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Out of 923 female dental nurses in the Helsinki district, 799 were interviewed using a computer-assisted telephone interview. A structured questionnaire was used to inquire about skin, respiratory symptoms, atopy, work history and methods, and exposure at work. The 328 nurses, who reported work-related dermatitis on their hands, forearms or face, were invited to an interview by an occupational physician; 245 nurses participated. 31 nurses had previously been diagnosed with an occupational skin disease (OSD). 133 nurses with a suspected OSD were selected for further clinical examinations with prick and patch testing. Among the 107 nurses examined, 22 new cases of OSD were diagnosed. There were altogether 29 cases of allergic contact dermatitis, 15 of contact urticaria, 12 of irritant contact dermatitis, and 1 case of onychomycosis. Rubber chemicals and natural rubber latex (NRL) in protective gloves, as well as dental-restorative plastic materials [(meth)acrylates], were the most common causes of allergy. 42% of the OSD cases in the studied population had been missing from the statistics (Finnish Register of Occupational Diseases). Plastic gloves or NRL gloves with a low-protein content are recommended for dental work. Skin exposure to (meth)acrylates should be avoided.

Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.

Unsaturated polyester (UP) cement caused allergic contact dermatitis in car repair work. The resin was a condensate of polyols and maleic anhydride with reactive solvent, auxiliary substances, and inorganic reinforcement substances. To identify the causative chemicals, the cement was tested on a sensitized patient. For analysis, samples of the resin were eluted with acetone and eluted with hexane to precipitate inorganic material and large polyester molecules. The eluate was evaporated. The remainder, dissolved in acetone, was separated into fractions on silica plates by thin layer chromatography (TLC). On the developed (hexane/chloroform, 15/85) plates, 20 bands were obtained under UV-light at 254 nm. Samples of the bands were scraped and used for patch testing. The scraping at a retention factor (R f ) of 0.24 caused a skin reaction. The bands at this retention were removed from six plates, combined, eluted with acetone and purified again by TLC. The purified fraction mixed in petrolatum in the dilution series was used for conclusive patch testing on the patient. An allergic reaction was induced at down to 0.003% wt/wt. According to MS and IR analyses, the isolated compound was diethyleneglycol maleate (DEGM, MW204). In addition to the resin part, the sanding dust also contained this monomer.

Exposure to wood dusts may cause various skin and mucosal symptoms. Allergic dermatoses, caused by wood dusts, diagnosed at the Finnish Institute of Occupational Health during 1976-1999 are reported here. 16 had allergic contact dermatitis and, 2 had contact urticaria. 9 men (3 cabinet makers, 3 joiners, 1 carpenter, 1 knifemaker and 1 machinist) were mainly exposed to tropical hardwoods. 1 man had dermatitis caused by western red cedar. 5 patients, 3 men and 2 women, were exposed to Finnish pine or spruce dusts, and 1 man to aspen. 7 also had rhinitis, 4 asthma or dyspnoea and 3 conjunctivitis. On patch testing, 10 men reacted to 9 different wood dusts, including teak (5), palisander (3), jacaranda (2), mahogany (2), walnut (2) and obeche (1). Reactions to wood allergens, including lapachol (2), deoxylapachol (1), (R)-3,4-dimethoxydahlbergione (2), 2,6-dimethoxy-1,4-benzoquinone (1), mansonone A (2) and salicyl alcohol (1), were noted in 4 cases. All but 1 of 5 patients exposed to pine or spruce dusts reacted to the sawdusts, all 5 to colophonium, 3 to abietic acid, 2 to tall oil resin, 3 to wood tar mix and 4 to other wood gum resins. Of the 2 CU patients, 1 was prick and RAST positive to obeche, 1 reacted with urticarial dermatitis to punah wood dust on chamber exposure. Occupational allergic dermatoses are mainly caused by the dusts of hardwoods, mostly due to Type IV allergy, but may also be caused by softwood dusts. Patch tests can be done with wood dusts, but should be confirmed by patch testing with wood allergens if possible.

The mechanism of occupational asthma from diisocyanates (DI)(1-10)(Fig. 1) is not fully known; only about 10%-30% of such patients have specific IgE antibodies to DI (3, 11, 12). A T-cell mediated response has been considered to be involved in DI asthma (13) and we therefore wondered whether patch testing might be of any help in its diagnosis.

The regulations relating to cosmetic products give no limit values for toxic elements such as metals or arsenic occurring as impurities in cosmetic products. The present study of metals (lead, cobalt, nickel, chromium) and arsenic in eye shadows in 88 colors of 25 brands and 49 products provides a basis for assessing the safety of eye shadow. 66 out of 88 (75%) of the colors contained more than 5 ppm of at least one of the elements, and all 49 products contained more than one 1 ppm of at least 1 of the elements. In one color, the amount of all elements was less than 1 ppm. The highest levels of cobalt and nickel were 41 and 49 ppm, respectively. These levels were high enough to cause allergic symptoms in those previously sensitized. Furthermore, long-term exposure to such levels may probably sensitize. The concentrations of arsenic were extremely low, 2.3 ppm at most. The level of lead was less than 20 ppm in all products. Accordingly, the concentrations of arsenic and lead seemed to be safe. 9 colors had concentrations of water-soluble chromium exceeding 2 ppm, and a very high level, 318 ppm, was encountered in 1 case. The overall results indicate that eye-shadows probably have no significant systemic toxicological effects. The groups at greatest risk are those already sensitized to the allergenic elements. Such consumers will have difficulties in choosing suitable products, since these elements in the form of impurities are not declared in the list of ingredients. Manufacturers should demand certification that the raw materials they buy contain no toxic elements. Although some of the products studied were acceptable, many had excessive levels of the elements from the consumer's viewpoint.

Patch testing is the predominant method of establishing contact allergy. The present patch test technique is the result of a continuous process of development and improvement since its first application in the late 19th century. The perfect patch test should give no false-positive and no false-negative reactions. The ideal patch test should also cause as few adverse reactions as possible, particularly no patch test sensitization. Even though the history and examination of a patient with suspected allergic contact dermatitis will give clues to possible sensitizers, it is not sufficient to patch test only with initially suspected sensitizers; unsuspected sensitizers used for patch testing frequently turn out to be the real cause of the dermatitis. Fortunately, a small number of substances are considered to account for the majority of delayed hypersensitivity reactions. Therefore, generally 20-25 test preparations consisting of chemically defined compounds, mixes of allergens, and natural and synthetic compounds, are grouped into a standard test series. The requirements to be fulfilled by a sensitizer in a standard patch test series are discussed in this article. A procedure of investigations is proposed before a sensitizer is included in a standard series.

Para-tertiary-butylcatechol (PTBC) is a rare allergen which is used in the rubber, paint and petroleum industries. We present 9 patients who were sensitized to PTBC and examined at the Finnish Institute of Occupational Health (FIOH) between 1974 and 1995. 3 of the patients had been exposed to PTBC in their work. 2 of them also had allergic reactions to para-tertiary-butylphenol (PTBP)-formaldehyde resin and to PTBP. 5 of the patients became sensitized to PTBC from patch testing. PTBC was found to be one of the most common causes of active sensitization in our clinic. Accordingly, at the FIOH, the patch test concentration of PTBC was lowered to 0.25% and this lower concentration is recommended for general use.

2,3-epoxypropyl trimethyl ammonium chloride (EPTMAC) is used in the production of cationic starch (CS) for the paper industry. It has been shown to be a sensitizer in guinea pigs, but cases of human sensitization are few. 4 workers were previously sensitized to the substance in a Finnish plant. This report describes 3 process men from another plant examined because of recurring dermatitis. 18 workers were involved in production, and had free access to all work sites. 3 process men, whose work involved drying the CS, had dermatitis, although they had only occasional contact with the cationizing chemical. 2 were already verified to be allergic to EPTMAC and had had variable dermatitis for 8-12 years. One had had dermatitis on his face for 1 year. Patch testing with a dilution series (1%, 0.5%, 0.2%, 0.1% pet.) confirmed their allergy to the cationizing chemical containing EPTMAC, but tests with CS were negative. In addition, 2 had contact allergy to Cl+ Me-isothiazolinone from contact with Kathon LX used as a slimicide in the process. In long-standing (years) recurrent dermatitis, re-examination of patients with verified exposure history and skin test is necessary. In line with our previous study, sampling the process materials, maintenance work and contamination of work sites and gloves caused sensitization. The results also confirm that EPTMAC is a strong human contact sensitizer. 0.2%-0.5% pure EPTMAC in pet. seems to be the optimal patch test concentration.

A worksite survey was conducted in all 38 Finnish electroplating plants. All workers (n = 163) who worked with nickel plating (bath workers, hangers and solution makers) were interviewed with a questionnaire about symptoms of nickel dermatitis, hand dermatitis, and about protective measures, atopy, etc. Patch testing with nickel sulfate was done with the TRUE TestTM method. All the workers, 94 men and 69 women, answered the questionnaire. The mean age of women was 41.1 years, and of men 43.1 years, respectively. Men had longer occupational exposure to nickel (14 years) than women (10 years). Most workers used protective gloves. 35% of women and 30% of men reported present or past hand dermatosis. 19% reported a history of atopic dermatitis. 15% of women (n = 8) and 4% (n = 2) of men had an allergic patch test reaction to nickel sulfate. 70% of those with an allergic patch test reaction to nickel reported past or present hand eczema. The prevalence of nickel allergy among the electroplaters was similar to that of patients in patch test clinics in Finland. An allergic patch test reaction to nickel sulfate does not necessarily oblige an electroplater to change jobs.

Data on occupational contact urticaria (protein contact dermatitis included) in Finland during 1990-1994 were analyzed. Altogether 815 cases were reported to the Finnish Register of Occupational Diseases during this period, compared with 1944 cases of occupational allergic contact dermatitis. Accordingly, the total number of occupational allergic contact dermatoses was 2759, 29.5% being contact urticaria and 70.5% being allergic contact dermatitis. Occupational contact urticaria was much more common in women (70%) than in men (30%). The 6 most common causes of contact urticaria were (1) cow dander (362 cases = 44.4%), (2) natural rubber latex (193 cases = 23.7%), (3) flour, grains and feed (92 cases = 11.3%), (4) handling of foodstuffs (25 cases = 3.1%), (5) industrial enzymes (14 cases = 1.7%) and (6) decorative plants (13 cases = 1.6%). The occupations with the highest numbers of occupational contact urticaria were farmers (341 cases), domestic animal attendants (61), bakers (53), nurses (42), chefs (40) and dental assistants (28). The ranking list of the most common occupations with occupational contact urticaria per 100,000 employed workers was as follows: (1) bakers (140.5 cases per 100,000 employed persons), (2) preparers of processed food, (3) dental assistants, (4) veterinary surgeons, (5) domestic animal attendants, (6) farmers and silviculturalists, (7) chefs, cooks and cold buffet managers, (8) dairy workers, (9) horticultural supervisors, (10) laboratory technicians and radiographers, (11) physicians, (12) butchers and sausage makers, (13) laboratory assistants, (14) dentists and (15) nurses (21.2 cases per 100,000 employed person). Low-molecular-weight chemicals caused very few cases of occupational contact urticaria, the most common being 2-ethylhexyl acrylate (5 cases). To summarize, occupational contact urticaria forms a large group of occupational contact dermatoses, and dermatologists need to be able to diagnose IgE-mediated immediate skin allergic diseases.

About 1000 patients were investigated at our clinic during 1991-1995 for occupational skin disease, and 5 had occupational allergic contact dermatitis from spices. The patients were chefs, or kitchen, coffee room, and restaurant workers. All patients had hand (or finger) dermatitis. The causative spices were: garlic, cinnamon, ginger, allspice and clove. The same patients also had allergic patch test reactions to foods: tomato, lettuce and carrot. Paprika elicited a weak allergic patch test reaction in 2 patients. Occupational allergic contact dermatitis from spices is relatively rare, but needs to be taken into consideration in patients who have hand dermatitis, and work with spices and foods. Patch testing with spices as is is useful, but testing with dilutions in pet, may be needed to confirm that the patch test reactions are allergic. Patients also need to be prick tested with spices and foods.

Of 22 workers in a ski factory, occupational allergic contact dermatitis was found in 8. 6 were sensitive to epoxy resin compounds, i.e., epoxy resins, hardeners or diluents, 1 to cobalt in glass-fiber reinforcements, and 1 to formaldehyde in a urea-formaldehyde glue and a lacquer. 4 workers had irritant contact dermatitis from epoxy resin compounds, lacquers, sanding dust, or glass-fiber dust. 3 had contact allergy from a new sensitizer, diethyleneglycol diglycidyl ether, in a reactive diluent. Immediate transfer of workers sensitized to epoxy resin from epoxy exposure prevents aggravation of their dermatitis and broadening of the sensitization to epoxy hardeners, diluents and other compounds.

12 cases of occupational allergic contact dermatitis caused by decorative plants were diagnosed in a 14-year period. The patients were middle-aged, and their average exposure time was 13 years. The plant families and plants causing occupational contact dermatitis were Compositae (5 patients: chrysanthemum, elecampane, gerbera, feverfew), Alstroemeriaceae (5 patients, Alstroemeria), Liliaceae (4 patients; tulip, hyacinth). Amaryllidaceae (2 patients: narcissus) and Caryophyllaceae (2 patients; carnation, cauzeflower). The known chemical allergens causing dermatitis were tuliposide-A and sesquiterepene lactones, such as alantolactones and parthenolide, in the Liliaceae and Compositae families. 7 of the 12 patients were able to continue their work; 5 were not because of severe relapses of skin symptoms. The plant allergen and extract series currently available are of great help in the diagnosis.

Rubber chemicals are among the most common occupational contact sensitizers. The most common rubber sensitizers are thiurams, thiazoles, carbamates and paraphenylenediamine derivatives. Here we present data on a less-well-known rubber chemical, N-(cyclohexylthio)phthalimide (CTP; CAS 17796-82-6). This chemical is currently the most widely used vulcanization retarder, but data on allergic contact dermatitis caused by CTP are lacking. We conducted a survey of 310 patients who had been patch tested with 30 rubber chemicals including CTP. 11 (3.5%) showed an allergic patch test reaction provoked by CTP, and 9.0% by thiurams. 4 of the patients reacted only to CTP and not to other rubber chemicals, whereas the other 7 concomitantly reacted to other rubber chemicals. After analyzing the patch test data of these 11 patients, it was concluded that CTP probably did not cross-react with the other rubber chemicals. Therefore the patch test results may indicate independent sensitization to CTP and other rubber chemicals. Because very little data on the components of rubber chemicals in rubber products are available, the source of the putative sensitization to the rubber vulcanization retarder CTP is unknown.

Polyfunctional aziridine (PFA) is increasingly used as a water-based cross-linker in 2-component paints, paint primers, lacquers, topcoats and other protective coatings. The cross-linker (PFA hardener) is made by reacting multifunctional acrylic monomer with a highly reactive aziridine compound. During 1992-1993, we came across 2 patients with allergic patch test reactions provoked by PFA hardener. One of the patients was a parquet layer, and the other a printer. Allergic contact dermatitis (ACD) was diagnosed by positive allergic patch test reactions to PFA hardener in a dilution series in pet.:0.3%-1% gave ++ to allergic reactions in both patients, whereas 0.1% gave a weak (+) or questionable reaction (?+), respectively. The methacrylate patch test series was negative in both patients, although gas chromatography/mass spectrometry analysis showed that PFA hardener contained 0.3% of trimethylolpropane triacrylate (TMPTA), a multifunctional acrylic monomer. One of the patients also had symptoms of contact urticaria, and a prick test with PFA hardener (1% aq.) induced a histamine-sized prick test reaction. The positive reactions with the PFA hardener and the negative reactions with the starting chemicals and additives in PFA, namely acrylates, propyleneimine and dimethylethanolamine, indicate that PFA caused ACD. This is in accordance with our previous observations, but differs from the reports of others, whose patients had been sensitized to acrylates present as remnants in the PFA hardener. As test substance, 0.5% PFA hardener in pet. is recommended for patch testing. Testing should be performed in patients with contact dermatitis if exposure to PFA has occurred. Skin prick tests may be of help to detect contact urticaria.

The present study summarizes information on toothpaste composition as supplied by the manufacturers. The survey covered 48 items, virtually all toothpastes offered for sale in Finland. It was concluded that the toothpastes are not entirely safe to use, because almost 50% of the products studied contained a total of some 30 compounds widely recognized as allergens. According to the literature, the most common allergens in toothpastes are flavours (e.g., cinnamic aldehyde, cinnamon oil and peppermint) and preservatives. Symptoms include stomatitis, cheilitis, glossitis, gingivitis, perioral dermatitis and immediate hypersensitivity.

Acid anhydrides are low-molecular-weight chemicals known to cause respiratory irritancy and allergy. Skin allergy has on rare occasions been reported. 2 workers contracted hives and itching on uncovered skin after 2 months exposure to methyltetrahydrophthalic anhydride (MTHPA) and methylhexahydrophthalic anhydride (MHHPA), to which they had airborne exposure. Later, the patients also developed conjunctivitis, rhinitis, sore throat, cough or asthma. In addition to MTHPA, 1 worker was also exposed to unsaturated polyester resin (UP). Both patients' immediate allergy to MTHPA and MHHPA was verified by positive prick tests to MTHPA and MHHPA, conjugated with human serum albumin (HSA), and positive radioallergosorbent tests (RASTs) to these anhydrides. On prick testing, both patients also reacted to a phthalic anhydride (PA)-HSA-conjugate and 1 of the patients to UP-HSA-conjugate. Specific immediate allergy to UP was shown by RAST. RAST inhibition with MTHPA, MHHPA and UP-resin conjugates confirmed IgE-mediated allergy and cross-reactivity between anhydrides. Our patients had developed airborne contact urticaria caused by phthalic anhydrides, in addition to respiratory allergy. Phthalic anhydride contained in the UP resin was possibly responsible for the immediate reaction of the skin.

It is known from experimental studies that antigenic potency and the concentration of antigen determine whether exposure to an antigen will result in sensitization. A single accidental exposure to concentrated antigen may therefore induce primary sensitization. The purpose of this report was to collect clinical cases in which a single exposure had resulted in contact dermatitis suspected to be allergic. Only patients without previous relevant skin symptoms were included. Patch testing was used to demonstrate sensitization. 6 patients developed occupational allergic contact dermatitis from accidental exposure. Patch testing revealed allergy to diglycidylether of bisphenol A epoxy resin, polyfunctional aziridine hardener, methyl acrylate, phenol-formaldehyde resin, and methylchloroisothiazolinone/methylisothiazolinone (Kathon LX), respectively. Furthermore, 2 patients developed allergic contact dermatitis from their first exposure to tear gas chemicals, namely omega-chloroacetophenone and ortho-chlorobenzylidene malonitrile. A single exposure can therefore induce both sensitization and subsequent allergic contact dermatitis without further exposure. The allergens described must be considered strong allergens. The skin should immediately be cleaned if an accidental splash with such an allergen has taken place. Language: en

A 48-year-old female silk-screen printer had worked in the manufacture of circuit boards for 12 years before she got the first symptoms of dermatitis on her wrists and lower arms. On the 1st patch test session, epoxy resin and the remainder of the standard series were negative, while a plastics and glues series gave an allergic reaction to 4,4'-diaminodiphenylmethane (DDM). The 2nd test session revealed allergic reactions to several acrylics, several epoxy compounds and 3 ink components. According to the material safety data sheets, 1 ink hardener contained DDM, but the causative agent in 1 ink and 1 ink hardener remained uncertain. The manufacturers of the 2 inks kindly provided us with their components for further patch tests. 2 of these components gave allergic reactions: triglycidyl isocyanurate (TGIC) and 2-hydroxyethyl methacrylate (2-HEMA). Our case report shows that the manufacture of circuit boards involves exposure to highly sensitizing chemicals. DDM, TGIC and 2-HEMA should be remembered as silk-screen printers' potential contact sensitizers in the manufacture of circuit boards.

A total of 100 workers, 86 from the glass-fibre-reinforced plastics (GRP) industry, 11 from polystyrene production and 3 from polyester resin coating manufacture, were examined for occupational skin hazards and for evaluation of skin protection. The workers had been exposed to many chemicals. Those working in the GRP industry had also been exposed to glass fibre and to dust produced by finishing work. 94% used protective gloves. 22 workers, all employed in the GRP industry, had contracted occupational skin disorders. 6 had allergic and 12 irritant contact dermatitis. 4 workers had an accidental injury caused by a peroxide catalyst, fire, hot air and constant mechanical friction. Allergic dermatoses were due to natural rubber (latex) (4 cases) in protective gloves, phenol-formaldehyde resin (1 case) and cobalt naphthenate (1 case). Irritant hand dermatoses (5 cases) were caused by the combined hazardous effect of unsaturated polyester or vinyl ester resins, organic solvents, glass fibre and dust from finishing work on the skin. Other cases of irritant dermatoses (7 cases) were due to the dust, promoted by mechanical friction of clothes. Skin disorders in the GRP industry were common (26%) but the symptoms were mild and only 3 patients had been on sick leave because of occupational skin disease.

Keywords: occupational; contact urticaria; protein contact dermatitis; industrial enzymes; proteases; process man; prick testing; rhinitis; conjunctivitis; allergy

Keywords: active sensitization; epoxy resin; occupational allergic contact dermatitis; laboratory technician; patch test technique; plastics and glues

Keywords: occupational; allergic contact dermatitis; optician; paresthesia; paronychia; anaerobic sealant; adhesive; ethylene glycol dimethacrylate; 2-hydroxyethyl methacrylate; (meth)acrylates; material safety data sheets

In addition to asthma, contact dermatitis may also develop from occupational contact with polyurethane (PU) chemicals. 6 cases of allergic contact dermatitis from exposure to PU chemicals were diagnosed in 1974-1990. The present paper summarizes the results and gives detailed descriptions of 3 such patients. 3 patients were allergic to 5 different diisocyanates (DICs), including 4,4'-diphenylmethane DIC (MDI), toluene DIC (TDI), 1,6-hexamethylene DIC (HID), and furthermore to diaminodiphenylmethane (MDA). 3 patients were sensitized by exposure to MDI. 2 of these reacted to MDI and MDA, and 1 to TDI in addition. 1 of the 3 patients reacted only to MDA, possibly formed by hydrolysis of MDI. Primary sensitization to MDA and cross-allergy to MDI could explain the reactions of the patients exposed to MDI, but separate sensitization may also be possible. Patch tests with fresh petrolatum (pet.) mixtures were first made and a 2% concentration was recommended for MDI and TDI. In order to determine the stability of DIC test substances, the last 2 patients were tested with old test substances. Tests with MDI 1.5% pet. and TDI 1.5% pet., 5.5 months and 15.5 months old, were positive. The results suggest that, when allergy to PU chemicals is suspected, patch tests should include, in addition to MDA, at least MDI and TDI 1.5-2% pet. They also suggest that test substances can be used for over a year, and that allergy to MDA may point to MDI exposure contained in PU chemicals.

A nonatopic female secretary developed hand dermatitis after I year of full-time work with telefax paper. Her dermatitis improved on sick leave and vacation and relapsed at work. Patch testing showed allergic reactions to several fragrances, balsam of Peru, colophony and neomycin. In 3 patch test sessions, her own telefax papers gave a doubtful reaction which persisted for 4 days, but it could not be determined whether the reactions were allergic or irritant. The colophony content of the telefax paper was about 1%, and it was possible that colophony in the telefax paper was responsible for the weak patch lest reactions. Accordingly, the contact dermatitis would have been allergic. The patient has now been relocated, does not handle telefax paper, and is symptomless. We concluded that our patient had an occupational hand contact dermatitis induced by telefax paper and possibly caused by coin phony allergy.

Irritant contact dermatitis caused by occupational contact with nitroglycerin has been known since the end of the last century. Nitroglycerin is an allergen, and the transdermal drug delivery systems for nitroglycerin recently used to treat angina pectoris have sensitized. 4 patients with allergic contact dermatitis caused by nitroglycerin from explosives are described, and 1 patient who was sensitized by transdermal nitroplaster. On patch testing, dynamite and/or the explosive components nitroglycerin, ethylene glycol dinitrate and dinitrotoluene gave allergic reactions. The following concentrations and vehicles are suggested for patch testing: nitroglycerin 0.5-2% pet., dinitrotoluene and ethylene glycol dinitrate 0.1-0.5% pet. Persons exposed to nitroglycerin at work should try to avoid skin contact by using protective gloves. It is advisable that those who have become allergic to nitroglycerin should wear disposable protective gloves when handling explosives.

This study comprises 40 patients with skin disorders from current or previous occupational exposure to epoxy resin compounds (ERC) during 1984-1988. ERCs were the 3rd most common cause (32 of 264 cases: 12.1%) of currently relevant allergic contact dermatitis: 23 cases from epoxy resins based on the diglycidyl ether of bisphenol A (DGEBA-ERs), 5 from reactive diluents, 1 from amine hardeners (DETA), and 3 from epoxy acrylates. 2 cases (0.8%) of irritant contact dermatitis were due to ERCs. Methyl hexahydrophthalic anhydride (MHHPA, an epoxy hardener) caused 1 case of contact urticaria. Previously relevant occupational allergic contact dermatitis from DGEBA-ERs was detected in 5 cases. On patch testing, ERC allergens gave the following positive reactions: epoxy resin of the standard series in 35 cases (4.0% of 870 tested), epoxy reactive diluents in 10 (7.1% of 140), cycloaliphatic epoxy resins in 4 (11.1% of 36), epoxy acrylates in 4 (4.5% of 88), and amine compounds commonly used as epoxy hardeners in 17. Despite extensive patch test series, testing with patients' own ERCs remains important.

Unsaturated polyester (UP) cement caused allergic contact dermatitis in car repair work. The resin was a condensate of polyols and maleic anhydride with reactive solvent, auxiliary substances, and inorganic reinforcement substances. To identify the causative chemicals, the cement was tested on a sensitized patient. For analysis, samples of the resin were eluted with acetone and eluted with hexane to precipitate inorganic material and large polyester molecules. The eluate was evaporated. The remainder, dissolved in acetone, was separated into fractions on silica plates by thin layer chromatography (TLC). On the developed (hexane/chloroform, 15/85) plates, 20 bands were obtained under UV-light at 254 nm. Samples of the bands were scraped and used for patch testing. The scraping at a retention factor (Rf) of 0.24 caused a skin reaction. The bands at this retention were removed from six plates, combined, eluted with acetone and purified again by TLC. The purified fraction mixed in petrolatum in the dilution series was used for conclusive patch testing on the patient. An allergic reaction was induced at down to 0.003% wt/wt. According to MS and IR analyses, the isolated compound was diethyleneglycol maleate (DEGM, MW204). In addition to the resin part, the sanding dust also contained this monomer.

Keywords: aziridine (PFA) hardener; trimethylpropane triacrylate; propyleneimine; dimethylethanol amine; wool wax alcohols; leather; dyeing; tannery; chronic sulfate; patch test; allergy; allergic contact dermatitis; asthma

Occupational diseases of dentists and dental nurses were compiled from the Finnish Register of Occupational Diseases. The cases were recorded during 3 3-year observation periods, namely 1982-1984, 1986-1988, and 1992-1994 (i.e., 9 observation years). The relative risk of developing occupational allergic contact dermatitis in different occupations was calculated from the statistics of the years 1986-1991, and was expressed as the age-standardized rate ratio (SRR). During the 9 observation years, the majority of registered occupational diseases of dentists and dental nurses were skin diseases (221/312; 70.8%), followed by occupational repetitive strain injuries (61/312; 19.6%) and occupational respiratory diseases (20/312; 6.4%). The incidence rate (IR) for allergic contact dermatoses/10,000 workers (contact urticaria included) increased from 26 (95% confidence interval (CI) 16-40) in 1982-1984 to 79 (95%, CI 64-97) in 1992-1994. The IR/10,000 of allergic contact dermatoses increased especially for dentists, from 5.4 (95% CI 0.7-19) in 1982 to 67 (95% CI 45-95) in 1992-1994. The increase of the IR/10,000 dental nurses was smaller: from 43 (95%, CI 26-66) in 1982-1984 to 87 (95% CI 67-111) in 1992-1994. There was no increase in the IR/10,000 cases of irritant dermatoses. The most common causes of allergic contact dermatitis were plastics, disinfectants and antimicrobials, rubber chemicals, and mercury/mercury salts. The most common causes of irritant contact dermatitis were detergents, wet and dirty work, plastic chemicals and antimicrobials. Currently, Finnish dentists have the highest risk and dental nurses have the 4th highest risk of any occupation for developing occupational allergic contact dermatitis: the risk was 6.4-fold (SRR 6.4) in dentists and 6.1-fold in dental nurses, as compared to the general working population. It is evident that safer acrylics and protective gloves, better product declarations and material safety data sheets, as well as more information about protective measures, including non-touch working techniques, are needed.

Questionnaire-tools for surveying occupational skin diseases and exposure are needed for comparable epidemiological research, workplace assessments, and evaluation of workplace interventions. The Nordic Occupational Skin Questionnaire Group supported by the Nordic Council of Ministers has developed a standardized questionnaire-tool for surveys on work-related skin diseases and skin exposures to environmental factors. Nordic Occupational Skin Questionnaire (NOSQ-2002) includes two questionnaires designed for separate purposes. NOSQ-2002/short is a 4-page questionnaire for screening skin problems at workplaces. NOSQ-2002/long is an in-depth survey tool for research purposes. The questionnaire covers occupational history, atopic symptoms, self-reported hand or forearm eczema, exacerbating factors, consequences and life impact of dermatoses, self-reported contact urticaria on hands or forearms, skin symptoms, skin tests, exposures, and protective glove use. For the time being, NOSQ-2002 is available in English, Danish, Swedish, Finnish and Icelandic. Further translations are welcomed. The NOSQ-2002 report includes a review of pertinent literature on questionnaire methods for skin disease studies. Questions on work and exposure can be tailored to specific populations or occupational groups, according to the instructions and recommendations given in NOSQ-2002/INFO version of the questionnaire. The NOSQ-2002 questionnaire files can be downloaded from http://www.ami.dk/NOSQ. The Nordic Council of Ministers has the copyright to the NOSQ-2002 questionnaires. Use of the questionnaires is free of charge. The NOSQ-2002 questionnaires and their present and possible future translations cannot be used commercially.