Laboratory assistant’s occupational allergic airborne contact dermatitis from nickel presenting as rosacea

ARTICLE

Nickel is the most common cause of allergic contact dermatitis (ACD), and it can also induce occupational skin diseases [1-3]. Here we report a case of a highly unusual form of occupational ACD caused by nickel.

Case report

A 30-year-old non-atopic man was working as a laboratory assistant in a metal research laboratory when he developed hand dermatitis for the first time. He was seen by a dermatologist who performed patch testing and diagnosed ACD from nickel. In his job the patient got occasional splashes of concentrated nickel solutions on his hands but was otherwise not in direct contact with nickel. When the cause of his hand dermatitis had been established, he started to use protective gloves and became symptomless. Ten years later he developed work-related highly pruritic symptoms on his face. The symptoms gradually became more severe, and the pruritus was so severe that it disturbed his sleep. When sent to us five years later at the age of 46, he had rosacea-like symptoms on the cheeks (Fig. 1) but claimed that they cleared without treatment when off work. Earlier the symptoms had disappeared in a couple of days, but the more severe symptoms took a week to clear up. Accordingly, he was taken off work, asked not to use any treatment, and when seen eight days later he was practically symptomless (Fig. 2). Patch testing was performed according to the recommendations of the International Contact Dermatitis Research Group (ICDRG) with 2 days' occlusion, using a modified European standard series (Chemotechnique Diagnostics, Malmö), and dilution series of cobalt chloride, nickel sulphate and potassium chromate. Nickel sulphate was positive down to 0.32% (pet) but otherwise patch test reactions were negative.

The patient's current tasks were to perform hydro- and pyrometallurgical experiments. Considerable amounts of nickel dust were present in the laboratory. Therefore, the patient was asked to send one-day dust samples from various sites of his work room (window sill, chair, table, etc.; a total 4-6 samples twice). The dust samples were analysed with the dimethylglyoxime spot test [4]: all samples gave a color reaction [4] indicating that allergenic amounts of nickel were present in the air of the workplace.

Discussion

Laboratory assistants are exposed to a great number of chemicals causing irritant or allergic contact dermatoses, contact urticaria and skin burns [5]. We have recently reported on the causes of occupational ACD and contact urticaria of the laboratory assistants diagnosed in our clinic [6], summarized in Table I. The present patient was the only laboratory assistant encountered in our clinic during 22 years who developed an occupational ACD from nickel.

Fischer [1] has reviewed occupational ACD from nickel including rare and curious case reports, but rosacea-like symptoms were not mentioned. In nickel-producing and nickel-using industries, the workers may be exposed to considerable amounts of airborne nickel [7], as in the present case, but ACD from airborne nickel has only seldom been reported [8]. In rosacea patients, contact dermatitis has been reported from thimerosal, paraphenylene diamine [9] and clindamycin [10]. Nickel is considered a pustulogen [11], and allergic pustular contact dermatitis has been ascribed to it [12].

Our patient had rosacea-like symptoms that disappeared when he was off work. The symptoms were highly pruritic, unlike rosacea. It was evident that airborne nickel, present in great concentrations in the air of the patient's work site, induced the follicular, papulomacular rosacea-like symptoms. Based on our investigations, we suggested that he should work in a nickel-free work environment. Arrangements for a transfer were planned at the work place, but no definite changes had taken place when he was seen six months later.

As recently pointed out by Corazza and coworkers [13] patients with rosacea should be patch tested if they have a history of aggravation of symptoms by cosmetics and medicaments. The present report shows that occupational allergens should also be remembered.

REFERENCES

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