Dermally Implanted Rubber

dermally implanted rubber
Numerous blue-black macules on forearm

A retired worker of a tire manufacturing plant presented with dermally implanted rubber in hands, forearms, and upper arms due to repetitive trauma

A 57-year-old male patient presented with dermally implanted rubber in hands, forearms, and upper arms. He had no symptoms at presentation. The patient had worked in a tire manufacturing plant for 37 years; however, he had retired 6 years back. He had a history of frequent episodes of trauma while cutting unvulcanised rubber implanted with sharp metal strips.

The patient reported that his work was to manipulate and hand-cut unvulcanised rubber sheets. Those sheets had uniform, thin metal wires embedded within the rubber sheets. Moreover, the metal wires extended beyond the ends of the rubber sheets. This exposed the patient to repeated puncture wounds while cutting the rubber sheets. Most probably, the repeated wire punctures “tattooed” the worker’s skin over a period of time with rubber particles; in other words, resulted in traumatic implantation of the rubber.

When asked, the patient revealed that he did not wear gloves while working as the use of gloves compromised his tactile ability. However, he wore forearm sleeves for over a decade. Moreover, he revealed that he also noticed similar skin findings in many of the co-workers in his department.

On examination, the left index finger had the most pronounced dermally implanted rubber, hence darkly discoloured.
dermally implanted rubber
Coalescent hyperpigmentation

Histopathological analysis of the lesions revealed perivascular pigment consistent with rubber tattoo. Since the patient had a history of lengthy retirement, no systemic biomarkers were measured. However, the patient showed specific curiosity about the increased risk of malignancies due to the “rubber tattoos.”

Manufacturing jobs contribute the most to the burden of occupational skin diseases as compared to other industries. Especially in the rubber industry, skin exposure and repetitive contact with warm unfinished rubber products is the primary route for dermal contamination.

The association of occupational rubber exposure and skin malignancy is not certain yet. Some studies have shown insufficient evidence to link the rubber industry with skin cancer, whereas other studies outlined an established link between the two. However, polycyclic aromatic hydrocarbons (PAHs) are skin carcinogens and are still very much present in the modern-day rubber industry.

Nonetheless, it is best to wear personal protective equipment, including gloves to prevent skin contact with uncured rubber. Moreover, for inhalational prevention in areas of fumes or dust particulate, task-specific mask filters are recommended.

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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