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Abstract
Background
In Korea, the only case of occupational erythema multiforme was found to be due to Bolivian rosewood, but there has been no case due to occupational chemicals in the manufacturing industry. Here, we report a case of erythema multiforme caused by dichlone and 3,3'-dichlorobenzidine(DCB) in a dye worker.
Case report
We report a 43-year-old male worker manifesting erythema multiforme-like skin lesions during the DCB synthesis, The patient's dermatitis was relieved when he avoided the process, and it became aggravated when he restarted his work. Patch and prick tests confirmed positive irritant reactions to two chemicals.
Conclusion
This case was diagnosed as erythema multiforme based on clinical manifestations. Symptoms worsened upon exposure to chemicals while avoiding exposure improved symptoms. Skin test results showed that dichlone and 3,3'-dichlorobenzidine induced irritant reactions. We assume that erythema multiforme occurring in workers is an occupational skin disease likely caused by dichlone and 3,3'-dichlorobenzidine.
Figures and Tables
Fig. 2
Result of skin prick test. Erythematous skin eruption developed after 24 hours at skin prick test site by 3,3'-dichlorobenzidine.
Fig. 3
Non-standard patch tests are conducted and cheked (A) after 48 hours and (B) after 96 hours. Positive results were appeared at sites that potassium dichromate(site 1), cobalt(II)chloride hexahydrate(number 5), nickelsulfate hexahydrate(site 7), dichlone(site 28), 3,3'-dichlorobenzidine(number 35) were injected.
Table 1
Skin prick test result with nonstandard antigens
*antigens are created with 100mg of each materials and 10ml of normal saline except number 5, 8 and 9 antigen.
†mixture of 100 mg of dichlone, 1 ml of 99% ethanol and 9 ml of normal saline.
‡mixture of 100 mg of dichlone, 1 ml of 99% ethanol and 99ml of normal saline.
§mixture of 100mg of 3,3'-Dichlorobenzidine and 100ml of normal saline.
Table 2
Skin patch test result with nonstandard antigens
*antigens are mixture of 100 mg of each materials and 10 ml of normal saline except number 26, 27 and 33 antigen.
†morphology readings are coded four-point positive reading scale of +/-, +, ++, +++. +/- is a questionable reaction; + is a definite positive reaction; ++ is a strong edematous or vesicular reaction; +++ is a extreme, spreading bullous or ulcerated response.
‡interpretation codes include ALL for allergy, IRR for irritancy, - for negative, NT for not tested, and ? for unknown.
§mixture of toluene and vaseline (1/10 v/v).
∥mixture of 100mg of Ortho-nitrochlorobenzene and 99% ethanol 1 ml and 9 ml of normal saline.
¶present means the cause or at least an aggravating factor in the present dermatitis.
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