Athavale P, Shum K W, Chen Y, Agius R, Cherry N, Gawkrodger D J
Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
Br J Dermatol. 2007 Sep;157(3):518-22. doi: 10.1111/j.1365-2133.2007.08030.x. Epub 2007 Jun 26.
Chromium and cobalt (and their compounds) are well recognized as being important causes of occupational contact dermatitis (OCD), particularly of the hands, although their exact contribution to occupational hand dermatitis varies between different studies. In some European studies, cases of chromium-related dermatitis have decreased following the addition of ferrous sulphate to cement to reduce the amount of available chromium.
To examine, using data from the U.K. occupational skin surveillance schemes, the proportionate reported incidence and changing trends in OCD considered to be related to chromium and cobalt for the 11-year period from February 1993 to December 2004.
Surveillance data collected by the two British occupational health surveillance schemes, EPIDERM and OPRA, from February 1993 to December 2004 were studied. These are occupational health surveillance schemes in the U.K. to which physicians voluntarily and anonymously report new cases of skin disease suspected to be work related.
Over the 11-year period, dermatologists reported 22 184 cases of OCD, comprising 77% of all types of occupational skin diseases that were disclosed. Chromium was recorded as being thought to play a role in 1226 (6%) of these, with cobalt identified as being likely to be implicated in 823 (4%). The numbers fluctuated on a year-on-year basis but there were no overall trends during the period of study. The male/female ratio was 5 : 1 for chromium and 1 : 1 for cobalt. Overall, the male/female ratio for OCD was 1.4 : 1. The rates of dermatitis believed to be related to both metals generally increased with age. In women, the highest rate for chromium was seen in the > 60 years age group, whereas conversely, for cobalt the rate decreased with age. For chromium-related OCD the most common occupations were builders and building contractors, bricklayers, construction workers and plasterers. For cobalt-related OCD, the commonest occupations were hairdressers/barbers, builders/building contractors, retail cash/checkout operators, machine operatives and domestic cleaners. Occupational physicians reported 15 016 cases of OCD (82% of all occupational skin diseases reported by them) for the period May 1994-December 2004. Of these, only 38 cases were thought to be related to chromium and 30 to cobalt (25 of the latter were processing labourers).
In this series, chromium was reported by dermatologists as potentially being involved in 6% of all cases of OCD in the U.K., and cobalt in 4%. Our data support the view that chromium-related dermatitis has an onset in later working life and often affects those in the building trades, whereas cobalt-related dermatitis seems to have an earlier onset and may affect a wide range of employments.
铬和钴（及其化合物）是职业性接触性皮炎（OCD），尤其是手部职业性接触性皮炎的重要病因，这一点已得到广泛认可，尽管它们在不同研究中对职业性手部皮炎的确切影响有所不同。在一些欧洲研究中，在水泥中添加硫酸亚铁以减少可利用铬的含量后，与铬相关的皮炎病例有所减少。
利用英国职业皮肤监测计划的数据，研究1993年2月至2004年12月这11年间，被认为与铬和钴相关的职业性接触性皮炎的报告发病率比例及变化趋势。
对英国两个职业健康监测计划EPIDERM和OPRA在1993年2月至2004年12月期间收集的监测数据进行研究。这两个计划是英国的职业健康监测计划，医生可自愿且匿名报告疑似与工作相关的皮肤病新病例。
在这11年期间，皮肤科医生报告了22184例职业性接触性皮炎病例，占所披露的所有职业性皮肤病类型的77%。其中，有1226例（6%）被记录为认为铬在其中起作用，823例（4%）被确定可能与钴有关。这些数字逐年波动，但在研究期间没有总体趋势。铬相关病例的男女比例为5∶1，钴相关病例的男女比例为1∶1。总体而言，职业性接触性皮炎的男女比例为1.4∶1。被认为与这两种金属相关的皮炎发病率通常随年龄增长而增加。在女性中，铬相关皮炎发病率最高的年龄段为60岁以上，而钴相关皮炎的发病率则随年龄下降。对于与铬相关的职业性接触性皮炎，最常见的职业是建筑工人和建筑承包商、瓦工、建筑工人和抹灰工。对于与钴相关的职业性接触性皮炎，最常见的职业是美发师/理发师、建筑工人/建筑承包商、零售收银员/收款员、机器操作工和家庭清洁工。职业医生在1994年5月至2004年12月期间报告了15016例职业性接触性皮炎病例（占他们报告的所有职业性皮肤病病例的82%）。其中，只有38例被认为与铬有关，30例与钴有关（后者中有25例是加工工人）。
在本系列研究中，皮肤科医生报告称，在英国所有职业性接触性皮炎病例中，铬可能涉及6%，钴涉及4%。我们的数据支持以下观点：与铬相关的皮炎在职业生涯后期发病，且常影响建筑行业从业者；而与钴相关的皮炎似乎发病较早，可能影响广泛的职业。
