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Background: EU legislation has reduced the epidemic of nickel contact allergy affecting the consumer, and shifted the focus towards occupational exposure. The acid wipe sampling technique was developed to quantitatively determine skin exposure to metals., Objectives: To assess the clinical usefulness of the acid wipe sampling technique as part of the diagnostic investigation for occupational nickel allergy-associated hand dermatitis., Patients and Methods: Six patients with vesicular dermatitis on the hands were included. Acid wipe sampling of skin and patch testing with a nickel sulfate dilution series were performed., Results: Nickel was detected in all samples from the hands. In all patients, the nickel content on the hands was higher than on the non-exposed control area., Conclusions: Occupational exposure to nickel-releasing items raised the nickel content on exposed skin as compared with a non-exposed control site. Nickel-reducing measures led to complete symptom relief in all cases. In cases of a positive nickel patch test reaction and hand eczema, patients should perform the dimethylglyoxime (DMG) test on metallic items at home and at work. The acid wipe sampling technique is useful for the diagnosis of occupational hand eczema following screening with the inexpensive DMG test., (© 2010 John Wiley & Sons A/S.)

Background: The accuracy of the dimethylglyoxime (DMG) nickel spot test has been questioned because of false negative and positive test reactions. The EN 1811, a European standard reference method developed by the European Committee for Standardization (CEN), is fine-tuned to estimate nickel release around the limit value of the EU Nickel Directive from products intended to come into direct and prolonged skin contact. Because assessments according to EN 1811 are expensive to perform, time consuming, and may destruct the test item, it should be of great value to know the accuracy of the DMG screening test., Objectives: To evaluate the sensitivity and specificity of the DMG test., Methods: DMG spot testing, chemical analysis according to the EN 1811 reference method, and X-ray fluorescence spectroscopy (XRF) were performed concomitantly on 96 metallic components from earrings recently purchased in San Francisco., Results: The sensitivity of the DMG test was 59.3% and the specificity was 97.5% based on DMG-test results and nickel release concentrations determined by the EN 1811 reference method., Conclusions: The DMG test has a high specificity but a modest sensitivity. It may serve well for screening purposes. Past exposure studies may have underestimated nickel release from consumer items.

Background: Cobalt, nickel, and chromium are important skin sensitizers. However, knowledge about cobalt exposure and causes of cobalt sensitization is limited., Objectives: To study release of cobalt, nickel, and chromium from some cobalt-containing hard metal alloys and to test reactivity to the materials in cobalt-sensitized patients., Methods: Discs suitable for patch testing were made of some hard metal alloys. Cobalt, nickel, and chromium release from the materials was determined by immersion in artificial sweat (2 min, 1 hr, 1 day, and 1 week). Patch test reactivity to the discs and to serial dilutions of cobalt and nickel was assessed in previously patch-tested dermatitis patients (19 cobalt positive and 18 cobalt-negative controls)., Results: All discs released cobalt, nickel, and chromium. Some discs released large amounts of cobalt (highest concentration: 290 microg/cm(2)/week). Seven discs elicited three or more positive test reactions., Conclusions: The concentration of released cobalt was high enough to elicit allergic contact dermatitis in cobalt-sensitized patients. As the materials in the discs are used in wear parts of hard metal tools, individuals with contact allergy to cobalt may develop hand eczema when handling such materials.

There is a great need to accurately assess skin exposure to contact allergens. We have developed a technique for assessment of skin exposure to nickel, chromium and cobalt using acid wipe sampling by cellulose wipes with 1% nitric acid. Chemical analysis was performed by inductively coupled plasma mass spectrometry (ICP-MS). The recovery of nickel, chromium and cobalt from arms and palms was 93%. The analytical result is expressed in terms of mass per unit area (microg/cm(2)). The developed acid wipe sampling technique is suitable for determination of nickel, chromium and cobalt deposited on the skin. The technique may be used in workplace studies, in studies of individuals in the general population, in dermatitis patients, in identification of risk groups, as well as in developing preventive strategies and in follow-up after intervention.

Frequent exposure to water and surfactants is considered to be the main cause of hand eczema from wet work. Ethoxylated surfactants are susceptible to oxidation and some of the oxidation products formed have proved to be contact sensitizers in guinea pigs. The question of human sensitization to oxidized surfactants was addressed in a multicentre study in the Stockholm region. 528 consecutive dermatitis patients were patch tested with widely used ethoxylated surfactants in oxidized and non-oxidized form as well as certain identified oxidation compounds. 61 patients presented with mild, clearly irritant reactions to some of the surfactants tested. 18 patients showed not only erythema but also oedema and/or papules and vesicles, using a morphologic descriptive system for reading the patch test reactions. These reactions occurred mostly to oxidized surfactants and oxidation products. When retesting 9 of these 18 patients only an allergic reaction to acetaldehyde was confirmed. We conclude that oxidized ethoxylated surfactants have increased irritant potential compared to non-oxidized material. Our working hypothesis is that oxidized surfactants of technical quality exert a lower risk of sensitization than do oxidized homologous pure surfactants. Among the potential allergens formed during autoxidation, formaldehyde and acetaldehyde must be considered as a source of unexpected exposure.

Metal release from 13 different gold-containing jewelry alloys stored for 1 and 3 weeks in artificial sweat was analysed. For chemical analysis, inductively-coupled plasma detection (ICP) and atomic absorption spectrophotometry (AA), with flame and with furnace, were used. No release of gold was detected. It is unlikely that skin contact with gold-containing metallic items such as jewelry is responsible for inducing contact allergy to gold or allergic contact dermatitis due to the gold. The patch-test reactivity to gold sodium thiosulfate needs to be explained by some other mechanism(s).

Nickel allergy in women has been thoroughly studied: its prevalence, the most important sources of sensitization, and risk factors for elicitation of dermatitis. Preventive measures have also been introduced. Nickel allergy in men has not, however, been equally focused on. Based on clinical experience, some publications indicating that tools may be a risk factor for nickel allergy and hand eczema in men, and the fact that large occupational groups regularly use tools, we decided to carry out a study, of the prevalence on the market of tools that release nickel. 27% of 565 hand-held tools with metal parts that come into contact with the skin were found to be dimethylglyoxime (DMG) test positive. Release of nickel and other metals into artificial sweat and composition of metals on the surface and in the base alloy were also studied. It is suggested that tool producers should consider nickel allergy and avoid nickel-releasing materials, and that analytical methods, relevant for nickel release from tools, should be further developed.