Year : 2006 | Volume
: 51 | Issue : 1 | Page : 30--32
Contact dermatitis in cement workers in Isfahan
Fariba Iraji, Ali Asilian, Shahla Enshaieh, Zabiholah Shamoradi, Gita Faghihi
Skin Disease Research Center and Department of Dermatology, Isfahan University School of Medicine, Isfaha, Iran
Skin Disease Research Center and Department of Dermatology, Isfahan University School of Medicine, Isfaha
BACKGROUND: Due to recent industrialization and inadequately protected workers or in other words poor supervision on constructive workers habits in our large city of Isfahan cement contact dermatitis is relatively high especially among cement factory workers and constructive personnel. PURPOSES: To investigate the prevalence rate of cement contact dermatitis in cement factory workers in Isfahan. METHODS: A case-control clinical study was carried out by randomly selecing 150 factory workders and 150 official clerks in a cement factory in Isfahan in 2001. After a complete physical examination, data was recorded in observational checklists. FINDINGS: The percentages of contact dermatitis prevalences in the first and the second groups were 22% and 5.3% respectively. About 60% of cement workers with contact dermatitis were between 30-40 years of age. There was a direct relationship with age in both groups of the workers. In the high-exposure group, the hand eczema along was 70% but in the other group the percentage of involvement was the same in exposed and unexposed anatomical areas. CONCLUSIONS: There was a direct relationship between occurrence and the severity of involvement and duration of contact in the first group. Cent percent of cement workers had contact dermatitis after 10 or less years, but the percentage among the other group was 35%. LIMITATION: Irritant contact dermatitis to cement has not been detected.
|How to cite this article:|
Iraji F, Asilian A, Enshaieh S, Shamoradi Z, Faghihi G. Contact dermatitis in cement workers in Isfahan.Indian J Dermatol 2006;51:30-32
|How to cite this URL:|
Iraji F, Asilian A, Enshaieh S, Shamoradi Z, Faghihi G. Contact dermatitis in cement workers in Isfahan. Indian J Dermatol [serial online] 2006 [cited 2020 Apr 4 ];51:30-32
Available from: http://www.e-ijd.org/text.asp?2006/51/1/30/25185
Occupational skin diseases represent approximately 40% of all occupational illnesses; different percentages from one country to another are determined by the extent and the type of industrialization and also by the knowledge and experience of the physicians. Among workders who contact with cement regularly, occupational dermatoses, especially contact dermatitis, has been one of the most frequently reported disorders for many years.
Skin contact with cement has been associated with irritant contact dermatitis, which ranges from cement burns to commulative irritant contact dermatitis. Cement bursn cause an acute ulceration most frequently seen in new and untrained cement workers. In non-sensitized workers who are exposed to cement on a regular basis, cummulative irritant contact dermatitis may result.
In addition to cement, contact with other agents used in cement factory, such as accelerators, glass fiber, cleansers, solvents, plasticizers and continual contact with water, dusts and physical agents, such as vibration and abrasion, are known to cause irritant contact dermatitis. Pre-employment health and safety training can be useful in preventing irritant contact dermatitis.
In addition to irritant contact dermatitis, the exposure to other allergens in cement is a significant cause of occupational allergic contact dermatitis. The most important allergens in cement are soluble hexavalent chromium (chromate) compounds. In addition to soluble hexavalent chromium, other metals such as nickel, cobalt and also ingredients of the gloves such as rubber chemicals, latex, epoxy resins and preservatives are well-known allergens for the cement workers.
Constructive workers from Western countries are known to have significant occupational dermatoses. The precise incidence and prevalence of dermatoses are unknown among the Iranian workers. The skin contact to cement or its mixtures can therefore be a major health problem in this group. The prevalence and severity of occupational dermatoses in cement workers with regular exposure to cement is also unknown in Isfahan.
We performed a cross-sectional survey to investigate the prevalence, causal agents, type of the work exposure and risk factors in this community population in Isfahan City, our second largest city, with a typical urban environment.
Materials and Methods
This study was a case-control clinical study in which we randomly selected 150 factory workers and 150 official clerks in a cement factory in Isfahan in 2001. Factory workers were in continued contact with cement dust such as workers in cement loading and transporting while the second group included official workers and clerks. All of the participants were interviewed by an experienced single physician in 2001 at their workplace. The interview was carried out with the help of a questionnaire, providing a detailed job condition, personal and past dermatological history and the length of employment in the current job position. The duration of exposure was calculated as years in occupation. The history of atopic symptoms, both personal and familial, was also recorded. In addition, the subjects were asked about their personal work habits, use of protective gloves and the type of gloves used. We performed patch test by using a potassium dichromate 0.5% in petrolatum antigen applied with poly-propylene chambers (Chemotechnique - Sweden) on the upper back skin of workers and after two readings in 48 h and 96 h respectively, we observed and interpreted the changes, so we proved cement contact dermatitis by overall assessment of history, clinical signs and the findings of the patch test.
Among 150 high cement contact workers, 33 of them (22%) had cement contact dermatitis while among 150 official clerks, 8 of them (5%) had cement dermatitis. The mean duration of contact with cement before occurrence of contact dermatitis in high contact group was 10-15 years but in official clerks was 15-20 years.
Hundred percent workders in high contact group had cement contact dermatitis in less than 10 years after cement contact but in another group 35% of them had cement contact dermatitis after more than 10 years after contact with cement. The frequency percent of contact dermatitis in the first and second groups were 22% and 5.3% respectively. Acute contact dermatitis was observed 1.66% in all of 30 workers.
Almost 60% of workers with contact dermatitis were between 30-40 years old, there was a direct relationship with age of workers. Only hand dermatitis in high contact group ws 70% but in the other group the percentage of involvement was the same in exposed and unexposed areas.
There was a direct relationship between occurrence and involvement rate and duration of contact. Occupational skin diseases may represent a major burder to some industries, especially in European countries. Those that involve high exposure to irritant oils, soaps and wet work such as metal workers in the motor industry, hairdressers and nurses seem to get the worst problems. Other occupations are associated with specific allergic reactions e.g. those handling epoxy resin or cement workers exposed to chromate. Such reactions may lead to lifelong sensitivity and permanent loss from the workforce.
It was the commonest form of dermatitis to cause early retirement among construction workers in Denmark and Sweden during this period. In 1979, Fregert and his colleagues suggested that the reduction of hexavalent water-soluble chromium to trivalent insoluble chromium during the production of cement would prevent chromium-induced dermatitis. The first method to reduce the amount of water-soluble chromium in cement was patented by Portland A/S Denmark in 1981.
Denmark passed legislation requiring the use of cement with lower levels of hexavalent chromium in 1983; Finland followed at the beginning of 1987 and Sweden in 1989. During the 1980s, Avnstorp, studied the prevalence of cement dermatitis and chromium allergy among Danish prefabrication workers, before and after the reduction of hexavalent water-soluble chromium in cement. His conclusion was that both hand dermatitis and chromium allergies decreased significantly from 1981 to 1987. The reduction of dermatitis among construction workders was attributed mainly to the addition of ferrous sulfate to cement.
Ferrous sulfate has been added to cement manufactured in Denmark, reducing the water soluble chromate, since September 1981. A comparison is made between the medical and employment status of a cohort of workers engaged, or who had been engaged, in the manufacture of prefabricate concrete building components in 1981 and in 1987. Workers who had allergic cement eczema in 1981 appeared to show no improvement 6 years after the reduction of chromate in the cement.
The worse medical prognosis of the chromate-sensitized workers could in part be due to the fact that some of these had secondary contact sensitivity to cobalt and rubber chemicals.
Improved hygienic conditions and an increase in the use of prefabricated cement elements might, therefore, explain the decrease in the 1980s. In addition, improved diagnostic procedures, statistics and occupational health services might explain the increase in chromium dermatitis in the 1970s and 1980s. In contrast, a high prevalence of chromium allergy among workders building the tunnel between England and France has recently been published. Allergic contact dermatitis (61.5%) occurred more often than irritant contact dermatitis (44.5%). Potassium dichromate caused roughly half of all cases of sensitization found to be occupationally relevant in the construction industry. The results indicate that potassium dichromate is still the most important allergen in the construction industry of Northern Bavaria; there has been no significant decline during the 1990s. This contrasts with the Scandinavian countries, where the prevalence of potassium dichromate sensitization declined following the rfeduction of chromium VI levels resulting from the addition of ferrous sulphate to cement.
We thank to respected representative of Chemotechnique company in Tehran to provide us Patch test material.
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