Derm Dx: An itchy rash on the hands - Clinical Advisor

Derm Dx: An itchy rash on the hands

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The patient is a 62-year-old Hispanic woman seeking treatment for an itchy rash affecting both hands. The dermatitis is of at least 2 years in duration. She works as a home healthcare aide. Examination reveals erythema, hyperpigmentation, lichenification, and scaling of the dorsal surface of both hands. No rash was noted elsewhere.

 

Natural rubber latex contains a number of potential allergens, including acidic structural protein and hevein.1 Latex allergy was first described in a German medical journal published in 1927.2 The incidence soared in the 1980s due to the increased use of...

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Natural rubber latex contains a number of potential allergens, including acidic structural protein and hevein.1 Latex allergy was first described in a German medical journal published in 1927.2 The incidence soared in the 1980s due to the increased use of gloves to prevent transmission of infectious diseases, increased protein content associated with mass production, and substitution of talc with cornstarch, the latter more apt to be coated with latex.3 Besides gloves, latex is found in a number of products, including balloons, condoms, and rubber boots.4  

Latex allergic contact eczema should be suspected in any individual with prolonged exposure to latex such as healthcare workers and housekeeping personnel.5 Diagnosis is based on history and clinical appearance. Skin testing or serologic testing may have a role in the diagnosis of more subtle cases.

Dr Schleicher is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at the Commonwealth Medical College and a Clinical Instructor of dermatology at Arcadia University and Kings College.


References

  1. Raulf M, Quirce S, Vandenplas O. Addressing molecular diagnosis of occupational allergies. Curr Allergy Asthma Rep. 2018;18:6.
  2. Stern G. Überempfindlichkeit gegen kautschuk als ursache von urticaria und quinckeschem ödem. KlinWochenschr. 1927;6:1096-1097.
  3. Barbariol S, Eymann A, Llera J, Parisi CA. Strategies for compliance with the internship program among three pediatric interns with latex allergy. Arch Argent Pediatr. 2017;115:583-587.
  4. Wu M1, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016;58:138-144.
  5. Wilkinson SM, Burd R. Latex: A cause of allergic contact eczema in users of natural rubber gloves. J Am Acad Dermatol. 1998;39:36-42.
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