A case of allergic contact dermatitis to dental bonding materials, masked by the use of gloves

A 27-year-old man presented with eczema on the volar aspect of his left hand, associated with itching and burning (Figure 1A). The skin lesion had developed 1 week earlier, with itching and scaling. Questions about occupational exposure revealed previous contact with snakes and fish, but no history of allergic diseases nor previous skin symptoms. The patient suffered from epilepsy and had been treated with valproate and lamotrigine from the age 6 years, but was otherwise healthy. Suspecting an infectious disease caused by snakes or fish, a punch biopsy and deep swab were performed. The histopathological examination showed epidermal necrolysis with eosinophils and T-lymphocyte infiltration, neutrophilic spongiosis, pustules formation, and impetiginization. According to these findings, the pathologist suspected an adverse drug reaction or insect/arthropod bites. The lesion healed with topical betamethasone and fusidic acid twice daily for 2 weeks; however, in the following months the patient consulted twice more for recurrence of the same skin lesion on the left hand (Figure 1A). As the recurrences always reappeared in the same site, and in view of a history of taking antiepileptic drugs, a fixed drug eruption was suspected. However, when further investigated, the patient