"Telangiectasia are dilated superficial blood vessels. They may occur in rosacea, in certain systemic diseases (ataxia-telangiectasia, scleroderma), or in long-term therapy with topical fluorinated corticosteroids"
[Merck Manual 2001 Sec.10, Chapter 109 (2001)]
Telangiectasia: An autosomal dominant vascular anomaly characterised by the presence of multiple small telangiectases of the skin, mucous membranes, gastrointestinal tract, and other organs, associated with recurrent episodes of bleeding from affected sites and gross or occult melena (Cancerweb, 2002)
Thériault G, Cordier S, Harvey R - "Medical Intelligence - Skin telangiectases in workers at an aluminum plant" Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Ste-Foy, Quebec, Canada, G1K 7P4; Supported under a contract from the Société d'Electrolyseet de Chimie Aléan Ltée, Montreal.
"OCCUPATIONAL-HEALTH physicians from a large Canadian aluminum company recently noticed the presence of numerous telangiectases on the skin of some production workers. Called to investigate, the Workmen's Compensation Commission confirmed the presence of these lesions. Some affected workers complained of the appearance of the lesions and worried about their effects on health. Researchers from the Soviet Union have reported the presence of telangiectases in workers at an aluminum electrolysis plant (1), but the lesion has received little or no attention in the Western medical literature.
We attempted to determine whether these skin lesions were related to work in aluminum and to identify the occupations associated with their occurrence. We report here the results of an epidemiologic study among 588 workers in a Canadian aluminum plant. We found an increased number of skin telangiectases on the upper chest, back,and shoulders in 40 per cent of the workers, with an apparent relation between the occurrence of lesions and the duration of occupational exposure. No excess of associated diseases was noted.
The observed skin lesions...were red to red-bluish maculae or flat patches (often linear in shape) with a maximum diameter of 1 mm to 3 cm. They were painless and nonpruritic, and they disappeared upon finger pressure. When the pressure was removed, the blood was seen reentering the enlarged vessels. These vascular lesions lay within the superficial layers of the dermis, and the skin over them had a normal appearance.
The telangiectases appeared mainly on the upper part of the chest, the back, and the shoulders. Sometimes they were also present on the face, neck, arms, and backs of the hands. They very rarely appeared below the waist and were not found on the nasal or buccalmucosa or in the fundi. Clothing did not affect their distribution,nor was an increased concentration or ring pattern found on the neck or wrists.
The lesions had a characteristic pattern of appearance. In men with less than 10 telangiectases, the most affected part of the body was the upper chest. In those with 10 to 19, the upper of the back was affected as well. Other involved areas were, in order, the neck, the upper arms, the forearms, the face, and the hands.
The lesions seemed to enlarge with time. Pearson correlation coefficients between the total number of telangiectases and the number of large ( 5 mm) telangiectases (r = 0.592, P<0.001), as well as between the number of lesions and the body surface covered with telangiectases (r = 0.856, P<0.0001) were highly significant. Thus, the size and dispersion of these lesions increased as they became more numerous.
Table 1 shows the association between telangiectases and duration of work in the aluminum plant. There is a direct relation; attack rates of telangiectases increased steadily with the number of years worked at the plant. After 25 years, a little over 59 per cent of the men had 10 or more telangiectases, and nearly 35 per cent had lesions that were 5 mm or larger in greatest dimension.
1) Sagyka AP, Longunov VP, Selivanenko VG, et al.- "Relationship between occupational vascular affections of the skin and occupational disorders of the cardiovascular system in workers of the electrolysis plant of an aluminum works (in Russian). Vlatnik Dermatol Venerol 7:73-7 (1977)
Balic J, Kansky A - “Skin telangiectasia in workers of an aluminium processing plant" Derm Beruf Umwelt 36(1):20-2 (1988)
* "Telangiectases were detected in 57 (46.7%) of 122 workers employed at the electrolysis department of the aluminium plant Lozovac/Sibenik, Yugoslavia. Of 116 workers employed in the smeltery of the same plant, telangiectases were observed in 19 persons (16.4%) and in a group of 121 public transportation workers from Sibenik 15 men (12.4%) displayed enlarged blood vessels. Statistical evaluation revealed the difference in number between workers showing telangiectases engaged in electrolysis and the other two samples to be significant. It may be assumed that telangiectases were caused by hydrogen fluoride and other fluorides. Further clinical parameters, as well as working conditions, are reviewed."
Balic J, Kansky A, Wolf A - "Telangiectasias, heavy sweating and diffuse itching of the skin in potroom workers working with the eletrolytic extraction of aluminum" Arh Hig Rada Toksikol 37(3):337-45 (1986)
Budina LV - "Skin diseases in workers engaged in halogen manufacture" Vestn Dermatol Venerol 0(8):37-39 (1991)
* "Examination of 872 subjects occupationally exposed to fluorine, bromine,iodine, chlorine, and compounds thereof have revealed epidermitis of the palms in 44.1%, telangiectasias of the face in 16.7%, leukoplakia of the lips and bucal mucosa in 4.7%, cicatrices after chemical burns in 3.0%, allergic dermatitis and eczema in 6.9%, mycoses of the soles in 7.9%, other dermatoses in 5.6% of the examinees. Allergenic effects of halogens were confirmed by skin tests and the neutrophil injury index in 21.3% of the examinees, in 18.2% of these latent sensitization was thus confirmed. Introduction of a complex of technologic, sanitary and hygienic measures was aimed at prevention of skin involvement in this population."
Burry JN - "Topical drug addiction: adverse effects of fluorinated corticosteroid creams and ointments" Med J Aust 1(8):393-6 (1973)
Ersoy F, Berkel AI, Sanal O, Oktay H - "Twenty-year follow-up of 160 patients with ataxia-telangiectasia" Turk J Pediatr 33(4):205-15 (1991)
Leyden JJ, Thew M, Kligman AM - "Steroid rosacea" Arch Dermatol 110:619-622(1974)
* "Ten patients who received topical fluorinated steroid therapy for facial eruptions developed a pattern consisting of persistent erythema, telangiectasias, atrophy and occasional papules and pustules. All the patients developed the rosacea-like dermatitis only after use of fluorinated steroid creams. Fluorinated steroids should never be used for prolonged periods on the face and should not be used in the treatment of acne or rosacea."
Mazurkiewicz W, Dabrowska H, Wnorowski J, Chadzynska M - "Complications in the course of the treatment of rosacea with fluocinolone acetonide (Synalar ointment) Przegl Dermatol 58(3):297-305 (1971)
Modly CE, Burnett JW - "Dermatologic manifestations of fluoride exposure" Cutis 40(2):89-90 (1987)
Pehr K, Moroz B - "Cutis marmorata telangiectatica congenita: long-term follow-up, review of the literature, and report of a case in conjunction with congenital hypothyroidism" Pediatr Dermatol 10(1):6-11 (1993)
Smith JG Jr, Wehr RF, Chalker DK - "Corticosteroid-induced cutaneous atrophy and telangiectasia. Experimental production associated with weight loss in rats" Arch Dermatol 112(8):1115-7 (1976)
* A bioassay for the evaluation of certain adverse effects of various corticosteroids was performed. Twenty-eight daily topical applications of corticosteroids to young rats produced reduction in body-weight gain, atrophy of the skin as determined by double skin-fold thickness micrometer measurement, and mild to severe telangiectasia. This animal model demonstrates corticosteroid-induced skin atrophy and telangiectasia and the correlation of the degree of atrophy and telangiectasia to body-weight change. Nine corticosteroids were evaluated by this method and are listed in terms of increasing severity of side-effects as follows: 1.0% hydrocortisone cream, 0.1% betamethasone valerate cream, 0.025% betamethasone benzoate cream, 0.05% flurandrenolide cream, 0.05% fluocinonide cream, 0.1% dexamethasone cream, and 0.03% flumethasone pivalate cream. Triamcinolone acetonide cream, 0.5%, and 0.2% fluocinolone acetonide cream resulted in death of the animals prior to completion of 28 days of topical application.
Sneddon I - "Adverse effect of topical fluorinated corticosteroids in rosacea" Br Med J I: 671 (1969)
Theriault G, Gingras S, Provencher S - "Telangiectasia in aluminium workers: a follow up" Br J Ind Med 41(3):367-72 (1984)
* "A five step investigation was carried out to gain a better understanding of the morbidity that accompanied the development of telangiectasia on aluminium workers and to find its cause. Fifty workers with multiple telangiectasia when matched with normal controls showed the same amount of illness except that evidence of ischaemia on the ECG was found in nine cases and one control. The cases did not show an excess of abnormal biochemical tests. The basic histopathological lesion affected the surrounding tissue rather than the vessels themselves. Working in the current environment and wearing masks seems to protect young workers from developing the lesions. The Soderberg and not the prebake process was associated with the lesions; the causative agent is probably a gas that contains both hydrocarbons and fluoride components emitted from the electrolytic reactors."
Tirlapur VG, Rice-Oxley JM - "Facial erythema and telangiectasia with synalar cream" Br J Clin Pract 35(7-8):275-6 (1981)
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