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Gulf War and Health: Insecticides and Solvents, Volume 2
reactions to propylene glycol, 30% of which were allergic in appearance. Not all studies determined a diagnosis of allergic contact dermatitis with exposure to propylene glycol. For example, at a skin clinic, Nater and colleagues (1977) conducted patch tests on 98 outpatients with eczema with propylene glycol. Eleven had positive patch-test reactions after a 48-hour application. However, because none of the study’s subjects gave a history consistent with possible allergic contact dermatitis related to propylene glycol, the authors concluded that all the reactions were irritant effects.
Wolf and colleagues (1994, 1996) evaluated the hand dermatitis of Israeli soldiers with occupational dermatitis. Cases and controls were patch-tested with a standard battery of contact sensitizers and five additional reagents: gun oil, hydraulic oil, automotive lubricant oil, white spirits, and gasoline. Olive oil was used as a control. In the exposed group, 31 patients (29%) had at least one positive skin reaction to the oil series, and 30 had reactions to the standard patch-test arrays. None of the 20 soldiers exposed to fuels and oils, but without dermatitis, had a positive test in the oil series. This study provides some indication that exposure to some oils, white spirits, and fuels can result in allergic contact dermatitis. However, no data are provided about clearing of the dermatitis after cessation of exposure.
Irritant Contact Dermatitis and Other Skin Disorders
Many of the studies of contact dermatitis involve workers who continue to be exposed to the substances of concern, so it is difficult to determine long-term effects after exposure ceases. Several descriptive studies reported a high prevalence of skin problems, including dermatitis, in workers exposed to solvents (e.g., Atav and Spencer, 1995; Cherry et al., 2000; Goon and Goh, 2000). However, those studies did not have control groups for comparison.
Yakes and colleagues (1991) conducted a cross-sectional study of newspaper pressroom workers. They obtained responses to a comprehensive health questionnaire and performed a skin examination of 212 pressroom workers. The results were compared with results in 33 compositors. On the questionnaire, pressroom workers were more likely to complain of dryness or cracked skin, itching, acne, and redness than were compositors (p values were all <0.05). Dermatitis was correlated with more frequent use of type 1 solvent (mineral spirits and naphtha blend), Cleansall (aliphatic hydrocarbons, pine oil, and surfactants), and isopropyl alcohol (p values were all <0.05). Participation rates in the study were high (over 90%), but only continuous exposure and disease were measured.
Svendsen and Hilt (1997) compared skin disorders in ships’ engineers exposed to mineral oil and solvents in the engine room with disorders in other seamen. On a questionnaire, engineers were more likely than were control subjects to report eczema, acne, dry skin, and any dermatitis. Use of Stoddard solvent was found to be positively associated with acne (OR=2.2, 95% CI=0.86–5.46), and there was a weaker association with hand dermatitis (OR=1.1, 95% CI=0.60–2.11).
Burg and Gist (1999) analyzed data from the trichloroethylene subregistry of the Agency for Toxic Substances and Disease Registry (ATSDR). Registrants were exposed to trichloroethylene-contaminated water and also might have been exposed to trichloroethane, tetrachloroethylene, dichloroethane, and dichloroethene. The study categorized the 4041 living members on the registry into four groups by amount and duration of exposure and examined the groups for possible relationships with 25 health outcomes. Using a cumulative trichloroethylene exposure index of parts-per-billion-years (ppb-yr) adjusted for age and