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The Letterflex urethane photopolymer mixture contains eight components. The curing agent penta erythritol-tetrakis-3 mercaptopropionate and an auxiliary substance present separately, namely 3 mercaptopropionic acid, gave positive reactions in five patients suffering from occupational contact allergic dermatitis. The mixture contains a third substance to which contact sensitization in a single patient has been described in the literature. This substance did not play any role in the patients' dermatitis. The ways in which the workers come into contact with the liquid form of the prepolymer, which is the sensitizing form of the mixture, are described. Safety measures and complete labelling are advised.

In a platemaking procedure differing from Nyloprint and Letterflex, contact sensitizations to 2-hydroxy-ethyl-methacrylate, di- and tetraethylene glycol dimethacrylate and nicotinic acid were found. Preoperational testing of the complete mixture gave a false impression of safety. Preventive measures and enumeration of acrylic substances so far recognized as sensitizers or cross-sensitizers are discussed.

The incidences of sensitisation to Kathon CG are reported for patients routinely tested from 1984 to 1986 in Bari, London, Louvain, Nijmegen, Oulu and San Francisco. For these 3 years, the overall frequency of sensitisation varied for women from 3.3% in Oulu to 0.6% in London and San Francisco and for men from 1.4% in Oulu to 0% in San Francisco. Women were predominantly sensitised, probably by cosmetics, toiletries and domestic cleaners. Occupational sensitisation was much less frequent.

Three printers showed a contact sensitization to the Letterflex® urethane photoprepolymer mixture. The technical chemistry of this new printing procedure is described.

The studies of Monash and Blank (1) demonstrated that, if the skin barrier is removed, water will evaporate from the skin surface at approximately the same rate as from a free water surface. Matoltsy et al. (2) confirmed the finding that water loss of the barrier becomes almost normal in only two or three days after the barrier is re-formed. Total regeneration however requires about two weeks. Matoltsy et al. (2) stated that soon after removal of the stratum corneum a “temporary barrier” with parakeratotic cells is formed, causing water loss to gradually decrease. The “temporary barrier” persists until the regenerating epidermis becomes capable of forming normally keratinized horn cells, the so-called “final barrier.

Der Autor diskutiert die Moglichkeit von Praventivmasnahmen gegen Hautschaden bei der Verarbeitung von Epoxydharzen an Hand der arbeitsdermatologischen Relation zwischen den zu verarbeitenden Stoffen und dem Arbeiter selber. So wird erlautert, wie durch Ersetzen, Mechanisieren, Absondern, durch arbeitshygienische und-methodische Masnahmen, durch Selektion, personliche Hygiene, Instruktion und Kontrolle eine Erniedrigung der Haufigkeit der Hautschaden bei der Epoxydverarbeitung erreicht werden kann.

In 13 patients with contact allergy to sesame oil, studies were undertaken to elucidate the nature of the allergens. Sesamol, sesamin and sesamolin were identified in crude and purified (pharmaceutical) sesame oil. Patch tests showed 8 of the 13 patients to be positive to sesamol and 12 to sesamolin and sesamin. Patch tests with the pure substances on thin-layer sheets were inconclusive as to any difference between these substances. Group allergy to several substances related to sesamol could not be clearly demonstrated.

The authors tested a large number of products on 100 patients with leg ulcers, that is, products used during the treatment of these ulcers. They studied the allergic reactions encountered and discuss in detail the precautions which should be taken.

Because p-tert.-butylphenolformaldehyde-free shoes are unavailable in the Dutch market we had to have shoes made of alternative materials for 13 patients reacting to this resin. These alternative materials consisted of leather samples prepared with various tanning agents, counters (heel stiffeners), stitching yarns, adhesives, etc. The composition of these alternative materials was kept a secret. New shoes were composed of materials to which the patient had shown negative reactions. These shoes are well tolerated. Only one patient reacted to virtually all materials tested. She may have an excited skin syndrome. She will be tested in the near future with the necessary materials applied one by one to find out whether this is true. Up to present we have encountered only a few shoe positive patients who have neither reacted to the resin, nor to a series of alternative adhesives. These patients will be studied in more detail as to the origin of their dermatitis.

Methods for investigating contact eczematous patients and for measuring the sensitizing potential of various substances are well known and in general, sufficiently effective. This is not true for irritant dermatitis, or for possible (skin) irritant substances; moreover, cosmetics commonly do not contain acutely harmful ingredients. The use of various instrumental measurements (insensible H2O loss, CO2 release, electrical impedance, sweat rate) as indicators of the irritant potentials of substances is advocated. At the same time it is suggested that the factory physician actively investigate the workers in his factory, since these workers are exposed to known substances in known concentrations and combinations, possibly for extensive periods. This may prove to be part of a new role for him. A cosmetic may be one of several factors increasing impairment and only beyond a certain limit may this result in overt disease. Below that limit the health reserve is only partially depleted. Whether this is harmful to a person depends on other stresses, such as medicaments, work materials, other cosmetics and environmental chemicals. The effect of these must also be quantified. A model of these cumulative stresses and reactions is presented and discussed.

The quick passage of methyl methacrylate at 21 degrees C and 35 degrees C through seven surgeon's glove materials in a diffusion chamber was quantified by gas-chromatographic analysis. Polystyrene-butadiene dissolved in methyl methacrylate, latex and polychlorobutadiene showed reversible expansion, during which material from the samples dissolved. In order to prevent these phenomena from interfering with the analyses, experiments were performed with 4.7 M methyl methacrylate in ethanol. Even then, the time in which methyl methacrylate permeated the membrane was too short for sufficient protection. When using these gloves, the orthopaedic surgeon who is fixing endoprostheses is no doubt occlusively exposed to methyl and other methacrylates, benzoyl peroxide, rubber additives, etc. Of glove materials which are not surgically used, vinyl was inferior to latex, whereas a very thin polyethylene copolymer did not change in methyl methacrylate, showed better resistance to diffusion, but was insufficiently elastic and easily perforated. A better protective material is urgently needed.

Two patients showed occupational contact sensitization to a component present in the Nyloprint photopolymer printing plate. The component could not be identified chemically. It contains an acrylamide group. Both patients gave group-specific reactions to NN' methylene bis acrylamide. This must be a closely realted substance. Possible preventive measures are discussed. The manufacturer should have disclosed the allergic substance and instructed his customer adequately. A "philosophy" concerning this point is being developed.

Contact sensitization to fragrance materials may be caused by occupational exposure to flavor compositions in the food trade and needs not to be due to cosmetic exposure exclusively. To illustrate this, investigative results in four bakers are discussed.

Swoboda [1] nannte in einer Aufstellung im Februar 1976 in Zurs Polyesterharze an erster Stelle unter den Kunstharzgruppen, die Allergene oder toxische Stoffe enthalten. Obwohl Polyesterharze zu den Polykondensaten gehoren und diese Kategorie der Kunstharze damals von mir [2, 3] aus theoretischen Grunden als mogliche Pathogene den Polymerisaten gegenubergestellt wurden, und obwohl ich vor 20 Jahren einige Beispiele von Kontaktsensibilisierungen gegen ungesattigte Polyesterharze beobachten konnte, kommen heutzutage Polyesterharze nach meiner, naturlich auch nur begrenzten Erfahrung kaum noch als Ursache von Arbeitsdermatosen vor.

An attempt is made to formulate some kind of working hypothesis concerning the pathophysiology, clinical appearance and treatment of irritant contact dermatitis. Acute irritant dermatitis may he caused by one single overwhelming external exposure of comparatively short duration. It is usually accidental and therefore recognized early as cause and effect. Chronic irritant dermatitis may be the result of a too early repetition of one impairing factor (chronic irritant dermatitis ‘traumiteration’ type), but is more commonly the result of the influence of a variety of stimuli, each starting to be active before recovery from the foregoing stimuli has been completed (chronic irritant dermatitis ‘summation’ type). By repetition of the same stimulus, or by a combination of varying stimuli, the degree of impairment surpasses a critical level, in consequence of which a clinical disease (irritant contact dermatitis) ensues. This clinical disease, however, is only ‘the tip of the iceberg’. Such stimuli may be chemical, mechanical and/or climatic. To find out which are the harmful factors requires a detailed case history about the patient's work, habits and hobbies, thus enabling him to avoid as many damaging exposures as is practical, and hence reducing the sum of causative factors. A number of causative factors are enumerated. The article is intended to be a catalyst to promote discussion on this subject.

The effects of topical applications on the living human forearm skin of 3 ml of DMSO 0.09 % JaCI in water solutions of various concentrations during a variety of exposure times were evaluated clinically, and with water vapour loss and impedance measurements. The water vapour loss measurement appeared not to be a sensitive parameter, since it showed only deviations from normal values if there were also clinical signs of irritation, e.g. if the skin is exposed during 15 min to a DMSO solution of 90 % or higher. Impeddance showed some increase after 15-min exposures to 30 % DMSO. In the range of 60 to 99.9 % DMSO, decreases of impedance were found increasing progressively with strength of solution and duration of exposure. Only the longer exposures (3 h to 60 % DMSO) or the higher concentrations (90 % DMSO and over during 15-min exposure) produced clinical signs. Daily repeated short-lasting (5–10 min) exposures to carefully chosen concentrations of DMSO (60, 73 and 86 %revealed that the skin of the volunteer was almost able to resist the lowest concentration. If exposed for 10 min the skin had some difficulty in recovering from the irritating influence of exposures to 60 or 73 % DMSO which took place the preceding day: there is some tendency to a progressive lowering of resistance. With repeated 5-min exposures to 86 % DMSO, this tendency to progressive lowering of resistance is more evident although there is a clear but somewhat incomplete recovery 24 h after each preceding exposure. If the skin is exposed daily to 86 % DMSO for 10 min. the regenerative capacity after the 12th exposure is exhausted. However, after the 17th exposure, extra regenerative forces seem to be mobilized restricting progressively the consequences of every exposure to follow. If the skin is no longer exposed (day 21), recovery is speedier and more complete than that seen after the 5-min exposures to the same strength. We propose calling this ‘adaptation’ or ‘hardening’.

In order to understand the medical implications of using adhesives a few remarks are made concerning forces which may be active in bonding two materials. Knowledge about the exact chemical composition of adhesives is essential for understanding possible untoward dermatological effects which are to be expected if the transition from a viscous to a solid state is based on chemical reactions between chemically active constituents. A number of examples are given about cited or suspected dermatologically untoward effects in using various types of glues and dental composite restorative resins.

Ephemeral topical contact with hexanediol diacrylate and butanediol diacrylate may cause delayed irritant dermatitis. During 4 years' observation of 20 workers utilizing these substances in the electron beam coating department of a door factory, contact sensitization did not occur. The characteristics of delayed contact irritancy are enumerated. The disease must be distinguished from allergic contact dermatitis, acute irritant dermatitis and cumulative irritant dermatitis.

Based on the results of exposure experiments on living human skin a working hypothesis is launched concerning the possible pathogenesis of irritant contact dermatitis. Below a certain and critical degree of exposure there is no alteration in clinical aspect of the exposed region. However, instrumentally (watervapour-loss measurements, impedance measurements) it is usually possible to register subclinical effects in such a field. These are interpreted as signs of impairment of metabolic homoiostatic systems. It is possible in certain cases to show that the skin is able to adapt its functions to a repeated load (illustrated with exposure experiments to DMSO). It seems useful to distinguish between a traumiterative irritant contact dermatitis (a result of too early repetition of just one type of load; see Aquabrom experiment) and a cumulative irritant contact dermatitis (resulting from a too early repetition of exposures differing in type; see experiment with soap and detergent solutions). In cumulative irritant contact dermatitis the sequence of the different loading factors is of importance: first soap and then detergent or the reverse.

Thirty-seven substances which may be used in finishing textiles were patch-tested on 66 patients who were suspected of suffering from a textile finish hypersensitivity. Twenty-seven patients reacted positively to one or more of the substances tested (see Table and text). Only seven patients reacted to formaldehyde. This formaldehyde hypersensitivity never occurred alone. In one of these patients the formaldehyde sensitization clearly occurred prior to the outbreak of his textile finish contact eczema. With respect to the other six patients we are inclined to consider the formaldehyde positive patch test likely as a result of group specificity to other textile finishes like dimethylol urea, ethylene urea, urea formaldehyde ether, triazon derivatives, and melamine formaldehyde. In addition to these a number of positive reactions occurred with two compounds derived from stearic acid (substances number 27 and 28) and sporadically also with other compounds.