D2.64 - Occupational allergic contact dermatitis due to rubber additives: clinical features and occupational implications

Occupational allergic contact dermatitis (ACD) from rubber additives (RA) is a major occupational health concern due to its high prevalence, chronic course, and considerable impact on work capacity. This study aimed to characterize the clinical, etiological, occupational, and medico-legal features of RA-induced occupational ACD.

This descriptive cross-sectional study reviewed all medical records of patients who consulted the occupational medicine department at La Rabta Hospital in Tunis between 1998 and 2024 for occupational ACD due to rubber additives.

A total of 86 cases of RA-induced ACD were collected, with a female predominance (57%), a mean age of 39.1 years, and a median professional seniority of 8 years. The most represented activity sectors were healthcare (51%), transport (9%), services (7%), and textile (5%). The most affected occupations were nurses (20%), cleaning staff (19%), and physicians (9%). Symptoms appeared after employment in all cases, with a median latency of 2 years and occured on working days and improved during time off in 92% of cases. The hands were the primary site of lesions (98%), with remote lesions in 41% of cases. Patch testing using the European standard series revealed sensitization to Thiuram mix, Mercaptobenzothiazole, Mercapto mix, and N-Isopropyl-N-phenyl-4-phenylenediamine in 67%, 16%, 15%, and 13% of cases, respectively. Patch tests using the rubber additive series were performed in eight cases and were positive in all. Patients with negative patch tests (n=5) had a positive avoidance-rechallenge test. The most implicated allergens were thiurams (69%), benzothiazoles (22%), and para-phenylenediamine derivatives (12%). Co-sensitization to multiple RA families was observed in 12% of cases. The ACD cases were related to glove use at work in 65 patients. The occupational origin of RA-induced ACD was confirmed in all cases, with 92% recognized as compensable occupational diseases. Workplace adjustments were recommended in all cases, primarily through the provision of appropriate gloves (81% of cases).

Occupational allergic contact dermatitis (ACD) from rubber additives (RA) is prevalent, with thiurams being the most implicated allergens. These dermatoses frequently impair medical fitness for work. Strengthening preventive strategies, including the use of suitable personal protective equipment and raising awareness among workers in high-risk sectors, is essential.