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ACTUAL CAUSES OF CERTAIN OCCUPATIONAL DERMATOSES: III. A Further Study with Special Reference to Effect of Alkali on the Skin, Effect of Soap on pH of Skin, Modern Cutaneous Detergents

ACTUAL CAUSES OF CERTAIN OCCUPATIONAL DERMATOSES: III. A Further Study with Special Reference to... Abstract IN PREVIOUS reports1 study was made of cutaneous diseases in patients observed by us who presented claims for compensation under the Pennsylvania law. In these studies we classified actual causes into groups rather than emphasizing occupation in relation to cause or making the simplest of classifications, namely, division of responsible agents into chemical, physical and biologic ones. We believe it is preferable to emphasize actual causes, since attention is focused on these causes. Prevention and investigative measures are suggested, and teaching of the subject is facilitated.2 The cases previously reported total 2,297; of the patients 1,729 were male and 568 female. The diseases of 1,059 (46.1 per cent) were diagnosed as occupational in origin and those of 1,238 as nonoccupational. The nonoccupational group was comprised of a variety of diseases of the skin. Diagnosis of the cutaneous lesion is the initial requirement in differentiating occupational from nonoccupational cause. References 1. Klauder, J. V.: Actual Causes of Certain Occupational Dermatoses , Arch. Dermat. & Syph. 48:579-600 ( (Dec.) ) 1943. 2. Klauder, J. V., and Hardy, M. K.: Actual Causes of Certain Occupational Dermatoses: II , Occup. Med. 1:168-181 ( (Feb.) ) 1946. 3. Klauder, J. V.: Teaching of Occupational Dermatoses , Arch. Dermat. & Syph. 48:153-158 ( (Aug.) ) 1943. 4. Klauder, J. V., and Brill, F. A., Jr.: Correlation of the Boiling Ranges of Some Petroleum Solvents with Their Irritant Action on the Skin , Arch. Dermat & Syph. 56:197-212 ( (Aug.) ) 1947. 5. Klauder, J. V.: Herpes Zoster Appearing After Trauma , J. A. M. A. 134: 245-248 ( (May 17) ) 1947. 6. Klauder, J. V.: Ocular Syphilis: IV. Interstitial Keratitis and Trauma , Arch. Ophth. 10:302-328 ( (Sept.) ) 1933. 7. Osborne, E., and Putnam, E. D.: Industrial Dermatoses, with Special Reference to Allergy and Mycotic Dermatitis , J. A. M. A. 99:972-977 ( (Sept. 17) ) 1932. 8. Schwartz, L.: Actual Causes of Dermatitis Attributed to Socks , Pub. Health Rep. 49:1176-1185 ( (Oct. 5) ) 1934. 9. Jenkins, W.: Dermatoses Among Gas and Tar Workers , Bristol, England, John Wright & Sons, Ltd., 1948. 10. Sellei, H., and Leiber, E.: Chemical and Physical Mechanism of Engine Preservation Oil , Lubrication Eng. 3:16-23 ( (Sept.) ) 1947. 11. White, R. P.: The Dermatergoses, or Occupational Affections of the Skin , ed. 4, London, H. K. Lewis & Co., Ltd., 1934, p. 339. 12. Klauder, J. V.; Gross, E. R., and Brown, H.: Prevention of Industrial Dermatitis , Arch. Dermat. & Syph. 41:331-356 ( (Feb.) ) 1940. 13. Lane, C. G.: Cutaneous Cleansing for Industrial Workers , J. Indust. Hyg. & Toxicol. 31:220-226 ( (July) ) 1949. 14. Although the role of nonoccupational exposure to ultraviolet rays could not be evaluated, the insurance carrier recognized an occupational phase in causation. 15. Burckhardt, W.: Beiträge zur Ekzemfrage: Die Rolle des Alkali in der Pathogenese des Ekzems speziell des Gewerbeekzems , Arch. f. Dermat. u. Syph. 173:155-167, 1935; 16. Das Maurerekzem (Eine experimentelle und klinische Studie zur Ekzemfrage) , Burckhardt Arch. f. Dermat. u. Syph. 178:1-44, 1938; 17. Neuere Untersuchungen über die Alkaliempfindlichkeit der Haut , Dermatologica 94:73-96, 1947. 18. Space permits only brief description of the technic Burckhardt now employs.14c In the neutralization test one drop of 1/80 N sodium hydroxide is placed on the skin and then one drop of an alcoholic solution 1: 2,000 of phenolphthalein. This mixture is covered with a glass block, and the time of disappearance of the red discoloration is noted. This procedure is repeated at the same site for 10 consecutive times. The results are graded as follows: in quick neutralization the red discoloration disappears in not more than five minutes; in the mean or average the disappearance requires five to seven minutes, and in slow it exceeds seven minutes. Burckhardt observed that patients with dermatitis attributed to alkaline substances showed results predominantly indicative of slow neutralization. In the sensitivity test one drop of 0.5 N sodium hydroxide is placed on the skin and covered with a glass block and allowed to remain for 10 minutes. This procedure is repeated until the following symptoms appear—sense of burning and redness accompanied with minute vesicles. The alkali-sensitive skin reacts after the first or second test. In the absence of reaction no more than eight tests are performed. Burckhardt prefers the sensitivity test if only one of the two aforementioned tests is performed. 19. In the entire studies herein reported pH determinations were made with the glass electrode of either a Beckman potentiometer or a Coleman potentiometer. 20. Sunderman, T. W., and Boerner, T.: Normal Values In Clinical Medicine , Philadelphia, W. B. Saunders Company, 1949, p. 479. 21. Bernstein, E. T., and Herrmann, F.: The Acidity on the Surface of the Skin , New York State J. Med. , 42:436-442, 1942 22. The pH of a 1 per cent aqueous solution (with distilled water) of 36 toilet soaps ranged from 9 to 11.11 23. It is reasonable that the buffer action of sweat under the rubber gloves and the pH of 5.9 of the talc (one sample tested) applied on the hands and inside the gloves facilitated a quicker return of pH to normal. This action of sweat may act to prevent dermatitis from excessive hand washing and possibly, too, infection of the hands. 24. Unlike the situation with dishes, there is no mechanical appliance employed in the washing of large pots and pans. 25. After cessation of work the hands and forearms of these two workers were dry and covered with a fine scale. One regularly used petrolatum as an emollient, and the other used a hand lotion, the pH of which (ironically) was 8.5. Use of the hand lotion was discontinued during the study period. Since the workers were Negroes (the skin was quite dark), neutralization tests and tests of sensitivity to alkali did not give satisfactory results. 26. It is reasonable that the shorter duration of employment as a dishwasher— four months—is one phase in explanation of the difference between the curve of the pH of this worker and those of the two pot and pan washers. 27. Fischer, C. C.: Prevention of Impetigo Neonatorum: Clinical Study of Various Methods Including Use of New Antiseptic Baby Lotion , Arch. Pediat. 61:352, 1944 28. Lane, C. G., and Blank, I. H.: Cutaneous Detergents , J. A. M. A. 118: 804-817 ( (March 7) ) 1942. 29. Blank, I. H.: Action of Soap on Skin: I. Patch Test with Fatty Acids , Arch. Dermat. & Syph. 39:811-824 ( (May) ) 1939. 30. Stokes, J.: "Simplifying" Dermatology for the Practitioner , Pennsylvania M. J. 52:1065-1071 ( (July) ) 1949. 31. A few of the liquid soaps and the liquid nonsoap detergents contained an antiseptic and were advised for cleansing of wounds and prevention of infection of the hands of industrial workers. In the case of some the label stated that the antiseptic was hexachlorophene (bis [2-hydroxy-3,5,6-trichlorophenyl] methane; G-11). 32. Personal communication to the authors. 33. Soap powder should be distinguished from "powdered soap," which includes soap chips, soap flakes, granular soaps and soap beads also employed for household uses. 34. The Wall Street Journal , (Dec. 24) , 1949 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Dermatology & Syphilology American Medical Association

ACTUAL CAUSES OF CERTAIN OCCUPATIONAL DERMATOSES: III. A Further Study with Special Reference to Effect of Alkali on the Skin, Effect of Soap on pH of Skin, Modern Cutaneous Detergents

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Publisher
American Medical Association
Copyright
Copyright © 1951 American Medical Association. All Rights Reserved.
ISSN
0096-5979
DOI
10.1001/archderm.1951.01570010004001
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Abstract

Abstract IN PREVIOUS reports1 study was made of cutaneous diseases in patients observed by us who presented claims for compensation under the Pennsylvania law. In these studies we classified actual causes into groups rather than emphasizing occupation in relation to cause or making the simplest of classifications, namely, division of responsible agents into chemical, physical and biologic ones. We believe it is preferable to emphasize actual causes, since attention is focused on these causes. Prevention and investigative measures are suggested, and teaching of the subject is facilitated.2 The cases previously reported total 2,297; of the patients 1,729 were male and 568 female. The diseases of 1,059 (46.1 per cent) were diagnosed as occupational in origin and those of 1,238 as nonoccupational. The nonoccupational group was comprised of a variety of diseases of the skin. Diagnosis of the cutaneous lesion is the initial requirement in differentiating occupational from nonoccupational cause. References 1. Klauder, J. V.: Actual Causes of Certain Occupational Dermatoses , Arch. Dermat. & Syph. 48:579-600 ( (Dec.) ) 1943. 2. Klauder, J. V., and Hardy, M. K.: Actual Causes of Certain Occupational Dermatoses: II , Occup. Med. 1:168-181 ( (Feb.) ) 1946. 3. Klauder, J. V.: Teaching of Occupational Dermatoses , Arch. Dermat. & Syph. 48:153-158 ( (Aug.) ) 1943. 4. Klauder, J. V., and Brill, F. A., Jr.: Correlation of the Boiling Ranges of Some Petroleum Solvents with Their Irritant Action on the Skin , Arch. Dermat & Syph. 56:197-212 ( (Aug.) ) 1947. 5. Klauder, J. V.: Herpes Zoster Appearing After Trauma , J. A. M. A. 134: 245-248 ( (May 17) ) 1947. 6. Klauder, J. V.: Ocular Syphilis: IV. Interstitial Keratitis and Trauma , Arch. Ophth. 10:302-328 ( (Sept.) ) 1933. 7. Osborne, E., and Putnam, E. D.: Industrial Dermatoses, with Special Reference to Allergy and Mycotic Dermatitis , J. A. M. A. 99:972-977 ( (Sept. 17) ) 1932. 8. Schwartz, L.: Actual Causes of Dermatitis Attributed to Socks , Pub. Health Rep. 49:1176-1185 ( (Oct. 5) ) 1934. 9. Jenkins, W.: Dermatoses Among Gas and Tar Workers , Bristol, England, John Wright & Sons, Ltd., 1948. 10. Sellei, H., and Leiber, E.: Chemical and Physical Mechanism of Engine Preservation Oil , Lubrication Eng. 3:16-23 ( (Sept.) ) 1947. 11. White, R. P.: The Dermatergoses, or Occupational Affections of the Skin , ed. 4, London, H. K. Lewis & Co., Ltd., 1934, p. 339. 12. Klauder, J. V.; Gross, E. R., and Brown, H.: Prevention of Industrial Dermatitis , Arch. Dermat. & Syph. 41:331-356 ( (Feb.) ) 1940. 13. Lane, C. G.: Cutaneous Cleansing for Industrial Workers , J. Indust. Hyg. & Toxicol. 31:220-226 ( (July) ) 1949. 14. Although the role of nonoccupational exposure to ultraviolet rays could not be evaluated, the insurance carrier recognized an occupational phase in causation. 15. Burckhardt, W.: Beiträge zur Ekzemfrage: Die Rolle des Alkali in der Pathogenese des Ekzems speziell des Gewerbeekzems , Arch. f. Dermat. u. Syph. 173:155-167, 1935; 16. Das Maurerekzem (Eine experimentelle und klinische Studie zur Ekzemfrage) , Burckhardt Arch. f. Dermat. u. Syph. 178:1-44, 1938; 17. Neuere Untersuchungen über die Alkaliempfindlichkeit der Haut , Dermatologica 94:73-96, 1947. 18. Space permits only brief description of the technic Burckhardt now employs.14c In the neutralization test one drop of 1/80 N sodium hydroxide is placed on the skin and then one drop of an alcoholic solution 1: 2,000 of phenolphthalein. This mixture is covered with a glass block, and the time of disappearance of the red discoloration is noted. This procedure is repeated at the same site for 10 consecutive times. The results are graded as follows: in quick neutralization the red discoloration disappears in not more than five minutes; in the mean or average the disappearance requires five to seven minutes, and in slow it exceeds seven minutes. Burckhardt observed that patients with dermatitis attributed to alkaline substances showed results predominantly indicative of slow neutralization. In the sensitivity test one drop of 0.5 N sodium hydroxide is placed on the skin and covered with a glass block and allowed to remain for 10 minutes. This procedure is repeated until the following symptoms appear—sense of burning and redness accompanied with minute vesicles. The alkali-sensitive skin reacts after the first or second test. In the absence of reaction no more than eight tests are performed. Burckhardt prefers the sensitivity test if only one of the two aforementioned tests is performed. 19. In the entire studies herein reported pH determinations were made with the glass electrode of either a Beckman potentiometer or a Coleman potentiometer. 20. Sunderman, T. W., and Boerner, T.: Normal Values In Clinical Medicine , Philadelphia, W. B. Saunders Company, 1949, p. 479. 21. Bernstein, E. T., and Herrmann, F.: The Acidity on the Surface of the Skin , New York State J. Med. , 42:436-442, 1942 22. The pH of a 1 per cent aqueous solution (with distilled water) of 36 toilet soaps ranged from 9 to 11.11 23. It is reasonable that the buffer action of sweat under the rubber gloves and the pH of 5.9 of the talc (one sample tested) applied on the hands and inside the gloves facilitated a quicker return of pH to normal. This action of sweat may act to prevent dermatitis from excessive hand washing and possibly, too, infection of the hands. 24. Unlike the situation with dishes, there is no mechanical appliance employed in the washing of large pots and pans. 25. After cessation of work the hands and forearms of these two workers were dry and covered with a fine scale. One regularly used petrolatum as an emollient, and the other used a hand lotion, the pH of which (ironically) was 8.5. Use of the hand lotion was discontinued during the study period. Since the workers were Negroes (the skin was quite dark), neutralization tests and tests of sensitivity to alkali did not give satisfactory results. 26. It is reasonable that the shorter duration of employment as a dishwasher— four months—is one phase in explanation of the difference between the curve of the pH of this worker and those of the two pot and pan washers. 27. Fischer, C. C.: Prevention of Impetigo Neonatorum: Clinical Study of Various Methods Including Use of New Antiseptic Baby Lotion , Arch. Pediat. 61:352, 1944 28. Lane, C. G., and Blank, I. H.: Cutaneous Detergents , J. A. M. A. 118: 804-817 ( (March 7) ) 1942. 29. Blank, I. H.: Action of Soap on Skin: I. Patch Test with Fatty Acids , Arch. Dermat. & Syph. 39:811-824 ( (May) ) 1939. 30. Stokes, J.: "Simplifying" Dermatology for the Practitioner , Pennsylvania M. J. 52:1065-1071 ( (July) ) 1949. 31. A few of the liquid soaps and the liquid nonsoap detergents contained an antiseptic and were advised for cleansing of wounds and prevention of infection of the hands of industrial workers. In the case of some the label stated that the antiseptic was hexachlorophene (bis [2-hydroxy-3,5,6-trichlorophenyl] methane; G-11). 32. Personal communication to the authors. 33. Soap powder should be distinguished from "powdered soap," which includes soap chips, soap flakes, granular soaps and soap beads also employed for household uses. 34. The Wall Street Journal , (Dec. 24) , 1949

Journal

A.M.A. Archives of Dermatology & SyphilologyAmerican Medical Association

Published: Jan 1, 1951

References