D2.40 - Occupational allergic contact dermatitis to metals: clinical features and impact on work fitness

Metal-induced occupational allergic contact dermatitis (ACD) is a common occupational health issue, often chronic and with significant impact on work capacity. This study aimed to describe the clinical and occupational features of metal-related occupational ACD and assess its implications for fitness for work.

This descriptive cross-sectional study reviewed all medical records of patients who consulted the occupational medicine department at La Rabta Hospital in Tunis between 1998 and 2019 for occupational ACD due to metals (chromium, cobalt, nickel).

We included 229 cases, predominantly male (62%), with a mean age of 43 ± 9.6 years and an average occupational seniority of 14 ± 9.9 years. The most affected job categories were general laborers (26.2%), bricklayers (19.7%), nurses (7.4%), and cleaning staff (5.7%). The sectors most represented were construction and public works (27.9%), healthcare (18.8%), transportation (8.7%), and textile (6.6%). The main occupational exposures involved cement (27.1%), detergents (17%), used industrial oils (10%), and leather (7%). Symptoms appeared on average 8 ± 8.7 years after employment, predominantly affecting the hands (84.9%). Sensitization was observed to chromium in 62.4% of cases (58.7% of which were relevant), nickel in 50.7% (35.3% of which were relevant), and cobalt in 44.5% (54.9% of which were relevant). Polysensitization to metals was observed in 46.3% of cases. The ACD was a compensable occupational disease in 47.6% of cases and required workplace adjustments in 69% of cases, including avoidance of allergen-handling tasks and implementation of appropriate skin protection measures.

Metals remain among the most frequent allergens causing occupational ACD. Prevention should focus on minimizing exposure through substitution of allergens and reinforcing individual protective measures.