Allergic contact dermatitis from a degreaser
S. Kerre, M.
Matura*, A. Goossens**
Dermatologist,
* Dermatochemistry
and Skin Allergy, Dept. of Chemistry,
** Department
of Dermatology,
Correspondence to:
A. Goossens
Department of Dermatology
Kapucijnenvoer 33
B-3000
Key words: citrus oil, contact
dermatitis, degreaser, limonene, occupational, oxidation products, solvent,
window installer
Case report
A 52 old
installer of windows presented with a dyshidrotic and
fissured, hyperkeratotic dermatitis of the fingers,
which had existed for several months. According
to the patient there was a clear correlation with his work where he came in
contact with acrylic glues and several degraesers and
detergents.
The patient
was patch tested with the European standard series, plastic and glues series, (Chemotechnique Diagnostics, Malmö, Sweden), several acrylates (Chemotechnique
Diagnostics, Malmö, Sweden) and his own products (acrylate-based glues, degraesers,
thinners, organic solvents), the latter being tested with semi-open tests. Only the degraeser “Reynaers aluminium (086.9181 alu-care,
Because the label of
this degraeser indicated “active component is a
solvent obtained from the treatment of citrus fruits and has a lemon smell”,
further patch testing was done with R-and
S-limonene (previously called d- and
l-limonene, respectively) (3 % in petrolatum), both showing a 2+ reaction
after 48 h.
Avoiding this product
has led to a clear improvement but not a complete resolution of his hand
dermatitis, which was also partly irritant.
Discussion
Limonene, like other monoterpenes, occurs naturally in several botanical species
such as in essential oils extracted from trees, plants and fruits. Citrus oil contains a very high (95 %)
concentration of limonene but different amounts of it are also found in many
other essential oils (e.g. tea tree oil), nowadays being very popular as
natural remedies (1).
Limonene is used as a substitute for chlorinated hydrocarbons, chlorofluorocarbons, and other solvents. It is used in degreasing metals (30 % limonene) prior to industrial painting, for cleaning in the electronic industry (50-100 % limonene) and printing industry (30-100 % limonene), and as a solvent in paints (2). It is also used as a solvent in histological laboratories (3) and as a flavour and fragrance additive in food, household cleaning products, and perfumes. The popularity of limonene for domestic and occupational products and for cosmetics was demonstrated in several studies (4, 5).
Limonene exists as two optical isomers, R- and S-limonene, and the racemic mixture dipentene. The purity of commercial R-limonene is about 90-98 %.Pure R-limonene in high concentrations is a strong irritant, but not allergenic. Limonene easily oxidizes upon air-exposure and forms allergenic oxidation products under experimental conditions that mimic normal storage and handling. Due to this, oxidized limonene was proven to be a sensitizer both in animal and human studies, while the non-oxidized mother compound did not cause contact allergy.The allergenicity depends on the oxidation products formed, the main allergenic culprit being limonene hydroperoxide. Furthermore, limonene oxide and carvone, two other degradation compounds with allergenic potential were also identified (6, 7). Allergic reactions to limonene have been described to degreasers used in car mechanics (8), wax polish (9), and hand cleansers(10). However, the purity and the presence of oxidation products in the limonene patch-test material was not considered in those early reports. Contact allergy to oxidized R-and S-limonene was also found in a large group of hand-eczema patients and thus seems to be an important allergen in hand dermatitis (11). It is also an important allergen in contact dermatitis due to essential oils (12).Because it is one of the most commonly used fragrance chemicals in scented products (household, cosmetics) it should also be tested in suspected fragrance allergy, all the more because it will not be detected by the main tool for testing fragrance allergy in the standard series, i.e. the fragrance mix (6). References 1. Russell M, Southwell I. Monoterpenoid accumulation in Melaleuca alternifolia seedlings. Phytochemistry 2002, 59:707-716.2. Lavoué J, Bégin D, Gérin M. Technical, occupational health and environmental aspects of metal degreasing with aqueous cleansers. Ann Occup Hyg 2003, 6:441-459.3. Wakelin SH, Mc Fadden JP, Leonard JN, Rycroft RJ. Allergic contact dermatitis from d-limone in a laboratory technician. Contact Dermatitis 1998, 38:64-164.4. Rastogi SC, Heydorn S, Johansen JD, Basketter DA. Fragrance chemicals in domestic and occupational products. Contact Dermatitis 2001, 45:221-225.
5. Rastogi SC, Lepoittevin JP, Johansen JD, Frosch PJ, Menné T, Bruze M, Dreier B, Andersen KE, White IR. Fragrances and other materials in deodorants: search for potentially sensitizing molecules using combined GC-MS and structure activity relationship (SAR) analysis. Contact Dermatitis 1998, 39:293-303.6. Matura M, Skold M, Borje A, Andersen KE, Bruze M, Frosch PJ, Goossens A, Johansen JD, Svedman C, White IR, Karlberg A-T. Selected oxidized fragrance terpenes are common contact allergens. Contact Dermatitis 2005, 52:320-328.7. Matura M, Goossens A, Bordalo O, Garcia-Bravo B, Magnusson K, Wrangsjö K, Karlberg A-T. Patch testing with oxidized R-(+) limonene and its hydroperoxide fraction. Contact Dermatitis 2003,49:15-21.
8. Meding B, Barregard L, Marcus K. Hand eczema in car mechanics. Contact Dermatitis 1994, 30:129-134.9. Martins C, Goncalo M, Goncalo S. Allergic contact dermatitis from dipentene in wax polish. Contact Dermatitis 1995, 33:126-127.10. Topham EJ, Wakelin SH. d-Limonene contact dermatitis from hand cleansers. Contact Dermatitis 2003, 49:108-109.11. Heydorn S, Johansen JD, Andersen KE, Bruze M, Svedman C, White IR, Basketter DA, Menné T. Fragrance allergy in patients with hand eczema: a clinical study. Contact Dermatitis 2003, 48:317-321.12. Fritz TM, Burg C, Krasovec M. Allergic contact dermatitis to cosmetics containing Melaleuca alternifolia (tea tree oil). Ann Dermatol Venereol 2001, 128:123-126.