Glove‐related contact dermatitis: Diagnostic value of a repeated application test

Contact dermatitis (CD) on hands is a frequent occupational disease.1 Gloves are the first personal protective equipment to cause occupational hand CD.2 Diagnosis of allergic CD (ACD) is based on patch tests (PT) or semi-open test (SO) to gloves and patch test to glove allergens. No standardized use test has been developed so far for the diagnosis of ACD to gloves. The aim of this work was to define the place of a Glove Repeated Application Test (GRAT) in the diagnostic strategy of glove-related contact dermatitis. This study included 58 patients with hand eczema who wore gloves and who completed a complete allergological exploration including GRAT, skin tests with personal gloves [semi-open test (SOg), patch tests with personal gloves (PTg)], and patch tests with purified allergens of the European rubber series and additions and of the European standard baseline series.3 The GRAT consisted of applying a piece of the glove held by a non-adhesive strip during 10 consecutive nights on the same area of the anterior face of the forearm. Patients used a new piece of glove each night in case of disposable glove, otherwise, the patients reused the same piece of glove. Positivity was defined by the presence of infiltrated erythema and papules or vesicles, covering at least 25% of the tested area (Supplemental Figure), according to the positivity criteria of the repeated open application test (ROAT) proposed by Johansen et al.4 Diagnosis of ACD was made for 18/58 patients, of whom 10 were allergic to gloves, based on the positivity of at least one relevant test (Table 1). GRAT was positive for 9/10 patients, SOg for 4/10, and PTg for 2/10 patients. For 2 patients, the GRAT was the only positive test and therefore we cannot formally exclude the possibility of irritant reactions. For 6/10 patients, allergens (thiurams) could be identified. The 48 other patients with hand eczema had a diagnosis of ACD to another product (8/58), of ICD (16/58), of atopic dermatitis (AD) (14/58), or of mixed ICD and AD (9/58). Finally, GRAT was the most frequently positive test for diagnosis of glove-related ACD. All the GRAT+ patients had their eczema disappear very quickly with the eviction of the culprit gloves and their replacement by other types of gloves. GRAT seems to be useful in the diagnosis of glove-related contact dermatitis. More data are needed to confirm these results. Céline Lamouroux: Investigation; writing – original draft; methodology; validation; writing – review and editing; formal analysis; project administration; data curation. Léa Bertolotti: Writing – review and editing; data curation. Clio Coste: Data curation. Pauline Pralong: Investigation; writing – review and editing; methodology; validation; data curation. Marine-Alexia Lefevre: Investigation; writing – review and editing; methodology; validation; data curation. Justine Pasteur: Investigation; methodology; validation; writing – review and editing; data curation. Aude Clément: Conceptualization; investigation; methodology; validation; writing – review and editing; data curation. Marie-Christine Ferrier le Bouëdec: Conceptualization; investigation; methodology. Barbara Charbotel: Writing – review and editing; validation. Jean-Baptiste Fassier: Validation; writing – review and editing. Marc Vocanson: Writing – review and editing; validation; data curation. Jean-François Nicolas: Conceptualization; investigation; writing – review and editing; writing – original draft; methodology; validation; data curation; supervision; visualization; software; resources. Florence Hacard: Writing – review and editing; data curation. Audrey Nosbaum: Writing – review and editing; data curation. The authors thank Dominique Tennstedt (Bruxelles) and Marie-Noëlle Crépy (Paris) for their critical advices on the study. The authors declare no conflict of interest for this study. Supplemental Figure: Representative pictures of positive GRAT (A) Patient #6; GRAT with a nitrile glove, on day 2. (B) Patient #2; GRAT with a neoprene glove, on day 3. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.