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

Abstract

Objectives: Workers exposed to trichloroethylene (TCE) rarely show severe generalized skin disorders and accompanying hepatitis which resemble drug hypersensitivities. The disorders are completely different from solvent-induced irritating contact dermatitis, and their serious consequences have become one of the critical occupational health issues recently in Asia. The present review sheds light on the analogous relationship between the reported patients' clinical manifestations and those of severe drug rash, and provides a comprehensive picture of the disorder occurrences among TCE-exposed workers to date.

Methods: All literature published in English and ad hoc publications in local languages were reviewed.

Results: The patients typically showed rash on the extremities, face, neck or trunk with/without fever 2 weeks to 2 months after commencement of occupational TCE exposure. Reported cutaneous manifestations were classified into two hypersensitivity categories, i.e. hypersensitivity syndrome and erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis. Based on this categorization, 124 (52%) cases were classified as the former and 115 (48%) as the latter. According to the two spectra, the prevalence of each clinical finding of TCE-related skin disorders was close to that in drug hypersensitivities except for disease incidence and the prevalence of fever, hepatitis, and lymphadenopathy. Occurrences of the disorders have been reported from the USA, Japan, Spain, Singapore, China, Korea, Thailand, and the Philippines. The case reports from industrialized countries were mostly published up to 1990, whereas cases from Asian industrializing countries appeared thereafter.

Conclusions: 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.