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Chrome allergy

Author: Vanessa Ngan, Staff Writer, 2002. Updated by Dr Jannet Gomez, Medical literature reviewer; Editor in Chief: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. October 2019.


Chrome allergy — codes and concepts
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What is chrome allergy?

Chrome allergy presents with a contact allergic dermatitis. It is due to a delayed hypersensitivity reaction to chromium salts (chromates), particularly Cr(III) and Cr(VI).

Chromium salts are used as an ingredient in the manufacture of many other products such as cement, mortar, leather, paints, and anticorrosives.

Although most people associate ‘chrome’ with the bright, shiny and durable finish of chrome-plated metal products, contact with these rarely give rise to chrome allergy. Allergic contact dermatitis due to contact with a metal object is usually caused by nickel.

Chrome allergy

Where are chromium salts found?

Most exposure to chromium salts is via the workplace, principally from cement and mortar used in the building industry. There are many other sources of chromates.

Home/personal sources of chromium salts

Examples include:

  • Chrome-tanned leather goods including shoes, gloves and other wearable items and accessories
  • Yellow or green cosmetics
  • Disinfecting and bleaching agents
  • Unlit and charred safety match heads
  • Green felt fabric used to cover snooker and card tables
  • Anti-rust primer and in yellow or green paint
  • Yellow-green tattoo ink
  • Radiator coolants
  • Dental or orthopaedic implants.

Work sources of chromium salts

Allergic cement dermatitis is usually due to dichromates found in cement and is highest amongst workers handling wet cement. Note that cement also causes irritant contact dermatitis.

  • Primer paints in the automobile industry
  • Metalworkers and welders of chromium steel alloys
  • Diesel locomotive radiator fluids, chromates used to prevent rust or radiators and pipelines
  • Plaster-like mixtures used in building repairs contain chromates
  • Dyemakers, colour makers, paint makers, painters
  • Engraving solutions
  • Pulp and paper industry
  • Artificial flower makers
  • Photographic workers
  • Pottery workers
  • Woodworkers
  • Explosives workers

What are the reactions to chromium salts?

Reactions to contact with chromium salts include:

Insertion of intracoronary stents, hip and knee prostheses and other implants containing chromium sometimes undergo failure. These procedures may be associated with various skin problems including eczema, vasculitis and urticaria. It is unknown whether this is a result of an allergic reaction to chrome but this has been suspected in some cases.

 Chrome ulcers and nasal septum perforation

  • Chrome ulcers and nasal septum perforation are most commonly seen in industrial exposure cases and may occur without accompanying allergy to chromates.
  • Chrome ulcers or chrome holes are typically crusted, painless lesions revealing a 2–5 mm pitted ulcer covered with exudate.
  • The ulcers most commonly occur on exposed parts of the body, mainly the hands, forearms and feet. They also develop readily at the site of insect bites and stings, sores or other injuries.
  • Initially, nasal septum ulceration may be painless, but with continued exposure, the necrotising effect of chromates to underlying tissues may become painful and lead to permanent scarring and disfigurement.
  • The reaction still occurs in workers exposed to strong chromate solutions in electroplating, tanning and chrome-producing manufacturers.

Cement dermatitis

Cement dermatitis is most prevalent in construction workers but may occur in artists, DIY homebuilders or other individuals who are exposed to cement through work or a hobby. Dichromates in cement are the cause of the allergic contact dermatitis reactions. Primary irritant reactions of cement dermatitis include dryness and fissuring of the skin caused by the drying (hygroscopic) properties of cement and injury or ulcers to the skin caused by mechanical irritation due to rough silica particles in cement. Individuals can develop cement dermatitis after working for many years without any problems.

Am I allergic to chromium salts?

Chrome allergy is diagnosed from the clinical history and by performing special allergy tests, called patch tests, using a solution of potassium dichromate.

Features of a positive patch test to potassium dichromate ion

  • Patch test site itches rather than burns
  • Reaction is papulovesicular
  • The reaction may spread beyond the borders of the original patch test site
  • Reaction persists for at least three days

Chrome dermatitis can persist in people even after they change occupations and are no longer exposed to chromates. Approximately two-thirds of those sensitive to chromates will still be allergic even when tested several years later. 

What is the treatment for chrome allergy?

Avoidance is the only long-term management strategy for chromate allergy. Dermatitis caused by chromates can become a chronic debilitating problem, so early diagnosis, followed by measures taken to minimise exposure or cease all contact with chromates is key to the management plan. De-sensitisation or hardening to chromates should not be relied upon.

Once dermatitis appears, treatment is as for any acute dermatitis/eczema, with topical corticosteroids, topical calcineurin inhibitorsemollients and treatment of any secondary bacterial infection (Staphylococcus aureus). Treatments for persistent or severe chromate allergy include phototherapy and immune-modulating treatments such as azathioprine, ciclosporin and methotrexate.

Where avoidance is not achievable, several methods have been used to try to minimise exposure.

Methods to minimise chromate exposure

  • Wear protective clothing and employ no-touch techniques.
  • The addition of other chemicals to cement or mortar neutralises the chromate content; these are usually iron sulphate or combination of barium hydrate, nitrate and chloride with lead acetate.
  • Avoid leather footwear and other leather items in contact with the skin.
  • Application of a barrier cream made from ascorbic acid (vitamin C) and EDTA (a chemical which binds metals).
  • Impregnation of ascorbic acid into filters of respirators enhances protection against inhalation of chromate dust, particularly useful in chromate-sensitive printing and lithography workers.
  • Use of disposable hand towels by workers in the chromate industry avoids cross-contamination.
  • Thoroughly wash all clothing contaminated with chromates.

Some people should also be advised to avoid certain foods with high chromium content, such as tomatoes, broccoli, lettuce and turnips.

What should I do to avoid chrome allergy?

In the workplace try to avoid exposure to chromates. However, this may not be practicable thus use measures to minimise exposure as described above. Identify potential sources of exposure using Material Safety Data Sheets; these are required for all chemicals and substances that you may come into contact within the workplace.

Outside of the workplace, the best way to avoid chrome allergy is by being aware of the possible sources of chromates. Wearing thick socks and reducing foot perspiration may help to reduce chromate-induced shoe dermatitis. If possible avoid leather or choose leather items that have been vegetable tanned.

Use only cosmetics that you know do not contain chromates. Avoid direct contact with matches and do not keep matches in clothing pockets. Thoroughly wash all clothes contaminated with chromates.

If you must use products that contain chromates, wear appropriate gloves or other protective clothing to avoid contact with your skin. Your dermatologist may have further specific advice, particularly if you are highly sensitive to chromates.

Alternative names for chrome

Chrome is known by several other names. These include:

  • Chromate
  • Chromium
  • Chromium salt
  • Potassium dichromate
  • Chromium sulphate
  • Chromite

Avoid all of these. At work, request a material safety data sheet to help identify alternatives that are safe hence avoiding contact with material containing chromates.

Further information

CAS number: 7778-50-9

Formula: Cr2K207 (the hexavalent form of chromium)

Cross-reactions:

Sensitiser:

Main sensitisers are the dichromates

Patch Test:

0.5% potassium dichromate in petrolatum

Sources of exposure to chrome and chromium salts

  • Anticorrosives
  • Anti-rust coatings
  • Anti-rust primer paints
  • Ashes
  • Artificial flowers
  • Batteries
  • Bleachers
  • Boiler linings
  • Ceramics
  • Cigarettes
  • Cement
  • Coolant oils
  • Cosmetics (mascara/eyeshadow)
  • Cutting oils
  • Defatting solvent
  • Detergents and bleaches
  • Dyes (textile)
  • Enamel
  • Engraving solutions
  • Explosives
  • Fabrics
  • Foundry sand
  • Furniture polishes
  • Glues
  • Green baize for cards, snooker, billiard table tops
  • Homoeopathic drugs
  • Ink
  • Leather goods (gloves, shoes, hats, wallets, bags, clothes)
  • Magnetic tapes
  • Matches (safety)
  • Metal alloys
  • Milk testers
  • Mortar
  • Newspaper
  • Offset printing
  • Oil from metalworking
  • Orthopaedic pins or screws
  • Pacemaker
  • Paint
  • Paper (photocopy paper)
  • Photography
  • Polishes and waxes (shoes, floor, etc.)
  • Postage stamps
  • Quicklime
  • Refractory materials
  • Rubber gloves
  • Shoe polish
  • Shoes
  • Solvent
  • Surgical (chromic) gut suture
  • Tattoo dye
  • Test reagent (laboratory)
  • Textile dyes
  • TV screens
  • Welding
  • Wood preservatives

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Related information

 

References

  • Hansen MB, Johansen JD, Menné T. Chromium allergy: significance of both Cr (III) and Cr (VI). Contact Dermatitis. 2003 Oct 1;49(4):206-12.
  • Yoshihisa Y, Shimizu T. Metal allergy and systemic contact dermatitis: an overview. Dermatology research and practice. 2012;2012. PubMed Central
  • Bregnbak D, Johansen JD, Jellesen MS, Zachariae C, Menné T, Thyssen JP. Chromium allergy and dermatitis: prevalence and main findings. Contact Dermatitis. 2015 Nov 1;73(5):261-80. PubMed
  • Kim MH, Choi YW, Choi HY, Myung KB. Prurigo pigmentosa from contact allergy to chrome in detergent. Contact Dermatitis. 2001 May 1;44(5):289-92. PubMed
  • Hansen MB, Rydin S, Menné T, Duus Johansen J. Quantitative aspects of contact allergy to chromium and exposure to chrome‐tanned leather. Contact Dermatitis. 2002 Sep 1;47(3):127-34. PubMed
  • Lachiewicz PF, Watters TS, Jacobs JJ. Metal hypersensitivity and total knee arthroplasty. The Journal of the American Academy of Orthopaedic Surgeons. 2016 Feb;24(2):106. PubMed Central
  • Özkaya E, Topkarci Z, Özarmaǧan G. Systemic allergic dermatitis from chromium in a multivitamin/multimineral tablet. Contact Dermatitis. 2010 Mar;62(3):184. PubMed
  • Paulden M, Rodgers M, Griffin S, Slack R, Duffy S, Ingram JR, Woolacott N, Sculpher M. Alitretinoin for the treatment of severe chronic hand eczema. Health Technol Assess. 2010 May 1;14(Suppl 1):39-46. Journal

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