Partially airborne allergic contact dermatitis to rubber additives in a car mechanic

Abstract

A 57-year-old atopic man who had worked as car mechanic for 40 years presented with severe dermatitis of the hands, lower arms up to the distal parts of the upper arms, the neck, and the face with spreading lesions on the trunk and lower limbs (Figures 1 and 2). The dermatitis had started in the past year and had shown a progressing, work-related course with worsening in the tyre changing season. After 4 weeks of absence from work and substantial improvements of skin lesions under treatment with topical corticosteroids, patch tests were performed and read according to the guidelines of the German Contact Dermatitis Research Group (DKG) with the DKG baseline series, the DKG series for rubber, topical preparations, preservatives, industrial biocides, glues, and resins (using test preparations from SmartPractice Europe, Greven, Germany, and Chemotechnique Diagnostics, Vellinge, Sweden), and a selection of patient s own products. Patch tests were removed on day (D) 2 and readings were performed on D2, D3, D4, and D7. Positive reactions to N-isopropyl-N0-phenylparaphenylenediamine (IPPD) (D2/3/4/7: 1+), Ndimethyl-1,3 butyl-N0-phenylparaphenylenediamine (DMPPD) (D2/3/4/ 7: 1+), thiuram mix (D2/3/4/7: 2+), tetraethylthiuram disulfide (D2/ D3/D4: 1+), dipentamethylene thiuram disulfide (D2/3/4/7: 1+), potassium dichromate (D2/3/4/7: 2+), cobalt chloride (D2/3/4/7: 1+), nickel sulfate (D2: ?+, D3/4/7: 1+), polyhexamethylene biguanide (PHMB) (D2: ?+, D3/4: 1+), and the PHMB-containing skin care product “Excipial Repair Sensitive” (Galderma Laboratorium, Düsseldorf, Germany) (D2: ?+, D3/D4/D7: 1+) tested “as is” were observed. Upon returning to work after replacing his dithiocarbamate-containing protective gloves with accelerator-free gloves as well as avoiding leather gloves and the PHMB-containing skin care product, the patient developed a major relapse of skin lesions on the hands, arms, face, and neck within a few days, finally leading to abandoning the occupation. Three