At the time of writing this blog, we are on our family holiday to Cumbria, opting for a UK based holiday because we’re both in professions where we can’t run the risk of us or the kids (not having been vaccinated) having to self isolate for 10 days upon our return.
Surprisingly, there has been plenty to do. England has also been in the midst of a heat wave so the North has not been so chillingly fresh as we expected. We were all prepared to be saying, “It’d be lovely up here in the summer!”. Covid has serendipitously made us aware of all the joys and pleasures that can be had from our own lands rather than travelling all the way to southern France to revel in their rolling hills, ruined castles and historic buildings.
We went to spend a day or two at Beamish, the open air Museum of the North, which celebrates and educates us on the story of life in the UK as it was from the 1820’s onwards. I had been many a time as a schoolchild and took my two youngest several years ago who enjoyed it exceedingly. I think the sweetshop in the 1900’s town was their favourite…
Anyway, it was interesting to find a placard on ‘Oil dermatitis’ in the old engine repair yard of the aforementioned 1900’s town. Having had the odd car mechanic present as a patient with this issue, I thought it warranted a little bit more investigation.
There is mention of an oil folliculitis in the British Journal of Industrial Medicine in 1960 but the first mention of eczema in production line workers in an automobile factory is in the same journal dated 1964. Those exposed to cutting oils, lubricating oils, greases, and engine and diesel oils were the most affected.
[Finnie JS. Oil folliculitis: a study of 200 men employed in an engineering factory. Brit J Industr Med 1960;17:130.]
[Newhouse ML. Epidemiology of skin disease in an automobile factory. Brit J Industr Med 1964;21:287.]
So it’s the oils that cause the problem? We use oils all the time in the treatment of eczema!
It is thought that it is not the exposure to the mineral oil that was the cause of the problem.
The authors found that reduction in wet work, protective measures ie wearing of gloves, hand hygiene ie the thorough washing of hands if exposed to cutting or engine oils caused a reduction in hand eczema. So it is largely a problem of an irritant hand dermatitis.
What about allergies?
Yes, subsequent studies also found that sensitisation to potassium dichromate was common with chromate sensitivity being four times greater among assemblers than among men doing other jobs in the factory. Hexavalent chromate was used for many years as a dip when plating nuts, bolts and screws used in assembly lines and by simply omitting this chromate dip resulted in a significant reduction in cases of chromate sensitivity and hence dermatitis.
[Newhouse ML. A cause of chromate dermatitis among assemblers in an automobile factory. Brit J Industr Med 1963; 20:199.]
What about more recent studies?
Yes, a study looking at occupational skin diseases in Singapore between 1989 and 1998 showed a high prevalence of irritant contact dermatitis (can occur in anyone if you irritate the skin barrier enough). This was found to be more common than allergic contact dermatitis (only happens in those who develop an allergic reaction to a chemical applied to the skin).
The major sources for an irritant contact dermatitis in the workplace were in the metal/engineering, building/construction, electrical/electronics and transport industries. The main irritants were wet work and detergents, solvents and oil/grease exposure.
If someone were to become allergic, the main allergens were chromate, rubber chemicals and nickel.
[Goon AT, Goh CL. Epidemiology of occupational skin disease in Singapore 1989-1998. Contact dermatitis 2000;43:133-6.]
A newer chemical was found in 2008 called (wait for it!) 2,5-dimercapto-1,3,4-thiadiazole and also phenyl-alpha-naphtylamine. Both were found in guide-way oil and grease, lubricants used in metalworking machines.
[Aalto-Korte K, Suuronen K, Kuuliala O et al. Contact allergy to 2,5-dimercapto-1,3,4-thiadiazole and phenyl-alpha-naphtylamine, allergens in industrial greases and lubricant oils – contact allergy to water-insoluble greases is uncommon but needs to be considered in some workers. Contact dermatitis 2008;58:93-6.]
The most recent study from 2020 showed considerable levels of nickel, chromium and cobalt in metalworking fluids and we know that these chemicals are common causes of an allergic contact dermatitis.
[Alinaghi F, Hedberg YS, Zachariae C et al. Metals in used and unused metalworking fluids : X-ray fluorescence spectrometry as a screening test. Contact dermatitis 2020;83:83-87.]
So what’s the advice?
It’s pretty much the same as back in the 1900’s, if you can read the placard in the photo, though I’m not sure we’d go so far as to recommend washing with chlorinated lime, bicarbonate of soda, boric acid and water!
Wear protective clothing and/or gloves, wash off any engine oil if exposed with soap and water and apply an emollient would be the advice now. Any dermatitis can be treated with your anti-eczema cream. If this is insufficient to reduce your eczema, then we would probably advise being referred to dermatology to see if there is an allergic component to either nickel, chromate or cobalt or anything else, for that matter. If this is negative, which can often be the case (as with my patient), seeking to be redeployed to an area of the industry where there is not direct exposure may have to be sought.
Kind regards,
Sandy
Dr Sandy Flann, Consultant Dermatologist
