Occupational Contact Dermatitis f ram Paints ROSSANO VALSECCHI, MD PAOLO LEGHISSA, MD SERGIO PIAZZOLLA, MD
A
s the rock paintings found in caves in various parts of Europe testify, paints have existed since the beginnings of history.’ Although paints and painting have existed from ancient times, the real production and commerce of paint products in Europe and the United States did not begin until 1700. Further progress in the production and use of paints came only after the Second World War with the development of the chemical industry and the growing demand from, in particular, car manufacturers.
For a detailed description,
Definition By “paint products” is meant all kinds of varnishes, paints, and enamels. Varnishes are unpigmented coatings of variable consistency that, when thinly spread over a surface, dry on contact with the oxygen in the air or because of the evaporation of solvents. All varnishes contain a coating substance and one or more solvents. Paints are pigmented coatings that, some time after being applied to a surface in the liquid state, form a dry and adherent film. They can be divided into oil paints, synthetic paints, and water paints (the volatile part of which is mainly water). Enamel paints, also more simply referred to as enamels, are pigmented coatings that imitate the appearance of ceramic enamels2
Classification of Paint Products on the Basis of Composition Oil products: Based on desiccating oils; usually also contain resins designed to improve their hardness and brilliance. From the Department of Dermatology and Insfitute of Occupational Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy. Address correspondence to Rossano Valsecchi, Department of Dermatology, Ospedali Riuniti di Bergamo, I-24100 Bergamo, Ifaly.
0 1992 by Elsevier Science Publishing
Synthetic products: Based on synthetic resins. Cellulose products: Based on nitrocellulose. Oleosynthetic products: Of mixed oil and synthetic composition. Nitrosynthetic products: Of mixed cellulose and synthetic composition. Water-based products: The main solvent is water. Special products: Antiacid, antifouling, antifire, insulating coatings.
Co., Inc.
l
0738-081x/92/$5.00
see Tables 1 and Z.‘J,*
Painting Techniques The principal means of application can be summarized as follows: Manualbrushing, using a spatula, French polishing, by heat, spraying; Automatic-spraying, rumbling, using a roller, by immersion, flow coating, skimming, baking, electrostatically, electrophoretically. The most widely used manual technique is spraying. The most widely used automatic procedures are immersion, flow coating, baking, electrostatic painting, and electrophoresis. In immersion, the object to be coated is immersed in a bath for an appropriate length of time. In flow coating, the surface is sprayed with an excess coating and then deteared in air-conditioned galleries. With baking, the surface is covered with a phenol, urea, or melamine-based prepolymer that is then oven-cured. An electrostatic field is created between the piece to be coated and a high-voltage electrode (130,000 V) in electrostatic painting. In electrophoresis, the piece to be coated acts as an anode and the bath in which it is immersed acts as a cathode, thus allowing the (water-soluble) coating to be transported to the surface of the object. The stripping phase, when layers of dried varnish and paint are removed, also plays a considerable role in skin disease. Stripping products vary according to the coating;
185
186
VALSECCHI,
LEGHISSA,
AND
Clinics in Dermatology
PIAZZOLLA
1992;10:185-188
Table 1. Some ofthe Most Common Constituents Binders Synthetic
Natural
resins
resins
Natural and synthetic desiccating oils Solvents/diluents Aliphatic hydrocarbons Aromatic hydrocarbons Esters Alcohols Ketones Glycols Ethers Nitro and chloro derivatives of aliphatic hydrocarbons Additives Plasticizers
Accelerators agents
and drying
Water repellents Antifoaming agents Antivegetative Antiseptics
agents
ofPaint Products
Polyesters, polyamines, polyamides, phenolformadelhydes, epoxies, silicons, isocyanines, polyimides, ketones, vinyls, acrylics, ureics Copal, shellac, colophony, bitumen, dammar, cellulose Linseed, wood, castor, coconut, and olive oils Heptane, petrol, mineral turpentine Toluol, xylol, naphtha, styrol Ethyl and butyl acetates Ethyl, methyl, and butyl alcohols Methyl ethyl ketone, acetone, cyclohexane Ethylene, cellosolve acetate Isopropyl ether, ethylene
Stearates, paraffins, tricresyl phosphate, glycols, triglycidylisocyanate, camphor, castor oils, phthalates Benzyl, terbutyl, methyl ethyl ketone, peroxides, lead, manganese and cobalt compounds with organic acids Cyclohexane derivatives Polyalcohols, silicones, amides, phosphates, vegetable fats Dithiocarbamide, phthalimide, and nitrate derivatives Formaldehyde, chloracetamide, mercury salts, isothiazoline derivatives Styrol, isocyanates
the most common are caustic soda, potash, ammonia, and other solvents.2J*5
The clinical picture has changed since 1960. There are fewer cases of lead poisoning or blood disease (because of the more limited use of white lead, benzol, and benzol homologates), and there is an increase in the number of cases of respiratory (particularly allergic) and central nervous system diseases6 The fumes, solvents, and mixed aerosol particles involved in spray painting may lead to irritating or allergizing effects at the level of the conjunctival, nasal, or upper airway mucosa. a-l2 Cases of hyposmia, probably from the use of solvents, have also been reported among house painters.13 As far as bronchopulmonary diseases are concerned, a large number of studies have highlighted the presence of chronic bronchitis,9J1J4 principally of the allergic type (bronchial asthma and extrinsic allergic alveolitis). The incidence of bronchial asthma reached its height in the 197Os, along with the commercialization of polyurethane paints. 9~14-19Other substances present in paints that are capable of provoking respiratory disease, particularly of the allergic kind, include trimethyl anhydride, phthalate anhydride and its derivates, maleic anhydride, and epoxy resins.20-24 Of particular historical interest is the presence of pneumoconiosis resulting from the use of enamels rich in crystalline silica, aluminum dust, and ferrous oxides as a primer for cast iron objects. 25*26There are various data in the literature concerning the digestive apparatus; although the liver toxicity of acute exposure to many of the compounds (particularly chlorinated solvents) in paints is well known, there are few epidemiologic data on digestive apparatus disease during chronic exposure to low concentrationsz6 Central and peripheral nervous system diseases are becoming increasingly important among painters, not only because of acute exposure to solvents, but also because of the continuous inhalation of small doses that can cause alterations in the central nervous system, particularly in cortical and subcortical strucTable 2. Pigment Classification Whites Inorganic
Paint Product Induced Diseases Any attempt to evaluate the main clinical manifestations of occupational diseases in painters is complicated by the lack of epidemiologic data. As demonstrated by the technical data concerning paint products, these diseases cannot be placed in a single category.6*7 Every product contains a number of chemical compounds, each of which has a different pathogenic action. Furthermore, each compound may have a different irritative, toxicologic, or immunologic effects on different organs (skin, lungs, or hemopoietic or nervous systems).’
Organic Colors Inorganic
Organic
Baryta, blanc Bxe, rutiIe titanium dioxide, titanium dioxide, lithopone, antimony oxide, basic lead sulfate, talc None
anatase oxide, zinc
Metallic aluminum, Prussian blue, cobalt blue, ultramarine blue, lead chromate, zinc chromate, ferrous oxide, cadmium sulfide, chromium green, chromium oxide green, metallic zinc, metallic copper, metallic lead, lampblack, lignite, cork, ivory, mesothorium-radio-22%promethium, mercuric oxide Aromatic amines, phthalocyanines, tolmdine, nitro derivatives, tar
VALSECCHI, LEGHISSA, AND PIAZZOLLA CONTACT DERMATITIS FROM PAINTS
Clinics in Dermatology 1992;20:185-188 tures, which can lead to the so-called “organic psychosyndrome, “ ‘T~‘-~Ocharacterized by alterations in mood, personality, and cognitive functions. Various toxic neuropathies affect the peripheral nervous system, manifesting paresthesia, dyesthesia, and asthenia of the limbs even in the absence of objective clinical signs.” There remains a lack of epidemiologic studies that would allow the entirety of the problem to be evaluated, just as there is a lack of studies evaluating vestibular damage.’
Paint Product Skin Diseases The incidence of contact allergic dermatitis in workers who use paint products is relatively low, although there are numerous potential risks of sensitization to these substances and frequent cases of contact dermatitis related to soaps, detergents, and solvents. Solvent-based paints may irritate the skin even though, today, they contain few allergens. Cases have been described of allergies to linseed oil, turpentine, colophony, and synthetic resins.31 There are many potentially irritating chemical substances in modern water-solvent paints, although their concentrations are very 10w.~~ The advent of paints containing epoxy, phenolformaldehyde, and acrylate resins could cause sensitization, although reports concerning such cases are currently rare.33 Allergies to turpentine, frequent in the past, have decreased considerably because of its reduced use.34 A study involving 2239 house painters in Stockholm found 87 cases of occupational dermatitis (3.9%); the study also revealed frequent allergies to chloroacetamide, a preservative used in water-based paints.35 Furthermore, a large number of cases of contact dermatitis from solvents have been observed in atopic patients. Over recent years, there have been frequent reports of occupational dermatitis caused by the germicides contained in waterbased paints36-38; among these, special mention should be made of isothiazoline derivatives, which have also been implicated in problems associated with cosmetics. These substances are currently used as fungicides in latex paints and the concentration used (30 ppm w/w) may be sensitizing.38 It should also be remembered that many surfactants may be irritants and that dioctyl sodium sulfosuccinate can lead to sensitization.39 Benzoyl peroxide, p-methoxyphenol, and hydroquinone (polymerization accelerators or inhibitors) are essentially irritant, whereas triethylamine and other amines found in the latest paints may be irritant and/or allergizing. Sensitization to dibutylphthalate and triphenylphosphate (antifire) plasticizers has been observed by Hjorthe40 Contact allergic dermatitis from the cyclohexane-derived resins added to paints to improve their water-repel-
187
lent properties has been observed by Bruze et al” in some house painters, paint sprayers, and tile layers. Aziridine, recently introduced as a crosslinker in acrylate-based systems, as well as its derivatives, may also cause sensitization.42 Cases of sensitization to the paint stripper dibutylthiourea have recently been described.43 We have personally seen 324 cases of contact dermatitis of the hands since 1985 (unpublished data), of which 16 (4.9%) were due to paint products: 8 cases of irritant contact dermatitis and 8 cases of an allergic nature. The latter included three cases of polysensitization (one patient was sensitized to potassium dichromate, tetramethylthiuramdisulfide, and carbamix; one to nickel sulfate and ethylenediamine; one to diaminodiphenylmethane and benzocaine) and two cases of sensitization to potassium dichromate (one to phenylglycidic ether and one to hexanotrodiphenylguanidine. None of these patients had either a personal or family history of atopy and immunoglobulin E values were within the norm.
References 1. IARC Monograph: Some organic solvents, resin monomers
2. 3. 4. 5. 6. 7.
8.
9.
10.
11.
12.
and related compounds, pigments and occupational exposures in paint manufacture and painting. Lyon: IARC, 1989: vo147. Manuale di vemiciatura: La rivista de1 colore. 1980. Villaveccbia, Eigenmann. Nuov Diz Merceol Chim Appl 1977;6:2652-66. Sartorelli E. Med Lav 1981;259-65. Candura F. Tecnologia industriale ad uso dei cultori. Med Lav 1974;614-6. Crepet M. Med Lav 1979;938-46. Zedda S. Aspetti clinici ed epidemiologici della patologia da prodotti vemicianti de1legno. Tratto da Prodotti vemicianti peril legno, Tutela dell’ambiente di lavoro e nuove prospettive. 1980;221-239. Raitta C, Husman K, Tossavainen A. Lens changes in car painters exposed to a mixture of organic solvents. Graefe’s Arch KIin Exp Ophthalmol 1976;200:149-56. Alexandersson R, Hedenstiema G. Respiratory hazards associated with exposure to formaldehyde and solvent in acid-curing paints. Arch Environ Health 1988;43:222- 7. Winchester R, Madjar VM. Solvent effects on workers in the paint, adhesive and printing industries. Ann Occup Hyg 1986;30:307- 17. White MC, Baker EL. Measurements of respiratory illness among construction painters. Br J Ind Med 1988;45:52331. Hellquist H, Irander K, EdIing C, et al. Nasal symptoms and histopathology in a group of spray-painters. Acta Otolaryngo1 1983;96:495-500.
188
VALSECCHI,
LEGHISSA,
AND
PIAZZOLLA
13. Lindstrom K, Wickstrom G. Psychological function changes among maintenance house painters exposed to low levels of organic solvents mixtures. Acta Psychiatr Stand 1983;67(suppl 303):81-91. 14. Schwartz DA, Baker EL. Respiratory illness in the construction industry. Airflow obstruction among painters. Chest 1988;93:134-7. 15. Nielsen J, Sango C, Winroth G, et al. Systemic reactions associated with polyisocyanate exposure. Stand J Work Environ Health 1985;11:51-4. 16. Welinder H, Nielsen J, Bensryd I, et al. IgG antibodies against poyisocyanates in car painters. Clin Allergy 1988;18:85-93. 17. Pepys J, Pickering CA, Breslin BXA, et al. Asthma due to inhaled chemical agents: Toluene diisocyanate. Clin Allergy 1972;2:225. 18. Sartorelli E, Franzinelli A, Catalan0 I’, et al. Patologia respiratoria da vernici poliuretaniche. Atti de1 39”Congresso Nazionale della Societa’Italiana. Med Lav 1976;439. 19. Mapp C, Moro G, Fabbri L, et al. Asma da toluenediisocianato: Studi di provocazione bronchiale specifica ed aspecifica. Med Lav 1979;3:203. 20. Wemfors M, Nielsen J, Schutz A, et al. Phthalic anhydrideinduced occupational asthma. Int Arch Allergy Appl Immunol 1986;79:77-82. 21. Hagmar L, Nielsen J, Skerfving S. Clinical features and epidemiology of occupational obstructive respiratory disease caused by small molecular weight organic chemicals. Monogr Allergy 1987;21:42-58. 22. Nielsen J, Welinder H, Schutz A, et al. Specific serum antibodies against phthalic anhydride in occupationally exposed subjects. J Allergy Clin Immunol 1988;82:126-33. 23. Mebl J. Manifestations respiratoires dues aux resines epoxy, a propos dune observation chez un peintre au pistolet. Arch Ma1 Prof 1967;28:595. 24. Nava C. La patologia allergica da resine epossidiche. Securitas 1974;59:469. 25. Maintz G, Werner L. Do paints and varnishes damage the respiratory system? Ges Hyg 1988;34:274-8. 26. Kurppa K, Husman K. Car painters’ exposure to a mixture of organic solvents. Serum activities of liver enzymes. Stand J Work Environ Health 1982;8:137-40. 27. Hane M, Axeloron D, Blume J, et al. Psycological function changes among house painters. Stand J Work Environ Health 1977;3:91.
Clinics in Dermatology 1992;10:785-288 28. Layer M. Investigation of symptoms in house painters at their work sites. Ugeskr Laeg 1976;138:1225. 29. Wennberg A, Elofsson SA, Gamberale F, et al. Long term exposure to organic solvents in industrial work, effects on the nervous system. Comunicazione al Congresso Intemazionale di Neurotossicologia, 19 79. 30. Savolainen H. Some aspect of mechanism by which industrial solvents produce neurotoxic effects. Chem Biol Interact 1977;18:1. 31. Piper R. Hazards of painting and varnishing. Br J Ind Med 1965;22:247-60. 32. Love11 CR, Rycroft RJG, Williams DMJ, et al. Contact dermatitis from the irritancy (immediate and delayed) and allergenic@ of hydroxypropylacrylate. Contact Dermatitis 1985;12:117-8. paints. A 33. Hansen MK, Larsen M, Cohr KH. Watrebomed review of their chemistry and toxicology and the results of determinations made during their use. Stand J Work Environ Health 1987;13:473-85. 34. Romaguera C, Alomar A, Conde’ Salazar L, et al. Turpentine sesitization. Contact Dermatitis 1986;14:197. 35. Hogberg M, Wahlberg JE. Health screening for occupational dermatoses in house painters. Contact Dermatitis 1980;6:100-106. 36. Mathias CGT, Andersen KE, Hamann K. Allergic contact dermatitis from 2-n-octyl-4-isothiazolin-3-one, a paint mildewcide. Contact Dermatitis 1983;9:507-9. 37. Mending B. Contact dermatitis from tetrachloroisophthalonitrile in paint. Contact Dermatitis 1986;15:187. 38. De Groot AC, Bos JD, Jagtman BA, et al. Contact allergy to preservatives II. Contact Dermatitis 1986;15:218-22. 39. Fisher AA. Contact dermatitis. 3rd ed. Philadelphia: Lea & Febiger, 1986:872. 40 Hjorth N. Contact dermatitis from cellulose acetate film. Berufsdermatosen 1964;12:86-100. 41. Bruze H, Boman A, Bergquist-Karlsson A, et al. Contact allergy to a cyclohexanone resin in humans and guinea pigs. Contact Dermatitis 1988;18:46-9. 42. Cofield BG, Storm FJ, Strawn CB. Contact allergy to aziridine paint hardener. Arch Dermatol 1985;121:373-76. 43. Kanerva L, Jolanki R, Plosila M, et al. Contact dermatitis from dibutylthiourea. Report of a case with fine structural observation of epicutaneous testing with dibutylthiourea. Contact Dermatitis 1984;10:158-62.
A
s the rock paintings found in caves in various parts of Europe testify, paints have existed since the beginnings of history.’ Although paints and painting have existed from ancient times, the real production and commerce of paint products in Europe and the United States did not begin until 1700. Further progress in the production and use of paints came only after the Second World War with the development of the chemical industry and the growing demand from, in particular, car manufacturers.
For a detailed description,
Definition By “paint products” is meant all kinds of varnishes, paints, and enamels. Varnishes are unpigmented coatings of variable consistency that, when thinly spread over a surface, dry on contact with the oxygen in the air or because of the evaporation of solvents. All varnishes contain a coating substance and one or more solvents. Paints are pigmented coatings that, some time after being applied to a surface in the liquid state, form a dry and adherent film. They can be divided into oil paints, synthetic paints, and water paints (the volatile part of which is mainly water). Enamel paints, also more simply referred to as enamels, are pigmented coatings that imitate the appearance of ceramic enamels2
Classification of Paint Products on the Basis of Composition Oil products: Based on desiccating oils; usually also contain resins designed to improve their hardness and brilliance. From the Department of Dermatology and Insfitute of Occupational Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy. Address correspondence to Rossano Valsecchi, Department of Dermatology, Ospedali Riuniti di Bergamo, I-24100 Bergamo, Ifaly.
0 1992 by Elsevier Science Publishing
Synthetic products: Based on synthetic resins. Cellulose products: Based on nitrocellulose. Oleosynthetic products: Of mixed oil and synthetic composition. Nitrosynthetic products: Of mixed cellulose and synthetic composition. Water-based products: The main solvent is water. Special products: Antiacid, antifouling, antifire, insulating coatings.
Co., Inc.
l
0738-081x/92/$5.00
see Tables 1 and Z.‘J,*
Painting Techniques The principal means of application can be summarized as follows: Manualbrushing, using a spatula, French polishing, by heat, spraying; Automatic-spraying, rumbling, using a roller, by immersion, flow coating, skimming, baking, electrostatically, electrophoretically. The most widely used manual technique is spraying. The most widely used automatic procedures are immersion, flow coating, baking, electrostatic painting, and electrophoresis. In immersion, the object to be coated is immersed in a bath for an appropriate length of time. In flow coating, the surface is sprayed with an excess coating and then deteared in air-conditioned galleries. With baking, the surface is covered with a phenol, urea, or melamine-based prepolymer that is then oven-cured. An electrostatic field is created between the piece to be coated and a high-voltage electrode (130,000 V) in electrostatic painting. In electrophoresis, the piece to be coated acts as an anode and the bath in which it is immersed acts as a cathode, thus allowing the (water-soluble) coating to be transported to the surface of the object. The stripping phase, when layers of dried varnish and paint are removed, also plays a considerable role in skin disease. Stripping products vary according to the coating;
185
186
VALSECCHI,
LEGHISSA,
AND
Clinics in Dermatology
PIAZZOLLA
1992;10:185-188
Table 1. Some ofthe Most Common Constituents Binders Synthetic
Natural
resins
resins
Natural and synthetic desiccating oils Solvents/diluents Aliphatic hydrocarbons Aromatic hydrocarbons Esters Alcohols Ketones Glycols Ethers Nitro and chloro derivatives of aliphatic hydrocarbons Additives Plasticizers
Accelerators agents
and drying
Water repellents Antifoaming agents Antivegetative Antiseptics
agents
ofPaint Products
Polyesters, polyamines, polyamides, phenolformadelhydes, epoxies, silicons, isocyanines, polyimides, ketones, vinyls, acrylics, ureics Copal, shellac, colophony, bitumen, dammar, cellulose Linseed, wood, castor, coconut, and olive oils Heptane, petrol, mineral turpentine Toluol, xylol, naphtha, styrol Ethyl and butyl acetates Ethyl, methyl, and butyl alcohols Methyl ethyl ketone, acetone, cyclohexane Ethylene, cellosolve acetate Isopropyl ether, ethylene
Stearates, paraffins, tricresyl phosphate, glycols, triglycidylisocyanate, camphor, castor oils, phthalates Benzyl, terbutyl, methyl ethyl ketone, peroxides, lead, manganese and cobalt compounds with organic acids Cyclohexane derivatives Polyalcohols, silicones, amides, phosphates, vegetable fats Dithiocarbamide, phthalimide, and nitrate derivatives Formaldehyde, chloracetamide, mercury salts, isothiazoline derivatives Styrol, isocyanates
the most common are caustic soda, potash, ammonia, and other solvents.2J*5
The clinical picture has changed since 1960. There are fewer cases of lead poisoning or blood disease (because of the more limited use of white lead, benzol, and benzol homologates), and there is an increase in the number of cases of respiratory (particularly allergic) and central nervous system diseases6 The fumes, solvents, and mixed aerosol particles involved in spray painting may lead to irritating or allergizing effects at the level of the conjunctival, nasal, or upper airway mucosa. a-l2 Cases of hyposmia, probably from the use of solvents, have also been reported among house painters.13 As far as bronchopulmonary diseases are concerned, a large number of studies have highlighted the presence of chronic bronchitis,9J1J4 principally of the allergic type (bronchial asthma and extrinsic allergic alveolitis). The incidence of bronchial asthma reached its height in the 197Os, along with the commercialization of polyurethane paints. 9~14-19Other substances present in paints that are capable of provoking respiratory disease, particularly of the allergic kind, include trimethyl anhydride, phthalate anhydride and its derivates, maleic anhydride, and epoxy resins.20-24 Of particular historical interest is the presence of pneumoconiosis resulting from the use of enamels rich in crystalline silica, aluminum dust, and ferrous oxides as a primer for cast iron objects. 25*26There are various data in the literature concerning the digestive apparatus; although the liver toxicity of acute exposure to many of the compounds (particularly chlorinated solvents) in paints is well known, there are few epidemiologic data on digestive apparatus disease during chronic exposure to low concentrationsz6 Central and peripheral nervous system diseases are becoming increasingly important among painters, not only because of acute exposure to solvents, but also because of the continuous inhalation of small doses that can cause alterations in the central nervous system, particularly in cortical and subcortical strucTable 2. Pigment Classification Whites Inorganic
Paint Product Induced Diseases Any attempt to evaluate the main clinical manifestations of occupational diseases in painters is complicated by the lack of epidemiologic data. As demonstrated by the technical data concerning paint products, these diseases cannot be placed in a single category.6*7 Every product contains a number of chemical compounds, each of which has a different pathogenic action. Furthermore, each compound may have a different irritative, toxicologic, or immunologic effects on different organs (skin, lungs, or hemopoietic or nervous systems).’
Organic Colors Inorganic
Organic
Baryta, blanc Bxe, rutiIe titanium dioxide, titanium dioxide, lithopone, antimony oxide, basic lead sulfate, talc None
anatase oxide, zinc
Metallic aluminum, Prussian blue, cobalt blue, ultramarine blue, lead chromate, zinc chromate, ferrous oxide, cadmium sulfide, chromium green, chromium oxide green, metallic zinc, metallic copper, metallic lead, lampblack, lignite, cork, ivory, mesothorium-radio-22%promethium, mercuric oxide Aromatic amines, phthalocyanines, tolmdine, nitro derivatives, tar
VALSECCHI, LEGHISSA, AND PIAZZOLLA CONTACT DERMATITIS FROM PAINTS
Clinics in Dermatology 1992;20:185-188 tures, which can lead to the so-called “organic psychosyndrome, “ ‘T~‘-~Ocharacterized by alterations in mood, personality, and cognitive functions. Various toxic neuropathies affect the peripheral nervous system, manifesting paresthesia, dyesthesia, and asthenia of the limbs even in the absence of objective clinical signs.” There remains a lack of epidemiologic studies that would allow the entirety of the problem to be evaluated, just as there is a lack of studies evaluating vestibular damage.’
Paint Product Skin Diseases The incidence of contact allergic dermatitis in workers who use paint products is relatively low, although there are numerous potential risks of sensitization to these substances and frequent cases of contact dermatitis related to soaps, detergents, and solvents. Solvent-based paints may irritate the skin even though, today, they contain few allergens. Cases have been described of allergies to linseed oil, turpentine, colophony, and synthetic resins.31 There are many potentially irritating chemical substances in modern water-solvent paints, although their concentrations are very 10w.~~ The advent of paints containing epoxy, phenolformaldehyde, and acrylate resins could cause sensitization, although reports concerning such cases are currently rare.33 Allergies to turpentine, frequent in the past, have decreased considerably because of its reduced use.34 A study involving 2239 house painters in Stockholm found 87 cases of occupational dermatitis (3.9%); the study also revealed frequent allergies to chloroacetamide, a preservative used in water-based paints.35 Furthermore, a large number of cases of contact dermatitis from solvents have been observed in atopic patients. Over recent years, there have been frequent reports of occupational dermatitis caused by the germicides contained in waterbased paints36-38; among these, special mention should be made of isothiazoline derivatives, which have also been implicated in problems associated with cosmetics. These substances are currently used as fungicides in latex paints and the concentration used (30 ppm w/w) may be sensitizing.38 It should also be remembered that many surfactants may be irritants and that dioctyl sodium sulfosuccinate can lead to sensitization.39 Benzoyl peroxide, p-methoxyphenol, and hydroquinone (polymerization accelerators or inhibitors) are essentially irritant, whereas triethylamine and other amines found in the latest paints may be irritant and/or allergizing. Sensitization to dibutylphthalate and triphenylphosphate (antifire) plasticizers has been observed by Hjorthe40 Contact allergic dermatitis from the cyclohexane-derived resins added to paints to improve their water-repel-
187
lent properties has been observed by Bruze et al” in some house painters, paint sprayers, and tile layers. Aziridine, recently introduced as a crosslinker in acrylate-based systems, as well as its derivatives, may also cause sensitization.42 Cases of sensitization to the paint stripper dibutylthiourea have recently been described.43 We have personally seen 324 cases of contact dermatitis of the hands since 1985 (unpublished data), of which 16 (4.9%) were due to paint products: 8 cases of irritant contact dermatitis and 8 cases of an allergic nature. The latter included three cases of polysensitization (one patient was sensitized to potassium dichromate, tetramethylthiuramdisulfide, and carbamix; one to nickel sulfate and ethylenediamine; one to diaminodiphenylmethane and benzocaine) and two cases of sensitization to potassium dichromate (one to phenylglycidic ether and one to hexanotrodiphenylguanidine. None of these patients had either a personal or family history of atopy and immunoglobulin E values were within the norm.
References 1. IARC Monograph: Some organic solvents, resin monomers
2. 3. 4. 5. 6. 7.
8.
9.
10.
11.
12.
and related compounds, pigments and occupational exposures in paint manufacture and painting. Lyon: IARC, 1989: vo147. Manuale di vemiciatura: La rivista de1 colore. 1980. Villaveccbia, Eigenmann. Nuov Diz Merceol Chim Appl 1977;6:2652-66. Sartorelli E. Med Lav 1981;259-65. Candura F. Tecnologia industriale ad uso dei cultori. Med Lav 1974;614-6. Crepet M. Med Lav 1979;938-46. Zedda S. Aspetti clinici ed epidemiologici della patologia da prodotti vemicianti de1legno. Tratto da Prodotti vemicianti peril legno, Tutela dell’ambiente di lavoro e nuove prospettive. 1980;221-239. Raitta C, Husman K, Tossavainen A. Lens changes in car painters exposed to a mixture of organic solvents. Graefe’s Arch KIin Exp Ophthalmol 1976;200:149-56. Alexandersson R, Hedenstiema G. Respiratory hazards associated with exposure to formaldehyde and solvent in acid-curing paints. Arch Environ Health 1988;43:222- 7. Winchester R, Madjar VM. Solvent effects on workers in the paint, adhesive and printing industries. Ann Occup Hyg 1986;30:307- 17. White MC, Baker EL. Measurements of respiratory illness among construction painters. Br J Ind Med 1988;45:52331. Hellquist H, Irander K, EdIing C, et al. Nasal symptoms and histopathology in a group of spray-painters. Acta Otolaryngo1 1983;96:495-500.
188
VALSECCHI,
LEGHISSA,
AND
PIAZZOLLA
13. Lindstrom K, Wickstrom G. Psychological function changes among maintenance house painters exposed to low levels of organic solvents mixtures. Acta Psychiatr Stand 1983;67(suppl 303):81-91. 14. Schwartz DA, Baker EL. Respiratory illness in the construction industry. Airflow obstruction among painters. Chest 1988;93:134-7. 15. Nielsen J, Sango C, Winroth G, et al. Systemic reactions associated with polyisocyanate exposure. Stand J Work Environ Health 1985;11:51-4. 16. Welinder H, Nielsen J, Bensryd I, et al. IgG antibodies against poyisocyanates in car painters. Clin Allergy 1988;18:85-93. 17. Pepys J, Pickering CA, Breslin BXA, et al. Asthma due to inhaled chemical agents: Toluene diisocyanate. Clin Allergy 1972;2:225. 18. Sartorelli E, Franzinelli A, Catalan0 I’, et al. Patologia respiratoria da vernici poliuretaniche. Atti de1 39”Congresso Nazionale della Societa’Italiana. Med Lav 1976;439. 19. Mapp C, Moro G, Fabbri L, et al. Asma da toluenediisocianato: Studi di provocazione bronchiale specifica ed aspecifica. Med Lav 1979;3:203. 20. Wemfors M, Nielsen J, Schutz A, et al. Phthalic anhydrideinduced occupational asthma. Int Arch Allergy Appl Immunol 1986;79:77-82. 21. Hagmar L, Nielsen J, Skerfving S. Clinical features and epidemiology of occupational obstructive respiratory disease caused by small molecular weight organic chemicals. Monogr Allergy 1987;21:42-58. 22. Nielsen J, Welinder H, Schutz A, et al. Specific serum antibodies against phthalic anhydride in occupationally exposed subjects. J Allergy Clin Immunol 1988;82:126-33. 23. Mebl J. Manifestations respiratoires dues aux resines epoxy, a propos dune observation chez un peintre au pistolet. Arch Ma1 Prof 1967;28:595. 24. Nava C. La patologia allergica da resine epossidiche. Securitas 1974;59:469. 25. Maintz G, Werner L. Do paints and varnishes damage the respiratory system? Ges Hyg 1988;34:274-8. 26. Kurppa K, Husman K. Car painters’ exposure to a mixture of organic solvents. Serum activities of liver enzymes. Stand J Work Environ Health 1982;8:137-40. 27. Hane M, Axeloron D, Blume J, et al. Psycological function changes among house painters. Stand J Work Environ Health 1977;3:91.
Clinics in Dermatology 1992;10:785-288 28. Layer M. Investigation of symptoms in house painters at their work sites. Ugeskr Laeg 1976;138:1225. 29. Wennberg A, Elofsson SA, Gamberale F, et al. Long term exposure to organic solvents in industrial work, effects on the nervous system. Comunicazione al Congresso Intemazionale di Neurotossicologia, 19 79. 30. Savolainen H. Some aspect of mechanism by which industrial solvents produce neurotoxic effects. Chem Biol Interact 1977;18:1. 31. Piper R. Hazards of painting and varnishing. Br J Ind Med 1965;22:247-60. 32. Love11 CR, Rycroft RJG, Williams DMJ, et al. Contact dermatitis from the irritancy (immediate and delayed) and allergenic@ of hydroxypropylacrylate. Contact Dermatitis 1985;12:117-8. paints. A 33. Hansen MK, Larsen M, Cohr KH. Watrebomed review of their chemistry and toxicology and the results of determinations made during their use. Stand J Work Environ Health 1987;13:473-85. 34. Romaguera C, Alomar A, Conde’ Salazar L, et al. Turpentine sesitization. Contact Dermatitis 1986;14:197. 35. Hogberg M, Wahlberg JE. Health screening for occupational dermatoses in house painters. Contact Dermatitis 1980;6:100-106. 36. Mathias CGT, Andersen KE, Hamann K. Allergic contact dermatitis from 2-n-octyl-4-isothiazolin-3-one, a paint mildewcide. Contact Dermatitis 1983;9:507-9. 37. Mending B. Contact dermatitis from tetrachloroisophthalonitrile in paint. Contact Dermatitis 1986;15:187. 38. De Groot AC, Bos JD, Jagtman BA, et al. Contact allergy to preservatives II. Contact Dermatitis 1986;15:218-22. 39. Fisher AA. Contact dermatitis. 3rd ed. Philadelphia: Lea & Febiger, 1986:872. 40 Hjorth N. Contact dermatitis from cellulose acetate film. Berufsdermatosen 1964;12:86-100. 41. Bruze H, Boman A, Bergquist-Karlsson A, et al. Contact allergy to a cyclohexanone resin in humans and guinea pigs. Contact Dermatitis 1988;18:46-9. 42. Cofield BG, Storm FJ, Strawn CB. Contact allergy to aziridine paint hardener. Arch Dermatol 1985;121:373-76. 43. Kanerva L, Jolanki R, Plosila M, et al. Contact dermatitis from dibutylthiourea. Report of a case with fine structural observation of epicutaneous testing with dibutylthiourea. Contact Dermatitis 1984;10:158-62.
