Contact dermatitis to PPD rubber in Maleki shoes

The Persian cloth shoe (Maleki) which has been in use for more than 800 years has a strong cloth sole and a woven cotton upper. In the last 20 years, used car tires have become readily available in Iran and the soles of some shoes are now made from these. A man with the typical picture of rubber dermatitis on the soles of his feet is described. On patch testing he gave a 2+ positive to PPD rubber and this was thought to be due to the fact that he had worn Maleki shoes for several years.