Skin and Allergy Research Unit, Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Center for Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Eur Acad Dermatol Venereol. 2019 Oct;33(10):1993-2000. doi: 10.1111/jdv.15678. Epub 2019 Jun 19.
Chronic lead toxicity is a worldwide public health problem. Lead possesses deleterious effects on many organ systems. However, little is known regarding its clinical and biophysical effects on the skin.
To investigate mucocutaneous signs and biophysical property changes in skin after chronic lead toxicity.
One hundred and eighty-seven patients who were car battery workers participated in the study. Complete history and physical examination were performed. Blood was collected for laboratory analyses. Thorough skin examination by dermatologists was carried out in 134 subjects. Additionally, 96 patients with blood lead levels (BLL) >70 μg/dL were further evaluated for skin elasticity, sebum content, transepidermal water loss (TEWL), hydration, pH and pigmentation. An equal number of age-, sex- and skin-type-matched subjects were recruited as controls.
The mean BLL of all subjects was 74.15 ± 11.58 μg/dL. The most frequently observed signs were gingival brown pigmentation in 112 (83.6%), gingivitis in 111 (82.8%) and lead line in 66 (49.3%) patients. The lead line was found in subjects with significantly higher BLLs (adjusted mean difference 6.45, 95% CI 2.30-10.60 μg/dL, P = 0.003) and in association with gingivitis (adjusted OR 7.32, 95% CI 2.08-25.74, P = 0.002). Mean BLL of the patients who underwent biophysical assessment was 82.77 ± 9.80 μg/dL. Patients exhibited a statistically significant lower skin hydration observed by corneometer as well as elasticity. The adjusted ORs of having dry skin and lower elasticity were 15.32 (95% CI 4.41-53.24), P < 0.001) and 1.96 (95% CI 1.06-3.60), P = 0.031), respectively. These differences were not significant for sebum content, TEWL, pH and pigmentation.
Importantly, even in normal-appearing skin, level of hydration and elasticity decreased in lead-intoxicated patients. These results suggest that lead might possess harmful effects on the skin at measurable levels.
慢性铅中毒是一个全球性的公共卫生问题。铅对许多器官系统都有有害影响。然而，关于铅对皮肤的临床和生物物理影响知之甚少。
研究慢性铅中毒后皮肤的黏膜和皮肤变化。
187 名电池工人参加了这项研究。进行了完整的病史和体格检查。采集血液进行实验室分析。皮肤科医生对 134 名受试者进行了彻底的皮肤检查。此外，对 96 名血铅水平（BLL）>70μg/dL 的患者进行皮肤弹性、皮脂含量、经皮水分丢失（TEWL）、水合作用、pH 值和色素沉着的评估。选择了数量相等的年龄、性别和皮肤类型匹配的受试者作为对照。
所有受试者的平均 BLL 为 74.15±11.58μg/dL。最常见的体征是 112 名（83.6%）患者的牙龈棕色色素沉着、111 名（82.8%）患者的牙龈炎和 66 名（49.3%）患者的铅线。铅线出现在 BLL 明显更高的患者中（调整平均差异 6.45，95%CI 2.30-10.60μg/dL，P=0.003），并且与牙龈炎相关（调整 OR 7.32，95%CI 2.08-25.74，P=0.002）。接受生物物理评估的患者的平均 BLL 为 82.77±9.80μg/dL。患者的皮肤水合作用通过皮脂计观察到统计学上显著降低，弹性也降低。皮肤干燥和弹性降低的调整比值比分别为 15.32（95%CI 4.41-53.24），P<0.001）和 1.96（95%CI 1.06-3.60），P=0.031）。皮脂含量、TEWL、pH 值和色素沉着无显著差异。
重要的是，即使在外观正常的皮肤中，铅中毒患者的皮肤水合作用和弹性也会下降。这些结果表明，铅在可测量水平上可能对皮肤有有害影响。
