Occupational trichloroethylene exposure as a cause of idiosyncratic generalized skin disorders and accompanying hepatitis similar to drug hypersensitivities

Abstract

The TCE-related generalized skin disorders are important not only in terms of the number of disease occurrences and severity but from the viewpoint of drug hypersensitivity. Systematic collection of clinical information is necessary in cases diagnosed by the same criteria as those used for drug hypersensitivities. Detailed exposure assessments are also required to establish preventive strategies in these countries.

Characterization of Liver Injury Associated with Hypersensitive Skin Reactions Induced by Trichloroethylene in the Guinea Pig Maximization Test

“…Intoxication cases of TCE have been reported since as early as 1915, showing organ damage involving the central nervous system, peripheral nervous system, liver, kidney, heart and skin. As for skin lesions, mucous membrane irritation, defatting skin and irritant dermatitis have been described 1,2) , but the severe generalized skin disorders accompanying hepatitis which resemble drug hypersensitivities have become the main clinical issue in the past 20 yr in Asia, especially in Guangdong, China, because of rapidly increasing numbers of patients and their serious consquences 3) . Up to now, more than 240 cases with 31 fatalities have been reported by the Guangdong Poison Control Center, China.…”

“…The patients typically show rash on the extremities, face, neck or trunk with or without fever 2 wk to 2 months after commencement of occupational TCE exposure 3) . The mortality is 9-13%, which is close to the corresponding figures observed for drug-induced generalized skin disorders 3) . Liver failure is one of the principal causes of mortality [8][9][10][11][12] .…”

Trichloroethylene Causes Generalized Hypersensitivity Skin Disorders Complicated by Hepatitis

“…Clusters of disorder occurrences in a workshop within a year, even within a half month in some cases, have been reported from several countries so far 12,13,37) . This cannot be explained solely by a dose-response relationship, differences in individual susceptibility, or reactivation of the latent viruses.…”

“…However, idiosyncratic generalized skin disorders complicated by h e p a t i t i s , w h i c h i s s i m i l a r t o s e r i o u s d r u g hypersensitivities, have also sporadically occurred in populations occupationally exposed to trichloroethylene (TCE) [2][3][4][5][6][7][8][9][10][11][12] . The number of patients suffering from these disorders has been increasing in Asia, i.e., The Philippines, Singapore, Taiwan and China since the 1990s 12,13) . Especially in Guangdong Province, in the southern part of China, more than 230 cases were registered from 1988 through 2006 regardless of the extensive efforts made by local government occupational health services.…”

“…First, the duration from commencement of TCE exposure to disease occurrence is about 2-5 wk, usually not more than 73 days 12) , with an average duration of about 1 month in Chinese cases 11,14) . If a worker does not suffer from the disorders by the end of the 3rd month after the start of exposure, he/she is not susceptible.…”