Irritant Contact Dermatitis in Military Healthcare Personnel During COVID-19: Case Report

Abstract

Background: Irritant contact dermatitis (ICD) is one of the most commonly reported occupational skin diseases, which is hard to differentiate from allergic contact dermatitis (ACD) clinically. Failure to identify the different forms of contact dermatitis can lead to suboptimal treatment and management of the patient, with long-term impacts on occupation and quality of life. In this manuscript, we describe a case of ICD occurring in a military healthcare personnel during the COVID-19 pandemic. While the patient presented with an acute pruritic rash over bilateral hands, a clinical feature characteristic of ACD, the patch tests performed on all test series returned negative. He was eventually diagnosed with ICD. Case Presentation: A 18-year old military medic developed an acute pruritic vesicular rash over his bilateral hands. He was exposed to butyl gloves from his personal protective equipment as well as frequent hand washing. As confirmatory patch tests were unavailable during the COVID-19 period, he was initially managed with topical corticosteroids and barrier protection with cotton gloves. He was then reviewed by a dermatologist with the suspension of exposure through discontinuation of direct contact with butyl gloves. The medic’s rash resolved with desquamation without scarring within one week of conservative treatment while waiting for confirmatory patch testing at a tertiary dermatological institution when patch test services resumed. The patch test performed on the medic’s butyl glove, other gloves, standard series, and rubber series, all returned negative. He was eventually diagnosed with acute ICD to frequent hand washing and wetwork and there was no further recurrence of the rash. Conclusion: Occupational history and a heightened awareness of the possibility of work-related illnesses were important factors for accurate diagnosis. Prompt suspension of exposure and engineering control measures through a double glove method helped to prevent a recurrence of ICD.