Artificial stone and silicosis: the Korean experience

Engineered stone (ES), also termed artificial stone, is a quartz-rich composite slab (typically 85–95% crystalline silica) used for kitchen and bathroom surfaces, and has driven a global resurgence of accelerated silicosis. Korea presents a distinctive context in which individual workers accumulated multi-era exposure across cementitious terrazzo (Dokkidashi), natural stone, polymer solid surface and high-quartz ES. We combine a narrative review of the Korean ES industry, respirable crystalline silica (RCS) exposure and clinical phenotype with a single-center case series. This study reviewed Korean trade, employment, exposure-measurement, and adjudicated-case data, and conducted a retrospective case series at the Pneumoconiosis Clinic, Seoul St. Mary’s Hospital (index window 1–31 March 2026). Rapid-progression cases required radiographic pneumoconiosis plus progressive massive fibrosis (PMF)/complicated disease, a forced vital capacity (FVC) decline ≥ 150 mL/year, or accelerated disease at presentation, with ≥1 year of follow-up and serial spirometry. The only ES-specific Korean exposure dataset (Institute of Occupation and Environment, C company, 2018) showed personal quartz of 0.045–0.179 mg/m 3 (up to 3.6 times over the Korean occupational exposure limit) and cristobalite of 0.026 mg/m 3 even under nominally wet processing; slab X-ray diffraction returned quartz contents of 24%, 65%, 70% and 100%, the 24%-quartz product additionally containing 28% cristobalite. Five rapid-progression cases (all men; median age 67 years) had 34–50 years of total stone work but only 3–7 years of ES exposure; all five had PMF, and the median annual FVC decline was −0.14 L/year (range −0.47 to −0.11). ES exposure was superimposed on decades of prior mixed silica exposure—a difference of degree rather than of kind from series reported elsewhere, possibly reflecting the shorter latency available to younger ES-only workers. Surveillance, exposure standards and compensation criteria should address multi-era exposure rather than ES alone.