Occupational Dermatitis among the Metal Working Fluid Factory Workers in Bengaluru \u2013 A Cross-Sectional Study

Contact with metal working fluids (MWF) is an important factor in the development of occupational hand dermatitis in patients working in the metal processing industry. Biocides are added to MWF as preservatives and are known sensitizers. We analysed 318 patch test reactions to N,N-methylene-bis-5-methyl-oxazolidine 1% in petrolatum (5-methyloxazolidine, Grotan OX, CAS no. 66204-44-2, a formaldehyde releasing biocide) present in coolant oils in patients exposed to MWF and with suspected occupational dermatitis (OD). Positive allergic reactions were noted in 15 (4.7%) cases. In 7 (47%) cases, we were able to confirm relevance by examining the material safety data sheets and these showed that N,N-methylene-bis-5-methyl-oxazolidine was present in the oils used by the patients. No certain relevance could be proved in 8 cases, but in these instances, further information on the biocides used in the oils could not be obtained. Positive reactions to formaldehyde were seen in 11 (73%) patients. Sensitization either to this biocide and/or formaldehyde allergy was considered to have been likely to have made a contribution to the workers' dermatitis.

Introduction: Metalworking fluids (MWFs) are widely used in metal working operations for cooling down, lubricating and reducing the friction between tools and work pieces which result in controlling the heat produced. Exposure to MWFs causes several adverse effects including respiratory problems, skin diseases, cancer and even infertility. This study examines workers’ exposure to MWF mist and the factors affecting the dispersion of it in an automobile factory. Materials and Methods: This cross-sectional study was carried out in metal working units (producing cylinder and cylinder head) of an automobile manufacturing factory during two seasons of spring and summer. From the total of 300 people working in the factory 75 workers were randomly selected. 38 workers were tested for total particulate status and 37 for the thoracic particulate status. The MWF used in unites was soluble. Using NIOSH 5524 method, sampling and exposure evaluation was carried out with personal air sampling pump, closed-faced 37-mm cassette, 37-mm diameter 2-µm pore size Teflon and personal cyclone. Thermal anemometer was used to measure the air temperature and air velocity. Data were analyzed using T, mann withney, ANOVA, regression, Pearson correlation coeficent tests. Results: The mean of workers exposure to total and thoracic dust were 2.65 ± 1.3 and 1.64 ± 0.95 mg/m3 respectively. The above values for MWF mists were 2.19 ± 0.92 and 1.28 ± 0.88 mg/m3 respectively. The results indicated a higher exposure to MWF mists in Terimery workplace than that of Donobat and Terimery Cylinder Head (P<0.05). Temperature had positive effect on MWF mists dispersion (P<0.05). Conclusion: All exposure levels were under the threshold limit value level (TLV-TWA, PEL = 5 mg/m3). However, they were well above the NIOSH Recommend Exposure level (REL = 0.5 mg/m3). The result showed that air temperature is an important factor in increasing MWF mists production and dispersion (r= 0.572).

Objective and methods: To evaluate the importance of occupational colophony exposure among occupational dermatitis patients we analyzed data of occupational dermatitis caused by colophony on the basis of the Finnish Register of Occupational Diseases (FROD) and among the colophony allergic patients studied in the Finnish Institute of Occupational Health (FIOH)in 1993–2002. Finnish physicians are obligated to report cases of occupational diseases to the FROD. Insurance companies remit patients to FIOH, mainly recommended by company doctors or dermatologists.Results: Altogether 128 cases (68 females and 60 males) of occupational dermatitis caused by colophony were reported to the FROD since 1993 to 2002 accounting for 3.4% of all occupational allergic contact dermatitis cases and another 67 had it as a second diagnosis. Mean age of the patients was 42 years, being lowest among engineering workers (34 years) Among colophony allergic patients studied in FIOH 46/89 had an occupational dermatitis caused by colophony; 14 of them as a second diagnosis. Engineering, metal working, wood working, agricultural or medical work were most common occupations. Among colophony allergic patients without an occupational dermatitis (22) or an occupational dermatitis caused by other causes (21)working with food materials and agricultural work were most common. Principal causative agents of occupational allergic contact dermatitis from colophony were cutting fluids, soldering fluxes, tall soft soap, adhesives and varnishes. Variable individual sources were occasionally detected. Mean exposure time was 12 years.Conclusion: Occupational dermatitis caused by colophony is difficult to diagnose, since non‐occupational colophony exposure is common.

Metalworkers are exposed to a variety of contact allergens by handling tools, metals, metalworking fluids (MWFs), oils and greases, rubber materials, and so on. Most large-scale reports on contact allergy due to MWFs are more than 10-years-old, and there are only few studies on contact allergy in mechanics and other metal workers not exposed to MWFs. To describe a current spectrum of contact sensitization in metalworkers with occupational dermatitis (OD). Retrospective analysis of patch test data collected by the Information Network of Departments of Dermatology (IVDK; 2010-2018), stratifying for 804 cutting metalworkers, 2197 mechanics, and 355 other metalworkers. Cutting metalworkers were most frequently sensitized to monoethanolamine (12.6%), colophonium/abietic acid (11.4%) and formaldehyde releasers (up to 8.5%) from the MWF series, and formaldehyde (4.6%) and iodopropynyl butylcarbamate (4.6%) from the baseline series. Sensitization among mechanics and other metalworkers indicates possible occupational exposure to MWFs, glues, and resins, although this may not be expected from their job titles. The spectrum of MWF contact allergens remained largely unchanged during the last years. Taking a comprehensive occupational history is indispensable in order to not miss relevant allergen exposures.

Phenoxyethanol (PE; Syn. 2-Phenyoxethanol; CAS no. 122-99-6) is one of the most commonly used preservatives in cosmetics and is also found in industrial products, including metalworking fluids. It is considered to have a low sensitization potential.1-3 A 59-year-old male toolmaker presented with therapy-resistant, 1-year lasting hand dermatitis suspected to be of occupational origin. Despite being on work leave and treatment with alitretinoin for the past 5 months, severe dermatitis of hands and lower arms was observed (Figure 1). We performed patch tests and readings according to the guidelines of the German Contact Dermatitis Research Group (DKG)4 using the DKG baseline series; the DKG series for topical preparations, preservatives, rubber, disinfectants, acrylates, industrial biocides, and metalworking fluids; and the patient's own metalworking fluid. Patch tests were removed at day (D) 2 with the exception of the metalworking fluid, which was removed already at D1 and reactions were evaluated at D2, D3, D4, and D7. Solely, a 2+ reaction to PE 1% pet. (SmartPractice, Greven, Germany) from D2 to D7 was noted (Figure 2A). PE was not found in any of the available safety datasheets of the patient's workplace products, including the metalworking fluid. However, according to the product labels, it was an ingredient of the patient's skin care products “Eucerin UreaRepair PLUS 5% Hand Creme” and “Nivea 3IN1 Repair Hand Creme” (both from Beiersdorf AG, Hamburg, Germany), which he had regularly applied on his hands and lower arms after the onset of dermatitis. Repeated open application test (ROAT) with “Eucerin UreaRepair PLUS 5% Hand Creme,” two times daily for 6 days on the inner sides of the patient's upper arm resulted in a positive reaction (Figure 2B). Dermatitis of hands and lower arms improved significantly after avoidance of these skin care products, indicating clinical relevance of the sensitization to PE as the contributing factor to the initially occupational irritant contact dermatitis. Despite its widespread use as preservative in cosmetic and pharmaceutical products as well as for other applications, only very few cases of allergic contact dermatitis and contact urticaria to PE have been reported.2, 5-7 Accordingly, a retrospective study of the Information Network of Departments of Dermatology (IVDK) revealed a very low sensitization rate of 0.24% among 6932 individuals patch tested in Germany, Austria, and Switzerland between 1996 and 2009.1 Similarly, in 681 cutting metalworkers patch tested with the DKG metalworking fluids series in IVDK centres from 2010 to 2018, sensitization to PE was rarely observed (0.3%).8 Although rare, allergic contact dermatitis to PE should be considered and if undiscovered may lead to longstanding disease and inefficient treatments. The present case illustrates the importance of performing early patch tests to avoid delays in diagnosis and prevention measures. Diagnostic workup of patients with suspected occupational hand dermatitis should include patch testing and in doubtful cases also ROAT with patient's own skin care products. The authors declare no conflicts of interest. Michaela Kolodziej: Conceptualization (equal); investigation (equal); writing – original draft (equal); writing – review and editing (equal). Alexander Kiewert: Investigation (supporting); writing – review and editing (equal). Christoph Skudlik: Investigation (supporting); writing – review and editing (equal). Richard Brans: Conceptualization (equal); investigation (equal); supervision (lead); writing – original draft (equal); writing – review and editing (equal).

Hypersensitivity Pneumonitis Due to Metalworking Fluid Exposures

BackgroundsOccurrence of airway irritation among industrial metal workers was investigated. The aims were to study the association between exposures from water-based metal working fluids (MWF) and the health outcome among the personnel, to assess potential effects on the proteome in nasal mucous membranes, and evaluate preventive actions.MethodsThe prevalence of airway symptoms related to work were examined among 271 metalworkers exposed to MWF and 24 metal workers not exposed to MWF at the same factory. At the same time, air levels of potentially harmful substances (oil mist, morpholine, monoethanolamine, formaldehyde) generated from MWF was measured. Nasal lavage fluid was collected from 13 workers and 15 controls and protein profiles were determined by a proteomic approach.ResultsAirway symptoms were reported in 39% of the workers exposed to MWF although the measured levels of MWF substances in the work place air were low. Highest prevalence was found among workers handling the MWF machines but also those working in the same hall were affected. Improvement of the ventilation to reduce MWF exposure lowered the prevalence of airway problems. Protein profiling showed significantly higher levels of S100-A9 and lower levels of SPLUNC1, cystatin SN, Ig J and β2-microglobulin among workers with airway symptoms.ConclusionsThis study confirms that upper airway symptoms among metal workers are a common problem and despite low levels of MWF-generated substances, effects on airway immune proteins are found. Further studies to clarify the role of specific MWF components in connection to airway inflammation and the identified biological markers are warranted.

Metal working fluid (MWF) emulsions are utilized as coolants and lubricants in machining processes like turning or drilling. During their operation life time cycle, MWFs change their properties due to impacting stresses which may influence the machining and tool performance. A frequent refreshing or renewal of MWFs in machining process is thus necessary. This investigation discusses measurement techniques of MWF emulsions to be used for MWF quality assessment and process monitoring. By means of optical spectroscopic measurement techniques (turbidimetry and laser diffraction), the evaluation of the temporal change of the wavelength exponent and the MWF emulsion droplet size is related to the MWF stability. The in-process monitoring of the MWFs in machining during several weeks of operation is shown. Thus, it will be demonstrated that optical spectroscopic measurement techniques may be applied to determine stability change of the emulsion system.

Bacterial contamination of preserved and non-preserved metal working fluids

Assessment of occupational exposure and spectrum of contact sensitization in metalworkers with occupational dermatitis: results of a cohort study within the OCCUDERM project.

The aim of this review was to identify, appraise and synthesize the best available evidence on the effectiveness of moisturizers, barrier creams, protective gloves, skin protection education and complex interventions (a combination of two or more of the interventions listed here) in preventing occupational irritant hand dermatitis (OIHD) in wet workers, comparing each intervention to an alternative intervention or to usual care (workers' regular skin care regimen). The most significant occupational skin problem potentially encountered in wet work occupations is occupational dermatitis. When the skin comes into contact with hazardous substances at work, this can cause occupational dermatitis. Substances which may cause occupational dermatitis include cleaning products, organic solvents, metalworking fluids, cement, flour, adhesives, other chemicals and even certain plants. Occupational skin disease has adverse effects on quality of life and the long term prognosis for skin health is poor unless workplace exposures are addressed. To date, no systematic review has been undertaken to determine the effectiveness of interventions for the primary prevention of OIHD in wet workers. The review included any workers from healthcare (e.g. nurses, doctors and allied health professionals) and also people in different wet work occupations (e.g. hairdressers, florists, catering workers, metal workers) at similar risk of OIHD. Studies that assessed the following interventions in the primary prevention of OIHD in wet workers at the workplace and at home (before and after work) were included:Types of studies considered were experimental study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, and before and after studies. Primary outcome measures were OIHD incidence, and secondary outcome measures were product evaluation and change of occupation because of OIHD versus staying in the occupation. Published and unpublished literature in the English language was sought between 2004 and 2017. The databases searched included: COCHRANE CENTRAL, MEDLINE, CINAHL, AMED and Embase. The search for unpublished studies included: Google Scholar, Open DOAR and Robert Gordon University's thesis database, "OPEN AIR". There were no studies located that met the inclusion requirements of this review. There is currently no evidence available to determine the effectiveness of interventions to prevent OIHD amongst wet workers that met this review's inclusion criteria.

Metal-working fluids (MWFs) are frequent causes of occupational irritant and allergic contact dermatitis (ACD) in metalworkers. MWFs usually contain many additives, such as biocides, emulsifiers, stabilisers, surfactants, lubricants, rust preventives, and others [1]. Various ingredients are important occupational sensitizers, and relevant MWF allergens have been found to be monoethanolamine, resin acids, formaldehyde releasers, and formaldehyde [2]. In June 2024, a 24-year-old man was referred for a chronic eczematous dermatitis lasting for 3 years with involvement of the face and neck, sometimes affecting also the forearms. He reported that his dermatitis appeared a few months after being hired as an operator at a computer numerical control (CNC) milling machine and improved significantly during periods of abstention from work. Eczematous lesions spared the periocular region and the hands, which were protected by goggles and gloves, respectively, worn as personal protective equipment (PPE) by the patient during his work activities. In light of the patient‘s history and clinical pattern, we hypothesised the role of occupational exposure to airborne contactants. The patient frequently used a lubricant-cooling oil (Mecafluid S/2 FF, Petronas Lubricants Italy S.p.A.) at work, sprayed at high pressure on the CNC milling machine components to reduce heat and friction. The CNC milling machine was not equipped with an aspirator, whereas a few suction ducts were present in the rooms where multiple milling machines were allocated. An airborne ACD to the MWF was suspected. Patch tests were performed using the SIDAPA (Società Italiana di Dermatologia Allergologica Professionale e Ambientale) 2023 baseline series (SmartPractice, Rome, Italy srl) occluded for 2 days using allergEAZE patch test chambers (SmartPractice, Phoenix, USA) on Soffix tape (Artsana, Grandate, Italy) [3]. The readings on day (D)2, D4, and D7 revealed a strong positivity to methylisothiazolinone (MI) 0.2% aq. (+++). The patient did not react to methylchlorisothiazolinone (MCI)/MI 0.02% aq. and benzisothiazolinone 0.1% pet., included in the SIDAPA 2023 baseline series. Subsequent patch testing with the MWF 10% pet. showed a positive reaction (++) on D3 and D7. This MWF was found to contain MI and benzisothiazolinone. Unfortunately, other substances present in the MWF (e.g., monoethanolamine, N-methyldiethanolamine, and iodopropynyl butyl carbamate) were not tested as they are not reported in the list of the testable haptens according to the Italian Medicine Agency AIFA [4]. The eczematous reaction resolved after treatment with topical corticosteroids and avoidance of the exposure to the MWF and any other MI-containing products. Isothiazolinones are well-known contact sensitizers and are preservatives extensively used in a wide range of cosmetic products, as well as household and industrial products, including MWFs [5]. Metal workers are among the occupational groups most frequently sensitised to MI or benzisothiazolinone [6]. Allergic reactions to isothiazolinones contained in MWFs have been described [7-9]. Airborne ACD from isothiazolinone derivatives is frequently associated with the use of paints and can sometimes occur with exposure to detergents [5], whereas occupational airborne ACD to isothiazolinones from other sources appears to be uncommon. Interestingly, Özkaya et al. described a case of contact allergy to MCI/MI in a maintenance and repair tramline worker with different clinical manifestations, including an airborne ACD caused by the exposure to rust remover and surface cleaner aerosols containing MCI/MI [9]. Given our patient‘s experience, we suggest considering the possibility of airborne ACD in individuals who are exposed to sprayed or vaporised MWFs containing isothiazolinone derivatives. This report highlights the need for increased awareness, more efficient PPE, and enhanced training of workers in order to prevent occupational contact dermatitis. Caterina Foti: conceptualization, methodology, supervision. Lucia Pacello: conceptualization, writing – original draft. Benedetta Tirone: conceptualization, writing – original draft. Giorgia Sbarra: investigation, writing – original draft. Riccardo Ravallese: investigation, methodology. William Andrew Rosato: methodology, writing – original draft. Nicoletta Cassano: conceptualization, writing – review and editing, supervision. Gino Antonio Vena: conceptualization, writing – review and editing, supervision. Paolo Romita: conceptualization, writing – review and editing, supervision. Piero Lovreglio: writing – original draft, supervision, methodology. All authors contributed equally and agree to publication of this version of the manuscript. The patient has signed written formal consent to publication of both medical history and clinical pictures. The authors declare no conflicts of interest.

To investigate the incidences and trends of occupational skin diseases (OSDs) and allergic respiratory diseases (ARDs) in machinists working in the fabrication of metal products. Data from the Finnish Register of Occupational Diseases during 1992-2001 were analysed. Incidence rates for skin and respiratory diseases of machinists were calculated and compared to the total working population. The patients investigated at the Finnish Institute of Occupational Health in the same period were described in detail. A total of 279 dermatoses and 34 ARDs were reported. Skin diseases accounted for 27% of all occupational diseases. The incidences of the skin and respiratory diseases were 1.6 and 0.2 cases per 1000 person-years, respectively. This represents a 3-fold risk for getting an OSD compared to the total working population. The number of allergic contact dermatitis (ACD) increased 3-fold during the study period. The most common causes of ACD were metalworking fluids (MWFs) and their ingredients such as formaldehyde, ethanolamines and colophony. Eighty-five per cent of ARDs were asthmas. The commonest causes of asthma were metal dusts and fumes, epoxy resins and hardeners and MWFs and their components. Contact dermatitis is a common occupational health problem in metalworking machinists, whereas occupational respiratory disease is rare. Only a few specific chemicals in the metalworking have thus far been identified as respiratory allergens. Specific skin tests and inhalation challenge tests with MWFs and their ingredients are recommended if an OSD or a respiratory disease is suspected.

Gas‐based metalworking fluids (MWFs) have been proposed as alternative coolants and lubricants in machining operations to mitigate concerns surrounding water use and pollution, industrial hygiene, occupational health, and performance limitations associated with water‐based (aqueous) MWFs that are ubiquitously used in the metals manufacturing industry. This study compares the primary energy and water use associated with the consumptive use, delivery, and disposal of aqueous MWFs with three gas‐based MWFs in the literature—minimum quantity lubricant‐in‐compressed air (MQL), liquid/gaseous N, and liquid/supercritical CO. The comparison accounts for reported differences in machining performance in peer‐reviewed experimental studies across several machining processes and materials. The analysis shows that despite the reported improvement in tool life with N and CO‐based MWFs, the electricity‐ and water‐intensive separation and purification processes for N and CO lead to their higher primary energy and water use per volume of material machined relative to water‐based MWFs. Although MQL is found to have lower primary energy use, significant consumptive water use associated with the vegetable oil commonly used with this MWF leads to higher overall water use than aqueous MWF, which is operated in a recirculative system. Gas‐based MWFs thus shift the water use upstream of the manufacturing plant. Primary energy and water use of gas‐based MWFs could be reduced by focusing on achieving higher material removal rates and throughput compared to aqueous MWF instead of solely targeting improvements in tool life. Additionally, the consumptive use of CO and N MWFs could be minimized by optimizing their flow rates and delivery to precisely meet the cooling and lubrication needs of specific machining processes instead of flooding the tool and workpiece with these gases. This article met the requirements for a gold–gold JIE data openness badge described at .

Micro-flood (MF) technology for sustainable manufacturing operations that are coolant less and occupationally friendly