Occupationa/ alopecia 
Case report 
OCCUPATIONAL ALOPECIA IN V ARIOUS WORKERS 
AFTER EXPOSURE TO CHEMICAL AGENTS. 
C. Frati, B. Bevilacqua, M.O. Battisti and G. Pizzutelli 
ABSTRACT 
It is pointed out that the importance of professional alopecia may sometimes be underestimated. Different types of professional 
alopecia depending on the causal agent are distinguished: physical, chemical, biological, and phaimacological. In 48 out of 51 
patients we found no professional aetiology. On the contrary, in 3 out of 51 patients we were able to detect an exogenous 
professional agent causing alopecia. The agents involved in our 3 cases of professional alopecia were: boric acid salts, thallium 
salts, and colchicine. In ali 3 patients there was no evidence of inflammatory lesions, telangectasia or scars. The complete 
resolution of the disease after removing the specific causal agent confirmed an exogenous aetiology. Treatment with cystine 
seems to have been beneficial. 
KEYWORDS 
occupational alopecia, boric acid, thallium salts, colchicine, cystine 
INTRODUCTION 
Alopecia indicates a pathological absence of hair in a 
restricted area, but this term is used also to illustrate a mild 
and widespreadreduction ofhair (1). We wouldliketo point 
124 
out that the importance of professional alopecia is sometimes 
underestimated. 
Professional alopecia can be grouped, depending on the 
acta dermatovenerologica A.P.A. Vol 2, 93, No 4 
Occupational alopecia 
causal agent, into: physical (trauma, bums, radiations); 
chemical (thallium, boric acid, chloroprene); biological 
(tubercolosis, tinea); and pharmacological (antimetabolites, 
anticoagulants) (2). 
Traumatic alopeciais due to a physical traumaon the scalp. 
Severa! authors described traumatic alopecia caused by caps 
or strings wom over long periods at work (3). 
Burns may be responsiblefor cicatricial alopecia, especially 
in: radiologists, surgeons, orthopaedists, dentists, and 
radiology technicians due to exposition over long periods to 
small doses of radiation without sufficient protection. These 
radiations can damage the germinative Iayer of epidermis 
and cause a dilatation of blood vessels in dermis with release 
of histamine that provokes erythema (4). 
Several chemical agents may be involved in professional 
alopecia (5) . Thallium is one ofthemost irnportant. It is used 
inglass and optical (lens) industries, fireworks manufacturing, 
preparation of phosphorescent paints, insecticides, and the 
like. Alopecia develops after 3 to 4 months in patches but it 
may suddenly become widespread if large quantities of 
thallium are ingested (6). Boric acid is utilized in several 
industries: glass, nuclear, textile and pharmaceuticals. It is 
also used as a bleaching agent. Persons exposed to this 
chemical may gradually develop widespread alopecia (7). 
Chloroprene is a colourless Iiquid used in the manufacture 
of tyres, carry ribbons, waterproof products, as well as of 
brake linings, welding machine tu bes, etc. Chloroprene may 
provoke a gradually developing widespread reversible 
alopecia (7) . Biological agents may occasionally cause a 
professional alopecia in medical personnel, e.g . doctors, 
nurses, technicians who are exposed to infections like 
tuberculosis or tinea (8). 
Antimetabolites like colchicine may produce a widespread 
pharmacological alopecia. Colchicine is an antirnitotic drug 
contained in lily bulbs, so professional exposure is possible, 
especially in florists (9). 
Anticoagulants, like coumarin, contained in rat pesticides, 
can develop a widespread alopecia 2 months after exposure 
(9). 
The airn of this report isto discuss "professional alopecia" 
among patients with hair loss. 
MA TERIALS AND METHODS 
In our service we observed 51 subjects frorn 11 to 72-year-
old , of whorn 27 were wornen affected by alopecia 
(androgenetic alopecia and kerion celsi were previously 
acta dermatovenerologica AP.A. Vol 2, 93, No 4 
excluded). All patients were submitted to a questionnaire 
with the airn of detecting endogenous and exogenous causal 
agents. 
Laboratory tests and clinical examinations to evidence the 
anagen/telogen ratio were performed. 
RESULTS 
In 48 subjects we found no professional aetiology. In these 
patients severa! agents were irnplicated to determine alopecia: 
in 12 stress, in 10 drugs, in 5 endocrine diseases, in 5 
seborrhea of the scalp, in 4 autoirnrnune diseases, in 2 iron 
deficiency, in 2 sudden loss of weight, in 2 trichotillornania, 
in 2 cosmetics, in 1 insect bite, in 1 anorexia, in 1 dornestic 
bum, and in 1 tinea. 
In 3 out of 51 patients we were able to find an exogenous 
professional agent which provoked alopecia. 
CASEI 
A 40-year-old man, in good condition, with normal 
alirnentary habits, not a drug user, was a worker in 
pharmaceutical industry during five years. A container of 
boric acid salts broke accidentally so that the worker's vertex 
of the scalp became exposed to a Iarge quantity of this 
substance. The patient developed an acute intoxication with 
headache and rnyalgia resolving in a few days. After a short 
period he noticed a widespread alopecia and consulted our 
service. The clinical examination revealed a gradually 
spreading alopecia of the vertex area and an anagen hair type 
of alopecia. The patient was removed frorn his job and in a 
few rnonths a cornplete regrowth of his hair took place. 
CASE2 
A 34-year-old man, a farrner, arrived to our observation 1 
month after the occunence of alopecia. The anamnestic data 
disclosed the use ofpesticides containing several substances 
capable of developing alopecia. An interesting finding was 
the elevated concentration of thalliurn salts in 24-hour urine 
(0.9 mg). Alopecia was evident on the scalp and the anns. 
CASE3 
A 35-year-old man, in good condition, with normal 
alimentary habits, not a drug user, was a worker in a flower 
garden. His duty was to pick, pack and water flowers. While 
working in shorts he fell accidentall y ona Iarge amount of lily 
bulbs so that his limbs came into contact with them. After 
about one month he developed an acute and widespread 
alopecia of the limbs. It is relevant to note that lily bulbs 
contain large quantities of colchicine, an antirnitotic agent 
capable of causing alopecia. 
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Occupationa/ alopecia 
DISCUSSION 
The authors' observations support the data of other authors 
who noticed that alopecia is a disease implicating numerous 
other factors in addition to the constitutional predisposition 
and heredity. 
In 3 out of 51 patients an exogenous agent was evidently 
the reason of hair loss. Laboratory tests and anamnestic 
examination revealed no other factor that might have been 
responsible for alopecia. All 3 patients had an anagen type of 
alopecia, and there was no evidence of inflan1111atory lesions, 
teleangectasiaorscars. Acompleteresolution ofthe symptoms 
following the patients' removal from contact with causative 
agents confirmed the involvement of anexogenous substance. 
It is interesting to note that case 3 had been previously 
affected by gout and treated with colchicine which fact 
contributed to the development of alopecia. 
In ali 3 patients, when kept away from the substance 
involved and treated with cystine, the symptoms disappeared 
as described previously (12-13) . 
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AUTHORS' ADDRESSES 
126 
Corrado Frati M.D. professor and chairman, Department of dermatology Frosinone Hospital 
Viale Mazzini 03100 Frosinone. Italy 
Leonardo Bevilacqua M.D. Department of occupational medicine, University "La Sapienza" Rome 
Piazzale Aldo Moro 00100 Rome. Italy 
Maria Gabriella Battisti M.D. same address. 
acta dermatovenerologica A.P.A. Vol 2. 93, No 4