Don't forget the sponge

Abstract

3-diphenylguanidine, carba mix, case report, diphenyl thiourea, occupational allergic contact dermatitis, rubber accelerator, surgical sponge Less well-recognized sources of rubber accelerators, including surgical scrub sponges, are important exposures to consider in surgical personnel experiencing occupationally induced hand and/or forearm dermatitis. ISAAC ET AL. 149 CASE REPORT A 30-year-old man presented with 8 years of bilateral hand dermatitis that started during medical school and continued into his surgical residency. At work, he frequently applied hand sanitizer, scrubbed his arms and hands before cases, and wore nitrile gloves. His hand dermatitis was previously treated with topical corticosteroids. His symptoms improved during extended periods outside the hospital.His hand and forearm dermatitis was well controlled during our initial evaluation, as he had been performing a research elective rather than clinical work. He was tested with our baseline, cosmetics, fragrance, rubber and bakery series (Chemotechnique Diagnostics, Vellinge, Sweden). The following occupational products were also tested: hand sanitizer, three surgical scrub sponges, two nitrile gloves, and 5% dilutions of two hand soaps and three surgical scrub solutions.Allergens were occluded under Finn Chambers (SmartPractice, Phoenix, Arizona), fixed with 3M Micropore tape, and removed after 2 days.On day (D) 3, the patient showed reactions to 1,3-diphenylguanidine (DPG) (+++), carba mix (++), diphenyl thiourea (+), shellac (++), 2-bromo-2-nitropropane-1,3-diol (Bronopol) (+), propolis (+), cobalt chloride (+), Disperse Blue 153 (+), dimethyl dihydroxyethyleneurea (+), dimethylol dihydroxyethyleneurea (+), geraniol (+), Mentha piperita oil (+), linalool (+), and Juniperus oxycedrus extract (+). He also had positive reactions to one hand soap (+) and one glove (+), and a +++ reaction to the BD E-Z 116 surgical scrub sponge (Figure 1). We diagnosed him with occupationally induced hand dermatitis secondary to fragrances in hand soaps and suspected rubber accelerators in his nitrile gloves and surgical scrub sponge. Although his exposure to the sponge was not as long in duration as his exposure to the gloves, the scrubbing procedure involves friction and contact with water for several minutes; therefore, the combined effects of rubber additives in the sponge and gloves, friction, and humidity all probably contributed to his symptoms. DISCUSSION Sensitization to rubber accelerators among healthcare workers (HCWs) is common. The estimated prevalence of rubber allergy inHCWs is up to 22%, as compared with 12% in the general US population. 1 Operating room personnel and atopic individuals are at higher risk of sensitization. 1,2 In a study of 425 HCWs, 17 of 22 patients with occupational contact allergy to gloves showed reactivity to rubber additives, most commonly DPG. 3 Hand dermatitis associated with non-natural rubber latex gloves is well established. 2,3 However, additional exposures, such as surgical scrub sponges, should also be considered i...

Allergic Contact Dermatitis Due to Thiourea Derivatives in a Gun Holster

“…Contact dermatitis from thioureas has been described in response to occupational products in health care, including tourniquets used for phlebotomy 3 and surgical scrub sponges. 4 To our knowledge, our case represents the first reported thiourea-associated contact dermatitis from a gun holster and highlights the importance of considering exposure to neoprene in evaluation of patients in law enforcement professions. Some cases of allergic contact dermatitis have been reported to improve in response to treatment with dupilumab, 5 which functions by blocking interleukin 4 receptor α and attenuating T H 2 immune responses.…”

“…Case reports and series have described contact dermatitis in response to products containing thioureas including neoprene orthopedic supports and sports equipment, such as wet suits and rubber shoes. Contact dermatitis from thioureas has been described in response to occupational products in health care, including tourniquets used for phlebotomy 3 and surgical scrub sponges 4 . To our knowledge, our case represents the first reported thiourea-associated contact dermatitis from a gun holster and highlights the importance of considering exposure to neoprene in evaluation of patients in law enforcement professions.…”

What Is New in Occupational Allergic Contact Dermatitis in the Year of the COVID Pandemic?

“…In the USA, a recent study found that carbamates represented the most common accelerators in medical and surgical gloves, whereas thiurams were used in a much smaller minority [105]. In addition to gloves, HCWs may also be exposed to rubber compounds through contact with medical supplies such as syringes, tubing, and catheters [99], as well as surgical scrub sponges [106].…”

Kontaktallergien – Neu aufkommende Allergene und Auswirkungen für das Gesundheitswesen

“…Eine experimentelle Studie ergab, dass die Anwendung von Händedesinfektionsmitteln mit Alkohol vor dem Anziehen von DPG-haltigen Polyisopren-Handschuhen die auf den Händen nachzuweisende Menge an DPG erhöhte; bei Anwendung von künstlichem Schweiß zum Vergleich wurden 84 % des DPG innerhalb der ersten 10 min des Tragens freigesetzt [183]. Außerdem können chirurgische Schwämme, die zur Reinigung vor dem Anziehen der Handschuhe verwendet werden, ebenfalls Beschleuniger enthalten und zu einer berufsbedingten ACD der Hände beitragen, wie im Fall eines US-amerikanischen Chirurgen, der für DPG sensibilisiert war [184]. In einer belgischen Studie mit 44 Beschäftigten des Gesundheitssektors reagierten 86 % positiv auf DPG, was die Bedeutung dieses Allergens unterstreicht [185].…”