Contact Leukoderma Induced by Latex Condom: A Case Report

Introduction

Contact leukoderma, or chemical leukoderma, or chemical vitiligo, is characterized by hypopigmented dermatosis caused by repeated exposure to specific chemicals, usually without signs of inflammation.¹ Chemical leukoderma affects all age groups, from children to older adults. Compared with children under 12, adults have a higher incidence of chemical leucoderma.² In the present case, the patient experienced depigmentation around the penis shaft after using a rubber condom for a long duration.

Case report

A 51-year-old married male presented to the dermatology outpatient department at Government General Hospital (RIMS), Kadapa, Andhra Pradesh, with a complaint of ring-shaped skin depigmentation around the penis persisting for eight months. The depigmented area remained stable without spreading to other body parts. The patient reported no associated symptoms such as pain, itching, or inflammation. His personal and family medical history revealed no autoimmune disorders or skin diseases. The patient had been married for 20 years and reported consistent use of rubber latex condoms during sexual intercourse for the past six years.

The depigmentation first appeared as a tiny spot eight months ago and slowly evolved to a complete ring-shaped pattern within two months, which remained unchanged and persistent for the next six months (Figure 1). On examination, a linear or circular band of centimeter-sized depigmentation was seen around the penis shaft. A positive reaction to the latex allergen patch indicates sensitization to latex and supports the diagnosis of latex allergy as the cause of the patient's skin depigmentation.

Based on the diagnostic evaluation, it was confirmed as contact leukoderma induced by rubber latex condoms. In line with the diagnosis, the patient was advised to discontinue the use of latex condoms to prevent further allergic reactions. Additionally, he was prescribed tacrolimus 0.1% ointment to be applied three times daily. Close monitoring of the patient's condition and adherence to the prescribed treatment regimen were recommended to achieve optimal outcomes. Follow-up appointments were scheduled for every 3 weeks to assess the response to treatment and address any concerns or complications that may arise. The patient was educated on strategies for avoiding latex and informed about alternative contraceptive options to reduce the risk of future allergic reactions.

Discussion

Chemical leukoderma can also be called contact leukoderma or occupational leukoderma.³ Certain aliphatic and aromatic derivatives of phenols and catechol, p-phenylenediamine (PPD), certain azo dyes, sulfhydryl, mercurial, and arsenic are commonly implicated in chemical leukoderma. Hair dyes, plastics, rubber, and leather products like shoes, belts, gloves, condoms, detergents, henna, and many other products can contain these chemicals and may cause leukoderma at the contact site.¹ In 1939, Oliver et al., first reported chemical leukoderma in leather manufacturing company employees who used acid-cured rubber gloves. The offending agent was identified as monobenzyl ether of hydroquinone (MBH), an antioxidant used in the rubber industry. As a result of those investigations, numerous chemicals have been discovered to cause chemical leukoderma. These chemicals are also found in various objects, which induce chemical leukoderma.⁴ In a clinic-aetiological study by Ghosh et al., on 864 cases of chemical leucoderma, the aetiological agents causing chemical leukoderma identified were hair dyes (27.4%), deodorant and spray perfumes (21.6%), detergent and cleansers (15.4%), adhesive bindis (12%), rubber chappals (9.4%), black socks and shoes (9.1%), eyeliner (8.2%), lip liner (4.8%), rubber condoms (3.5%), lipstick (3.3%), fur toys (3.1%), toothpaste (1.9%), insecticides (1.7%), Alta (1.2%), and amulet string color (0.9%).²

In a case study by Downing et al., multiple white patches were observed on the patient's penis, with depigmentation extending from both sides of the median groove of the glans penis, particularly affecting the undersurfaces. However, the mucous membrane appeared normal, and no other depigmentation patches were observed on the entire skin. The patient reported a history of using rubber condoms for six years.⁵ In another case report by Banerjee et al., six patients presented with a six-month history of ring-shaped depigmentation around the penile shaft, attributed to the continued use of condoms for two years after marriage. Upon examination, a linear, circular discoloration band was noted around the penis shaft, corresponding to the condom's point of most excellent contact. Contact leukoderma caused by latex condoms was suspected.⁶ Patch testing using condom latex and mercaptobenzothiazole dusting powder was conducted, with positive results observed after 72 hours.⁶ It was suggested that harmful substances in latex condoms may directly cause melanocytotoxicity, leading to depigmentation, independent of their ability to induce sensitization through cell-mediated immunity.² Prolonged and repetitive use of rubber condoms can potentially result in irritation and, in rare cases, depigmentation of the penis shaft due to friction and close contact between the condom and the skin.⁶

Although the exact method by which these compounds affect melanocytes remains unknown, laboratory testing has shown that several azo dyes can bind to human DNA. This process can immediately lead to cell death via apoptosis.⁷ Additionally, it has been shown that the chemical leukoderma-inducing agent 4-tertiary butyl phenol, which can also induce apoptosis in melano-cytes, can cause leucoderma.⁸ Moreover, there is proof that azo dyes, which share structural similarities with tyrosine and compete with it to bind the tyrosinase enzyme, can directly inhibit melanogenesis. It is hypothesized that the melanocyte may sustain oxida-tive damage due to the hydroxylation products created when phenolic substances and tyrosinase interact.⁹ Tyrosinase-related protein-1, another melan-ocyte-specific enzyme, mediates melanocyte damage from phenolic substances. This damage is most likely mediated by the production of intermediates that overwhelm antioxidant mechanisms.¹⁰

Conclusion

Contact leukoderma is a rare condition commonly seen in patients more susceptible to certain chemicals. Early detection of the chemical irritants or depigmented areas of the skin, along with direction for suitable treatment, is critical to halting disease progression and reversing the condition.

Informed consent: Written informed consent was obtained before history taking and examination to publish the case report and any relevant images.

Funding

None

Conflict of Interest

The authors have no conflicts of interest to declare.