Vanden Broecke, K; Zimerson, E; Bruze, M; Goossens, A
A 65-year-old non-atopic man presented in 1 July 2012 to the emergency department of our hospital with a well-demarcated severe oedematous and vesicular reaction on the back of his right hand, extending to his wrist and forearm (Fig. 1); on the back of his left hand, he showed only a very discrete papulovesicular itching reaction. Three days previously, he had cleaned his garden shed with ammonia diluted in water by use of a sponge, thereby wearing a rubber glove on his right hand only (Vileda Comfort and Care, Comfort plus, extra-absorbent®; Vileda, Verviers, Belgium), the interior side being coated with a moisturizer, said to contain perfume and chamomile. With the left (ungloved) hand, he had occasionally held the wet sponge. He had noticed that some of the ammonia solution had spilled into the glove, but he had continued cleaning for ∼2 hr without taking it off, without any discomfort. It was only on the next day that the itching, redness and swelling started to develop. The lesions had become really severe, despite using a corticosteroid cream (Fucicort®; Leo, Wilrijk, Belgium). At the emergency unit, the patient received treatment with oral steroids, application of a wet dressing for 15 min twice daily, Diprosone® cream (Schering-Plough, Heist-op-den-Berg, Belgium), and systemic antihistamines and ibuprofen; this was followed by gradual improvement of the skin lesions after 2 weeks; the treatment was further reduced, and a moisturizer was prescribed. However, the patient was seen by us in October, and mentioned that he had stopped using the moisturizer, as it had again produced worsening of his skin lesions.
The patient had been patch tested in 2009, and had been shown to be allergic to cetrimide, (a quaternary ammonium compound), isopropanol, iodine, and povidone iodine, which had been considered to be relevant to skin lesions that he had developed during wound treatment of his left elbow following osteosynthesis. The dermatitis had been treated with Fucicort® cream. Later on, he had experienced a skin reaction on his knee following the application of an ointment, the name of which he could not recall.
As a retired endive farmer, he had been wearing rubber gloves for > 20 years without any skin problems.
