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Ottawa, ON—Office workers, scuba divers, and people
with sleep apnea may have one thing in common: a contact allergy
to Neoprene™ (polymers of the monomer chloroprene).
Neoprene, often used as a substitute for latex, is resistant to
chemicals, oils, fats, and atmospheric degradation, said Joel DeKoven,
MD, assistant professor and director of the dermatology residency
program, University of Toronto.
Neoprene is a component of some:
• Computer accessories (eg, wrist supports and mouse pads),
• Sports equipment (eg, diving gear, gloves, shoes, and goggles),
and
• Medical devices (eg, CPAP masks, compression garments, stomal
appliance adhesives, and orthopedic braces/supports).
It may also be used in garden hoses, fire hoses, cell phone covers,
adhesive tape, furniture, photocopy paper, photography fixing agents,
blueprints, textile patterns, silver polish, paint and glue removers,
and shoes.
Either thioureas or para-tertiary-butylphenol-formaldehyde resin
may be implicated as the allergen involved in allergic contact dermatitis
to neoprene. Thioureas, which are used as accelerators in the manufacture
of Neoprene-based rubber, are not included in standard patch tests.
Some patients may have to be tested to as many as five pure and
mixed thioureas to identify the allergen.
Diagnosis
Diagnosis may be largely dependent on a detailed history. However,
though one may know what to look for, extracting the information
may be difficult, Dr. DeKoven said. He illustrated this point by
recounting a conversation that he had had with a computer trainer
who had been referred for patch testing because of recurrent flexor
wrist dermatitis. Her dermatologist had discussed the referral with
the patient, noting a talk that she had heard Dr. DeKoven give on
the subject of allergy to Neoprene products, including computer
wrist supports.
“I got into the history with the patient and it was clear that
she was puzzled why she had been referred. My first question was,
‘So, do you have a computer wrist support?”
“No, I don’t,” she answered, “Some of my colleagues
like them but I didn’t want one.”
“Did you ever use a computer wrist support on your computer?”
I probed.”
“No, never,” she replied. We both blankly stared at each
other.
“Finally, a bright fourth-year student who was working with
me asked, ‘Do you use other peoples’ computers?’
“Well, of course I do. I train people on their computers.”
Para-tertiary-butylphenol-formaldehyde resin is a component in Neoprene-based
adhesives. Neoprene glues are a sensitizer, Dr. DeKoven said.
“Neoprene glues are used in about 20 per cent of North American
shoes. They may be used more commonly in countries such as The Netherlands.”
Classically, it was taught that allergic contact dermatitis to shoes
manifests as a rash on the dorsum of the feet. However, some patients
will develop an eruption on both the dorsum and the soles and a
significant subset may only have involvement on the soles of the
feet.
“When you’re looking at shoe dermatitis, you also have
to think of insoles and orthotics.” Two patients were presented
who showed an acute contact reaction to Neoprene glues contained
in their orthotics.
The management of Neoprene allergy in shoes may include the use
of non-Neoprene-based (urethane) glue, wearing high-quality leather
shoes, removing the shoes as much as possible, and wearing slippers
at home.
“Sometimes we’ll need extra help from highly qualified
shoe consultants who may be able to give our patients access to
non-Neoprene-based products.”
For more information
Alpin CG, Bower C, Finucane K, Sansom JE. Contact
allergy to IPPD and diphenylth-
iourea in an orthopedic brace. Contact Dermatitis 2001;45(5):301.
Roberts JL, Hanifin JM. Athletic shoe dermatitis. Contact allergy
to ethyl butyl thiourea.
JAMA 1979;241(3):275-276.
Wintzen M, van Zuuren EJ. Computer-related skin diseases. Contact
Dermatitis
2003;48(5):241.
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