|Year : 2020 | Volume
| Issue : 4 | Page : 256-257
Fiberglass (glass wool) dermatitis: Rapid diagnoses using simple polarized microscope
Connie Liu1, Mei-Ju Ko2, Ruey-Yi Lin1, Meng-Sui Lee3
1 Department of Dermatology, Taipei City Hospital, Taipei, Taiwan
2 Department of Dermatology, Taipei City Hospital; Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
3 Department of Dermatology, Taipei City Hospital; Department of Dermatology, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
|Date of Submission||15-Nov-2018|
|Date of Decision||19-Sep-2019|
|Date of Acceptance||18-Jun-2020|
|Date of Web Publication||16-Dec-2020|
Dr. Meng-Sui Lee
Department of Dermatology, Taipei City Hospital, 33, Section 2, Zhonghua Road, Taipei 100
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Liu C, Ko MJ, Lin RY, Lee MS. Fiberglass (glass wool) dermatitis: Rapid diagnoses using simple polarized microscope. Dermatol Sin 2020;38:256-7
A 59-year-old man who has been working in the glass wool industry for decades presented with painful eruptions over the left neck, shoulder, and upper back lasting for several days. Examination revealed multiple well-defined, variously-sized, red, mildly oozing macules, and patches with crusty scales on the left neck and upper shoulder [Figure 1]a and [Figure 1]b. Microscopically, tape stripping from the lesional skin showed birefringent foreign fibers under polarized light [Figure 2]a and [Figure 2]b. The diagnosis of fiberglass contact dermatitis was made, and the patient was advised to wear clothes that fully cover his skin when at his workplace. This patient showed good clinical response over the following 2 weeks with oral levocetirizine (5 mg daily), acetaminophen (500 mg thrice daily), prednisolone (5 mg thrice daily), and topical steroids.
|Figure 1: Splash-like, red, mildly oozing macules, and patches with crusty scales on the left neck and upper shoulder of a 59-year-old man (a) Close-up view (b)|
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|Figure 2: Specimens obtained from tape stripping of the lesional skin. Birefringence was noted when adjusted the rotatable polarizer (a,b)|
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Fiberglass dermatitis is one of the most common occupational dermatoses. It was originally described by Sulzberger in 1942. The terms glass fiber, and fiberglass are often used interchangeably. Glass fiber is a material containing silicon along with a number of other constituents and can be roughly divided into two genres, continuous glass filaments and glass wool. Glass wool differs from continuous glass filaments in physical characteristics.
There are many reports in the literature of occupation-related continuous glass filaments dermatitis in people who work in plastic reinforcement plants, scrap yards, and in electronics plants (handling printed circuit boards)., Glass wool differs from continuous glass filaments in that it is manufactured in combination with glue to create many small air pockets, creating its characteristic insulating properties . It is widely used as a thermal insulating material. Cases of occupation-related dermatitis from exposure to glass wool have also been reported in the literature, although much less frequently than fiberglass exposure. In the construction industry, the prevalence of occupation-related glass wool dermatitis can be as high as 61%.
The glass fibers are amorphous in structure but break very easily, and they can penetrate and remain in the cornified layer of the skin on contact or through occupational exposure, leading to irritant contact dermatitis., Studies have shown that the irritability is directly proportional to the diameter and inversely proportional to the length of these fiber fragments. Clinically, glass fiber causes pruritus at the exposure sites, followed by painful linear excoriation or erosion from scratching. Without a detailed exposure history, fiberglass dermatitis may clinically resemble scabies, eczematous dermatitis, folliculitis, or urticaria.
Due to the well-known birefringent property of glass fiber, fiberglass dermatitis can be easily diagnosed with a detailed exposure history and a positive skin stripping examination using a simple polarized light microscope. It has also been reportedly diagnosed using skin biopsy and scanning electron microscope., However, skin stripping and polarized light microscope examination is a more accessible, cost-effective, and non-invasive procedure and is thus preferred by experienced clinicians.
The patient in our report works in a glass wool blanket factory, and was exposed to a superfine type of glass wool, with a fiber diameter of 5–10 μm, according to the manufacturer. The various types of glass fiber products are made using different components, and therefore, the morphology and pattern of the polarized glass fibers may differ between products. We compared the morphology pattern of the fibers obtained from both the lesion site and the glass wool factory under a polarized microscope, and found identical bipolarized fibers with a diameter of 5–10μm.
We wondered why the patient had never experienced similar episodes before, despite having worked in the glass wool industry for decades. The patient mentioned that he had been wearing fully protective clothing at his workplace for decades, but he had recently lost the button of his polo shirt, leaving the area of skin where the lesion was located exposed. We noticed that the polo shirt had buttons on the right hand side, making it possible to expose the skin on the left side skin when the button was lost. The positive tape stripping result was only obtained from the lesional skin. Samples from other uninvolved skin areas did not contain glass fibers. In order to prevent this occupational disease, proper protective clothing is essential.
In conclusion, physicians should pay highly attention to itchy skin rash on exposure site, especially among workers engaged in the construction industry, insulation-related industry, and electronics factory or who else had related contact history. With a simple skin-stripping exam, fiberglass dermatitis can be quickly diagnosed by simple polarized microscope.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]