Contact and Occupational Dermatitis

Dr Leon Wall opened the meeting by discussing information he had gained at the 1988 U.S. Academy Meeting. Among other topics he drew attention to sensitivity to p-phenylene diamine from a number of sources, and to the cross reactions of this substance with procaine in "tonic" preparations. Contact urticaria was noted as being increasingly common (and more frequently recognised). He helped many in the audience by describing methods used in testing for contact urticaria to latex, including the use of 20 glove pieces (lcm squares) soaked in 5ml saline for 30 minutes to prepare a test solution. Dr Stanley Levy (Almay Cosmetics) showed the careful approach to cosmetic preparation used by responsible companies. Individual ingredients and the final product of a new formulation are tested for irritancy, allergenicity and comedogenicity. Subsequently usage tests may be conducted in people with sensitive skin. Ultimately post-marketing surveillance determines the validity of the pre-release programme. Dr Rosemary McCuUagh discussed a number of problems encountered with cosmetic and medicament bases, including allergy to 'Tween 40' and 'Tween 80', and in two patients to cetostearyl alcohol, without reaction to more common allergens. Dr Margaret Tam noted the increasing frequency of glutaraldehyde sensitivity in dental workers. Discussion followed relating to the possibility of irritant patch tests (unlikely with 1% aqueous solution as the test material) and to the need for improved labelling of containers of glutaraldehyde to state that repeated contact can cause skin sensitivity. Dr Ted Emmett referred to encouragement of research into industrial dermatology by "Worksafe", in the form of grants for basic or clinical studies. He also discussed the bioavailanility of nickel and rubber additive chemicals in products, and the need to test ethyl butyl thiourea in people suspected of rubber sensitivity (e.g. jogging shoes and wetsuits). Dr Ian McColl followed by presenting a patient with multiple sensitivities, and with urticarial/erythema multiforme outbreaks which were related to rubber contact. Dr Margot Whitfield described a patient with 'bush dermatitis' probably related to windborne pine pollen, and she also reviewed the problems of U.V. cured inks. Dr Leon Wall gave a comprehensive paper with results of a study on the knowledge and attitudes of health support personnel in industry to skin disease. He interviewed many people, ranging from industrial medical officers, safety officers, rehabilitation personnel, union representatives, and members of compensation office staff. He found that in general knowledge of the subject was poor, that there was no understanding of the similar meaning of 'eczema' and 'dermatitis', that the effect of irritants was not fully recognised but that patch tests were over-valued, and that there was a greater expectation of recovery from dermatitis than that held by dermatologists. He considered that there is great need for both education into skin problems, and a change of attitude about dermatitis in health care personnel at all levels in industry. Dr Richard Reitschel, of the Oschner Clinic, New Orleans spoke on contact dermatitis in children, pointing out that this problem does occur but is often not recognised, and that patchtesting of children is important. He did note that some allergens may produce irritant reactions in atopic subjects but he did not advocate changing the concentration of patch test allergens for testing children. The meeting concluded with presentation by Dr Susi Freeman of a number of cases which illustrated problems with sunscreens, allergy to clothing and difficulties in testing clothing, and the importance of regarding positive patch tests to fragrance as significant in elucidating the cause of dermatitis. DAVID S. NURSE