Understanding Glove Related Contact Dermatitis

[dropcap]Y[/dropcap]ou may wear disposable nitrile, latex or vinyl gloves many hours each work day.  If your hands develop dry, itchy, irritated areas or blisters, you are understandably concerned.  Wearing gloves and having healthy skin is imperative in your line of work.

Could your gloves be to blame?  In this Q&A article, we’ll help you get the bottom of the types of glove related contact dermatitis, their causes, and how you might find a resolution for your skin condition.

Q.   What is contact dermatitis?

A.   Occupationally related contact dermatitis is a skin condition that can develop from frequent and repeated use of hand hygiene products, exposure to chemicals and glove use. Contact dermatitis is classified as either irritant or allergic.

Irritant contact dermatitis is common, nonallergic, and develops as dry, itchy, irritated areas on the skin around the area of contact.  It is usually caused by an irritant, such as the chemicals commonly used in the manufacture of hand products and gloves.  It can also be caused by water, (including improper hand drying before donning gloves,) soaps, detergents, solvents, acids, alkalis and friction. Diagnosis is made by reviewing the patient’s medical history, current symptoms, and exclusion of Type IV and Type I hypersensitivity.  This is not an allergic reaction.

Allergic contact dermatitis (type IV hypersensitivity) often manifests as an itchy, red rash, sometimes with small blisters, beginning approximately 6 to 48 hours after contact.  Like irritant dermatitis, it is usually confined to the areas of contact.  It can result from exposure to accelerators and other chemicals used in the manufacture of most latex and non-latex gloves.  Diagnosis is made by reviewing the patient’s medical history, current symptoms and by performing a skin patch test.

Q.   What are chemical “accelerators?”

A.   Chemical accelerators are used in the glove manufacturing process to “accelerate” the linkage of rubber molecules in natural rubber latex or synthetic rubber latex, such as nitrile and vinyl. The chemicals transform the liquid rubber into a thin, strong and elastic glove film, and stabilizes the material.

These sulfur-based chemical accelerators (dithiocarbamates, thiurams and mercaptobenzothiazoles (MBT)) cause the majority of skin dermatitis reactions.

Q.   What are “accelerator-free” gloves?

A.   Accelerator-free gloves, like FreeStyle1100, and Scion700 are manufactured using a breakthrough cross-linking technology that does not use chemical accelerators (dithiocarbamates, thiurams and mercaptobenzothiazoles (MBT.)) The result is a thin, soft and stretchy glove that is actually stronger than traditionally manufactured nitrile glove material.

Q.   What does “Low Dermatitis Potential” mean?

A.   This is an FDA approved claim reserved for gloves that have been tested, and are 1) proven free of chemical accelerator residue, 2) will not induce skin irritation, and 3) will not cause any potential sensitization reaction.

Q.   How long should I try accelerator-free gloves?

A.   Each person is unique. Some individuals know within a few hours, while others require an extended trial of several days or even weeks to know if accelerator-free gloves will resolve their hand dermatitis. (Additional samples of FreeStyle1100 are available for individuals needing a longer period of time to evaluate the glove.)

Q.   Is there anything else in a glove that can cause allergic contact dermatitis?

A.   Yes.  Although 90% of glove allergies are caused by accelerators, the remaining individuals may be reacting to other substances sometimes used in the manufacture of gloves, such as lanolin, polyoxypropyleneglycol (a coagulant,) dyes (organic or inorganic,) quaternary ammonium compounds, and preservatives.

Q.  How important is it to resolve contact dermatitis early?

A.   Skin is an important barrier to bloodborne pathogens and disease. Broken skin due to ongoing irritation or allergy puts an individual at higher risk. A chronic skin condition is painful, and could result in an individual having to abandon their career choice.

Q.  I don’t have contact dermatitis. Should I still consider switching to an accelerator-free glove?

A.   Yes. According to NIOSH, “Because the prognosis of occupational irritant and allergic dermatitis is poor, prevention is imperative. This fact is emphasized by one study showing that 75% of patients with occupational contact dermatitis developed chronic skin disease.” (1) With thousands of potentially harmful chemicals being introduced into the workplace each year, it is important to reduce your exposure wherever possible.

References
NIOSH (The National Institute for Occupational Safety and Health,) Allergic & Irritant Dermatitis(1)
CDC (Centers for Disease Control and Prevention) Frequently Asked Questions, Contact Dermatitis and Latex Allergy

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Tips to Avoid Contact Dermatitis This Winter

Tips to Avoid Contact Dermatitis This Winter

The winter season is here.  That means colds and flu, and overly-drying, heated air in our homes and workplaces.  Add necessary frequent hand washing to this combo and you may end up with a very uncomfortable situation – contact dermatitis.

Contact dermatitis can be divided into two categories – irritant and allergic.  Irritant contact dermatitis is the most common type.  It can be as mild as a rash, or as debilitating as dry, itchy skin that can crack and bleed.  It occurs because the outer layer of your skin has been damaged.  Most often, this is due to harsh soaps and damaging chemical solvents.  Allergic contact dermatitis occurs when an allergen triggers an immune response in your skin.  It shows up as a red rash, with bumps and sometimes blisters.  It can be caused by natural rubber, the sulfur-based chemical accelerators used in the production of many non-latex gloves, as well as perfumes, cosmetics and hair dyes.

A Pricey Problem

Dermatitis is a widespread problem.  Up to 35 percent of all occupational diseases are skin diseases, with contact dermatitis making up the majority of the cases.  In 2005, The Society for Investigative Dermatology and the American Academy of Dermatology reported that contact dermatitis was associated with more than 9 million physician office visits resulting in more than $1.4 billion spent on treatment.

Because of increased exposure to chemicals, detergents and frequent hand washing, workers in health care, construction, food service and cleaning are especially vulnerable.  Individuals with a history of eczema, latex allergy, prone to sunburn, and repeated exposure to water should be especially careful in order to avoid dermatitis.

What You Can Do

To avoid occupational contact dermatitis, carefully take stock of your environment and habits:

Health Care Workers  –   After washing with soap and water, are you drying your hands gently, so that you do not cause unnecessary damage to your skin?  If you are starting to notice a rash, has your facility recently changed to a new brand of hand soap?  Your skin may be irritated by a chemical in the new product.   Because alcohol-based hand rubs do not cause dermatitis, the CDC recommends they be used whenever possible in health care settings.  These foams and gels often contain emollients and substantially reduce skin irritation and dryness.

Industrial / Cleaning / Food Service Workers – What chemicals, oils and cleaning agents do your hands come into contact with?  Are you wearing the right glove material (nitrile vs. latex) to protect your hands from that irritant?  Are you around wet cement, cement dust or paper dust?  These irritants can also cause dermatitis.  Make sure you are wearing disposable gloves to protect your hands.   If your hands do come into contact with cement or chemicals, wash your hands immediately with a fragrance-free, neutral pH hand soap with emollients, and gently dry your hands without excessive rubbing.  (Alcohol-based hand rubs are not recommended for food service workers, as its effectiveness is reduced when in the presence of food proteins.)

You will likely experience dry hands this winter.  The cold air and wind chaps your hands, and the low humidity level further removes moisture from your skin.  By paying careful attention to how you wash and dry your hands, and protect your skin from harsh detergents and chemicals, you can greatly reduce your chances of developing painful contact dermatitis.

Could your gloves be the problem?

Try FreeStyle1100 and Scion700 Nitrile Exam Gloves with “Low Dermatitis Potential”

The sulfur-based chemical accelerators – carbamates, thiurams and mercaptobenzothiazoles (MBT) – commonly found in non-latex gloves can lead to contact dermatitis.  If you suspect your gloves are causing your current skin irritation, request a sample pack of FreeStyle1100 Accelerator-Free Nitrile Exam Gloves and Scion700 Nitrile Exam Gloves with Low Dermatitis Potential.

Acrylates in the Dental Office – Hazards and Hand Protection

Acrylates Dental Office Hazard

In the dental office, occupational hazards are everywhere.  You wear masks and gloves to protect yourself from the dangers of infection from close contact with patients’ saliva and blood.  You give attention to your posture to minimize the risk of musculoskeletal disease.  And you wear nitrile gloves, sometimes two pair, when working with acrylates.

Or perhaps not.   A search of some popular dental journals online yielded zero articles on the hazards of what the American Contact Dermatitis Society named the 2012 Allergen of the Year – Acrylates.

Acrylates – What Are They?

Though they get little mention, acrylates are everywhere.   The salts of acrylic or methacrylic acid can be polymerized to form solid plastics.  Polymerized methacrylate was first used in the 1930s, when mass production of Plexiglas began.  It is now used in windowpanes, car lights and windshields, and streetlamps.  Over time, other acrylates have been synthesized and are now found in paints, adhesives, printing inks and medical devices.  Fully polymerized acrylic plastics are inert and harmless.  However, the building blocks – acrylates and methacrylates – are strong irritants and notorious allergens.

But what does this have to do with safety in the dental office?

Acrylates in the Dental Office

These days, many methacrylates are used in dental bonding materials.  These dental materials seem to be a major cause of contact dermatitis in dental personnel.   The polymerization (curing process) of these adhesives and materials occurs with exposure to UV light and with the help of a priming photoinitiator, or when two components are mixed causing a chemical reaction.   In both cases, unreacted monomers are released.  These “free monomers” can cause irritation to skin and eyes, asthma, and allergic dermatitis.

“Dental surgeons, assistants, and technicians are also at risk of allergic sensitization from monofunctional and polyfunctional (meth)acrylates and from the epoxy acrylate prepolymers.”  – American Contact Dermatitis Society

Widely used dentin primers and dentin bonding agents and cements that contain 2-HEMA (hydroxyethyl methacrylate) have been studied.  The authors concluded that the free monomers released from HEMA can affect dental personnel as well as patients in the immediate vicinity.

There are numerous reports of acrylate associated allergy in dental personnel, including fingertip paraesthesia and occupational allergic contact dermatitis caused by a restorative dental material with polymethylmethacrylate.

 

Testing and Protection

Testing for allergic sensitization to acrylates is difficult.  The allergens have to be kept frozen or refrigerated, delayed positive results are common, and patch testing can cause severe allergic reaction.

Methacrylate monomers penetrate vinyl and latex gloves within minutes.  For this reason, the American Contact Dermatitis Society recommends double gloving with nitrile gloves, or polyethylene gloves under nitrile gloves.  This should afford adequate protection for tasks that do not exceed 30 to 60 minutes.

Dental products such as acrylics, resins and polymer materials represent significant advances in dentistry and are here to stay.  Your best option to minimize the risk of developing an acrylate allergy is to stay informed about the signs and symptoms of allergic reactions, keep records of dental materials being used, and put in place whatever precautions are available to limit your exposure.

Are you concerned about acrylates?  Share your comments below.

Sources:
American Contact Dermatitis Society – Acrylates – Contact Allergen of the Year
Dental Occupation Hazards – A Review

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