Occupational skin disease in mining: an Australian case series.

The mining industry has one of the highest rates of occupational disease across all industries. However, occupational skin disease (OSD) is not commonly reported in this industry, although has been estimated to affect up to 51 people per 100,000 workers, with contact dermatitis accounting for the majority of cases. It often has a poor prognosis and leads to days lost from work. There have been relatively few reports regarding the specific forms of OSD encountered by miners worldwide. We report our experience of miners attending our Occupational Dermatology Clinic and our investigations at two Australian mines. We compare our findings with other reports of OSD in the mining population. The most commonly observed skin condition was irritant contact dermatitis, but miliaria and allergic contact dermatitis were also observed. It is not surprising that most cases of OSD appear to be related to harsh working conditions and exposures to multiple skin irritants, however, specific exposures causing ACD should not be forgotten. Our findings are consistent with previous studies of OSD in miners.

Immediate hypersensitivity to chlorhexidine.

Chlorhexidine is a widely used and effective antiseptic agent. Although skin contact is usually well tolerated, it may cause both immediate and delayed hypersensitivity reactions. We report a case of immediate hypersensitivity to chlorhexidine causing both skin and respiratory symptoms following occupational exposure to chlorhexidine in a health-care worker.

The first Australian Baseline Series: Recommendations for patch testing in suspected contact dermatitis.

BACKGROUND AND OBJECTIVES: Patch testing is a standard diagnostic tool used in the identification of causative allergens in allergic contact dermatitis. Ongoing surveillance of rates of allergen positivity is vitally important to detect trends and allow comparisons between countries. The objective of this study was to propose the first evidence-based Australian baseline series, based on retrospective review of our patch test data. We aimed to identify the most important and most relevant allergens in our population. METHODS: We conducted a 10-year (2001-2010) retrospective review of data from the contact dermatitis clinic and the occupational dermatitis clinic from our institution. RESULTS: We patch tested 5281 patients in all. The top 20 allergens with the highest number of relevant positive patch test reactions were: fragrance mix 1: nickel, potassium dichromate, Myroxylon pereirae, formaldehyde, p-phenylenediamine (PPD), thiuram mix, colophony (rosin), dermatophagoides mix, ammonium persulfate, quaternium-15, cobalt chloride, methylchloroisothiazolinone or methylisothiazolinone, diazolidinylurea, epoxy resin, 1,3-dimethylol-5,5-dimethyl hydantoin, Compositae mix, toluenesulfonamide formaldehyde resin, basic red 46 and imidazolidinyl urea. CONCLUSION: We have elucidated the most frequent and relevant contact allergens in our patient population and used this information to construct the first Australian baseline series.

Non-infectious skin disease in Indigenous Australians.

The burden of non-infectious skin disease in the Indigenous Australian population has not been previously examined. This study considers the published data on the epidemiology and clinical features of a number of non-infectious skin diseases in Indigenous Australians. It also outlines hypotheses for the possible differences in the prevalence of such diseases in this group compared with the general Australian population. There is a paucity of literature on the topic but, from the material available, Indigenous Australians appear to have a reduced prevalence of psoriasis, type 1 hypersensitivity reactions and skin cancer but increased rates of lupus erythematosus, kava dermopathy and vitamin D deficiency when compared to the non-Indigenous Australian population. This article profiles the prevalence and presentation of non-infectious skin diseases in the Indigenous Australian population to synthesise our limited knowledge and highlight deficiencies in our understanding.

Suspected allergic contact dermatitis to iodopropynyl butylcarbamate in an alcohol hand rub commonly used in Australian health-care settings.

We report a case of suspected allergic contact dermatitis to the preservative and uncommon allergen iodopropynyl butylcarbamate, found in Microshield Angel hand gel, a skin cleanser commonly used in Australian health-care settings.

Allergic contact dermatitis to chlorhexidine.

Chlorhexidine is a commonly used antiseptic agent in the health-care setting. Although exposure to chlorhexidine is very common, allergic contact dermatitis (ACD) is rarely reported. We report a case series of ACD to chlorhexidine in health-care workers and discuss our rates of allergy to chlorhexidine, from patch-testing performed at the Skin and Cancer Foundation, Melbourne, Australia. Of 7890 patients patch-tested, 840 patients were tested to 0.5% chlorhexidine diacetate with 28 (3%) positive reactions, 13 (2%) of which relevant to their presenting dermatitis. Altogether 1565 patients were tested to 0.5% chlorhexidine digluconate, with 47 (3%) positive reactions, 16 (1%) of which were relevant. We estimate our rate of relevant chlorhexidine ACD from our total clinic patients, non-occupational and occupational, to be at least 19/7890 (0.24%). Our rate of relevant chlorhexidine ACD in health-care workers is 10/541 (2%). Interestingly, our rates of chlorhexidine allergy are slightly higher than documented elsewhere. This raises the possibility that chlorhexidine is underestimated as an allergen worldwide, and should be tested for in health-care workers where there is a history of exposure.