Provocative use test of nickel coins in nickel-sensitized subjects and controls.

BACKGROUND: Consensus exists on levels of nickel release that are well tolerated in exposure to nickel-containing items in direct and continuous contact with skin (e.g. watches). The clinical relevance of nickel-containing coins eliciting nickel dermatitis associated with extensive occupational exposure (e.g. coins handled by cashiers) has not been determined. OBJECTIVES: To examine whether nickel-containing coins might be an elicitor of allergic contact dermatitis (ACD) in occupational settings with extensive exposure to coins (i.e. cashiers). METHODS: Eighteen subjects (10 nickel sensitized and eight non-nickel sensitized) completed this study after screening of history, physical examination and diagnostic patch testing (5% nickel sulphate). Each volunteer handled 10 coins (nickel-containing coins or non-nickel-containing coins) in a cross-over design at 5-min intervals (5 min handling followed by 5 min rest) for 8 h per day, for a total of 12 days excluding the weekend. One hand was gloved while the other was not during coin handling. Visual scoring and bioengineering measurements were recorded at each of four predetermined sites at baseline (day 1), end of day 5 and day 12 (last day of exposure). RESULTS: There were no statistical differences for either visual or bioengineering data comparing: (i) nickel-sensitized vs. non-nickel-sensitized subjects handling nickel-containing coins at day 1, day 5 and day 12; (ii) day 12 vs. day 1 (baseline) for nickel-sensitized subjects handling nickel-containing coins; (iii) handling of nickel-containing coins vs. non-nickel-containing coins by nickel-sensitized subjects at day 5 and day 12; (iv) gloved hand vs. ungloved hand of nickel-sensitized subjects handling nickel-containing coins at day 12. Limitations of the method and clinical extrapolation are detailed. CONCLUSIONS: Individuals handling these nickel-containing coins daily did not develop ACD, as judged by visual signs or bioengineering parameters.

Factors determining percutaneous metal absorption.

Metals play a vital role in human, animal and plant physiology, and important research, past and ongoing, is directed towards exploring the interrelated mechanisms that govern their penetration through skin. Much insight has been gained through these efforts, but our understanding of the process is still incomplete, mainly due to the failure to allow for the effects of chemical speciation of metallic elements, especially the transition metals. Also, the skin as target organ presents imponderable and wide margins of variability. In vivo permeability is subject to homeostasis regulating the overall organism; in vitro, the sections of skin used for diffusion experiments are likely to present artifacts. Endeavors to define rules governing skin penetration to give predictive quantitative structure-diffusion relationships for metallic elements for risk assessment purposes have been unsuccessful, and penetration of the skin still needs to be determined separately for each metal species, either by in vitro or in vivo assays. Phenomena observed by us and other investigators, which appear to determine the process of skin permeation for a number of metals, are reviewed, separating the exogenous factors from the characteristics of the skin or other endogenous factors.

Allergic contact dermatitis elicitation thresholds of potent allergens in humans.

Literature scoured for human allergenicity to individual chemicals yields a limited number of potent sensitizers, which can be classified in four categories: metals, botanicals, biocides and miscellany. Potency is defined as strong for substances eliciting eczematous reactions to patch concentrations of 500 ppm (parts per million) or less in sensitized individuals. Most data encountered stem from studies conducted on dermatology patients tested routinely for hypersensitivity; only few data have been generated by systematic serial dilution testing.

In vitro permeation of nickel salts through human stratum corneum.

Allergic contact dermatitis due to nickel salts is common. It is therefore important to measure the permeation of these salts through the stratum corneum (SC), the primary rate-limiting domain in skin. An advanced diffusion system and analytical techniques now enable better measurement of the flux than was possible in earlier experiments. Human SC was prepared by trypsinization of dermatomed cadaver leg skin. The diffusion system included diffusion cells with a spiral line. Aqueous solutions of nickel salts (Ni(NO3)2, NiSO4, NiCl2 and Ni(-OOCCH3)2 at 1% Ni2+ concentration) were used as the donor solution (400 microL/cell). The receptor fluid, pure water, was collected up to 96 h after application of the donor solutions. Nickel concentrations in the donor and receptor fluid, as well as in the SC, were analysed using inductively coupled plasma mass spectrometry (ICP-MS) with a confidence limit of 0.5 ppb. Based on the total recovery of nickel from the experiments, about 98% of the dose remained in the donor solution, whereas 1% or less was retained in SC and less than 1% was found in the receptor fluid. Following an early surge, nickel permeates slowly across SC. The steady-state permeability coefficients of nickel were calculated from the flux data (approximately 5.2-8.5 x 10(-7) cm/h) with no significant difference among the salts. The results concur in principle with earlier studies conducted using the full-thickness human skin in vitro, and suggest that in vivo nickel ions may permeate simultaneously by routes of diffusion such as the shunt pathway, apart from slow transcellular/intercellular diffusion alone.

Human stratum corneum adsorption of nickel salts. Investigation of depth profiles by tape stripping in vivo.

Sequential adhesive tape stripping was implemented to characterize the penetration of nickel salts in human stratum corneum. Exposure areas of the salts in methanol applied open on arm and back skin in low volume were stripped 20 times to the level of the glistening layer at intervals of 30 min to 24 h post-dosing, and the strips analyzed for metal content by inductively coupled plasma-atomic emission spectroscopy. In the case of nickel chloride, sulfate, nitrate and acetate, material left on the skin surface, the depth-penetration profiles in the stratum corneum, and the dosage unaccounted for suggest the following conclusions: (a) Up to 24 h, most of the nickel dose applied remains on the skin surface or is adsorbed in the uppermost layers of the stratum corneum. (b) At higher concentrations, incomplete material recovery becomes discernible; within 24 h, nickel salts thus appear to penetrate beyond the stratum corneum to a minor degree, possibly via the skin shunts. (c) While the concentration gradients of nickel adsorbed vary with counter ion, anatomical site, dose and exposure time, for all variables tested the depth profiles converge to non-detectable levels (< 20 ppb) towards the level of the glistening layer. A notable exception is nickel as nitrate, for which levels continue at low but constant levels (1% of dose) beyond the third stratum corneum strip, indicative of intercellular diffusion. (d) Differences in material recovered suggest that the stratum corneum on the arm is more penetrable to nickel than stratum corneum on the back. (e) The counter ion in nickel salts plays a major part in their diffusion into the stratum corneum, suggestive of ion pairing. Overall, the data point to all three avenues of skin penetration by nickel: intracellular, intercellular, and transappendageal.

Human stratum corneum penetration by nickel. In vivo study of depth distribution after occlusive application of the metal as powder.

Sequential tape stripping was implemented on three healthy volunteers to examine the surface distribution of nickel through human stratum corneum in vivo following occlusive application of the metal as powder on the volar forearm. Exposure sites were stripped 20 times at intervals from 5 min to 96 h post-dosing and the strips analyzed for metal content by Inductively Coupled Plasma-Mass Spectroscopy with a detection limit for nickel of 0.5 ppb. The gradients of nickel distribution profiles increased proportionally with occlusion time, but after the 10th strip to the 20th strip continued at constant levels. Total nickel removed with 20 stratum corneum strips to the level of the glistening layer after maximum occlusion of 96 h was 41.6 micrograms/cm2 (+/- 12.2; average n = 3). In order to normalize the nickel depth distribution profiles, stratum corneum removed by stripping of untreated skin after occlusion was determined by weighing. Following application of nickel dust over 24 h, analysis of the 20th strip still indicated nickel present at 1.42 micrograms/cm2 (+/- 0.68; average n = 3). These data indicate that, in contact with skin, nickel metal is oxidized to form soluble, stratum corneum-diffusible compounds which may penetrate the intact stratum corneum, presumably by the intercellular route, and have the potential to elicit allergic reactions.

Use tests: ROAT (repeated open application test)/PUT (provocative use test): an overview.

As one step in defining the clinical relevance of exposure to an allergen identified with patch testing, use tests (provocative use test (PUT), and repeated open application test (ROAT)) have been used. In 1/2 of the cases of seemingly reliable patch tests, use tests are negative, suggesting that the patient's biologic threshold of response had not been reached with open application dosing. Dramatic differences exist in regional skin reactivity and percutaneous penetration. Negative results of use tests on normal skin may become positive on diseased skin. To refine this assay further, more controlled observations and analysis of reaction differences between normal and damaged skin, and among regional anatomic sites might be performed. In addition, we require a standardized measurement for the results. Use testing has significant potential in refinement of the evidence-based diagnosis of clinical relevance. However, for general validation, we should fill the deficiencies described above.

Nickel content of standard patch test materials.

The nickel sulfate content in standard patch test materials currently used in the US, Europe and Japan was determined by inductively-coupled plasma atomic emission spectroscopy, a state-of-the-art microanalytical method which allows nickel detection to levels of 7 ppb (microg/l). In 2 materials with a nominal concentration of 5% nickel sulfate hexahydrate in pet., the range (calculated averages of triplicate analyses of 3 different batches) was from 4.72 to 4.87% and 4.97 to 5.39%, respectively. In 1 material with a 2.5% nominal concentration in pet., the values ranged from 2.41 to 2.48%. The range seen in a 5% NiSO4 hexahydrate aq. material was 4.95 to 5.03%. The range for 2.5% NiSO4 anh. in pet. was 2.39 to 2.49%. This data suggest a significant improvement in quality control compared to our previously published data.

Colorimetric method for quantifying human Stratum corneum removed by adhesive-tape stripping.

Tape-stripping of the skin is a useful method for removing the stratum corneum and obtaining more information about the function of this skill layer as the main barrier for skin penetration. The amount of stratum corneum removed is of relevance in establishing the concentration profile of chemicals within the stratum corneum after topical application. Weighing is the preferred method for measuring the amount stripped, but because it is often subject to artifacts, alternative methods are sought. We present a simple, colorimetric method for determining the amount stratum corneum removed by sequential adhesive-tape-stripping of human skin in vivo. The method is based on quantification of the sodium hydroxide soluble protein fraction using a commercially available protein assay similar to the Lowry assay. The method is shown to be an accurate and reproducible alternative to weighing, also demonstrating uniform removal of stratum corneum layers following the very initial strips.

Scope and limitation of some approaches to predicting contact hypersensitivity.

Allergic contact dermatitis (ACD) is the endpoint of a complex sequence of events. Construction of a predictive computational assay requires a combination of statistical analyses, semi-empirical modelling, chemical acumen and a good understanding of prohapten activation. Main events on the path to the altered self are chemical and microbial conversion on and in the stratum corneum (SC), epidermal penetration, non-specific binding, and finally hapten-protein conjugation. This report reviews the principal approaches currently taken in the prediction of ACD, using computer-based SAR, QSAR and expert systems, and also includes the BIOSAR models, which combine statistical analysis with chemical knowledge. Specifically designed to predict the ACD potential of chemicals in man, the BIOSAR approach of two-value regression analysis achieved a success rate of 88% when trained on a set of 72 compounds of wide diversity, with a sensitivity of 83% and specificity of 100%.

Gold: an allergen of growing significance.

Gold moved into the limelight of medical literature thanks to the anti-inflammatory activity and effectiveness of gold compounds in the treatment of rheumatoid arthritis, but more recently also because of the growing incidence of hypersensitivity induced by it which is expressed in cutaneous and mucosal reactions. This review discusses dermatotoxicity associated with gold. In some countries gold has moved into second place as allergen, following nickel. Such recognition is mainly due to improved diagnostic methods and to its inclusion in routine dermal patch testing. Some unconventional manifestations of hypersensitivity are associated with use patterns which involve intimate contact with the metal as a component of jewelry. In-depth analysis of the growing number of cases of allergy has revealed various immunological idiosyncrasies as being characteristic of this metal. These include late reactions to challenge, extraordinary persistence of clinical effects, formation of intracutaneous nodules and immunogenic granuloma unresponsive to conventional steroid therapy, the occurrence of eczema at sites distant from the site of contact, and flare-ups of eczema upon systemic provocation with allergen which are characteristic of drug induced allergy. These manifestations demand investigations at the molecular level of the unusual mechanisms of action involved.

Fragrance allergens: Classification and ranking by QSAR.

Quantitative structure-activity relationship (QSAR) models which predict both skin penetration and cell mediated immunity for small molecular weight non-electrolytes developed earlier were validated on 74 known allergens and non-allergens chosen among fragrance chemicals in common use to test discriminating and grading power. While the test set used for classification was based on experience in humans exclusively, the rank model was tested for sensitization potency including guinea pig data also. In the classification test, 12 of 74 compounds fell in the indeterminate range and were non-classifiable by the present QSAR model. On the remaining 62 compounds the model performs with 90% sensitivity and 100% specificity at 92% concordance. The rank model correctly grades 65 of 74 compounds (88% concordance), with 60% specificity based on exact prediction of non-allergens (NON), and 95% sensitivity on allergens (ACD) allowing for a variance of +/- one level among weak, moderate and severe ratings. In combination, the two models perform with 93% overall concordance on the test set of 74 compounds.

A quantitative structure-toxicity relationships model for the dermal sensitization guinea pig maximization assay.

We have developed quantitative structure-toxicity relationship (QSTR) models for assessing dermal sensitization using guinea pig maximization test (GPMT) results. The models are derived from 315 carefully evaluated chemicals. There are two models, one for aromatics (excluding one-benzene-ring compounds), and the other for aliphatics and one-benzene-ring compounds. For sensitizers, the models can resolve whether they are weak/moderate or severe sensitizers. The statistical methodology, based on linear discriminant analysis, incorporates an optimum prediction space (OPS) algorithm. This algorithm ensures that the QSTR model will be used only to make predictions on query structures which fall within its domain. Calculation of the similarities between a query structure and the database compounds from which the applicable model was developed are used to validate each skin sensitization assessment. The cross-validated specificity of the equations ranges between 81 and 91%, and the sensitivity between 85 and 95%. For an independent test set, specificity is 79%, and sensitivity 82%.

A local lymph-node assay validation study of a structure-activity relationship model for contact allergens.

A structure-activity relationship model for prediction of contact allergenic potential of chemicals had previously been developed. The model had been shown to be able to classify known allergens and nonallergens using data on physicochemical and reactivity parameters of functional groups by discriminant two-value multiple regression analysis. To investigate the model, six selected chemicals which had not been previously investigated for allergenicity were studied with both the model and a murine local lymph-node assay. The same compounds were predicted to be allergens (3-bromo-2-coumaranone, 1-nitrocyclohexene and alpha-acryloyloxy-beta, beta-dimethyl-beta-butyrolactone) and nonallergens (1-carbethoxy-4-piperidone, 6,7-dimethoxy-2-tetralone and 9-acetylanthracene) by both the model and the local lymph-node assay.

Uptake of two zwitterionic surfactants into human skin in vivo.

To evaluate the potential risk associated with dermal exposure to nitrogen-containing amphiphiles commonly found in household and personal-care products, the uptake of N,N-dimethyl-N-dodecylglycine (dodecylbetaine, C12BET) and N,N-dimethyl-N-hexadecylglycine (hexadecylbetaine, C16BET) into human skin in vivo has been measured. The 14C-radiolabeled chemicals were applied in aqueous solution (C12BET concentrations 16, 100, and 800 mM; C16BET concentrations 0.14, 1.0, and 5.4 mM) to the dorsal upper arms of male volunteers for 30 min. At the end of this exposure period, the remaining applied solution was removed, the skin surface was thoroughly washed, and the stratum corneum at the administration site was removed by repeated tape-stripping. Dermal uptake was assessed (i) by direct measurement of the radioactivity recovered on the tape-strips, and (ii) from a predictive relationship previously derived from other research using a similar protocol. As expected, agreement between the two approaches was reasonable (generally within a factor of 3-4); the predictive relationship attempts to account for penetrant which cannot be recovered by the tape-stripping process, and anticipates, therefore, greater chemical exposure to the body than that expected on the basis of the tape-strip associated material alone. A positive control, using the previously studied penetrant, caffeine, demonstrated that the experimental procedure was conducted appropriately. Absorption of the betaines into human skin was significant (for C12BET, uptake was 28-160 nmol/cm2; that for C16BET was 2.3-19.5 nmol/cm2) and was primarily localized (as was caffeine) in the outer layers of the stratum corneum. In parallel experiments, in which unlabeled betaines were applied for 30 min, instead of tape-stripping, skin barrier function (measured by transepidermal water loss) was assessed. No betaine-induced effects on the stratum corneum were observed (in contrast to the sometimes large perturbations seen in vitro following considerably longer exposure times). Overall, the results indicated that the use of these betaines in personal care products, when intended for limited use and rinse-off application, gives no reason for safety concerns.

Metals and the skin.

Certain metals, and many metal-based compounds, are inherently toxic, and their presence in occupational and environmental settings raises appropriate questions concerning human exposure. Contact of these materials with the skin represents an important route of exposure, which is not well characterized. The purpose of this review, therefore, is to assemble the available, useful information pertinent to risk assessment following dermal contact. Specifically, we summarize here: (1) data relevant to the qualitative and (where possible) quantitative evaluation of metal compound permeation through the skin; (2) the role of each metal in metabolism, particularly with respect to the skin, and the potentially toxic effects that may result from dermal contact; and (3) the immunological characteristics (including allergenicity) of the metals and their derivatives. In total, information on 31 metals has been reviewed. It is clear that many diverse factors determine the ability of metal-based species to permeate biological membranes, not all of which have been fully defined. Therefore, considerably more experimentation, targeted at the development of high-quality transport data, will be required before the specification of practically useful structure-activity relationships are possible.

The effects of zwitterionic surfactants on skin barrier function.

The action of five zwitterionic surfactants on the barrier function of hairless mouse skin has been studied in vitro. The surfactants considered were dodecylbetaine and hexadecylbetaine (C12BET and C16BET, respectively), hexadecylsulfobetaine (C16SUB), N,N-dimethyl-N-dodecylamine oxide (C12AO), and dodecyltrimethylammonium bromide (C12TAB). Excised skin was pretreated with each surfactant, at various concentrations, for 16 hr, following which the permeation of a model compound, nicotinamide, was measured. The action of the surfactants was assessed by comparing nicotinamide flux through surfactant-pretreated skin with that across control membranes which were exposed to buffer alone for 16 hr. All surfactants decreased skin barrier function to some extent. The degree of nicotinamide penetration enhancement induced was correlated with the ratio of the surfactant pretreatment concentration to the surfactant critical micelle concentration, suggesting that solubilization of stratum corneum lipids may be an important mechanism in explaining the effects observed. More detailed studies with 14C-radiolabeled C12BET and C16BET showed that the dodecyl analog was itself well absorbed, whereas the C16 compound partitioned into the skin favorably but then transferred only very slowly into the receptor phase. These observations were consistent with toxicity studies (albeit at much higher concentrations in a different animal model, the rat) which indicated that the dermal LD50 of C12BET was significantly less than that of C16BET (the value for which was so large that it could not be reliably determined). Overall, this study provides, we believe, useful information pertinent to the potential dermal toxicity of the surfactants considered following occupational or environmental exposure.

Irritation factors of sodium hypochlorite solutions in human skin.

The recommended concentration for patch testing with sodium hypochlorite [NaOCl] (bleach) is 1%, generally obtained by diluting commercial bleach. In doing so, other active (potentially irritant) components of bleach, especially hypochlorous acid [HOCl] and sodium hydroxide [NaOH], are neglected. Magnitudes of potential irritant species other than NaOCl, such as alkalinity, are ordinarily not labeled on the product, though they may vary considerably between brands. Thus, patch testing with 1% hypochlorite obtained by diluting different brand bleaches can potentially elicit non-specific irritant responses, also depending upon the test volume applied. In this study, skin irritation induced by 24-h patch testing with 20 microliters or 100 microliters, with constant NaOCl concentration (1%) and different NaOH concentrations (0.01-1.0%), was studied in adult human volunteers, by means of visual scores and skin color reflectance measurements. No irritation was elicited by application of 20 microliters 1% OCl-, independent of the NaOH concentration. However, all solutions induced significant irritation in a volume of 100 microliters. Skin reactions did not show a straight pH dose response, a maximum reaction being seen to the solution containing 0.1% NaOH. Skin surface pH values had increased when monitored immediately after removal of the patch material. However, 24 h later, baseline values were again reached at most sites, demonstrating an efficient buffering capacity of human skin, even after challenge with alkaline solutions of pH 13.4. We suggest that a non-irritant concentration for diagnostic patch testing for allergic contact dermatitis with an aluminum chamber, using 17 microliters to 20 microliters test volume, could be as high as 1% NaOCl and 1% NaOH.