Generalized Skin Reactions in Relation to Trichloroethylene Exposure: A Review from the Viewpoint of Drug‐Metabolizing Enzymes

Abstract

Generalized Skin Reactions in Relation to Trichloroethylene Exposure: A Review from the Viewpoint of Drug-metabolizing Enzymes: Tamie NAKAJIMA, et al. Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine-The literature was reviewed to study cases of intoxication with systemic dermatitis associated with exposure to trichloroethylene. The average age of patients in the reports reviewed to date was twenty-nine; these diseases were found in relatively young persons and no difference was found according to gender. Many cases occurred within one month after the onset of exposure to trichloroethylene, and were accompanied by hepatitis, jaundice, hepatomegaly or hepatosplenomegaly. Most of the patients had no history of drug abuse or herpes infection. The level of exposure to trichloroethylene was not recorded in many cases, but ranged from less than 9 ppm to 800 ppm. In the severest cases, the lesions involved mucous membranes such as the conjunctiva and oral cavity, and the patients were diagnosed with Stevens-Johnson syndrome, but the etiology of the disease after trichloroethylene exposure remains unclear. Since several drugs have also been shown to cause systemic dermatitis with hepatitis, susceptibility factors are discussed. Many patients were found to have the slow acetylator genotype of Nacetyltransferase (NAT) 2, suggesting that the NAT2 genotype is a susceptibility factor. This hypothesis may also be applicable to trichloroethylene because NAT is involved in the glutathione-mediated metabolism. (J Occup Health 2003; 45: 8-14)

Generalized Eruption Accompanied by Hepatitis in Two Thai Metal Cleaners Exposed to Trichloroethylene

“…Moreover, urine samplings for epidemiological survey, which were collected at middle instead of at the end of workweek, could provide underestimated results 10) . Although the causal relationship between occupational exposure to TCE and generalized eruption accompanied by acute hepatitis appeared definite, the substance responsible for the development of the illness has not yet been identified 6,12) . The two patients developed their illnesses almost simultaneously in a company where TCE has been used for a long time.…”

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

“…These disorders have been grouped under "Occupational medicamentosa-like dermatitis (OMLD) induced by TCE" in the Chinese National Diagnostic Criteria 4) . OMLD induced by TCE is completely different from TCE-induced irritant contact dermatitis in terms of unclear dose-response relationship, period of exposure before disease onset, generalized rash, fever, lymphadenopathy, and recurrence just after minimal reexposure [5][6][7] . 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) .…”

Human Herpesvirus 6 Reactivation in Trichloroethylene‐exposed Workers Suffering from Generalized Skin Disorders Accompanied by Hepatic Dysfunction

“…A close link between occupational solvent exposure, mostly trichloroethylene (TCE), and severe generalized skin disorders has been suggested by a series of case reports [3][4][5][6][7][8][9][10][11] . Recently, the number of patients suffering from TCE-related severe skin disorders has been increasing in Asia, especially the Philippines, Singapore, Taiwan and Guangdong Province, China 10,12,13) . In Guangdong, the Hospital for Occupational Diseases Control of Guangdong Province treated the first patient with the disorder in 1997, and 201 cases including 13 fatalities had been hospitalized by the end of 2005.…”