Charles Choi1, Saba Vafaei-Nodeh2, Jamie Phillips3, Gillian de Gannes4. 1. Fourth-year medical student, at the University of British Columbia in Vancouver. 2. Third-year medical student, at the University of British Columbia in Vancouver. 3. Fourth-year dermatology resident at the University of British Columbia. 4. Medical Director of the Contact Dermatitis Clinic at St Paul's Hospital in Vancouver.
Abstract
OBJECTIVE: To provide an approach to identifying topical medicament ingredients that cause allergic contact dermatitis (ACD) and to recognizing common clinical scenarios in which these ingredients might present. SOURCES OF INFORMATION: A retrospective chart review was conducted of patients patch tested at the Contact Dermatitis Clinic at St Paul's Hospital in Vancouver, BC, between November 2016 and June 2019. Data from the North American Contact Dermatitis Group from 2015 to 2016 and The Ottawa Hospital patch test clinic from 2000 to 2010 were also reviewed. MAIN MESSAGE: Topical antibiotics are the most common cause of ACD to medicaments and frequently cause cosensitization to multiple allergens. This hypersensitivity reaction is often seen following surgical procedures and should be distinguished from postoperative infection. Corticosteroid allergy is easy to miss and should be suspected in cases of corticosteroid-sensitive dermatoses that worsen despite appropriate treatment. Topical anesthetics and propylene glycol are other causes of ACD found in many prescription and over-the-counter products. CONCLUSION: Allergic contact dermatitis is easy to miss and should always be considered in cases of eczematous eruptions. A thorough drug history including all topical products-both prescription and over-the-counter-is critical. Patch testing can help identify specific allergens for the patient to avoid.
OBJECTIVE: To provide an approach to identifying topical medicament ingredients that cause allergic contact dermatitis (ACD) and to recognizing common clinical scenarios in which these ingredients might present. SOURCES OF INFORMATION: A retrospective chart review was conducted of patients patch tested at the Contact Dermatitis Clinic at St Paul's Hospital in Vancouver, BC, between November 2016 and June 2019. Data from the North American Contact Dermatitis Group from 2015 to 2016 and The Ottawa Hospital patch test clinic from 2000 to 2010 were also reviewed. MAIN MESSAGE: Topical antibiotics are the most common cause of ACD to medicaments and frequently cause cosensitization to multiple allergens. This hypersensitivity reaction is often seen following surgical procedures and should be distinguished from postoperative infection. Corticosteroid allergy is easy to miss and should be suspected in cases of corticosteroid-sensitive dermatoses that worsen despite appropriate treatment. Topical anesthetics and propylene glycol are other causes of ACD found in many prescription and over-the-counter products. CONCLUSION:Allergic contact dermatitis is easy to miss and should always be considered in cases of eczematous eruptions. A thorough drug history including all topical products-both prescription and over-the-counter-is critical. Patch testing can help identify specific allergens for the patient to avoid.
Authors: D P Smack; A C Harrington; C Dunn; R S Howard; A J Szkutnik; S J Krivda; J B Caldwell; W D James Journal: JAMA Date: 1996-09-25 Impact factor: 56.272
Authors: John F Elliott; Mariam Abbas; Peter Hull; Gillian de Gannes; Reza Toussi; Azita Milani Journal: J Cutan Med Surg Date: 2015-12-23 Impact factor: 2.092