Contact Dermatitis • Contact Points

FACIAL ACD WITHOUT HAND INVOLVEMENT FROM GLOVES • HIGGINS & NIXON

Facial allergic contact dermatitis without hand involvement caused

by disposable latex gloves
Claire Higgins and Rosemary Nixon
Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., Carlton, Victoria 3053, Australia

doi:10.1111/cod.12502

Key words: carbamates; contact allergy; eczema; face dermatitis; glove; latex; occupational; patch test; rubber
chemicals; thiurams; case report.

Allergic contact dermatitis (ACD) caused by rubber glove

Correspondence: Dr Claire Higgins, Occupational Dermatology Research and
Education Centre, Skin and Cancer Foundation Inc., Level 1, 80 Drummond
Street, Carlton, Victoria 3053, Australia. Tel: +61 3 9623 9400; Fax: +61 3
9639 3575. E-mail: chiggins@occderm.asn.au
Conflicts of interest: The authors declare no conflict of interests.
accelerators has been well described in hospital and
laboratory personnel (1). Rarely, regions distant from
the site of direct contact with gloves may be affected. We
report the case of a hospital biochemist who presented

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Contact Dermatitis, 74, 246–256 251
 Contact Dermatitis • Contact Points
FACIAL ACD WITHOUT HAND INVOLVEMENT FROM GLOVES • HIGGINS & NIXON
with facial ACD but without hand involvement caused by
her own gloves.
Case Report
A 56-year-old non-atopic female presented with a
6-month history of florid central facial and periorbital
dermatitis (Fig. 1). The rash was pruritic, erythematous,
and scaly. The patient had minimal dermatitis of the
forearms, and no hand involvement. The rash would
occur within several hours of her starting work, and
improved considerably with time away from the work-
place. She had no urticaria, angioedema, or respiratory
symptoms, and her rash did not improve with antihis-
tamines. She had worked as a hospital biochemist for over
25 years, and her job involved processing routine bio-
chemical specimens. She wore disposable non-powdered
latex gloves when handling specimens, changing these
many times a day. The technical data sheet reported
these gloves as containing zinc diethyldithiocarbamate
(ZDEC) and zinc-2-mercaptobenzothiazole (ZMBT) as
accelerators.
Patch tests were performed with an extended European
baseline series, rubber, antiseptic and cosmetics series, a
series of gold allergens (Chemotechnique, Vellinge, Swe-
den; Hermal, Reinbek, Germany), and the patient’s own
glove sample tested ‘as is’. Allergens were applied with
Finn Chambers® (Epitest, Tuusula, Finland; now Smart
Practice® , Phoenix, AZ, USA) on Scanpor® tape (Norge-
splaster, Vennesla, Norway). Readings were performed on
day (D)2 and D4 according to ICDRG criteria. The patient
developed positive reactions to thiuram mix (1.0% pet.),
to tetraethylthiuram disulfide (TETD) (1.0% pet.), and to
Fig. 1. Central facial and periorbital allergic contact dermatitis in
56-year-old biochemist.
252
her own glove sample. A radioallergosorbent test to latex
gave a negative result.
A diagnosis of ACD caused by her latex glove and the
rubber accelerator TETD was postulated, and the patient
was advised to switch to accelerator-free nitrile gloves.
Two weeks after she changed to using accelerator-free
gloves, her facial dermatitis had improved significantly.
At this point, she decided to retry her original gloves.
This caused a severe flare of dermatitis on her face
and a mild eruption on the forearms, requiring oral
prednisolone and 2 weeks off work. She subsequently
used the accelerator-free gloves, and has remained
symptom-free.
Discussion
It is unusual to experience such marked facial involve-
ment with ACD caused by rubber gloves, particularly
without hand involvement. A literature review showed
only two definitive case reports of patients with ACD
caused by rubber chemicals in whom the eruption
occurred solely in regions distant from the site of direct
exposure. The first case was similar to ours: a phle-
botomist with facial/neck ACD caused by disposable latex
gloves, but no hand involvement, in whom patch testing
caused recurrence of the eruption (2). The second case
was a carpet layer with face/eyelid and penis swelling after
handling a rubber-backed carpet, also sparing the hands
(3). There are a few other references to this phenomenon,
although, clearly, latex allergy needs to be excluded before
this diagnosis can be made. For example, Tan described a
motor mechanic with contact urticaria caused by latex
gloves manifesting as facial swelling (4). In a survey of
healthcare personnel regarding glove-related symptoms,
4 reported facial irritation without hand involvement,
although this may also have been complicated by latex
allergy (5). Jordan, as cited in Fisher (6), described eyelid
dermatitis without hand eczema in obstetricians and
nurses who were allergic to rubber gloves. It was pos-
tulated that, in personnel who frequently put on then
take off gloves, rubber chemicals are transferred from the
hands to the eyelids through brief contact, but are sub-
sequently removed from the hands by washing, leaving
allergens on the face only. The thinner, more sensitive
facial skin may also have a lower threshold for elicitation
of allergic contact dermatitis than the thicker skin of the
hands, because of differences in penetration by the rubber
chemicals (7).
More recently, 2 cases of airborne ACD caused by rub-
ber glove accelerators have been described (7, 8). In each
case, the patient experienced hand dermatitis prior to
changing to accelerator-free gloves. Subsequently, peri-
orbital/facial symptoms occurred as a result of exposure
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Contact Dermatitis, 74, 246–256
 Contact Dermatitis • Contact Points

HIGHLY ACTIVE ANTIRETROVIRAL THERAPY HYPERSENSITIVITY • SUÁREZ-LORENZO ET AL.

to airborne allergens from colleagues’ gloves. This sit-
uation is different from that of our patient, who had
never experienced hand dermatitis, and yet experienced
facial dermatitis and reacted to her own glove on patch
testing.
Finally, our patient reacted to her culprit glove and
TETD but not to the two accelerators listed as being
present (ZDEC and ZMBT). Possible causes of this find-
ing include mislabelling of glove accelerators, thiuram
contamination occurring during glove manufacture, or
false-negative patch test results. More complex expla-
nations include thiuram/carbamate cross-reactivity,
oxidation of ZDEC to TETD (9), or changes in chemical
structure during vulcanization (10).
To our knowledge, this is only the second reported case
of facial ACD caused by rubber gloves in the absence of
hand dermatitis. The case also highlights the importance
of patch testing with patients’ own glove samples.
Acknowledgements
We thank Dr J Cahill for critical reading and useful
suggestions, and the patient for consent to inclusion of
clinical photography.

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