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Occupational skin ulceration in chrome platers.

Ulceration of the skin due to contact with hexavalent chromium was first described by Cummings in 1827. One hundred years later, in 1928, Blair published a study of 12 cases of skin and nasal ulceration at a time when chrome plating had become commercially successful. Formal regulations to protect workers heath were introduced for the first time in the UK in 1931, when the risks of occupational exposure to chromium had become well established. A review was undertaken of 13 cases of skin ulceration which had been identified from an earlier study of ill health in chrome platers. Data were collected on 55 platers from 17 companies. Fifty-one were right-handed, three were ambidextrous and one was left-handed. There was evidence of previous skin ulceration in 11 platers (20%) from four of the 17 companies (23%). Two platers were found to have active chrome ulcers at the time of the study (4%). Of the 11 platers with previous ulcers, six had a single ulcer scar, two had two scars, one had three scars and two had more than three. All ulcers occurred on the hands, the most common site being around the proximal interphalangeal joint and on the lateral aspects of the terminal and middle pharynx of the middle and index fingers. The development of a chrome ulcer or 'chrome hole' follows a prescribed course yet there is little in the literature which discusses the healing and scarring process. Contact of hexavalent chrome with the skin only results in an ulcer if there is a cut, abrasion or any other defect in the protective epidermis. There may be intense itching at the site — particu-