CD05 Return of cement-related allergic contact dermatitis: a case series and review of the literature

Abstract

Abstract We report a case of a 23-year-old male bricklayer of 6 years who presented to our cutaneous allergy service with a 3-year history of a hand and foot dermatitis. Workwear included leather work boots and fibreglass gloves, which he used intermittently. His past medical history included childhood eczema and hay fever. Patch testing revealed strong reactions (++) to potassium dichromate and cobalt. Both were felt to be of current relevance due to cement exposure at work and from the leather in his boots. A review of our database revealed 8088 patients tested to the British Society for Cutaneous Allergy standard battery. A total of 662 were positive to cobalt and 339 to potassium dichromate. Of these, 121 patients were positive to both potassium dichromate and cobalt. Four of these were bricklayers, only one of whom was seen prior to the European Union (EU) cement directive. All reported hand dermatitis, and two also had foot involvement. In order to minimize chromate allergy, EU legislation in 2005 banned the sale of cements containing more than 2 parts per million (0.0002%) of hexavalent chromium. This minimal level is often achieved by adding a reducing agent such as ferrous sulphate to chromium III, which is less bioavailable and less likely to penetrate through the skin. Work suggests that rates of chromium-related allergic contact dermatitis (ACD) have diminished following this legislation with the incidence rate ratio between 2002–2004 and 2005–2009 falling to 0.37 (P = 0.001) in cement workers (Stocks SJ, McNamee R, Turner S et al. Has European Union legislation to reduce exposure to chromate in cement been effective in reducing the incidence of allergic contact dermatitis attributed to chromate in the UK? Occup Environ Med 2012; 69:150–2). Despite this change, sensitization is still possible without adequate protection, such as in our patient’s case. Additionally, the reducing agent’s activity diminishes over time; therefore, if it is not appropriately stored or used after its recommended shelf life, it may expose users to higher levels than are regulated. Despite the low concentration of cobalt in cement (0.01%), allergy may occur. It has been noted that sensitization to both metals is common in bricklayers, but this coexisting sensitivity was not seen in other professions where patients were allergic to chromium (Giménez Camarasa JM. Cobalt contact dermatitis. Acta Derm Venereol 1967; 47:287–92). We aim to highlight the ongoing issue of ACD associated with cement and review the recent history around potassium dichromate and cobalt in this regard.