Diagnosis: Chromate Exposure
After noticing the circles, you take a more extensive work history and find that this patient works at an electroplating facility. You contact the employer, and learn that he has regular, unprotected contact with solutions containing chromates. The skin lesions are characteristic of skin exposure to chrome-containing materials.
Chromic acid and alkaline chromate are commonly encountered in the tanning and electroplating industries. These chemicals may be corrosive when they enter the skin through a minor wound or break in the skin. This exposure may result in the formation of chronic, ulcerative lesions known as “chrome holes.”
These chrome hole lesions are usually found on the fingers, hands, or forearms of exposed workers. “Chrome holes” also may occur on the dorsal surfaces of the feet if chrome-containing chemicals are allowed to permeate boots or shoes. Chrome-related lesions are usually painless, and may persist for up to several months. Healing occurs spontaneously and results in permanent atrophic scar formation. Identical skin lesions also may be associated with occupational exposure to arsenic or zinc salts, although these occur with less frequency than with chrome exposures.© 2002 Lippincott Williams & Wilkins, Inc.