Allergic Contact Dermatitis: Early Recognition and Diagnosis of Important Allergens

Sharon E. Jacob; Tace Steele

Disclosures

Dermatology Nursing. 2006;18(5):443-439, plus 4. 

In This Article

Rubber Chemical

Allergies to rubber chemicals can be caused by the raw rubber compound (latex) or the chemicals added to improve its utility. Allergy to the natural latex component is well documented as a type I (IgE) mediated response (Sussman & Beezhold, 1995). Alternatively the processing chemicals of the rubber, accelerators (carbamates, mercaptobenzothiazoles, and thiurams), and vulcanizers are known to cause the typical type IV delayed hypersensitivity reaction. Accelerators help harden and shape the latex collected from the Hevea brasiliensis tree (Mydlarski et al., 2003). Many patients will suspect a latex allergy when they experience a reaction to rubber gloves. Latex allergy testing can be performed with an allergy-specific IgE antibody test or by dermal prick testing, while testing for rubber processing chemical allergies is done by the patch test. Allergies to the rubber processing chemicals are very common among health care workers and atopic patients (Fuchs & Wahl, 1992).

Carbamates are found within the rubber components of toys, elastics, and gloves. This can present with a distinctive dermatitis in the distribution of underwear elastic and the dorsal aspect of the hands in a common locale. Mercaptobenzothiazole is one of the most common causes of shoe rubber allergies. Mercaptobenzothiazole commonly causes what is known as scuba diver dermatitis, a reaction to diving masks (Freiman, Barankin, & Elpern, 2004). These patients will present with erythema and pruritus surrounding their eyes. Thiuram, another accelerator, is the most common cause of glove allergy; however, it is also used as an antimicrobial. It can be found in fungicides and soaps (Geier, Lessmann, Uter, & Schnuch, 2003). Contraceptives including diaphragms, dental dams, and condoms may contain thiuram (DermNet.com, 2005c). Patients can react to condoms due to a latex allergy or sensitization to a rubber accelerator (Bircher, Hirsbrunner, & Langauer, 1993). There is even a case report of sensitization to thiuram from the sticky backing of a temporary tattoo (Hallai, Meirion-Hughes, & Stone, 2004).

Black rubber mix is a rubber additive used in industrial rubber products such as for belts and tubing; however, it can be found in sports equipment (TRUEtest.com, 2001a). Black rubber mix cross reacts with PPD (hair dye), so patients should avoid both allergens (Menne, White, Bruynzeel, & Dooms-Goossens, 1992). PPD is widely used in hair dye, even though the FDA prohibits its use on skin. This has not stopped companies from adding it to temporary henna tattoos to make them last longer; several case reports describe children reacting to henna tattoos (Onder, Atahan, Oztas, & Oztas, 2001). Hairstylists are at high risk for developing an allergy, but exposure may put them at risk for much worse conditions (Sosted, Rastogi, Andersen, Johansen, & Menne, 2004). Studies show an association with bladder cancer and PPD in rats (Nohynek et al., 2004). There are also notable racial differences in incidence rates. In one study, black patients had a higher incidence of sensitization to PPD than white patients. The number of people coloring their hair seems to be the same across racial and ethnic groups, but the amount of PPD in darker hair dyes is increased (Deleo et al., 2002). The patients will present with a characteristic dermatitis around their eyes, ears, and adjoining face, but sparing the scalp. PPD was recently nominated for allergen of the year because of dramatic rise in incidence.

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