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 exposure during marking periods of 1 to 2 days. Analysis of the paper did not identify the sensitizing agents or significant irritants. The problem was alleviated by spreading the task of marking papers over several days and frequent hand-washing during handling of the paper.

Menné and Hjorth 1985. Menné and Hjorth [1985] reported from Denmark that frictional trauma with CCP to the palms and fingertips can provoke dermatitis. Elimination of the exposure led to healing within 2 to 3 weeks. Three case histories of patients with frictional contact dermatitis were examined.

Case 1 involved a 35-year-old male office worker. Each day for 2 years, he had handled 100 to 200 documents written on CCP. He gradually developed a scaling patch of dermatitis on the left hypothenar, second finger, and tip of the right index finger at areas of contact with paper. Standard skin-patch tests and paper- and glue-patch tests were negative.

In Case 2, a 64-year-old female medical secretary spent long hours handling CCP. She had noted pruritic vesicles on the left palm surface of the thumb that was in contact with the paper. Eruptions decreased when she wore gloves. Standard skin-patch tests and patch tests to the carbonless paper were negative.

In Case 3, a 37-year-old male bus driver had a fissured eczema of the fingertips, apparently caused by tearing CCP tickets from the stub. The eczema cleared during holidays and on night shifts when there were fewer passengers. Standard skin-patch tests and patch tests with the ticket paper were negative. The histopathology of this type of dermatitis was characteristic, showing necrosis of prickle cells with intraepidermal vesicles and an absence of spongiosis, which excludes a diagnosis of chemical dermatitis. The authors concluded that in patients with dermatitis of the palm or fingertips, frictional trauma should be considered.

Olsen and Mørck 1985. See Section 4.2.3.2 for a discussion of this study.

Apol and Thoburn 1986. Apol and Thoburn [1986] reported on an investigation requested by an authorized representative of the Association of Western Pulp and Paper Workers in the United States. They examined employee exposure to diethylenetriamine (DETA), hexamethylene diisocyanate (HMDI), and other chemicals used during the production of CCP at the Boise Cascade facility in Vancouver, Washington. This facility makes paper from pulp and applies CCP coatings to the paper. Personal breathing zone samples and area samples were collected to determine worker exposures to chemicals used by the coater preparation operators, coating operators, and maintenance personnel. The airborne concentrations were as follows: HMDI (<0.7 to 14.0 μg/m³, DETA (<0.01 to <0.35 part per million [ppm]), phenol (<0.02 to 0.15 ppm), formaldehyde (<0.04 to <0.08 ppm), biphenyl (0.003 to <0.02 ppm), butyl biphenyl (0.12 to 0.29 ppm), petroleum solvents (0.7 to 12 mg/m³), and total particulate (one sample was 2.70 mg/m³). All the sample results were less than the regulatory limits for these substances. Symptoms reported as a result of exposure included voice change, cough (sometimes productive), tightness and soreness in the chest, running sinuses, and skin rashes.

Medical interviews with 65 employees suggested that when the process was operating properly, few (number unspecified) health complaints were associated with the coating process. The maintenance workers had symptoms associated with exposure to the coating equipment, with the HMDI equipment reportedly being the worst offender. Four workers reported pulmonary symptoms consistent with exposure to diisocyanates. Breathing