been proven using rhodium trichloride (RhCl3) dissolved in synthetic sweat at a pH of 6.5. However, the skin surface pH of refinery workers may be lower than 6.5. The aim of this study was to investigate the influence of pH 6.5 and 4.5 on the in vitro permeation of rhodium through intact Caucasian skin using Franz diffusion cells. A concentration of 0.3 mg mL-1 rhodium was used and analyses were performed using inductively coupled plasma mass spectrometry and inductively coupled plasma optical emission spectrometry. Results indicated a cumulative increase in permeation over 24 h. Rhodium permeation after 12 h was significantly greater at pH 4.5 (1.56 ± 0.24 ng cm-2) than at 6.5 (0.85 ± 0.13 ng cm-2; p = 0.02). At both pH levels, there was a highly significant difference ( p < 0.01) between the mass of rhodium remaining in the skin (1428.68 ± 224.67 ng cm-2 at pH 4.5 and 1029.90 ± 115.96 ng cm-2 at pH 6.5) and the mass that diffused through (0.88 ± 0.17 ng cm-2 at pH 4.5 and 0.62 ± 0.10 ng cm-2 at pH 6.5). From these findings, it is evident that an acidic working environment or low skin surface pH may enhance permeation of rhodium salts, contributing to sensitization and adverse health effects.

In Vitro Permeation of Metals through Human Skin: A Review and Recommendations.

During the last few decades, the interest in skin permeation of, specifically, metals has increased with the in vitro method utilizing diffusion cells as the prominent method of investigating permeability. This review provides a systematic synopsis focused on an in vitro diffusion cell method utilizing human skin and examines the differences in experimental design as this could influence the results obtained. The permeation of metals such as chromium, cobalt, copper, gold, lead, mercury, nickel, palladium, platinum, rhodium, silver, titanium, and zinc are discussed. The metals included in this review, except for titanium and zinc, can permeate through intact human skin under physiological conditions. On the basis of flux values, the order of permeability could be summarized as Cu > Pb > Cr > Ni > Co > Pt > Hg > Rh (excluding nanoparticles). Permeability of metals through human skin is highly variable with the different methodologies as a contributing factor. Furthermore, metals are retained in the skin which could lead to reservoir (depot) formation and extended exposure even after the removal thereof from the outer surface of the skin. Finally, recommendations are provided on the standardization of experimental design and format of data reporting to enable the comparison of results from future in vitro metal permeation studies.

International guidelines for the in vivo assessment of skin properties in non-clinical settings: Part 2. transepidermal water loss and skin hydration.

BACKGROUND: There is an emerging perspective that it is not sufficient to just assess skin exposure to physical and chemical stressors in workplaces, but that it is also important to assess the condition, i.e. skin barrier function of the exposed skin at the time of exposure. The workplace environment, representing a non-clinical environment, can be highly variable and difficult to control, thereby presenting unique measurement challenges not typically encountered in clinical settings. METHODS: An expert working group convened a workshop as part of the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals (OEESC) to develop basic guidelines and best practices (based on existing clinical guidelines, published data, and own experiences) for the in vivo measurement of transepidermal water loss (TEWL) and skin hydration in non-clinical settings with specific reference to the workplace as a worst-case scenario. RESULTS: Key elements of these guidelines are: (i) to minimize or recognize, to the extent feasible, the influences of relevant endogenous-, exogenous-, environmental- and measurement/instrumentation-related factors; (ii) to measure TEWL with a closed-chamber type instrument; (iii) report results as a difference or percent change (rather than absolute values); and (iv) accurately report any notable deviations from this guidelines. CONCLUSION: It is anticipated that these guidelines will promote consistent data reporting, which will facilitate inter-comparison of study results.

Flow cytometric analysis of the oxidative status in human peripheral blood mononuclear cells of workers exposed to welding fumes.

Flow cytometry is a simple analytical technique that identifies, counts, and characterizes cells. The oxidative status of cells is influenced by many exogenous sources, such as occupational exposure to welding fumes. This study evaluated flow cytometry as a method to determine the oxidative status of male welders (n = 15) occupationally exposed to welding fumes. Flow cytometric analysis of reactive oxygen species (ROS) was carried out in peripheral blood mononuclear cells (PBMC) by using the probe 2, 7-dichlorodihydrofluorescein diacetate (DCFH-DA). Lipid peroxidation was measured by the decrease of fluor-DHPE fluorescence and intracellular glutathione (GSH) levels by using mercury orange. All of the parameters were also observed under a confocal microscope. The oxidative stress ratio was calculated from the oxidative damage and the antioxidant capacity to give an accurate account of the cellular oxidative status. ROS and lipid peroxidation levels were elevated by approximately 87% and approximately 96%, respectively, and GSH levels lowered approximately 96% in PBMC of workers exposed to welding fumes compared with non-exposed controls. The oxidative stress ratio was significantly higher (p < 0.001) in the exposed group. Flow cytometry can be useful for the measurement of cellular oxidative stress in somatic cells of workers exposed to welding fumes and other occupational settings. Calculating an oxidative stress index may be useful in predicting disease outcomes and whether preventative control measures are efficient.

Assessment of dermal exposure and skin condition of workers exposed to nickel at a South African base metal refinery.

OBJECTIVES: The objectives of this study were to assess dermal exposure of cell workers to nickel at a South African base metal refinery and to characterize their skin condition by measuring the skin hydration and trans epidermal water loss (TEWL) indices. METHODS: The skin hydration index of the index finger, palm, neck, and forehead was measured before, during and at the end of the shift. The TEWL index was measured before and at the end of the shift. Dermal exposure samples were collected with Ghostwipes from the index finger and palm of the dominant hand, before, during, and at the end of the shift. Neck and forehead samples were collected before and at the end of the shift. Wipe samples of various surfaces in the workplace were also collected. Wipes were analyzed for nickel according to NIOSH method 9102, using inductively coupled plasma-atomic emission spectrometry. RESULTS: Hydration indices measured on the hands decreased significantly during the shift, but recovered to normal levels by the end of the shift. TEWL indices for the index finger and palm of the hands are indicative of a low barrier function even before commencement of the shift, which further deteriorated significantly during the shift. During the shift, substantial nickel skin loading occurred on the index finger and palm of the hand. Levels on the neck and forehead were much lower. Various workplace surfaces, which workers come into contact with, were also contaminated with nickel. CONCLUSIONS: The skin condition and high levels of nickel on the skin were most probably caused by inadequate chemical protection provided by protective gloves. Although, the permeability of nickel through intact skin is considered to be low, a decreased barrier function of dehydrated or slightly damaged skin will increase its permeability for nickel. The ethnicity of these exposed workers may contribute significantly toward the low incidence of allergic contact dermatitis observed. Several measures to lower dermal exposure to nickel are also recommended.