D2.39 - Occupational Contact Dermatitis with Polysensitization to Metals: Challenges for Work Fitness and Prevention

The widespread presence of metals in the workplace increases the risk of co-exposure to multiple allergens, thereby raising the likelihood of polysensitization. The aim of this study was to describe the occupational and clinical characteristics of occupational allergic contact dermatitis (ACD) with polysensitization to metals, and to assess its impact on fitness for work.

This cross-sectional study included patients referred to the occupational medicine department of La Rabta Hospital between 1998 and 2019 for an occupational ACD with a polysensitization to metals (chromium, cobalt and/or nickel).

A total of 106 patients were included, predominantly male (69.8%), with a mean age of 44 ± 9.4 years and an average professional seniority of 16 ± 9.2 years. Polysensitization was more frequent in workers with over 15 years of seniority (p = 0.024). The most represented sectors were construction (39.6%), textile (8.5%), and healthcare (8.5%). The most affected job categories were masons (27.4%), construction workers (7.5%), cleaning staff (6%), and nurses (5.7%). Occupational exposures included cement (37.7%), detergents (14.2%), leather (9.4%), used industrial oils (6.6%), and metal instruments (5.7%). Cutaneous symptoms appeared after hiring in 92.7% of cases, with a mean latency of 11.6 ± 9 years, predominantly affecting the hands (89.3%). Polysensitization to chromium and cobalt was the most frequent combination (50 cases), while sensitization to all three metals occurred in 26 cases (11.3%). The ACD was a compensable occupational disease in 58.5% of cases. Job modifications were implemented in 87.7% of patients, mainly involving avoidance of tasks requiring direct contact with metals containing the allergen and the use of appropriate protective equipment.

Polysensitization to metals is disabling, and skin lesions often persist due to the widespread presence of these allergens. Strengthening preventive measures, including allergen substitution and enhanced protective strategies, is essential to reduce occupational risk.