Metal
Country/region, period
Dermatitis patients
General population
Ref.
n
W
M
Total
n
W
M
Total
Ni
Europe, 1985–2010a
180,390
17–32
3–10
12–25
[11]
Europe 2005–2006
19,793
19–24
[12]
Denmark 1990/2006
3,460
9
1
5.9
[13]
Denmark, 1995–1996b
1,146
13.7
2.5
8.6
[14]
Spain, 2000–2005
1,092
26
3
29.3
[15]
North America, 2009–2010
4,294
15.5
[16]
Co
Europe 2005–2006
19,793
6.2–8.8
[12]
Denmark 1990/2006
3,460
0.4
0.1
0.2
[13]
Denmark, 1995–1996b
1,146
1.5
0.6
1.0
[14]
Sweden
3,790
7
9
[17]
North America, 2009–2010
4,303
6.2
[16]
Spain 2000–2005
1,092
8.3
2.4
10.8
[15]
Cr
Denmark 1985–2007
16,228
2.5
2.4
2.5
[18]
Denmark 1990/2006
3,460
0.3
0
0.1
[13]
Europe 2005–2006
19,793
4.5–5.9
[12]
Denmark, 1995–1996b
1,146
0.2
1.0
0.5
[14]
North America 2009–2010
4,306
2.3
[16]
Spain 2000–2005
1,092
4.1
3.4
7.5
[15]
Pd
Spain 2000–2005
1,092
10.5
1.2
11.7
[15]
Italy 1991–2000
4,446
6.7
2.3
5.3
[19]
Italy 2006
3,093
13
[20]
11.5.1 Nickel
Occupational nickel dermatitis is often presented as chronic hand eczema. Nickel dermatitis in consumers is often explained by prolonged contact with different personal nickel-releasing items. However, it must be stressed that also consumers develop hand eczema by repetitive contact with a broad range of nickel-releasing items in everyday life (Table 11.2).
Table 11.2
Examples of sources of exposures for consumers and occupational workers
Metal | Sources of exposure – examples | |
|---|---|---|
Consumer items | Occupational groups | |
Ni | Belts, buttons, coins, doorknobs, handles, jewellery, keys, laptops, mobile phones, sewing materials, tools, watches | Carpenters, cashiers, dental technicians, electricians, hair dressers, plating industry workers, metal workers, tailors |
Co | Body implants, dental implants, jewellery (to some extent), paints, putties | Dental technicians, hard metal workers, metal workers, painters, pottery workers, printing industry |
Cr | Cement, dental implants, galvanised metal items, leather items (belts, boots, gloves, shoes, wrist bands) | Construction workers, dental technicians, tannery workers |
Pd | Dental implants, jewellery | Analytical chemists, electroplating workers, jewellers |
Au | Dental materials, intracoronary stents | Electronics workers, jewellers |
11.5.2 Chromium
Patients often have a persistent eczema, sometimes widespread. It can sometimes be missed due to the fact that it resembles atopic dermatitis, due to a marked dryness and lichenification. Cement eczema is often initially displayed at the dorsal aspect of the hands, in a nummular pattern. It can in a later stage also involve the rest of the hand. Foot dermatitis is also common due to chromium in leather shoes or boots; hand eczema due to leather gloves and other leather items in contact with the hands is also seen.
11.5.3 Cobalt
It is rare to find cobalt allergy without either nickel and/or chromium allergy in patients. The most prominent finding of solitary cobalt allergy reactions is found among hard metal, glass and pottery workers. It is often difficult for dermatologists to explain the sources of skin exposure to cobalt, because relatively little is known about the uses of cobalt.
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