COD
Contact Dermatitis • Contact Points
Contact Dermatitis
• CONTRIBUTIONS TO THIS SECTION MAY NOT UNDERGO PEER REVIEW, BUT WILL BE REVIEWED BY THE EDITOR •
Occupational airborne contact dermatitis caused by trifluoroacetic acid in an organic chemistry laboratory Ji Yeon Byun, Ju Yun Woo, You Won Choi and Hae Young Choi Department of Dermatology, School of Medicine, Ewha Womans University, Seoul 58-710, Korea doi:10.1111/cod.12138
Key words: airborne; allergic contact dermatitis; laboratory workers; occupational; organic chemistry; trifluoroacetic acid.
Chemists and technicians are exposed to various chemicals. Airborne contact dermatitis caused by volatile chemicals has been shown (1–4). We report a case of airborne allergic contact dermatitis caused by trifluoroacetic acid (TFA) in a laboratory technician.
Case Report A 24-year-old Korean man had a 6-month history of recurrent rash on his neck and arms. He was otherwise healthy, and started his job at an organic chemistry laboratory 18 months previously. He reported that exposure to organic solvents or acidic agents, especially TFA, at the workplace caused him skin problems. On examination, pruritic, excoriated and lichenified patches were seen on the forehead, neck, and forearms. Patch tests were performed with the TRUE Test® (SmartPractice, Hillerod, Denmark), a cosmetic series (Chemotechnique Diagnostics, Vellinge, Sweden), and five chemicals (dichloromethane 1% pet., tetrahydrofuran 1% pet., pyridine 1% aqua, piperidine 1% aqua, and TFA 1%. aqua). The chemicals were brought in by the patient and prepared for the patch tests in our clinic. Patch tests were placed on the upper back, and readings were performed on D2 and D4, according to International Contact Dermatitis Research Group guidelines. There were positive reactions to TFA at D2 and D4, and positive reactions to benzyl alcohol and phenoxyethanol on D4. After informed consent had been obtained, 5 normal control volunteers were patch tested with TFA 1%, 0.1% and 0.01% aqua; no positive reactions were observed.
Correspondence: Hae Young Choi, Department of Dermatology, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheongu, Seoul 158-710, Korea. Tel: +82-2-2650-5160; Fax: +82-2-2652-6925. E-mail: [email protected] Conflicts of interest: The authors have declared no conflicts.
The most relevant allergen was TFA, and the patient was diagnosed with allergic contact dermatitis caused by TFA. The positive results for benzyl alcohol and phenoxyethanol were less relevant, because the patient did not report any problems with cosmetic products. He was nevertheless advised to avoid using products containing benzyl alcohol or phenoxyethanol, in addition to exposure to TFA. The use of TFA in a fume hood or avoiding experiments using the chemical was encouraged. After treatment with a short course of oral methylprednisolone and topical steroids, the patient managed well at work for 6 months. However, he returned to the clinic because of a pruritic skin eruption, which started on the face, neck, and arms, and generalized to the trunk, after he had cleaned the laboratory (Fig. 1).
Discussion TFA (CAS no. 76-05-1) is a stable perfluorinated carboxylic acid, and is a liquid that fumes in air (5). It is a reagent used in organic synthesis because of a combination of convenient properties: volatility, solubility in organic solvents, and its strength as an acid (6). TFA is also used in liquid chromatography of organic compounds, nuclear magnetic resonance spectroscopy, and mass spectrometry. According to the supplier’s material safety data sheet, TFA can cause burns to the skin, eyes, mucous membranes, and other exposed tissues, because of its strong acidity and fast tissue penetration. However, TFA does not release fluoride ions, so it does not show any toxicity resembling that of hydrofluoric acid, such as hypocalcaemia or hypomagnesaemia. A case of chemical burns caused by trifluoroacetic anhydride in a chemistry student has been described; this occurred after spillage over the arm and leg during pipetting (5). When we performed patch tests on normal subjects, a burning sensation at the site on which 1% TFA had been applied was complained of by the first control subject, so serial
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd • All rights reserved Contact Dermatitis, 70, 63–66
63
Contact Dermatitis • Contact Points PROTEIN CONTACT DERMATITIS • BREGNBAK ET AL.
Fig. 1. Pruritic scaly papular patches were observed on the face, neck, arms, and trunk.
dilutions were tested together to investigate potential irritation. Transient burning sensations for several hours at the site on which 1% TFA had been applied occurred in 2 control subjects, but neither true positive nor irritant reactions were observed on any TFA application sites on D2 and D4 in normal subjects. The index patient did not complain of a burning sensation during the patch testing with 1% TFA, and he declined to perform additional patch tests with serial dilutions.
It is likely that our patient’s rash was caused by an allergic reaction rather than chemical irritation, because his rash was pruritic, airborne contact was sufficient to cause the eruption on the exposed areas, and no reaction was seen in control subjects. This is the first case of allergic contact dermatitis caused by TFA. Even though complete avoidance may be difficult, strict personal hygiene measures and safety practice in chemistry laboratories are recommended.
References 1 Huygens S, Goossens A. An update on airborne contact dermatitis. Contact Dermatitis 2001: 44: 1–6. 2 Lammintausta K, Neuvonen H. Airborne allergic contact dermatitis from 4-(bromomethyl)benzoic acid in a university chemist. Contact Dermatitis 2008: 58: 314–315.
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3 Thompson R, Finn A M, Rycroft R J. Allergic contact dermatitis from para-nitrobenzyl bromide. Contact Dermatitis 1998: 38: 232–233. 4 Wakelin S H, Price A E, Basketter D A, Rycroft R J. Allergic contact dermatitis from ethoxymethylenemalononitrile in an agrochemical chemist. Contact Dermatitis 1998: 38: 237.
5 Nakamura M, Miyachi Y. Chemical burn due to trifluoroacetic anhydride. Contact Dermatitis 2002: 47: 236. 6 Eldman K, Nichols P. Trifluoroacetic acid. In: Encyclopedia of Reagents for Organic Synthesis, Paquette L (ed): New York, John Wiley & Sons, Ltd, 2005. doi:10.1002/047084289X.
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 70, 63–66
Contact Dermatitis • Contact Points
Contact Dermatitis
• CONTRIBUTIONS TO THIS SECTION MAY NOT UNDERGO PEER REVIEW, BUT WILL BE REVIEWED BY THE EDITOR •
Occupational airborne contact dermatitis caused by trifluoroacetic acid in an organic chemistry laboratory Ji Yeon Byun, Ju Yun Woo, You Won Choi and Hae Young Choi Department of Dermatology, School of Medicine, Ewha Womans University, Seoul 58-710, Korea doi:10.1111/cod.12138
Key words: airborne; allergic contact dermatitis; laboratory workers; occupational; organic chemistry; trifluoroacetic acid.
Chemists and technicians are exposed to various chemicals. Airborne contact dermatitis caused by volatile chemicals has been shown (1–4). We report a case of airborne allergic contact dermatitis caused by trifluoroacetic acid (TFA) in a laboratory technician.
Case Report A 24-year-old Korean man had a 6-month history of recurrent rash on his neck and arms. He was otherwise healthy, and started his job at an organic chemistry laboratory 18 months previously. He reported that exposure to organic solvents or acidic agents, especially TFA, at the workplace caused him skin problems. On examination, pruritic, excoriated and lichenified patches were seen on the forehead, neck, and forearms. Patch tests were performed with the TRUE Test® (SmartPractice, Hillerod, Denmark), a cosmetic series (Chemotechnique Diagnostics, Vellinge, Sweden), and five chemicals (dichloromethane 1% pet., tetrahydrofuran 1% pet., pyridine 1% aqua, piperidine 1% aqua, and TFA 1%. aqua). The chemicals were brought in by the patient and prepared for the patch tests in our clinic. Patch tests were placed on the upper back, and readings were performed on D2 and D4, according to International Contact Dermatitis Research Group guidelines. There were positive reactions to TFA at D2 and D4, and positive reactions to benzyl alcohol and phenoxyethanol on D4. After informed consent had been obtained, 5 normal control volunteers were patch tested with TFA 1%, 0.1% and 0.01% aqua; no positive reactions were observed.
Correspondence: Hae Young Choi, Department of Dermatology, Ewha Womans University, Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheongu, Seoul 158-710, Korea. Tel: +82-2-2650-5160; Fax: +82-2-2652-6925. E-mail: [email protected] Conflicts of interest: The authors have declared no conflicts.
The most relevant allergen was TFA, and the patient was diagnosed with allergic contact dermatitis caused by TFA. The positive results for benzyl alcohol and phenoxyethanol were less relevant, because the patient did not report any problems with cosmetic products. He was nevertheless advised to avoid using products containing benzyl alcohol or phenoxyethanol, in addition to exposure to TFA. The use of TFA in a fume hood or avoiding experiments using the chemical was encouraged. After treatment with a short course of oral methylprednisolone and topical steroids, the patient managed well at work for 6 months. However, he returned to the clinic because of a pruritic skin eruption, which started on the face, neck, and arms, and generalized to the trunk, after he had cleaned the laboratory (Fig. 1).
Discussion TFA (CAS no. 76-05-1) is a stable perfluorinated carboxylic acid, and is a liquid that fumes in air (5). It is a reagent used in organic synthesis because of a combination of convenient properties: volatility, solubility in organic solvents, and its strength as an acid (6). TFA is also used in liquid chromatography of organic compounds, nuclear magnetic resonance spectroscopy, and mass spectrometry. According to the supplier’s material safety data sheet, TFA can cause burns to the skin, eyes, mucous membranes, and other exposed tissues, because of its strong acidity and fast tissue penetration. However, TFA does not release fluoride ions, so it does not show any toxicity resembling that of hydrofluoric acid, such as hypocalcaemia or hypomagnesaemia. A case of chemical burns caused by trifluoroacetic anhydride in a chemistry student has been described; this occurred after spillage over the arm and leg during pipetting (5). When we performed patch tests on normal subjects, a burning sensation at the site on which 1% TFA had been applied was complained of by the first control subject, so serial
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd • All rights reserved Contact Dermatitis, 70, 63–66
63
Contact Dermatitis • Contact Points PROTEIN CONTACT DERMATITIS • BREGNBAK ET AL.
Fig. 1. Pruritic scaly papular patches were observed on the face, neck, arms, and trunk.
dilutions were tested together to investigate potential irritation. Transient burning sensations for several hours at the site on which 1% TFA had been applied occurred in 2 control subjects, but neither true positive nor irritant reactions were observed on any TFA application sites on D2 and D4 in normal subjects. The index patient did not complain of a burning sensation during the patch testing with 1% TFA, and he declined to perform additional patch tests with serial dilutions.
It is likely that our patient’s rash was caused by an allergic reaction rather than chemical irritation, because his rash was pruritic, airborne contact was sufficient to cause the eruption on the exposed areas, and no reaction was seen in control subjects. This is the first case of allergic contact dermatitis caused by TFA. Even though complete avoidance may be difficult, strict personal hygiene measures and safety practice in chemistry laboratories are recommended.
References 1 Huygens S, Goossens A. An update on airborne contact dermatitis. Contact Dermatitis 2001: 44: 1–6. 2 Lammintausta K, Neuvonen H. Airborne allergic contact dermatitis from 4-(bromomethyl)benzoic acid in a university chemist. Contact Dermatitis 2008: 58: 314–315.
64
3 Thompson R, Finn A M, Rycroft R J. Allergic contact dermatitis from para-nitrobenzyl bromide. Contact Dermatitis 1998: 38: 232–233. 4 Wakelin S H, Price A E, Basketter D A, Rycroft R J. Allergic contact dermatitis from ethoxymethylenemalononitrile in an agrochemical chemist. Contact Dermatitis 1998: 38: 237.
5 Nakamura M, Miyachi Y. Chemical burn due to trifluoroacetic anhydride. Contact Dermatitis 2002: 47: 236. 6 Eldman K, Nichols P. Trifluoroacetic acid. In: Encyclopedia of Reagents for Organic Synthesis, Paquette L (ed): New York, John Wiley & Sons, Ltd, 2005. doi:10.1002/047084289X.
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 70, 63–66
