Kunststoffe - Chemische grundlagen, verwendung und bedeutung als kontaktallergene

The human being of the year 2000 is surrounded by plastics. The variety of products manufactured by the chemical industry is nearly impossible to comprehend. The medical knowledge of plastics has large gaps, even among dermatologists and environmental physicians. In the present review the most important plastic components are discussed regarding 1. chemical structure and production, 2. use and applications, 3. reactions on the skin and mucous membranes and, 4. epicutaneous testing. Major groups are polymethacrylic acid esters (dental restorations, safety glass, glues, lacquers), polyethylene (foils, tubes, pressure casts), polypropylene (foils, textile fibres), polyurethane (parts for vehicles, isolation, upholstering), epoxy resins (lacquers, laminates), polyamides (textile fibres, vehicle production), polyester (fibres, lacquers), and polycarbonates (casts of various types). While the end product rarely causes skin reactions, the individual components have great importance for occupational dermatology. Acute and chronic irritant dermatitis as well as allergic contact dermatitis of various intensity and localization are observed. Reactions on the mucous membranes (rhinitis, conjunctivitis, asthma) are often irritant but specific IgE- mediated events do also occur. Highly reactive monomers and oligomers and various additives may cause high levels of sensitization and lead to surrender of the profession (epoxy resins, acrylates). Dental technicians are particularly at risk. Epicutaneous testing should be performed only by allergologists with special experience in this field because insufficient dilution of the materials may lead to severe irritative reactions or even cause active sensitization. Prevention must follow several strategies: improvement of knowledge of physicians and involved persons producing or handling plastic materials, particularly workers who have direct skin contact with non-polymerized components; development of adequate protective measures, if skin contact is unavoidable ('no touch' or 'minimal contact'); intensifying cooperation with the chemical industry in order to recognize sensitizations at an early stage; continuous search for less endangering materials.