Contact dermatitis to topical acne drugs: a review of the literature

Acne vulgaris is a chronic dermatological disorder that affects the majority of teenagers in the Western world. Topical therapy is widely used to treat mild‐moderate acne and is known as well‐tolerated thanks to its low systemic toxicity, although associated to skin adverse effects. Acne seems to be associated also to an intrinsic alteration of the epidermal barrier, regarding both the upper and the follicular stratum corneum that promotes the onset of such local side effects. The commonest one is irritant contact dermatitis, an event of frequent observation occurring with erythema, burning, dryness, scaling, and itching, usually characterized by low severity and limited duration. Among topical acne drugs, retinoids are the most irritating ones. Another side effect is allergic contact dermatitis: it is rare and mainly associated to benzoyl peroxide.     

The immunology of Contact dermatitis

This review summarizes current knowledge of the pathophysiological events which lie behind the development of contact dermatitis. The clinical distinction between allergic and irritant eczema is discussed. New observations are evaluated on our understanding of how allergic and irritant eczema may in many respects be similar, evolving through common physiological pathways of immune inflammation.     

Contact dermatitis from telefax paper

A nonatopic female secretary developed hand dermatitis after 1 year of full-time work with telefax paper. Her dermatitis improved on sick leave and vacation and relapsed at work. Patch testing showed allergic reactions to several fragrances, balsam of Peru, colophony and neomycin. In 3 patch test sessions, her own telefax papers gave a doubtful reaction which persisted for 4 days, but it could not be determined whether the reactions were allergic or irritant. The colophony content of the telefax paper was about 1%, and it was possible that colophony in the telefax paper was responsible for the weak path test reactions. Accordingly, the contact dermatitis would have been allergic. The patient has now been relocated, does not handle telefax paper, and is symptomless. We concluded that our patient had an occupational hand contact dermatitis induced by telefax paper and possibly caused by colophony allergy.     

文身染料所致接触性皮炎二例

报道2例文身染料所致接触性皮炎。2例由文身染料所致的接触性皮炎,文身染料斑贴试验结果阳性,局部类固醇及抗过敏治疗后好转,留有轻度色素沉着。     

Contact dermatitis to alcohol swabs masquerading as vaccine allergy

A 14-year-old girl developed an eruption on her upper arm of pruritic, follicular papules each time she received a vaccination. This was initially thought to be a local reaction to the vaccines. After a similar rash appeared at a venepuncture site, a contact allergy to the alcohol swabs used before the procedures was postulated. A repeated open application test clarified this observation.     

Contact dermatitis due to use of Octenisept® in wound care

Background: Octenisept^®, containing 0.1% octenidine/2% phenoxyethanol, is a widely used antiseptic in modern wound management. It is considered to have a very low allergenic potential. Thus far, neither allergic nor irritant contact dermatitis to the product has been described. Patients and methods: Chronic wounds in 251 patients were treated with Octenisept^®; 11 developed signs of contact dermatitis. The symptoms improved after discontinuation of the antiseptic. Eight of these patients were patch tested to the antiseptic and its components. Results: The eight patients all showed a positive reaction to the product. In at least three cases a reaction to the components cocamidopropyl betaine and phenoxyethanol was found, but not to octenidine dihydrochloride. Conclusions: In this cohort, more than three percent of the treated patients developed a contact dermatitis to the antiseptic. However, the differentiation between allergic and irritant contact dermatitis towards the ingredients of the antiseptic remains problematic.     

Contact allergy to the fungicide benomyl?

Benomyl is a widely used fungicide. Contact allergy to benomyl has been reported in a few cases. We describe a group of 62 workers, exposed to benomyl. None had contact dermatitis from benomyl. It appears that benomyl at most is a weak sensitizer. We suggest that earlier-reported allergy may represent cross-reactions and/or that the development of contact allergy to benomyl requires previous exposure to other chemically related pesticides.     

Contact allergy to chloroacetamide

Chloroacetamide is an uncommon skin care product allergen. A case of allergic contact dermatitis to this preservative is described in a patient who reacted to an underarm deodorant     

Contact allergy to aeroallergens in children with atopic dermatitis: comparison with allergic contact dermatitis

Immediate and delayed cutaneous hypersensitivity are believed to be implicated in the physiopathology atopic dermatitis (AD). The purpose of this study was to evaluate Type I and Type IV allergy to aeroallergens in children with AD. 59 children (mean age 5.2 years), presenting with AD according to Hanifin and Rajka's criteria, were skin tested (patch and corresponding prick tests) with common environmental aeroallergens and a restricted panel of the European standard series over a 1-year period. History and clinical data were carefully recorded using a standardized evaluation sheet: total and specific IgE serum levels were evaluated 17 of 59 patients (28.8%) had at least 1 positive patch test, 32 of 59 patients (54.2%) had at least 1 positive prick test. Corresponding patch and prick tests were observed in 8 out of 17 patients. 5 children with positive patch tests had negative prick tests. Irritant pustular reactions (2/59, i.e. 3%), "angry back" reactions (6/59, i.e. 10%) and doubtful reactions (3/59, i.e. 5%) were excluded from the positive group. Positive patch tests observed included, in decreasing order: D. pteronyssinus and D. farinæ (26.8%) garden trees (12.2%), plantain (9.8%), timothy grass, mugwort and damp area trees (4.9% each), and orchard grass (2.44%). 6 children with positive aeroallergen patch tests and 11 children with negative aeroallergen patch tests had at least 1 positive patch test to standard allergens. All children with an irritant reaction to aeroallergens had no reaction to standard patch tests. The relevance of aeroallergens in upgrading the severity of AD lesions has still to be explored by challenge studies and by long-term follow-up.