What is the treatment for dermatitis caused by wearing medical gloves?

Treatment of Dermatitis from Wearing Medical Gloves

For glove-related dermatitis, immediately switch to accelerator-free gloves (rubber-free neoprene or nitrile), apply moisturizer before and after glove use, and use topical corticosteroids for active inflammation, with patch testing essential for recalcitrant cases. 1

Immediate Glove Modification

Switch Glove Type

• Use accelerator-free gloves such as rubber-free neoprene or nitrile gloves as first-line intervention for suspected glove allergic contact dermatitis (ACD). 1
• Avoid standard nitrile gloves initially, as rubber accelerators are still commonly used in their manufacturing and remain a frequent cause of glove ACD. 1
• Consider vinyl gloves as they typically do not contain rubber accelerators, though they have lower tensile strength and rare ACD reports exist. 1
• Apply moisturizer after washing hands and before wearing gloves to create a protective barrier. 1

Use Glove Liners

• Consider cotton glove liners or loose plastic gloves (plastic clear, disposable food gloves) underneath medical gloves to reduce direct skin contact with allergens. 1
• Use water-based moisturizers under gloves; oil-based moisturizers can break down latex and rubber by causing material swelling or brittleness. 1

Distinguish Between Irritant vs. Allergic Contact Dermatitis

Clinical Recognition

Both irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) can present as acute (erythema, edema, vesicles), subacute (crusting, scaling), or chronic (lichenification) patterns. 1

For Irritant Contact Dermatitis (ICD)

• Identify and avoid irritants including frequent hand washing with hot water, harsh soaps, and prolonged glove occlusion without moisturizer. 1
• Switch to less-irritating products devoid of allergenic surfactants, preservatives, fragrances, or dyes. 1
• Apply topical corticosteroids if conservative measures fail, but use cautiously to avoid steroid-induced skin barrier damage. 1
• Barrier creams (humectants) may help but are equivalent to regular moisturizers. 1

For Allergic Contact Dermatitis (ACD)

• Patch testing is mandatory for suspected ACD to identify the specific allergen. 1, 2
• Test with both the European rubber series and the patient's own gloves, as the European baseline series is insufficient to detect glove allergy. 3
• Perform both patch tests and semi-open tests with the patient's own gloves, as 28% of positive reactions are detected only by semi-open testing. 3
• Test PVC gloves as well, as positive reactions can occur even with these "safer" alternatives. 3
• Apply topical corticosteroids to mitigate flares once allergens are identified and avoided. 1

Hand Hygiene and Moisturization Protocol

Proper Hand Washing Technique

• Wash hands with lukewarm or cool water (never hot or very cold water) and soap for at least 20 seconds. 1, 2
• Use nonfrictional pat drying rather than rubbing. 1
• Choose soaps/synthetic detergents devoid of allergenic surfactants, preservatives, fragrances, or dyes, preferably with added moisturizers. 1
• Never apply gloves when hands are still wet from hand washing or sanitizer. 2, 4

Aggressive Moisturization Strategy

• Apply moisturizer immediately after every hand washing using two fingertip units for adequate hand coverage. 2
• Use moisturizers packaged in tubes (not jars) to prevent contamination. 1
• Keep pocket-sized moisturizers for frequent reapplication throughout the day. 1
• For severe dryness, use "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks. 1, 2
• At night, apply moisturizer followed by cotton or loose plastic gloves to create an occlusive barrier. 1

Topical Corticosteroid Therapy

Application Guidelines

• Apply topical corticosteroids (e.g., hydrocortisone) to affected areas 3-4 times daily for active inflammation. 5
• Hydrocortisone is FDA-approved for temporary relief of itching associated with eczema, dermatitis, and skin irritation. 5
• For children under 2 years, consult a physician before use. 5
• Limit prolonged use to avoid steroid-induced skin barrier damage, but do not hesitate to use for active flares. 1, 4

Critical Pitfalls to Avoid

Common Mistakes That Worsen Dermatitis

• Never wash hands with dish detergent or other known irritants. 1
• Avoid washing hands with very hot or very cold water. 1
• Do not use disinfectant wipes to clean hands. 1
• Never use superglue (ethyl cyanoacrylate) to seal fissures or healing cracks. 1, 4
• Avoid increased duration of glove occlusion without underlying moisturizer application. 1
• Do not apply products containing topical antibiotics (neomycin, bacitracin) without dermatology guidance, as these are common allergens. 1

When to Escalate Treatment

Indications for Dermatology Referral

• Refer for patch testing if ACD is suspected to identify specific allergens. 1, 2
• Refer if no improvement after 6 weeks of conservative treatment. 2, 4
• Refer for recalcitrant hand dermatitis not responding to topical treatments. 1, 2
• Refer if there is a change in baseline hand dermatitis pattern. 1, 4

Advanced Therapies for Refractory Cases

• Consider stronger topical corticosteroids for recalcitrant cases. 1, 2
• Phototherapy may be necessary for cases failing topical treatments. 1, 2
• Systemic therapy or occupational modification may be required for severe, persistent cases. 1, 2

Occupational Considerations

Healthcare workers represent the largest group affected by occupational glove dermatitis. 6 Sensitization patterns to rubber accelerators (thiurams, dithiocarbamates, mercaptobenzothiazole) have remained unchanged over decades despite awareness, with 13% of occupational dermatitis patients sensitized to thiurams. 6 There is an urgent need for allergen declaration on glove packages and wider availability of gloves with reduced accelerator content. 6