Document zzjaqQzJnEeKp0e6VKDLpY1Dz

FILE NAME: Household Contact (HC) DATE: 1943 Sept DOC#: HC033 DOCUMENT DESCRIPTION: Medical Journal Article - Halowax Acne - Archives of Dermatology and Syphilogogy Archives of Dermatology and Syptilol^y VoriiMZ 48 SEPTEMBER 1943 Copyright, 1943, SV t m : A mkstoan M iucai, A ssociatih NuMAEk 3 HALOW AX ACNE . ("C A B LE R A SH ") a ' cutaneous er uptio n CHLORINATED i n m a r in e elec tric ian s d u e to NAPHTHALENES AND DIPHENYLS certain v: TV." ' CHARLES KEMM GOOD, Tsf-D. AND NATHAN PEN SKY, M.D. . . NEW YORK , -- /'A: vvv The present study is concerned with an eruption observed, and studied in a series of marine electricians engaged in working with .certain types ;oi .electrical cable in a ;?largc shipbuilding organization over a period of several years. . - . The first patient was seen on Dec. 31, 1941. The number of cases has gradually increased to a total of 52 at the time of writing,. Many-patients:;haye:been-under.. 'constant observation for a period of one and one-half to two years. The studies on : Hepatic function to be described were based on a.selected,group of;25, patientsiwho presented a more extensive involvement. Ncw eases still; arc .developing,;and the 'study.continues. A cooperative and free exchange of information with physicians. elsewhere in the United States who are seeing, and .treating-patients with .this veruption has been maintained. 'Phis has been mutually helpful in the attempts to solve the problems presented and beneficial to the patients in the relief that it has been at times possible to afford them. - - -. - Halowax acne or "cable rash" is the general term commonly used to designate He.eruption. It is by no means a new clinical entity. Soon after the introduction, of tar and its derivatives into industry, acnefonn eruptions began .to appear and were leported in the literature by early observers. Dermatologists atid industrial .physicians.studied the causation, control and prevention intensively. Most'of these; -Studies have appeared in specialized-publications, principally those devoted to i industrial medicine. ; * v Perm Kumkheit was the teim used to describe the condition by the fiefman waters1 at the time of World W ar I. This acneform eruption, identical with the clinical-picture now appearing, occurred among workers on gas masks and on gas proof clothing. It was caused by chlorinated naphthalenes. . Today chemically related substances (known by the trade-name Halowax) are being used m considerable amounts o n ;$hipS;-;-v'Halowaxi.- compounded by the Halowax Corporation, a subsidiary, of tbe Union -Carbide; and Caibon Company. It is a waxlike substance, a mixture of clilorinated hydrocarbons pioduccd chemically by chlorination of naphthalene and diphenyl. This material rijncorpoi.atcd into electrical cables designed for specific purpose on naval vessels. . V. } ? rieky, L.: Die Pernakratifchoit (Chloractie), ICIin. Wchrtschr. 6:845 and 897, 1927. n i t 1, 1il1 UlltllailIb K .; Oppenhcim, M., and Rifle, J. H ,: Die Schadigun&cn dec Haut ttorch rut u,,d eewerbliehe Arbeit, Leipzig, Leopold Voss, 1926, pp. 303-243. , .m ARCHIVES' OR DERM ATOLOGY AM D SYPRILOLOGY -It is a clique and invaluable material, possessing many cssrmtw J ' qualities.. Extremely resistant to physical wear, ciim ic^corrosion r * t water) and wide range of changes in temperature, it is, in addition ^ `^g-seaafl.roof. I t strongly withstands heat J r i W Z l m S V ,y and S?CI electrical currents is extremely high. Under heat it has a point By varying the degree of chlorination, materials of d - tmy bc obtamed- -The hardness of the Halowax is directlv percentage of chlorination. -An. average composition i s ^ L f ^ naphthalene and: 80 percent hexachioronaphthalene to which , Y "Sh %V/ .,,,,iilpii Wit PMcit*, iSiufjter;, 1110'13' Pi Peutitchlor^ :M fi c1 cent chlorinated diphenyl may be added. l i s S 2 , , i t e I M I I , content of approximately 60.per cent. The content may be adh " S m * f * * 1on work Halowax is principally used in insulating wire for system*; of ifto>tv,, - ' and for the deGausse system of rendering ships electrically neutral Tmun,ca^0l> mmes. When in operation, a constant electric current o f I S ltly)- -passing through cables strung through the ^ :,s;- i , nr) as it wa i `'life :of tea T 1 1ritirs ." , 7 1 -. acim g a s a- u u x , effectively -counteract In ,,,,1 the electric currents -generated J iv the mvriaA of JL, ,* .s and neuj . . . les and lai ^ * * * * TM denl ^ ? * * * > * <* a * b p a t ' ^ i m S u , i 5 * 5 -The cables themselves are relatively flexihlp - Tti-., ,, , , , / -. . diameter, is about 3 inches f 7 q \ n ,/ t, iai .covered- H approximate copperW Kach b u n d le iTM d w ithW i nS1StS f individua! t i d i e s of bundle is -then m t e d w h ? aiT aX ^ p re g n a te d into asbestos. The outer layer of rubberized fa b r i^ Tin? l a ^ 3" 6' SurroTMdin this is woven an incorporating-`several snch h ai ^ 11s. l_ayer> m turn, has a rayon cover. Bv : f,.cd.- Naval ahd cittgo v e r i a r e r S i h rse d Gwsse < 7 . Ttt.srJptic 'tij been note< ,! --oUlijowax hq iiltoous slijf '.ten j'decirjc 'fesedf the c ns lost, becau rw, iniltained t rsh, they i Sit ftf Woinc'i T " * ? " ? a,taChi"S l"W ,hc *<* ` i h l 0f '*m B * for several TM*e,: H exposed. In this process fraiTM lwa^' drmoved and the bare copper strands emitted. A d f s' S t d At K S " "T ^ f * ^ er' " f ' -ri|lfe; bundle ends to effect connections il iv ^ ' ^ n,ccessary to heat the caWe a,,d wniid are exposed to tlie fums that m, ! acIdltlon the dust itself, the electricians .. is strung along the hull of the w he .SCncratcd by-the, heat. Because the wire -work-are necessarily-dose and c o n f i n T l ^ ^ TM ^ 10"''the spaces ***** the !TM" ` tttllff " T hescnr.w ` confined Ventilation is extrem ely difficult. ` who, for the'most enartl I1S-P^eV^0,1S^ reported w.ere observed among ;workers derrived frromm cruudde ltar /i hwr le6 ei,1l^Sa-.Secdi kinl bhuanddling thhe chlorinated naphhtthhaalenes ra 1hi1... .. tar (tar camphor, uanhthalpm '*.,,ut,,-*- * * u ) </cr , hn,v). dr hot state or when tUhpP'!J, t , "tl/,c Ppliasticizxi,ntg materials, usually in a imnoolltteini electrical appa0rat'uvs,lt(n`sutchhe Lpr,0oCdu^ct tthUu1sS oolbjtha.ihllwt'di was` m....e.il,t.e,.d.5 Landj .v.Ia-r.i,o..:u.s. kinds, of' insulation, - - COndcnsers and coils) .were dipped into^.it.fdr-seciiring finished product f o r 11fd:iserved was in electricians;-handling the cokh to: any funres so generaw i--> riirely was heat used, and the. exposure- ... . o generated was.shght. The latest method of connecting the wire- GOOD-PENSKY--HALOWAX ACNE 253 ijcally eliminates the use of solder and heat. An ingenious lug is used that finnly and securely attaches the wire to the points desired purely by mechanical friction and pressure. - Admirable descriptions of the lesions seen have been those reported by the American writers Schwartz,23* Mayers and Silverberg,8 and Sulzberger* and the -'Hiitish writer Thelwell Jones.0 Schwartz's detailed study and report published in 1936 clearly establishes his priority on this subject. It was the first to appear in the American literature. In his cases the rash was encountered both.dn workers handling the hot molten materia), being thus exposed to the fumes, and in persons working with the cold electric wire and cable, Mayers and Silverberg's study was based on workers engaged in the manufacture of electrical condensers. Thelwell Tones0 observed the eruptions appearing in workers handling the crude naphthalene (tar) as it was chemically processed for use in industry. .In.both reports high degrees of temperature were involved and the concentration of fumes that the workers were exposed to was relatively high as compared with the present series. These writers described a variety of lesions.. Mayers and Silverberg conveniently classified them into three main groups: (1 ) acncform eruptions with pustules, -papules and large comedos; (2 ) vesiculoerythernatous eruptions usually observed in dermatitis venenata; (3 ) simple erythematous .eruptions with pruritus, .. The eruption to be described and with which-tie present study is concerned has been noted by these previous .writers. With-.the onset o f .present world. ; hostilities shipbuilding construction expanded .enormously, : Considerable amounts, of Kalowax began to be used, and Halowax acne or "cable rash" began to appear : in various shipyards. A s a result, Tenewed interest in the problem has arisen. Marine electricians: began to consult physicians not only, for the rash itself, but "because of the disability produced. Time vital for the production of critical material - was lost, because skilled electricians were obliged to do other .kinds of work and new, untrained workers taught to do the work. When other-workers .learned of the rash, they were deterred from, handling the cable. With the increasing employ - ment of women in defense industries, the situation may. be further complicated. INCIDENCE Piactically all workers in the department handling such cable tended to acquire varying degrees of "cable rash." The onset dated from a preliminary latent period of a few weeks to several months.. The elements of hot .weather, and perspiration seemed to be definite predisposing factors., Many workers engaged.in. the. late fall or winter did not begin to acquire any considerable number of lesions or have symptoms until the following spring and summer. Individual differences as to . texture and coloring of the skin produced no appreciable variations as to.. 2. Schwartz, L.: Dermatitis from Synthetic. Resins and W a x e s , ' H e a l t h . .1936; Skin Hazards in American, Industry,: l-*art. II, PjibltcHeaith Bulletin 229> VnN States'Treasury Department, Public Health Service, 19 36 ;. An Outbreak of Halowax Acne.("Cable Rash") Among Electricians, J. A. M. A. 122:158 (May 15) 1943. 3. Mayers, M. R,, and Silverberg, M. G .: Skin Conditions Resulting from Exposure to terlain Chlorinated Hydrocarbons, J. Indust. Hyg. & Toxicol. 20:241, 1938; Effect upon Skin Due to Exposure to Some Chlorinated Hydrocarbons, Indust. Ball. New York State Dept, cabor, August 1938, p. 361; Effect upon Skin Due to Exposure to Some Chlorinated Hydro- Qrbons, Indust. Bull., New York State Dept. Labor, September 1938, p. 425. . - AJmlzberger, M. B.; Rostenberg. A,, Jr., and Slier, J. ).: Acneform Eruption, New wik State J. Med. 34:899, 1934. : ./ ............... - . : : . v . 5. Jones, A. T.: The Etiology of Acne with Special Reference to Acneof Octupational J-mgi, J, Indust. Hyg. & Toxicol. 23:290, 1941. . 1 ss fel S-' iiSll'S'rsfSS uf Wmmmmi' v*-i'wi "s a*%'&V: : I' m, jgy|!: kljl mM%mm# Kfl Ills 254 ARCHIVES OF DERMATOLOGY AND SYPHLOLQ& susceptibility ,tq-the-,development of the. eruption. Dry and oilv c<i i " well as diverse types of skins were included in the various n a t i o n a l S " * m the survey. All the workers were anon 1 he age group e lu d e d 2 S 63 years. In a few cases the workers' wives had'a slight ernnHTM, . . ,8to their husbands', probably from contact with work clothes and F,-Jn f 5e"lb,it|S shirts and underwear. . . . ilom l.iujndering Tatch tests were of no value in anticipating p e r s o n s ' . "cable rash." - This observation has been consistentlyreported - writers.' DESCRIPTION OF THE CUTANEOUS I-ESIONS . . Iri addition' to the usual acuminate papules which result- front the iuerin ' plugging, .of the hair follicles and the orifices of the sebaceous gland? -fflici V * -wllich become secondarily infected to form pustules, furuncles aiid1abscesses' follicular, hyperplasia of the sebaceous glands of the skin'of the faiT onaus. lal : .'black comedos appear in the follicular orifices as a result of" the ctivjlty 6f the S 1V ".At timethese cysts arc Iai'Se enough'.to suggest m'ilia; - like lesions are found in almost countless numbers: on the. exposed portions o % body, especially on-the face-and forearms. ' In many Gaseslless^umefbus sitnilar . lesions were found scattered on the arms; torso/apd-legs;;. The most ireqiienfsi where lesions were found on all patients and in greatest amounts were on the skin over the malar eminences, the circumorbital areas, the margins of the'lobesof ttr ' ^ ad the mastoid regions. Frequently-they extended '.into'the' hiurllfe aniifo the scalp, - The eyelids and bps were devoid of lesions/' The skin Chh-fo&w-' :rareljt affected and'presented' relatively few lesions. ; Th dorsa.oh'the fingWs were ,fregi^fitly.involved, as were the forearms. ' - ' -''v- - - . -- sym ptom s ' ' .-4 .1? ' ! ' v ? ^ie. lemons described,,sey-efe, -persistent, nd.Iat-tim;.q}iii5t nit.fctabr pruritus at the sites affected.was a ,common eompint.h^Th'prhpte. .^as.,m9st -noticeable in tirse workers .who had-. ;superimposed-'or e'Qmplicsitmg dermatitis in addition to the purely acneform lesions. Occasionally it was severe .require: use of- a -,sedative to secure..sleep. ''Efeatf. aggravated fhc symptoms. Burning and soreness of the eyes ("bloodshot") were a frequent complaint.. Many of the men were' engaged in electric work in close -.prbgirfiity to eleqtric welders, and flashes from the .oxyacetyl.ene hureAhy,have fl1'* $ymjttom, There were considerable dust and nietailidpSdicics'in tne Holds of the ships where the.men were laying cable'. - , :V'- ; Lassitude was the next and most common complaint. It was felt that the long hours, often an average of ten a day, togethet with the time required in traveling to and from work contributed to the fatigue of the men. Also many workers had eeti recruited ^from ordinary peacetime positions,' often sedentary,' and were *hoi;t.`tensive training courses. Ventilation to an adequafe .. wa?;impossible; . . - - . .-. occabioiia)1y noted were anorexia, nausea, heaUachcsrvague Hfifr.-f*' "^w313, .^Pdtonce, loss of weight, insomnia, alopecia and. dlltfen# i* taste. Jaundice was never observed. - . . . . /d .-JAV - ' . survey widespread publicity in.'the press J o ; a: s . r . a l i . joj Ihc number ^ i" 3 P1ocessn"ig the cable occurred. This factor definitely inorenstd uic nuimier aud variety of complaints. .- , '.. - jQGy Am SY^ipiM^3 1 Cl u p tio n . D r y i d o a y ^ ' deci hi the various n.( H i e a g c g r o ^ t e ^ * w m s had a slight frnpm,, ^ <.P`dulh j, <?H \ N im |i ,, 11 " ' ^ ta tly -,pQr;e, |jy. 4 J pules which result'frai % es of the schaceoys*^M i4v m pustules,-f m if , ' ds of the -dun ot the rc .n ur hj ifices as a result ofhe'hity cf^ Jugh to suggest milk "These'm is numbers is. In many cases hW-innie orso and legs, 'T h^f||ff id in greatest aipoutsv^un.ine^ il areas, the margftfo{5f>k'ife they extended into theMri 1 1 d of lesions. "The slfiuoi uim^w lesions. The doreaholther| hgtrw iMS ' ' eveie, persist^ .s a common complainirTiprii^ i had a i.-jpr. imposti or ''Uipli* m lesions, Occas.onaiy' it sai sa m(,;])(' sh'ip. H u 1 and p'f'.pirlm reness of th i^s" (''fclobl^l^ 'Cie engagd in elcctnc-'Work un the oxyacetyfpn hutnin irle i itile dusl sud ineialklW*1 ^ aymg cable - i complaint Ir was fe!; |jifl :r with th .lime requirenti' of the men A's n a' ' 11 osttions, often sedentary, s. Ventilation to ah'at anorexia^ nausea, tisomma, alopecia and^isftr^ ' " ' Mi r i the p ie ss to a ; ^ ' ^ ed , r,hi'> factor d"iii 'tel; '* am j Fig. 1.--Hatowax dermatitis. g o o d - p e n s k y --h a l o w a x a c n e 255 SYSTEMIC INVOLVEMENT : :. Mam m s A series of patients with extensive cutaneous involvement Were studied for possible systemic effects. In addition to clinical examination's, including dluoro^ ' topic study, tests for hepatic function and impairment were included. Complete hematologic studies were made. No evidence of any visceral effect was obtained i'that could be ascribed to exposure to the chlorinated naphthalene and diphenyls. 'Particular attention was given to the possibility of hepatic damage (atrophy): and anemia suggesting the aplastic variety. No relation with' "cable: rash": \vith any internal disturbance was disovered. ' . w:' : . ............... . d u r a t io n ok t h e k r u p t io n ; H B BL r iff? mm : I -W B iS S I mm m m A m Sm ir iiis i >* - :- I l W Ph iPi sSiakisi As. long as many of the electricians continued working with Halovvax cable, .the eruption, persisted and even extended in some instances. With the onset of. colder weather, the institution of preventive measures described later and aggressive - local therapy, many were able to continue at their work.and a decided amelioration, of symptoms was effected. The eruption itself was improved in many in this group, sI a minority of the patients the eruption persisted for as long as; one and one-half:- years after treatment and total freedom from exposure. These patients arc still being observed. . ; ' therapy - ` ?; , In addition to prophylaxis many measures were used to relieve symptoms and improve the eruption. These included: various keratolytic agents, such as sulfur and salicylic acid, and antiseptics, such as resorcinol, sulfonamide compounds, ammoniated mercury and icththammol. These were used in various ointment ;and liquid bases. Emulsions of both oil in water and water in oil types were used. The ointment bases included those ordinarily used; together with several of the more?recent types incorporating wetting agents. Various soaps :containing, sub stances conceivably indicated for controlling and improving the. eruption were tried. Among these were proprietary "antiseptic" and "germicidal" soaps commonly found on the market; soaps containing pumice, marble and sulfur were also included. Various sulfonated. oils were tried. Soaps.containing:trisodium, mctar- pliosphate..were at times of value as detergents. Morris' recently suggested cleansing mixture incorporating oleic.acid and butyl stearate has not had sufficient Itial::A few related formulas were found of some value. Those consisted of 45 . per cent sulfonated neat's foot oil, 45 per cent light liquid petrolatum and 10 per cent of a solution of gelatin (1 part of gelatin in.4 parts.of?water; 1 part .of this preparation was added to l ] k parts of white granulated eorn meal,,with a .trace... ;;$ 0,5 per cent chlorobutanol as a preservative).;:. Another detergent used consisted Of.sulfonated castor'oil with a of 7.2, and containing 50 per cent, of- oil-content, .. together with 2 per cent of a wetting agent (aerosol OT dry, the.-.cjioctyl ester of sodiutn sulfosuccinate in 99 to 100 per cent concentration). . . .. . -'i?1' patients with acute dermatitis wet compresses; of commonly used medical... a>onts were used to allay the symptoms. These iiiclttded isotonic solution, of sodium chloride, 3 per cent solution of boric acid, hot magnesium: sulfate: solution).splutipn 5;,boric acid and salicylic acid (Thiersch's; sohition):, alid.solution.of .aluminum acetate (Burow's solution) 1: 20 to 1:10. Solution of sulfurated lime (Vlemiuckx' hhqn) :in varying concentration was found ineffectual, and irritating.- Sodium, `sxainetaphosphate in 1 per cent concentration seems to merit further trial. Aoentgon and ultraviolet therapy in careful dosages were of ;distinct value m oroving symptoms and accelerating the restoration of a clearer skim . Solid Ambon u Kl !i ffeitfenffipft tff&1** ' i Tssssfa 'f-b3S J PI -. -^g mm .ri-'^.^W; g=?'^ SS JUi r'5 $ id yP"^ r ^ i| m$A , J K# ' S jSp3l *K9E '% S| ......... 3TsSSi2li',".^J*^ i. i- i s mm # s'SSl a il pwajl ^gj lHf&c^gp I1, : tji iilf 2S6 ARCH IVES OP D E R M A T O LO G Y AN D SYPU lLO L0Gy : P ^ 4% dioxide seemed occasionally beneficial. Attempts at removst nf , : "- >plugs by adhesive tape left on for varying periods were futile Vs - W ^ l i o aiKl stock, had no demonstrable value. Mechanical icmov-d o f '^ follicles by use of a comedo extractor or by facial m a s s if I,,, ` PiugM;$tV Os*born. e ccaljled attientio*n to the fact thatLt "Lthuec. hs ui Jusatann/cioss mi n. ^ l T T k ssoollvents,,,.fixed in the tissue by lipids.. HH e sugmge*ste.d! t,ha*t a T 1,lhJtk 1r<' M l be- of value m eliminating these substances and'possibly as v nr' *c' ^ ' Unfortunately, there has not been the opportunity for pursuing t S J ] ^ ' y S # ; ' ' ' . PROPHVLACTIC MEASURES 1 - _ In order to prevent the development of "cable rash'' a,, r V ' symptoms in persons already affected, no expense was snared L , !,** tf?- -to,reduce ,the concentration .of Halowax in the workers' 1 ?liped effo&' At the same .time measures to promote rigid cleanliness of the skin w e r e h s t S These ;.prev.eentive measures included' ventilatiSne Tm, nK...... . l l W 1 ' frequent :change .of clothing, both work clothes and underwear i n d i v S t 7 ' an4 adequate facilita for securing and opportunities to secure L thorough c l ' of . he skm during the; work .day. Frequent changes of clothing were s L 7 7 iti watei.;\vas provided, and the employees were-given an oDnortimitv ^ V 'ui increet .^(arfuttil aie ijistovere ''An valua: VarirmsWertb Vh 011 tlie conil)any's time. Coverall work dfonns w e n f S j X ^ Protective qreams,were furnished to the workers, and they were inffrifM-'-' dry ayi bme of W Und Wheni USe them- -*'*?cse ctearns wcrc u s e d a io iic U l- !The chrn ^ S S a r S ^ r 'l Wlth i f " ' Tfie sulfonated.pils grtmcKoJ-i S t;,W1 ' ? h " ? for S0?P- The val"a of such creams has not^bcE-;*y-:-;-jiie.ci)oisi;a ofhTnr r demonstrated as a preventive measure as yet. Use of cove)alls an<p-: i isoblie fj contnmed eCItVh C*?th,nf dev.lcf ' surh as facp TM $ k s, sleeves and iiousers/is bcutg HtyyE D. I and*that th W o r k e d tiiat they ,ncreasc " -'anjount ohheat and pctspitsi^-. the c o n r iitil Tk d ,n C0P erate m u sin & them . They ^ e m also to'avals fssi Piti] ca^olivdrafe' -.fldpargVdscs.-oi *he pntlre .vitamin B. oerpiexirf * loss of salts w i p t ^ a j ,lnt,a^C ^ L"cs ancl in gestion of saline tablets to combat `excessive use of slm ^ V 0 7 oiuvalue in controlling symptoms due to fatigue. Hie , xspiye use;of alpohol and tobacco was discouraged. ' ''. : . Sbiyii'w7SS1T r 'U1^'ini5i ^ attac^ problem is th ingenious suggestion of-. P I S bm LtlsS# U :!^ - Because f t ^ KCHAITSM- of. ? uoi>u c t io n o p ' l e s io n s ' . -P^vijj;bflprsile .ti5h mC17 nCp of IIalowax dermatitis among a relativelyiaif vjesiulav;dermatitis os .re^itlts of patch tests. and- the absence:'of.id#". - 'ii.niiceiissai'v to hs^nn 'C^ s ,n contact irritations at the site of exposui?rit.s?PiF 3 ^eve!Pment 0f hjfpersensitivity to -the wax,, Ea.tlicr, * . 6- Osbornc.-K n -i'n-- y<-Hern)auuj1.-:ifi .. SidzberwV to the authors... .- " - - - w . ^UoQ%'p)nor98i4|lStovf|3)-Y4tl a"d Baer> -Nw-1EenettaHw-fVy*1* ^ ^ ; A- ^ u ^1 fiMLuri ,'' . : ; tws earet fructmilem.alyor,,f(nlllees-j,;' uilcal removal o'f't"W-" d*' gestecl tlia:. (i \,~v/ at. possibly as a ' p ^ V for pursuing >URES cable rash" aj\cl- iroiMSi ! was. spared .. __ vorkers', enviroftinetii^lS .Jiness of the skirt,3-1 ^ i' by blower atnl ex' pdi.Hijdei'we.ir, ii divic Lies to sea re a lieu. >es of clothing wi-e f ven an oppprtunit^.tb all: work 1.ituims wif^ vorkers,vain] they were w , lean >wen us'G t.ou: ie siilfnnatPi' vis jtiircnfolifl" t.oconffv-ssiuTr&li:-,ipcrYkahmiscnffl!'teiare as yet . , Use o|:x|ylg)|lJ iks, :sleeves astiBwinfef. to, rThey se^mlafsliipllip' i: B -compiek;.a stiouiofisaiine gsymptoms(1 ' ' 0 % ged. i is the ingenious -sjifg&W < ne 'chemical tieatfsto 0,ir. (lie v/>'i,,'is 11'ore tid Ir In uumponto'mns d c'ri'ip rd hi "Ii V i'd"'" wersof.-yenetfatio in. XJiis puberty n, f aftqi a i uisferred to eft enl o r w i i s*Shi matitis among'a $i -r tests and'tb ^ ,# e5fe^ L t the site of < * ^ 2 , isitmty to the wj GOOD-PENSKY--HALOWA X ACNE 257 primary irritation by the wax was believed to be the method, of production The explanation of this eruption offered by other investigators seems to be adequate and borne out by the elements involved being a foreign body reaction in the hair follicles and sebaceous glands due to the presence of these chlorinated naphthalenes This occurs from mechanical'plugging by the particles per .se and from the condensation of the fumes emitted by the waxes in the cable. Rubbing, scratching, perspiration and heat in the closed holds of ships were further predisposing factors' Schwartz and. Tulipari stated: that the fumes are not. decomposed nor do: they contain any free chlorine. They agree with other investigators that the chlorine radical itself has an irritating effect on the plugged follicle,. . . :.... , .: SUMMARY AND CONCI.URIONS Synthetic wax (Halowax). dermatitis is a common cutaneous hazard ni manne electricians handling certain types of electrical cables. An increasing number of employees with this dermatitis may be anticipated 3in.. the near future unless suitable and adequate substitutes for these synthetic waxes arc discovered or more effective means of prevention and therapy are-developed. An evaluation of various preventive measures is made. - * The probable mechanism of the production of these lesions is discussed. ' - The absence of systemic, visceral and hemopoietic involvement in handling the -cold",dry synthetic wax cable is noted. .. . '' :The chronicity of the eruption and its resistance to therapy- are emphasized, No evidence of internal absorption has been found in these cases The coopcralion ofthe following persons made this study possible: Col. L ,Schwartz, United States Public Health Service, and Drs. J. J. Brozdowski, j. Hcrradora, A. G. Cranch, J A Hookey, E. D. Osborne, G. E. Morris and M. B, Sulzberger. * 2 East Fifty-Fourth Street. 2167 Eighty-First Street, Brooklyn. ; / Ihors -, . I : Wev/' P . ARCHIVES OF DERMATOLOGY AND SYPHILOLOGT EDITORIAL BOARD HOW ARD FOX, Clrief Editor 140 E ast l-'lfty-F ou rtli Street, N ew York C. DENN Hi, Kansas City, Mo. HAROLD N. COLE. Cleveland tfiiBrnrOT OATTMlTfl Til FRED D. WEDMAN, Philadelphia GEORGE it- MacKEE, New York c>iiv AU7 llnelnn V o l u m e 48 1943 PU B LISH E R S AMERICAN M EDICAL ASSOCIATION CHICAGO. ILL.