Comparison between patch test results of natural dyes and standard allergens in batik workers with occupational contact dermatitis

Abstract

Background

Occupational contact dermatitis (OCD) is a skin disorder caused by contact with any substances found in the workplace. Occupational contact dermatitis is second most common occupational disease (15% of all cases of occupational disease). Occupational contact dermatitis is divided into allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) which is 80% of cases that affects hands. Batik is an art that is painted on cloth, it is one of Indonesian cultural heritage. Batik workers have a higher risk of obtaining OCD due to exposure to chemicals and fluids used during work. Natural dyes used in the dyeing process are less likely to cause ACD than standard allergens. Some of the natural dyes used in the dyeing process in batik industries are Indigofera tinctoria, sappan wood (Caesalpinia sappan), and Mahagony (Swietenia mahagoni) cause skin sensitisation.

Objective

To compare the results of patch testing between natural dyes (Indigofera tinctoria, sappan wood (Caesalpinia sappan), and Mahagony (Swietenia mahagoni) with standard allergens (p-phneyldiamine 0.1%, potassium dichromate 0.5% and formaldehyde 0.1%) as a cause of ACD in batik workers in Surakarta, East Java, Indonesia.

Method

A cross-sectional study was conducted on 63 subjects batik workers with OCD in Surakarta, East Java, Indonesia. Subjects were patch tested with three standard allergens (p-phenylenediamine 0.1%, potassium dichromate 0.5%, and formaldehyde 1%) and natural dyes (Indigofera tinctoria, sappan wood (Caesalpinia sappan), and Mahagony (Swietenia mahagoni). A closed patch test was evaluated 48 and 96 hour later. Screening of OCD in batik workers in Surakarta, East Java, Indonesia was based on Nordic Occupational Skin Questionnaire NOSQ-2002, and diagnosis of OCD was based on Mathias criteria (at least 4 out of 7 criteria were met). Data were analysed using a non-parametric Chi-square test with SPSS 21 with a significant difference if the p-value < 0.05.

Result

Natural dyes significantly caused allergic contact dermatitis in batik workers in Surakarta, East Java, Indonesia than standard allergens (p = 0.016). A positive patch test was found in 11 patients, standard allergen p-phenylenediamine (PPD) 0.1% was seen on one patient, potassium dichromate 0.5% on two patients, and formaldehyde 1% on two patients. A positive patch test using Indigofera tinctoria was found at one patient, sappan wood (Caesalpinia sappan) in three patients, and Mahagony (Swietenia mahagoni) in five patients.

Conclusion

Natural dyes cause more positive patch test results in batik workers.

Keywords:

• ACD
• Natural dyes
• occupational contact dermatitis
• standard allergens
• patch test

Acknowledgement

The author would like to thank dr. Sri Awalia Febriana, dermatology & venereologist, Ph.D., teaching staff of General Hospital Dr. Sardjito/Gadjah Mada University Yogyakarta, Indonesia for the support and suggestions regarding this research.

Author contributions

EDN wrote the manuscript, conducted the research, and performed the patch test and OCD screening on research subjects. MEI provided advice on research, correction of writing and supervised reading the patch test results. SW provided advice on research, writing, and data analysis and also supervised the reading of the patch test results. MM advised on research and manuscript editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).