Reader question: I have a question about contact dermatitis. I don’t wear latex gloves. What should I do to to relieve itchy/pain and how do I prevent it?
Contact dermatitis can be caused by irritants such as soaps, cosmetics, or chemicals in gloves, which trigger allergic reactions. Oral health professionals are exposed to many irritants during their work day such as frequent hand washing, chemicals, and glove usage. In the past, natural rubber latex (NRL) gloves were used frequently and they often caused allergic reactions. Nonlatex gloves, such as nitrile, are an acceptable substitute.1–4 However, reactions to nitrile are also common.5 Some of the materials used in the manufacturing process can create delayed reactions (type IV), such as irritant contact dermatitis and allergic contact dermatitis. Thiurams, carbamates, and thiazoles used in the vulcanization process for strength and elasticity are the most common chemicals that cause type IV reactions. Geier et al5 reported that allergies to thiurams and other chemicals are common and their prevalence has changed very little during the past 17 years based on a retrospective analysis of 93,615 patients who were patch tested in a dermatology network from 2002 to 2010. Of those patients, 3,448 (0.036%) had occupationally-related contact dermatitis, with health care workers (n=1,058) being one of the most common occupational groups with sensitivity to thiurams (13%), carbamates (3.5%), and thiazoles (3.0%).
Oral health professionals must proceed with caution even with nitrile, as brands and glove lots can vary. An in vitro study of 29 different gloves by Cripa et al6 showed that nitrile glove manufacturing varied widely. They found that powdered latex gloves had the highest protein content at 917.38 µg/g (82.5%), while the protein content in nitrile gloves ranged from 5.17 µg/g (0%) to 22.62 µg/g (20%). A case report by Gonzalo et al7 found that five hospital health care workers with known latex allergy had immediate (type I) reactions to nitrile gloves (rhinitis and contact urticaria) even though they had previously tolerated other nitrile gloves. The presence of NRL proteins caused the immediate reactions in these five workers. Mistakes in the manufacturing process can happen, so the need exists for reduction of allergens, standardized testing for accelerators, reduction of chemical additives such as thiurams and carbamates, mandatory labeling of glove products to include total protein content and allergenic protein levels, and the development of guidelines or standards so consumers can make informed choices about gloves.
Although type IV skin reactions to some of the chemical additives in nitrile gloves are common, they are far less threatening than type I reactions more frequently associated with NRL, so they are a good choice for most clinicians.8 A study by Boyle et al8 compared the hands of 50 oral health professionals (n=26 wore latex gloves, n=24 wore nitrile gloves) working 8 hours per day four times per week over 3-months and found no differences in cutaneous skin health among the two groups.
Oral health professionals should be aware of potential irritants and avoid them as much as possible. Methods to decrease contact dermatitis include washing hands with cool water and fragrance-free soap, gently drying hands, using moisturizers, and wearing nitrile gloves without thiurams or carbamates. It might take some trial and error to find the brand of gloves that is the least irritating. Gloves manufactured in the United States may be a wise choice due to superior manufacturing processes. Allergy testing for chemicals may also be an option if the dermatitis does not clear up. Many types of gloves are available in the marketplace today, so investigating the ingredients or manufacturing process is a good place to start. A strong working knowledge of all options is key to making an informed choice.
- Connor T. Permeability of nitrile rubber, latex, polyurethane, and neoprene gloves to 18 antineoplastic drugs. Am J Health-Syst Pharm. 1999;56:2450–2453.
- Korniewicz DM, ElMasri M, Broyles JM, Martin CD, O’Connell KP. Performance of latex and non-latex medical examination gloves during simulated use. Am J Infect Control. 2002;30:133–138.
- Patel HB, Fleming GJ, Burke FJ. Puncture resistance and stiffness of nitrile and latex dental examination gloves. Br Dent J. 2004;196:695–700.
- Murray CA, Burke FJ, McHugh S. An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice. Br Dent J. 2001;190:377–380.
- Geier J, Lessmann H, Mahler V, Pohrt U, Uter W, Schnuch A. Occupational contact allergy caused by rubber gloves-nothing has changed. Contact Dermatitis. 2012;67:149–156.
- Crippa M, Belleri L, Mistrello G, Carsana T, Neri G, Alessio L. Prevention of latex allergy among health care workers: evaluation of the extractable latex protein content in different types of medical gloves. Am J Ind Med. 2003;44:24–31.
- Gonzalo MA, Caballero ML, Gil-Marchet MS, Meneo I, Perez-Calderon R, Garcia-Borruel L. Hypersensistivity reactions to due to nitrile gloves. J Allergy Clin Immunol. 2012;129:562–564.
- Boyle DK, Forsyth A, Bagg J, Stroubou K, Griffiths CM, Burke FJ. An investigation of the effect of prolonged glove wearing on the hand skin health of dental healthcare workers. J Dent. 2002;30:233–241.