Allergic Contact Dermatitis: A Surgeon’s Dilemma

In early 2014, I reluctantly made my way to the Dermatologist’s office as encouraged by my Fellowship Director. “How long have you been having these symptoms?” he asked. I thought carefully back to the first time I noticed that my hands blistered and started itching at least four years before that visit. By the time I finally sought help, my hands were raw under the cotton gloves I wore after applying steroid ointments or Vaseline. The problem had slowly worsened over time probably due to developing allergic contact dermatitis as well as increasing exposure to the offending substances.

The Dermatologist recommended skin testing which involved placing numerous discs of various allergens on my back for five days. I was skeptical since I had performed my own latex avoidance trial using only nitrile gloves at the bedside and in the operating room for several months with no improvement. That avoidance test failed because I am not allergic to latex but to a rubber accelerator called carba mix, which is a chemical used in the processing of latex products such as surgical gloves. It turns out that it is also used in many nitrile gloves. Suddenly, I was halfway through my final year of surgical training with a disease directly related to my occupation.

It is estimated that 8-12% of healthcare workers are latex sensitive compared to 1-6% of the general population. Occupational skin reactions are the second leading cause of occupational disease in the United States after traumatic injury. The most common reaction to latex is irritant contact dermatitis with dry, itchy skin and is not a true allergy. Allergic contact dermatitis is delayed blistering of the skin similar to the reaction many people have to poison ivy. The next level in severity is immediate hypersensitivity, with symptoms ranging from rash or hives, to runny nose and wheezing or even anaphylaxis which may be triggered by simply being in the same room with the allergen.

Risk factors for developing latex or latex-associated allergy include ongoing latex exposure, personal history of atopic disease, and personal history of multiple medical procedures or surgeries. Several measures for reduction in latex allergies were recommended by the Centers for Disease Control National Institute for Occupational Safety and Health (CDC NIOSH) in the late 1990s including:

1. Use non-latex gloves for contact with non-infectious materials
2. Use powder-free latex gloves when using latex
3. frequently clean areas contaminated with latex dust
4. Frequently change ventilation filters and vacuum bags used in latex-contaminated areas

However, I was exposed to latex powdered gloves at multiple facilities during my training.

When you are diagnosed with a chemical allergy, the treating physician gives you instructions on how to avoid contact with those chemicals. I found sterile and non-sterile gloves that I could safely use. At home, I had to replace hundreds of items including: shampoo, deodorant, household cleaners, nylon stockings, toothpaste, diaper cream, and dish soap.

Thankfully, the team at Mayo Clinic developed a database to identify safe products for home use and it is available for a fee under the name Skinsafe. Mayo and the hospitals where I now work ordered the gloves and soaps I need  without protest. My situation is manageable now, but I have talked to many healthcare workers who suffered skin reactions for years without resolution. Please care for yourself and colleagues who experience allergic contact dermatitis by learning how to prevent and recognize this common work-related illness.

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Lillian Erdahl, MD, FACS is an Assistant Professor of Surgery at the University of Iowa where she practices Breast and General Surgery. She is also Associate Program Director in General Surgery; head of the Iowa City VA Breast Clinic; and involved in curriculum development for medical students, residents, and fellows. Her research interests include breast cancer prevention and treatment, faculty development, and surgical education. Her work for gender equity in medicine includes involvement in the Association of Women Surgeons as co-chair of the Twitter subcommittee and work with the @PROWDWomen group.