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In an epidemiological study of 286 metalworkers exposed to metalworking fluids (MWF), the prevalence of skin problems was investigated. Minor changes, such as a dry rough skin with slight erythema, were seen in 31%, and major changes, such as more serious and widespread dermatitis, were observed in 27% of all workers. By far the most cases were of irritant origin; in only 2.8% was a contact sensitization established. Exposure to water-based MWF caused irritant contact dermatitis more often than exposure to neat oils. No influence was found of the presence of atopy on the occurrence of dermatitis. Other factors that may result in irritation of the skin are discussed, as well as measures to be taken to minimize insult of the skin.

An animal model for the excited skin syndrome was developed in the guinea pig. Hyperirritability of the skin could be induced by immunization with Freund’s complete adjuvant (FCA). This hyperirritability was evident from the enhancement of both patch test reactions to an irritant (sodium lauryl sulfate) and open epicutaneous test reactions to a contact sensitizer (2,4-dinitrochlorobenzene). The skin tests were performed at sites other than those pretreated with FCA. Maximum enhancement was observed in a period 3–5 weeks after FCA immunization. A similar but less marked hyperirritability could be induced by eliciting a localized chronic croton oil dermatitis. The period of hyperirritability induced by FCA or croton oil was preceded by a short period (1–14 days) of depressed skin reactivity.

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