Non-infectious dermatologic Non-infectious dermatologic diseases associated with diseases associated with

chronic exposure to mining chronic exposure to mining tailings in a Peruvian tailings in a Peruvian

communitycommunity Willy RamosWilly Ramos11, Carlos Galarza, Carlos Galarza11, Gerardo Ronceros, Gerardo Ronceros11, Ferdinand de , Ferdinand de

AmatAmat11, Maria Teran, Maria Teran11 and and Alex G Ortega-LoayzaAlex G Ortega-Loayza1,21,2. .

1 1 Instituto de Investigaciones Clínicas de la Universidad Nacional Instituto de Investigaciones Clínicas de la Universidad Nacional Mayor de San Marcos, Hospital Nacional Dos de Mayo, Lima-Mayor de San Marcos, Hospital Nacional Dos de Mayo, Lima-

Peru.Peru.2 2 Department of Medicine, University of North Carolina at Chapel Hill, Department of Medicine, University of North Carolina at Chapel Hill,

USAUSA

INTRODUCTIONINTRODUCTION

What are mining tailings? What are mining tailings? Metallic wastes containing mercury, arsenic, lead and Metallic wastes containing mercury, arsenic, lead and

cadmium which are deposited into the environment due cadmium which are deposited into the environment due to mining activity. to mining activity.

FIGURES 1 and 2FIGURES 1 and 2: : Mining tailings in the exposed population, located Mining tailings in the exposed population, located near agricultural areas.near agricultural areas.

Mining contributes heavily to the Peruvian Mining contributes heavily to the Peruvian economy, and may result in the deposit of economy, and may result in the deposit of toxic wastes near populated areas.toxic wastes near populated areas.

In Peru, there are mining tailings in several In Peru, there are mining tailings in several cities.cities. (San Mateo de Huanchor in Lima). (San Mateo de Huanchor in Lima).

FIGURE 3: Location of exposed and non-exposed communities to mining tailings in the district of San Mateo de Huanchor (Huarochiri, Lima).

TABLE 1: Average concentrations of relevant environmental metals in mining tailings and sediments in San Mateo de Huanchor.

ANALYZED ANALYZED METALIC METALIC ELEMENTELEMENT

REFERENCE REFERENCE VALUES IN VALUES IN

SEDIMENTS SEDIMENTS

REFERENCE REFERENCE VALUES WHO VALUES WHO

(SOILS AND (SOILS AND SEDIMENTS SEDIMENTS

SEDIMENTS SEDIMENTS IN RIO IN RIO

BLANCOBLANCO

(Non-exposed (Non-exposed town)town)

MINING MINING TAILING OF TAILING OF

TAMBORAQUE TAMBORAQUE

(Exposed town)(Exposed town)

MINING TAILING MINING TAILING OF MAYOCOF MAYOC

(Exposed town)(Exposed town)

AsAs 8 mg/Kg8 mg/Kg 1–40 mg/Kg1–40 mg/Kg 21 mg/Kg21 mg/Kg > 10000 mg/Kg> 10000 mg/Kg > 10000 mg/Kg> 10000 mg/Kg

CuCu 15 mg/Kg15 mg/Kg 2–250 mg/Kg2–250 mg/Kg 51 mg/Kg51 mg/Kg 514 mg/Kg514 mg/Kg 800 mg/Kg800 mg/Kg

HgHg 0.08 mg/Kg0.08 mg/Kg < 0.050 mg/Kg< 0.050 mg/Kg 0.11 mg/Kg0.11 mg/Kg MNDMND 1.21 mg/kg1.21 mg/kg

PbPb 5 mg/Kg5 mg/Kg 10–70 mg/Kg10–70 mg/Kg 62 mg/Kg62 mg/Kg 2561 mg/Kg2561 mg/Kg 1900 mg/Kg1900 mg/Kg

ZnZn 100 mg/Kg100 mg/Kg 10–300 mg/Kg10–300 mg/Kg 160 mg/Kg160 mg/Kg 2317 mg/Kg2317 mg/Kg 3400 mg/kg3400 mg/kg

What are non-infectious dermatologic What are non-infectious dermatologic diseases? diseases? Seborrheic dermatitis, atopic dermatitis, Seborrheic dermatitis, atopic dermatitis,

hyper/hypo pigmentation, photodermatitis, hyper/hypo pigmentation, photodermatitis, psoriasis, pruritus, keratosis, etc.psoriasis, pruritus, keratosis, etc.

AIMAIM

To determine if the chronic exposure to To determine if the chronic exposure to mining tailings constitutes a risk factor for the mining tailings constitutes a risk factor for the development of dermatologic diseases in San development of dermatologic diseases in San Mateo de Huanchor (Peruvian community). Mateo de Huanchor (Peruvian community).

PATIENTS and METHODSPATIENTS and METHODS Observational case-control study from Observational case-control study from

November 2003 to February 2004.November 2003 to February 2004.

Inclusion criteria: Inclusion criteria: individuals living in the communities for at least one individuals living in the communities for at least one

year.year.

Exclusion criteria: Exclusion criteria: individuals exposed to sources of contamination individuals exposed to sources of contamination

other than mining tailings.other than mining tailings. individuals with non-infectious dermatologic individuals with non-infectious dermatologic

diseases related to chronic actinic damage.diseases related to chronic actinic damage.

The study had three phases: The study had three phases: 1) selection of the area of study.1) selection of the area of study. 2) epidemiologic census.2) epidemiologic census. 3) evaluation of the presence of non-3) evaluation of the presence of non-

infectious dermatologic diseases in the adult infectious dermatologic diseases in the adult and pediatric population.and pediatric population.

Population:Population:

Exposed people: inhabitants from the 3 mining communities.Exposed people: inhabitants from the 3 mining communities. Non-exposed people: inhabitants from the 2 communities 20 km Non-exposed people: inhabitants from the 2 communities 20 km

apart from the mining communities.apart from the mining communities.

Statistical Analysis:Statistical Analysis: The SPSS 13.0 statistical program, consisting of a univariate, The SPSS 13.0 statistical program, consisting of a univariate,

bivariate and multivariate analysis.bivariate and multivariate analysis.

EXPOSED NON-EXPOSED

ADULTS 121 109

CHILDREN 71 64

RESULTSRESULTS

TABLE 2: Characteristics of the adult population.

CHARACTERISTICSCHARACTERISTICS EXPOSED EXPOSED GROUPGROUP

NON-EXPOSED NON-EXPOSED GROUPGROUP

Sample (n)Sample (n) 121121 109109

Age (years)Age (years) 20.13 ± 18.9120.13 ± 18.91 21.49 ± 16.7121.49 ± 16.71

Masculine, No. (%)Masculine, No. (%) 59 (48.8)59 (48.8) 46 (42.2)46 (42.2)

Feminine, No. (%)Feminine, No. (%) 62 (51.2)62 (51.2) 63 (57.8)63 (57.8)

Non-infectious dermatologic Non-infectious dermatologic disease, No. (%)disease, No. (%)

86 (71.1)86 (71.1) 37 (33.9)37 (33.9)

TABLE 3: Non infectious dermatologic diseases in exposed and non-exposed adults to mining tailings.

37.2

19.0

17.4

15.2

16.2

9.9

9.1

11

6.4

10.1

1.8

1.8

2.7

0.0 10.0 20.0 30.0 40.0

Xerosis

Seborrheic dermatitis

Keratosis pilaris

Atopic dermatitis

Non-pruritic papulovesicular eruption

Contact dermatitis

Arsenicosis

%

NON EXPOSED

EXPOSED

We found 11 cases of arsenicosis in the exposed group We found 11 cases of arsenicosis in the exposed group (Prevalence rate= 9.1 cases per 100 habitants).(Prevalence rate= 9.1 cases per 100 habitants).

FIGURE 4: Palmoplantar arsenical keratosis in an adult female exposed to mining tailings.

FIGURE 5: Arsenical hyperpigmentation in a male exposed to mining tailings.

TABLE 4: Dermatologic lesions and clearance of arsenic in 24-hour urine samples in adult patients with chronic arsenicosis.

TYPE OFLESION

NUMBER OF

PATIENTS

LOCALIZATION OF LESIONS

CLEARANCE OF ARSENIC (*) IN 24-

HOUR-URINE

Keratosis and Hyperpigmentation

2 Plantar 31-66 ug/L

Hyperpigmentation 1 Thorax, Abdomen 58 ug/L

Keratosis 6 Plantar, Palmar, Palmoplantar, Thighs, Thorax

33-62 ug/L

Mee’s lines 2 Nails of hands 53-56 ug/L

DERMATOLOGIC DERMATOLOGIC DIAGNOSISDIAGNOSIS

p p VALUE VALUE

ODDS ODDS RATIORATIO

CONFIDENCE CONFIDENCE INTERVALINTERVAL

ArsenicosisArsenicosis 0.030.03 NCNC NCNC

Non-pruritic papulovesicular eruptionNon-pruritic papulovesicular eruption 0.010.01 6.986.98 1.52 – 32.101.52 – 32.10

XerosisXerosis < 0.001< 0.001 5.035.03 2.45 – 10.372.45 – 10.37

Seborrheic dermatitisSeborrheic dermatitis 0.010.01 4.174.17 1.60 – 10.891.60 – 10.89

Contact dermatitisContact dermatitis 0.040.04 3.823.82 1.04 – 13.991.04 – 13.99

Atopic dermatitisAtopic dermatitis 0.030.03 5.265.26 1.13 – 24.601.13 – 24.60

Keratosis pilarisKeratosis pilaris 0.090.09 1.981.98 0.89 – 4.390.89 – 4.39

Lichen simplex cronicusLichen simplex cronicus 0.100.10 6.056.05 0.70 – 52.600.70 – 52.60

TABLE 5: Statistical analysis of non-infectious dermatologic diseases in the adult population.

TABLE 6: Characteristics of the pediatric population.

CHARACTERISTICSCHARACTERISTICS EXPOSED EXPOSED GROUPGROUP

NON-EXPOSED NON-EXPOSED GROUPGROUP

Sample (n)Sample (n) 7171 6464

Age (years)Age (years) 7.51 ± 7.51 ± 4.03 4.03

9.61 ± 4.36 9.61 ± 4.36

Masculine, No. (%)Masculine, No. (%) 52 (73.2) 52 (73.2) 29 (45.3) 29 (45.3)

Feminine, No. (%)Feminine, No. (%) 19 (26.8) 19 (26.8) 35 (54.7) 35 (54.7)

Non-infectious dermatologic Non-infectious dermatologic disease, No. (%)disease, No. (%)

49 (69) 49 (69) 19 (29.6) 19 (29.6)

TABLE 3: Non infectious dermatologic diseases in exposed and non-exposed children to mining tailings.

39.2

14.0

11.4

2.8

11

10.112.6

8.8

1.6

3.1

3.1

0.0 10.0 20.0 30.0 40.0 50.0

Xerosis

Atopic dermatitis

Keratosis pilaris

Contact dermatitis

Non-pruritic papulovesicular eruption

Arsenicosis

%

Non Exposed

Exposed

DERMATOLOGIC DERMATOLOGIC DIAGNOSISDIAGNOSIS

p p VALUE VALUE

ODDS ODDS RATIORATIO

CONFIDENCCONFIDENCE INTERVALE INTERVAL

XerosisXerosis 0.0020.002 3.683.68 1.59 – 8.511.59 – 8.51

Atopic dermatitisAtopic dermatitis 0.0450.045 5.085.08 1.04 – 24.921.04 – 24.92

Contact dermatitisContact dermatitis 0.0540.054 8.208.20 0.97 – 69.470.97 – 69.47

Non-pruritic papulovesicular eruptionNon-pruritic papulovesicular eruption 0.1510.151 3.413.41 0.64 – 18.150.64 – 18.15

Keratosis pilarisKeratosis pilaris 0.9800.980 0.990.99 0.36 – 2.740.36 – 2.74

TABLE 7: Statistical analysis of non-infectious dermatologic diseases in the pediatric population.

CONCLUSIONSCONCLUSIONS

In the adult population:In the adult population: Chronic exposure to mining tailings is Chronic exposure to mining tailings is

associated with arsenicosis, non-pruritic associated with arsenicosis, non-pruritic papulovesicular eruption, xerosis, papulovesicular eruption, xerosis, seborrheic dermatitis, atopic dermatitis seborrheic dermatitis, atopic dermatitis and contact dermatitis.and contact dermatitis.

There is an association between high There is an association between high levels of arsenic(1000x) in mining levels of arsenic(1000x) in mining tailings and the appearance of pre-tailings and the appearance of pre-cancerous lesions such as arsenical cancerous lesions such as arsenical keratosis.keratosis.

In the pediatric populationIn the pediatric population:: Chronic exposure to mining tailings is Chronic exposure to mining tailings is

associated with atopic dermatitis and associated with atopic dermatitis and xerosis.xerosis.

Chronic exposure to mining tailings is Chronic exposure to mining tailings is not associated with arsenicosis.not associated with arsenicosis.

The present study suggests that the The present study suggests that the chronic exposure to mining tailings chronic exposure to mining tailings constitutes a risk factor to develop non-constitutes a risk factor to develop non-infectious dermatologic diseases.infectious dermatologic diseases.

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