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製鉄所勤務の42歳男性，初診の2週間前から両手背の掻痒感を自覚していた．両手背に苔癬化をきたした紅斑局面を認めた．職場で使用している手袋のパッチテストを行い，手袋のゴム部分で陽性となった．製鉄工場で勤務していることから，金属パッチテストを実施し亜鉛で陽性反応を示した．ゴムの加硫促進助剤に含まれる亜鉛によるアレルギー性接触皮膚炎と診断した．職業性皮膚疾患のなかでも接触皮膚炎は最多であり，原因物質も様々である．ゴム（ラテックス）に対するアレルギー反応はⅠ型アレルギーとⅣ型アレルギーがあり，Ⅳ型アレルギー反応としてはチウラムなど加硫促進剤に対するアレルギーが多い．本症例のように亜鉛アレルギーがある場合，ゴムに対してもアレルギー反応を起こすことがあり，注意が必要である．A 42-year-old man working at a steel mill recognized itching and erythema on the dorsal surfaces of his hands for 2 weeks prior to his first visit to our department. Lichenized erythematous plaques were observed on the dorsal surfaces of his fingers and hands. A patch testing of the rubber part of the gloves showed a positive reaction. We also conducted a patch testing of metals to exclude a possibility of contact dermatitis mediated by metals as occupational materials. The patch testing of metals showed a positive reaction to zinc, which is not an occupational material in his steel mill, but his rubber gloves contained zinc in the rubber accelerators, which might have been the trigger that caused his allergic contact dermatitis. Contact dermatitis is the most common occupational skin disease, and various materials are the causative agents. Allergic reactions to rubber (latex) are classified into type I allergy and type IV allergy. Type IV allergic reaction is observed in rubber accelerators such as thiuram; however, our case showed that zinc allergy could be a possible causative agent in patients with contact dermatitis due to rubber gloves. |
