Experimental patch testing with chromium-coated materials.

BACKGROUND: Chromium coatings on metal alloys can be decorative, and prevent corrosion and metal ion release. We recently showed that handling of a chromium-containing disc resulted in chromium deposition on the skin. OBJECTIVES: To examine patch test reactivity to chromium-coated discs. METHODS: We included 15 patients: 10 chromium-allergic patients, and 5 patients without chromium allergy. All were patch tested with potassium dichromate, cobalt chloride, nickel sulfate, and nine different metallic discs. The chromium-allergic patients were also patch tested with serial dilutions of potassium dichromate. RESULTS: Positive/weaker reactions were observed to disc B (1 of 10), disc C (1 of 10), and disc D, disc E, and disc I (4 of 10 each). As no controls reacted to any of the discs, the weak reactions indicate allergic reactions. Positive patch test reactions to 1770 ppm chromium(VI) in the serial dilutions of potassium dichromate were observed in 7 of 10 patients. When the case group was narrowed down to include only the patients with a current positive patch test reaction to potassium dichromate, elicitation of dermatitis by both chromium(III) and chromium(VI) discs was observed in 4 of 7 of patients. CONCLUSIONS: Many of the patients reacted to both chromium(III) and chromium(VI) surfaces. Our results indicate that both chromium(VI) and chromium(III) pose a risk to chromium-allergic patients.

Experimental skin deposition of chromium on the hands following handling of samples of leather and metal.

BACKGROUND: Chromium is an important skin sensitizer. Exposure to it has been regulated in cement, and recently in leather. Studies on the deposition of chromium ions on the skin as a result of handling different chromium-containing materials are sparse, but could improve the risk assessment of contact sensitization and allergic contact dermatitis caused by chromium. OBJECTIVES: To determine whether the handling of chromium-containing samples of leather and metal results in the deposition of chromium onto the skin. METHODS: Five healthy volunteers participated. For 30 min, they handled samples of leather and metal known to contain and release chromium. Skin deposition of chromium was assessed with the acid wipe sampling technique. RESULTS: Acid wipe sampling of the participants' fingers showed chromium deposition on the skin in all participants who had been exposed to leather (range 0.01-0.20 µg/cm(2) ) and in 3 of 5 participants after they had manually handled metal discs (range 0.02-0.04 µg/cm(2) ). CONCLUSIONS: We found that samples of leather and metal had the ability to deposit chromium on the skin at significant levels, in spite of a short duration of exposure.

Recent trends in epidemiology, sensitization and legal requirements of selected relevant contact allergens.

Numerous studies have focused on emerging allergens causing contact allergy and allergic contact dermatitis in eczema populations and the general population, whereas only a few European multicenter studies systematically manage to detect prevalence rates of various contact allergies over time in eczema populations. Contact allergy is a life-time condition, which may lead to allergic contact dermatitis in individuals who do not manage to avoid exposure to the ascertained allergen in question. It is therefore of utmost importance that clinicians and dermatologists have sufficient knowledge on common allergens causing contact allergies in the general and working population. This review aimed to highlight the newest knowledge of frequent allergens of clinical importance. Literature was sought from the Pubmed™ database, Google™ scholar and textbooks. On the basis of the literature within the last 5 years, a comprehensive review of methylisothiazolinone, chromium, cobalt, rubber accelerators and fragrance ingredients were conducted. Of each allergen we discuss in detail the temporal trend of prevalence, source of exposure, clinical manifestation of allergic contact dermatitis and legislative measurements on how to regulate the exposure.

Chromium allergy and dermatitis: prevalence and main findings.

The history of chromium as an allergen goes back more than a century, and includes an interventional success with national legislation that led to significant changes in the epidemiology of chromium allergy in construction workers. The 2015 EU Leather Regulation once again put a focus on chromium allergy, emphasizing that the investigation of chromium allergy is still far from complete. Our review article on chromium focuses on the allergen's chemical properties, its potential exposure sources, and the allergen's interaction with the skin, and also provides an overview of the regulations, and analyses the epidemiological pattern between nations and across continents. We provide an update on the allergen from a dermatological point of view, and conclude that much still remains to be discovered about the allergen, and that continued surveillance of exposure sources and prevalence rates is necessary.

Chromium(VI) release from leather and metals can be detected with a diphenylcarbazide spot test.

BACKGROUND: Along with chromium, nickel and cobalt are the clinically most important metal allergens. However, unlike for nickel and cobalt, there is no validated colorimetric spot test that detects chromium. Such a test could help both clinicians and their patients with chromium dermatitis to identify culprit exposures. OBJECTIVES: To evaluate the use of diphenylcarbazide (DPC) as a spot test reagent for the identification of chromium(VI) release. METHODS: A colorimetric chromium(VI) spot test based on DPC was prepared and used on different items from small market surveys. RESULTS: The DPC spot test was able to identify chromium(VI) release at 0.5 ppm without interference from other pure metals, alloys, or leather. A market survey using the test showed no chromium(VI) release from work tools (0/100). However, chromium(VI) release from metal screws (7/60), one earring (1/50), leather shoes (4/100) and leather gloves (6/11) was observed. We found no false-positive test reactions. Confirmatory testing was performed with X-ray fluorescence (XRF) and spectrophotometrically on extraction fluids. CONCLUSIONS: The use of DPC as a colorimetric spot test reagent appears to be a good and valid test method for detecting the release of chromium(VI) ions from leather and metal articles. The spot test has the potential to become a valuable screening tool.

Association between cobalt allergy and dermatitis caused by leather articles--a questionnaire study.

BACKGROUND: Cobalt is a strong skin sensitizer and a prevalent contact allergen. Recent studies have recognized exposure to leather articles as a potential cause of cobalt allergy. OBJECTIVES: To examine the association between contact allergy to cobalt and a history of dermatitis resulting from exposure to leather. METHODS: A questionnaire case-control study was performed: the case group consisted of 183 dermatitis patients with a positive patch test reaction to cobalt chloride and a negative patch test reaction to potassium dichromate; the control group consisted of 621 dermatitis patients who did not react to either cobalt or chromium in patch testing. Comparisons were made by use of a χ(2) -test, Fisher's exact, and the Mann-Whitney test. Logistic regression analyses were used to test for associations while taking confounding factors into consideration. RESULTS: Leather was observed as the most frequent exposure source causing dermatitis in the case group. Although the case group significantly more often reported non-occupational dermatitis caused by leather exposure (p < 0.001), no association was found between cobalt allergy and dermatitis caused by work-related exposure to leather. CONCLUSIONS: Our study suggests a positive association between cobalt allergy and a history of dermatitis caused by non-occupational exposure to leather articles.

Characteristics of chromium-allergic dermatitis patients prior to regulatory intervention for chromium in leather: a questionnaire study.

BACKGROUND: Chromium-tanned leather articles currently constitute the most important cause of contact allergy to chromium in Denmark. A regulation on the content of hexavalent chromium in leather was adopted in November 2013 by the EU member states. OBJECTIVES: To characterize patients with chromium allergy and their disease, to serve as a baseline for future studies on the potential effect of the new regulation on chromium in leather. METHODS: A questionnaire case-control study was performed on 155 dermatitis patients with positive patch test reactions to potassium dichromate and a matched control group of 621 dermatitis patients. Comparisons were made by use of a χ(2) -test and the Mann-Whitney U-test. Logistic regression analyses were used to test for associations. RESULTS: Sixty-six per cent of chromium-allergic patients had a positive history of contact dermatitis caused by leather exposure. They had a significantly lower quality of life (p < 0.001), a higher prevalence of dermatitis during the last year (p = 0.008), a higher use of medication during the past 12 months (p = 0.001) and a higher prevalence of sick leave (p = 0.007) than patients in the control group. CONCLUSIONS: Chromium-allergic patients have more severe and more chronic contact dermatitis. Their primary chromium exposure comes from leather articles.

Failure of total hip implants: metals and metal release in 52 cases.

BACKGROUND: The pathogenesis of total joint replacement failure is multifactorial. One hypothesis suggests that corrosion and wear of alloys result in metal ion release, which may then cause sensitization and even implant failure, owing to the acquired immune reactivity. OBJECTIVES: To assess cobalt, nickel and chromium(VI) release from, and the metal composition of, failed metal-on-ethylene total hip replacements. MATERIALS/METHODS: Implant components from 52 revision cases were evaluated with spot tests for free nickel, cobalt, and chromium (VI) ions. Implant composition was determined with X-ray fluorescence spectroscopy, and information on the reason for revision and complications in relation to surgery was collected from the medical charts when possible (72%). For 10 implants, corrosion was further characterized with scanning electron microscopy. RESULTS: We detected cobalt release from three of 38 removed femoral heads and from one of 24 femoral stems. Nickel release was detected from one of 24 femoral stems. No chromium(VI) release was detected. CONCLUSIONS: We found that cobalt and nickel were released from some failed total hip arthroplasties, and corrosion was frequently observed. Metal ions and particles corroded from metal-on-polyethylene may play a role in the complex aetiopathology of implant failure.

Infliximab and complications after colectomy in patients with ulcerative colitis.

BACKGROUND: Infliximab treatment may increase the risk of subsequent postoperative complications in patients with ulcerative colitis. The main purpose of the present study therefore was to assess postoperative complications in patients who have undergone colectomy for ulcerative colitis with and without previous infliximab treatment. METHODS: Through a database search within a five-year period ulcerative colitis patients in a single highly specialized department, who had undergone colectomy, were identified. In total 71 ulcerative colitis patients were identified and analyzed according to pretreatment with infliximab or not. Twenty patients who had received infliximab within 12 weeks prior to colectomy were compared to 51 patients on standard treatment. Data on patient background, concomitant medication, endoscopic and the laboratory results, clinical activity, and complications within 30 days after colectomy were recorded. RESULTS: At primary surgery, patient groups were similar with respect to distribution on gender, age, smoking behavior and concomitant medication. There were significant differences in partial Mayo-scores (7,95 (IFX) vs. 7,64, P=0.032); preoperative CRP-levels (42,72 (IFX) vs. 63,2, P=0.05); postoperative hospitalization time (10,9 (IFX) vs. 11,3 days, P=0.039); and in number of patients who underwent elective surgery (10% vs. 37,3%, P=0.015). There was no short-term mortality in either group and no significant difference in terms of postoperative complications between patients treated with IFX or not. However, the number of postoperative infectious complications was increased in corticosteroid-treated patients irrespective of IFX or not (45,8% in CS group vs. 13,0%, P=0.028). CONCLUSIONS: The use of infliximab does not seem to associate with an increased risk of short-term postoperative complications in ulcerative colitis.