What is contact dermatitis?
Contact dermatitis is an eczematous skin reaction arising from direct contact with a causative agent. It is the most common type of occupational skin disease. Contact dermatitis is classified as either allergic contact dermatitis or irritant contact dermatitis or a combination of both.
Contact dermatitis to nitrile is mostly allergic contact dermatitis, but irritant contact dermatitis may also occur.
What is nitrile and what is it used for?
Nitrile is an organic compound most commonly used to produce nitrile rubber. Nitrile rubber is a large synthetic rubber, a copolymer of acrylonitrile and butadiene, used in the production of latex-free gloves. Nitrile rubber is also used to produce transmission belts, seals, and hoses.
Nitrile is also used in the production of insecticides and as a raw material for the production of synthetic fibres and resins .
Who gets contact dermatitis to nitrile?
Allergic contact dermatitis to nitrile is most likely in people who wear disposable nitrile rubber gloves.
- They have often chosen latex-free nitrile gloves because they also have latex allergy.
- The most commonly affected professions include healthcare workers (dentists, nurses, doctors), hairdressers, and food handlers.
- Contact dermatitis may also rarely affect people working in the automotive and aeronautical industry or in industrial factories producing synthetic fibres or insecticides.
What causes contact dermatitis to nitrile?
Allergic contact dermatitis to nitrile is usually due to allergy to rubber accelerators used to manufacture nitrile rubber gloves . These include thiurams, dithiocarbamates, and mercaptobenzothiazole .
Hypersensitivity may also be due to acrylonitrile, but this is extremely rare, and acrylonitrate more commonly causes an irritant contact dermatitis. Acrylonitrile is a small molecule that can easily penetrate the skin, and has been recognised as a potent toxin and sensitiser [1,4,5].
What are the clinical features of contact dermatitis to nitrile?
- It presents as a pruritic, erythematous, scaly rash on the areas of skin contact.
- Allergic contact dermatitis can extend to involve distant sites.
- Irritant contact dermatitis is usually confined to the site of contact.
- Transient paraesthesia has also been reported and is thought to be due to acrylonitrile . See Cutaneous dysaesthesia.
How is contact dermatitis to nitrile diagnosed?
Allergic contact dermatitis is often diagnosed after taking a detailed clinical history and examining the patient carefully.
Positive patch tests to nitrile
What is the treatment for contact dermatitis to nitrile?
Treatment of contact dermatitis involves avoiding exposure to nitrile and topical medical treatment.
Avoiding nitrile exposure
Avoidance of exposure to rubber accelerators requires the use of disposable nitrile accelerator-free gloves, such as Ansell Micro-Touch Nitrafree®, Showa N-dex free®, and Sensicare Free Accelerator Free Blue Nitrile Gloves®.
Advise dental or medical practitioners of any allergy to nitrile gloves, although exposure in the healthcare setting rarely causes problems.
In the rare case of an allergy to acrylonitrile, butyl rubber gloves have been found to limit its permeability and may be considered as an alternative for mechanics and factory workers [4,5]. These gloves are generally not practicable for healthcare workers, hairdressers, or laboratory technicians.
Barrier creams have not been found to protect sufficiently against acrylonitrile penetration and are not recommended .
What is the outcome of contact dermatitis to nitrile?
The prognosis after diagnosis of contact dermatitis to nitrile is dependent on patient education and avoidance of the allergen. Approximately 10–15% of people with occupational contact dermatitis continue to experience dermatitis with no obvious cause .