Occupational allergic contact dermatitis induced by adhesives used for prevention of chafing in the military forces-A case report.

Occupational dermatitis in the army has been reported previously.1, 2 In this case report the use of adhesives for primary prevention of chafing of the feet caused severe allergic contact dermatitis. A male conscript, 24-years-old, was referred for suspected occupational contact dermatitis. The patient gave written informed consent to publication of the case report and photos. The conscript had rhinoconjunctivitis, atopic dermatitis, otherwise healthy. In the armed forces, he worked as a driver and excavator operator. He had no previous work or leisure experience with electronics, medical devices (MDs), or wood. In 2021, the armed forces prepared a prolonged march. To prevent chafing,1, 2 the conscripts were recommended to apply adhesives on their feet. Taping of the feet has been used for decades within the armed forces but is also recommended on social media. During the exercise, the patient developed dermatitis with blistering on both feet localized in the region where the feet were taped (Figures 1-3). The dermatitis reappeared when the same procedure of taping was performed at next extended march. After this, the tape was considered the possible culprit agent and therefore avoided. At referral post-inflammatory lesions could still be seen on the ankles and dorsum aspect of the feet. The patient had prior to his time in the army not experienced skin problems with adhesives or bandaid. Two different brands, Optiplaste®-C (Essity, BSN Medical SAS, Vibraye, France) and Strappal® (Essity, BSN Medical SAS) had been used. Patch testing was performed with the Swedish baseline series, and Malmö extended baseline series, and the two adhesives tested as is and as ultrasonic acetone extracts.3 Test preparations obtained from Chemotechnique Diagnostics, Vellinge Sweden, or prepared in our laboratory. Finn ChamberAQUA® (SmartPractice, Phoenix, Arizona) was used. The patch tests were removed on day (D)2. Readings were performed twice, on D3 and D7 with test classification according to ICDRG and ESCD.4, 5 The patient had extreme (+++) reactions to colophony (20% pet and 60% Softisan) and oxidized (ox.) limonene. Strong (++) reactions were noted to Myroxylon pereirae, fragrance mix (FM) I, FM II, phenol-formaldehyde resin (PFR-2), and ox. linalool, and propolis. Extreme reactions were also noted to both adhesives tested as is and as ultrasonic extracts.3 Allergic contact dermatitis from Optiplaste®-C and Strappal® was diagnosed. Both products contain colophony-related substances. The patient had an extremely strong reaction to colophony. Given the history and the reactivity, the most likely explanation is that the patient was occupationally sensitized. However, in retrospect, it is impossible to totally exclude that the patient was not sensitized to colophony prior to the military service, as symptoms according to the patient started already after some days at first exposure. Contact allergy was also established to FMs I and II, PFR-2, Myroxylon pereirae, and hydroperoxides of limonene and linalool. Significant overrepresentation of simultaneous contact allergies to colophony, Myryxolon pereirae, FM I, and PFR-2 was reported in the 1980s6 and this pattern expanded with contact allergies to FM II, ox. limonene, and ox. linalool is not only seen in the present case but also in other recruits with the same exposure.7 Limonene has previously been reported in adhesives.8 However, chemical analyses at our laboratory could neither detect any of the unoxidized terpens, nor the ox. ones in any of the adhesives tested. The use of MD has increased enormously in the last decades. Occupational irritant and allergic contact dermatitis from MDs is well known among healthcare personnel. This case of clearly occupational nature is to the best of our knowledge the first report on occupational allergic contact dermatitis to adhesives recommended for primary prevention of chafing within the armed forces. Svedman Cecilia: Conceptualization; methodology; funding acquisition; writing – original draft; writing – review and editing; data curation; supervision; resources; investigation. Dahlin Jakob: Conceptualization; investigation; methodology; writing – original draft. Hamnerius Nils: Conceptualization; investigation; writing – original draft; methodology; data curation. Adwa Usamah N AR: Investigation; data curation. Bruze Magnus: Conceptualization; investigation; writing – original draft; data curation; methodology. The authors declare no conflict of interest.