Dicyclohexylcarbodiimide commonly causes contact dermatitis but can also be acutely tissue cytotoxic

Dicyclohexylcarbodiimide (DCC; CAS no. 538-75-0) has been used by the pharmaceutical industry as a coupling agent in polypeptide synthesis.1 It is a versatile organic reagent that has increased use in the elastomers, fibres, foam, and polyester industries, as well as the recombinant DNA industry and food industry.2, 3 Reports have shown that DCC is a known elicitor of irritant and/or allergic contact dermatitis; however, its potentially acute cytotoxic effects may be underappreciated.4, 5 A Material Safety Data Sheet for DCC not only states that it can cause skin sensitization, but also demonstrates that it can lead to acute dermal toxicity, serious eye damage, and acute oral toxicity.6 We describe a case of exposure to DCC with complications extending beyond the severity of just cutaneous dermatitis. A 25-year-old female science researcher was exposed to DCC while performing protein-coupling work under a ventilated hood, wearing only nitrile gloves. She reported that she spilled a weigh-boat of a pre-determined amount of DCC onto herself, with most of the contact occurring on her right forearm and the right side of her face. Within an hour, the patient reported experiencing moderate pruritus and burning on her forearm, extensive coughing, facial dermatitis, headache, and marked irritation and blurry vision in the right eye. Upon presentation, a day after her accident, the patient's right forearm had extensive erythema with scale, crust, and minimal exudate. We prescribed a course of topical clobetasol propionate 0.05% ointment twice a day to the forearm, a tapering dose of oral steroids, cetirizine, and hydroxyzine, which improved her rash, headache, and coughing. She also saw an ophthalmologist who diagnosed her right eye with irritant conjunctivitis and corneal ulceration. She was given an ophthalmic lubricant and a short course of ophthalmic dexamethasone. After 2 weeks, she had complete restoration of vision. She reported being aware that DCC is a substance known to cause skin reactions among laboratory personnel but was unaware of its acute cytotoxic effects. Two months after the accident, the patient received a patch test using IQ Ultra chambers (Dormer Laboratories, Toronto, Canada; occluded for 2 days and read in 4 days), to 0.1% pet. DCC (Sigma-Aldrich, Burlington, Massachusetts), revealing a +++ reaction.4 We have previously seen cases of localized contact dermatitis to DCC; however, this case is distinct due to the presence of other non-cutaneous acute toxic manifestations brought on by DCC exposure. The eye damage provoked by DCC has been reported in only one other report.7 Additional research into DCC reveals that this substance can cause severe tissue cytotoxicity, be potentially neurotoxic, and mediate potential carcinogenicity.2, 3 Although there is consensus among the scientific community that DCC should be treated with caution and handled under a hood, underappreciation of the high tissue cytotoxicity and potentially carcinogenic effects of DCC has led researchers to adopt a more relaxed safety approach when handling this chemical. After highlighting these effects, the patient's laboratory re-instated strict measures for handling DCC, consisting of the use of a ventilated hood, wearing nitrile gloves, taping disposable Tyvek-type sleeves to currently worn gloves, wearing National Institute of Occupational Safety and Health-approved half-face respirator, equipped with an organic vapour/acid gas cartridge, and wearing splash-proof safety goggles. After the patient was instructed to avoid any exposure to DCC, she now avoids working with this agent. Facilities that frequently use toxic contact allergens, such as DCC, should establish and adhere to protocols from written guidelines and chemical hygiene plans as well as consider creating a distinct staff position for ensuring the education of all laboratory staff on safety requirements.8, 9 A 2013 study of 2400 scientists revealed that only 60% of the group had received any safety training on the specific hazardous materials they were handling.10 Holding regular orientations and safety training sessions can aid in reducing exposure, especially in environments such as academic laboratories that experience high rates of staff turnover.2, 9, 10 The authors declare no conflicts of interest. William Nahm: Conceptualization (lead); methodology (lead); project administration (lead); supervision (lead); writing – original draft (lead); writing – review and editing (lead). Andrea Schreck: Methodology (equal); project administration (equal); writing – original draft (equal); writing – review and editing (equal). Jaideep Prasad: Methodology (equal); project administration (equal); writing – original draft (equal); writing – review and editing (equal). Eli Rapoport: Methodology (equal); project administration (equal); writing – original draft (equal); writing – review and editing (equal). Jesus Fragoso: Methodology (equal); project administration (equal); supervision (equal); writing – original draft (equal); writing – review and editing (equal). Carlos Vega: Methodology (equal); project administration (equal); supervision (equal); writing – original draft (equal); writing – review and editing (equal).

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