CHAPTER 25

 
Different types of metals or their synthetics may act as a skin sensitizers.

Some of these are discussed below briefly.

1. Chromium Dermatitis 
   The chromates are strong skin sensitizers. They may act as a primary irritant or causing delayed type of contact eczema. Chromates sensitization occurs in painters, photographers, diesel engine mechanics, welders, tanners and those who are exposed to different dyes. Dichromates are found in shoes, zippers, leather hat bands, leather camera cases, cement, glues and chrome plated custom jewels.

Diagnosis
Patch test.

1. Avoid contact with the chromate

2. Active treatment: is the same as that of contact dermatitis

2. Nickel

Nickel metal can cause dermatitis but other metals dermatitis is due to metal salts that of chromate, mercury, zinc, gold, silver and others. Metal salts are available in earrings, hairpins, rings, braces and spectacle frames.

Fig. 194a. Contact dermatitis (Necklace)

Fig. 194b.. Metal dermatitis

Gold salts and platinum especially when mixed with other metals may cause dermatitis. The most common source of metallic nickel is plated objects. Stainless steel (usually containing 8% Ni and 18% Cr.) seems not to have the same capacity to elicit contact dermatitis as alloys with, for example, copper in coins, but cooking foods with acid pH, such as fruit, in stainless steel saucepans may increase nickel release.

The nickel salts (nickel sulfate, nickel ammonium sulfate, etc.) are all used in plating processes.

Eye shadow may contain nickel. Very small amounts of nickel are sufficient to elicit dermatitis.

Sources of nickel have been detected in medical injectors and cardiac pacemakers.

Certain foods and beverages contain much higher concentrations of nickel than others, such as domestic water, and exposure to nickel may also be a contaminant for vegetables from fertilizers .

3. Mercury

   Different types of mercuric salts may cause dermatitis. The different mercuric salts that may cause skin sensitization are:

   Mercuric salts as Mercurochrome used as a common antiseptic may cause dermatitis. Phenyl mercuric salts used in glue or gelatin waving solution, in cosmetic industry as a preservative, in agriculture as insecticide and fungicide. Many salts of aluminum may cause allergy or irritation to the skin surface.

   The metal is used in amalgam (alloy of silver or copper and mercury) for tooth filling and in instruments.

   Generalized exanthemas have been reported in sensitized individuals from amalgam and broken thermometers.

   Metallic mercury is a rare cause of cutaneous granuloma .The inorganic mercury salts are nowadays less used as topical medicaments.

   The organic compounds are used in pesticides and as antimicrobial agents in oils, paints and the textile industry, in water, in the paper industry and in shoe linings, but seldom cause sensitization. Sometimes the organic compounds are used as preservatives in injection solutions, gamma globulin and antigenic extracts, or in expectorants, creams, skin disinfectants, eye drops and contact lens solutions.

   Phenyl mercuric borate (Merfen) is still much used as a disinfectant and fungicide.

   Phenyl mercuric acetate is used in some vaginal spermicides, which may cause allergic reaction.

   Red mercuric sulfide (cinnabar) is used in red tattoos causing granulomatous reactions and in artists paints. It may contain impurity of cadmium sulfide and can thereby cause phototoxic reactions.

   Most cases that are sensitive to mercury , react on patch testing to the metal both the inorganic and organic compounds .

   Aluminum injected as hydroxide in adsorbed vaccine can cause granuloma. It has also been reported as rare contact sensitizers.

   Recycled alumina can cause pruritus.

4. Arsenic

   Arsenic salts are common cause of dermatitis. Different type are used in the manufacture of chalk, fabrics and domestic articles, disinfectant in agriculture and as a preservative of animal skins .

   Arsenic may be present in medicaments, wood preservatives, pesticides, glass industry, tanning, fireworks, additives, gold in fireproof packaging and animal foodstuff .

5. Gold

   Gold metal is a common skin sensitizer.

   Gold salts, e.g. gold trichloride (used in photography, gold plating and gilding glass and porcelain) are sensitizers.

   White gold may contain nickel.

   Gold chloride is strong sensitizer.

   Patch tests for these salts can give positive reaction .

6. Iodine

   Formerly when iodine was widely used as an antiseptic and antimycotic agent the frequency of sensitization was much higher than it is now .

   Povidone-iodine solution has only 1% available iodine and is a rare sensitizers.

REFERENCES

1. Burrows D. Adverse chromate reactions on the skin. In: Burrows D, ed. Chromium: Metabolism and Toxicity. Boca Raton, Florida: CRC Press, 1983: 137-63.

2. Hambly EM, Wilkinson DS. Contact dermatitis to butyl acrylate in spectacle frames. Contact Derm 1978; 4: 115.

3. Kirton V, Wilkinson DS. Sensitivity to cinnamic aldehyde in a toothpaste. Contact Derm 1975; 1: 77-80.

4. Calnan CD. Nickel dermatitis. Br J Dermatol 1956; 60: 229-36.

5. Christensen OB, M?ller H. Nickel allergy and hand eczema. Contact Derm 1975; 1: l29-35.

6. Shelley WB, Hurley HJ. The allergic origin of zirconium deodorant granulomas. Br J Dermatol 1958; 70: 75-101.

7. Volden C, Kiokan H, Kauli G et al. Phototoxic and contact toxic reactions to the exocarp of sweet oranges: a common cause of cheilitis? Contact Derm 1983; 9: 201-4.

8. Cronin E. Clinical prediction of patch test results. Trans St John‘s Hosp Derm Soc 1972; 58: 153-62.

9. Edman B. Sites of contact dermatitis in relationship to particular allergens. Contact Derm 1985; 13: 129-35.

10. Fisher AA. Metal dermatitis - some questions and answers. Cutis 1977; 19: 156, 158, 164, 165 and 169.

11. Fregert S. Occupational dermatitis in a 10-year material. Contact Derm 1975; 1: 96-107.

12. Husain SL. Contact dermatitis in the West of Scotland. Contact Derm 1977; 3: 327-32.

13. Menné†T, Brandrup F, Thestrup-Pedersen K et al. Patch test reactivity to nickel alloys. Contact Derm 1987; 16: 255-9.

14. Meller H. Intradermal testing in doubtful cases of contact allergy to metals. Contact Derm 1989; 20: 120-3.

15. Berger C, Muslmani M, Menezes Brandao F et al. Thin layer chromatography search for Disperse Yellow 3 and Disperse Orange 3 in 52 stockings and pantyhose. Contact Derm 1984; 10: 154-7.

16. Cronin E. Formalin textile dermatitis. Br J Dermatol 1963; 75: 267-73.

17. Cronin E. Studies in contact dermatitis: XVIII. Dyes in clothing. Trans St John‘s Hosp Derm Soc 1968; 54: 156-64.

18. De Groot AK, Gerkens F. Contact urticaria from a chemical textile finish. Contact Derm 1989; 20: 63-4.

19. Farli M, Gasperini M, Giorgini S et al. Clothing dermatitis. Contact Derm 1986; 14: 316-17.

20. Fisher AA, Kanof NB, Bionchi EM. Free formaldehyde in textiles and paper. Arch Dermatol 1962; 36: 753-6.

21. Fisher AA. The notorious poison ivy family of Anacardiaceae plants. Cutis 1977; 20: 570-95.

22. Mitchell JC, Rook AJ. Diagnosis of contact dermatitis from plants. Int J Dermatol 1977; 16: 257-66.

23. Rothenborg HW, Menne T, Stlin K-E. Temperature dependent primary irritant dermatitis from lemon perfume. Contact Derm 1977; 3: 37-48.

24. Powell SM, Barrett DK. An outbreak of contact dermatitis from Rhus verniciflua (Toxicondendron vernifluvum). Contact Derm 1986; 14: 288-9.

25. Rook A. Plant dermatitis. Br Med J 1960; 2: 1771-4.

26. Rudzki E, Grzywa A. Immediate reactions to Balsam of Peru, cassia oil and ethyl vanillin. Contact Derm 1976; 2: 360-1.

27. Thune PO, Solberg YJ. Photosensitivity and allergy to aromatic lichen acids and compositae oleoresins and other plant substances. Contact Derm 1980; 6: 64-71.

28. Cronin E. Contact Dermatitis. Edinburgh: Churchill Livingstone, 1980.

29. Edman B. Sites of contact dermatitis in relationship to particular allergens. Contact Derm 1985; 13: 120-35.

30. Hodgson CA, Hellier FF. Dermatitis caused by shirts in B.L.A. J Roy Army Med Corps 1946; 87: 110-17.

31. Epstein E, Maibach HI. Ethylenediamine allergic contact dermatitis. Arch Dermatol 1968; 92: 476-7.

32. Frosch PJ, Kligman AM. A method for appraising the stinging capacity of topically applied substances. J Soc Cosmet Chm
    1977; 28: 197-209.

33. Christophersen J, MennÈ TM, Tanghof P et al. Clinical patch test data evaluated by multivariate analysis. Contact Derm
    1989; 21: 291-9.

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