Allergic contact dermatitis (ACD) continues to be a significant occupational and consumer health issue, with new cases emerging from both industrial and everyday exposures. Two recent case studies, 1 involving a pipe relining worker sensitized to acrylates and another involving nickel exposure from a cosmetic applicator, demonstrate how ACD arises in unexpected contexts.1-2 Recent research on titanium allergy further broadens the conversation, underscoring that even metals once thought biologically inert may pose underrecognized risks.3 Together, these findings provide timely lessons as Labor Day draws attention to worker and consumer safety.
Case 1: Acrylate Allergy in Pipe Relining
A 56-year-old technician with over a decade of experience in pipe relining developed recurrent facial erythema, eyelid edema, and vesicle formation shortly after his company transitioned from epoxy-based to acrylate-based resins. Researchers stated patch testing confirmed sensitization to multiple acrylates and methacrylates, and to epoxy resin at higher concentrations. Despite personal protective equipment, contamination of gloves and clothing led to repeated facial exposure.1
The presentation initially suggested type I hypersensitivity, according to the study, but the delayed onset of symptoms and strong patch test responses confirmed ACD. Ultimately, the severity of his reactions required sick leave and cessation of work. This case highlights the diagnostic complexity of occupational dermatitis and the rising relevance of acrylate allergy in industrial settings, particularly as acrylate-based systems become more widely adopted.
Case 2: Nickel in Cosmetic Applicators
A 41-year-old woman developed eyelid dermatitis after using an eye cream packaged with a metal applicator. While the cream itself tested negative, patch testing confirmed sensitization to nickel, and repeated open application testing implicated the applicator tip as the source. This novel route of exposure underscores how cosmetic packaging, not just product formulation, can trigger ACD.2
The case emphasizes gaps in regulatory oversight: while the EU Nickel Directive restricts nickel release in jewelry and accessories, cosmetic packaging remains largely unregulated. As metal applicators and rollers gain popularity, researchers behind the case study suggested clinicians should consider packaging materials as potential hidden allergens.
Emerging Evidence: Titanium Allergy
Titanium has long been considered a safe and biocompatible metal, widely used in aerospace, automotive, and medical industries. Titanium dioxide (TiO₂), its most common form, serves as a physical UV filter in sunscreens and cosmetics, and titanium alloys are the standard material in orthopedic and dental implants due to their strength, corrosion resistance, and ability to integrate with bone. It is also marketed as “hypoallergenic” in jewelry for patients with nickel allergy.3
Traditionally, titanium was considered non-allergenic, as TiO₂ does not penetrate skin or gastrointestinal barriers. However, emerging research demonstrates that titanium ions and salts released from corrosion products can activate immune responses. A recent retrospective study from Tel Aviv Sourasky Medical Centre evaluated 255 patients patch tested with a metal series between 2012 and 2024. Titanium oxalate hydrate elicited positive reactions in 5% of patients, while titanium nitride did not. Most sensitized patients were women, often with co-sensitization to nickel, cobalt, or vanadium.
Clinical presentations included localized dermatitis on the hands or face, but researchers noted 2 patients developed generalized rashes after implant placement, including 1 case of bullous pemphigoid following hip replacement surgery. These findings suggest titanium-induced sensitization may play a role in implant failure and systemic skin disorders, although the diagnosis remains controversial due to variability in patch test reagents and interpretation.
Skin Safety Across Work and Life
Together, these cases and research findings illustrate the evolving nature of ACD in both occupational and consumer settings. For workers, acrylates represent a growing hazard in industries adopting new resin systems, with contamination risks persisting even with protective equipment. For consumers, nickel in cosmetic packaging demonstrates that allergen exposure extends beyond workplace environments, often in ways overlooked by existing regulations. The titanium data highlight the need to remain cautious about materials assumed safe, particularly as medical device use expands worldwide.
On Labor Day, when worker protections and occupational health come into focus, these examples remind clinicians and policymakers alike that skin safety is integral to overall safety. Comprehensive patch testing, including patient-specific materials, remains the diagnostic gold standard, though additional methods such as lymphocyte transformation assays may provide adjunctive value. At the regulatory level, stronger oversight of both industrial and consumer materials could help prevent emerging sources of sensitization.
Conclusion
ACD reflects the intersection of industrial progress, consumer trends, and clinical vigilance. The relining worker’s acrylate allergy, the consumer’s nickel exposure from a cosmetic applicator, and the expanding evidence on titanium sensitization all demonstrate the wide range of risks modern workers and consumers face. As industries evolve and new products enter the market, clinicians must remain alert to novel sources of allergen exposure. Labor Day offers an important reminder that protecting skin health—whether in the workplace or at home—is essential to safeguarding overall well-being.
References
- Szumniak J, Dahlin J, Antelmi A. Occupational allergic contact dermatitis resembling angioedema induced by acrylates in a pipe relining worker. Contact Dermatitis. 2025. doi:10.1111/cod.70023
- Sukakul T, Dahlin J, Svedman C. Eyelid allergic contact dermatitis caused by nickel from a surprising source: An illustrating case of illuminating eye care. Contact Dermatitis. 2025. doi:10.1111/cod.70009
- Daniely D, Zemser-Werner V, Gilon-Omer R, Bar J, Slodownik D. Titanium: An unusual allergen With various presentations-A retrospective cohort study. Contact Dermatitis. Published online August 26, 2025. doi:10.1111/cod.70021