Occupational Airborne Allergic Contact Dermatitis Caused by Gold

Simonetta Giorgini; Linda Tognetti; Fabio Zanieri; Torello Lotti

Disclosures

Dermatitis. 2010;21(5):284-287. 

In This Article

Case Reports

Case 1

A 23-year-old woman with no previous skin disease had worked for a year as a restorer probationer, attending the annual master ''polychrome and golden frame and wooden opuses restoration'' in a Florentine restoring school. Three days a week, she worked with two gilding techniques: (1) ''leaf gilding,'' which involves the application of pure gold leaf to a wooden pretreated frame and requires many business days of work, and (2) ''dust gilding,'' in which extremely fine gold dust (obtained by milling pure gold) is spread out by being dropped onto the pretreated surfaces of miniatures and icons, a process also used for retouching already-gilded objects. The patient always wore ordinary rubber gloves during her restoring work. Most of the time, she wore a little respiratory mask on her nose and mouth, so she had no oral contact with either the gold leaf or gold dust. She came to us at the end of the master course (ie, after 12 months of working) because of an eyelid dermatitis that had appeared 2 months previously. The patient had erythema on both upper eyelids (moderate on the right eyelid, mild on the left one) along with moderate thickening of the medial eyelid margins. Deepening of the eyelids' lines was mild (Fig 1). She claimed to have frequent itching of the eyelids. There was no other skin involvement. She used no topical products apart from moisturizing cream, and she wore golden jewelry with no problems.

Figure 1.

Patient 1 at presentation.

After diagnosis, the patient tried to follow our advice and managed to avoid working with gold. Her eyelid skin gradually cleared in 2 months. Eight months later, she resumed a restoration job that involved some gilding. At the 12-month follow-up, we noticed a relapse of the airborne CD; the erythema was mild, but there was moderate lichenification of the upper eyelids and moderate itching (Fig 2). She confirmed that the dermatitis had reappeared after 1 month of her working.

Figure 2.

Patient 1 at follow-up, 4 months after having resumed work.

Case 2

A 52-year-old nonatopic woman had been working for 20 years on a restoration. Five years before coming to our clinic, she had started working in a gilding laboratory once a week. She gilded old objects such as antique wooden frames and furniture, ceramic objects, and metallic and glass pots. In addition to using leaf- and dust-gilding techniques, she had been doing gold plating, which is accomplished through an electrolytic process in a chemical bath and is used mainly for gilding metal objects. Nearly once every 1 or 2 months, she used the ''fire gilding'' technique, which involves the fusion of metallic gold. During her work, she wore ordinary rubber gloves and occasionally wore a respirator to protect the lower half of the face. The patient came to us because of a recurring dermatitis over the forehead and on the exposed parts of her forearms. It had first appeared 3 years previously; it fluctuated thereafter, improving on weekends and clearing on holidays. During this time, she customarily applied moisturizing creams and sometimes topical corticosteroids. At presentation, she showed a symmetric rash that involved both upper and lower eyelids and the skin between the eyebrows. The thickness of the upper eyelids was increased, and the lines of the eyelids were deepened (Fig 3). A mild erythema had spread on the anterior part of the neck. She complained of facial itching and a sensation of discomfort caused by the reduced elasticity of facial skin. No other skin areas were involved. She had no problems with occasionally wearing gold jewelry.

Figure 3.

Patient 2 at the 1-month control.

After diagnosis, the patient followed our advice by avoiding gilding techniques in her work in the restoration business. At her follow-ups, we observed a complete recovery from the airborne CD on her face and neck.

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