Occupational Allergic Contact Dermatitis Resembling Angioedema Induced by Acrylates in a Pipe Relining Worker

A 56-year-old man, who had been working as a technician in a relining company for over 13 years, came to our attention for a recurrent facial erythema with swollen eyelids. The condition has progressively worsened over multiple episodes in the last 2 years. Mild itching and redness typically developed 4–5 h after starting work, progressing to severe eyelid oedema and vesicles within 12 h. The lesions gradually subsided over a period of 4–5 days, leaving post-inflammatory erythema on the eyelids and cheeks. The patient never experienced swelling of the lips, oral mucosa, or any respiratory symptoms. Since the last episode (Figure 1), the lesions cleared after 5 days of oral Betamethasone (3 mg/day) and the patient has remained on sick leave. In the past 3 years, the company has introduced a new relining system based on acrylates, replacing the epoxy materials used previously. Patch testing was performed at the Department of Occupational and Environmental Dermatology in Malmö, 2 weeks after the skin disorder had healed. The test was conducted using the Swedish baseline series, an additional baseline series used in Malmö, the acrylate, isocyanate, and epoxy series (Chemotechnique Diagnostics, Vellinge, Sweden), nitrile gloves used at work, and a dipropylene glycol diacrylate 0.1% [1] in-house preparation (TCI Europé NV, Zwijndrecht, Belgium), based on the substances listed in the safety data sheet of work materials (Table 1). Patch testing was carried out using FinnChamber Aqua test chambers (Smart Practice, Phoenix, Arizona). Test readings were conducted according to the guidelines of the International Contact Dermatitis Group (ICDRG) and the European Society of Contact Dermatitis (ESCD) [1, 2]. Positive reactions were observed to several acrylates and methacrylates, while a doubtful reaction was recorded to epoxy resin 1.0%, tested in the Swedish baseline series. Since this concentration is non-irritant, a 5% concentration was also tested, which elicited a strong positive reaction (Table 1). Following a workplace visit, supplementary patch testing was performed using an additional acrylates series, a higher concentration of epoxy resin, and a UV light-cured resin (UVLCR), and an acrylate-impregnated hose used at work (Table 1). The relining of old pipes supplying households and industrial buildings involves creating an inner coating of epoxy or acrylate resins within the existing pipes [3, 4]. Despite the use of personal protective equipment (PPE), there are risks of accidental skin exposure [4, 5], particularly if resins contaminate clothing or protective gloves. In this case, the clinical presentation initially mimicked a Type I allergy with eyelid swelling. However, the delayed onset of symptoms and the known presence of strong skin sensitizers in relining settings justified the primary suspicion of allergic contact dermatitis, confirmed by the results of the investigation. The likelihood of airborne contact dermatitis was considered low, since the low volatility at room temperature of acrylates/methacrylates identified in the products (hydroxypropyl methacrylate and tripropylene glycol diacrylate) together with their use at room temperature suggested a minimal airborne exposure. The symptoms were mainly caused by the patient frequently touching his face with contaminated hands or nitrile gloves during manual mixing and application of resins. The patient had to stop working due to severe contact allergies. Current relevance was given to acrylate allergies, while the current relevance of epoxy resin allergy remained uncertain due to occasional exposure and unclear symptom correlation. A recent case of contact eyelid oedema following sensitisation to acrylates and isocyanates in gel nail polish [6] along with well-documented cases induced by contact allergy to oxidative hair dyes [7], highlights how these presentations may be under-recognized manifestations of severe contact allergy. We diagnosed a case of occupational allergic contact dermatitis caused by acrylates in a pipe relining worker, primarily due to facial contamination. Testing targeted series and patients' actual work materials is crucial, as not all substances used in pipe relining are available in standard patch test preparations [4, 8]. Given the increasing use of strong sensitizers such as acrylates in relining work, we expect that the incidence of these cases is likely to rise. All authors read and approved the final version of the manuscript. The authors have nothing to report. The authors have nothing to report. The patients gave their consent for publication. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.