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Contact Allergy to Topical Drugs

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Contact Dermatitis

Abstract

Topical drugs applied onto the skin or the mucosae can cause local adverse effects, including contact dermatitis, and, eventually, also systemic adverse effects. Allergic contact dermatitis from topical drugs occurs in more than 10% of patients attending contact clinics, but irritant, phototoxic or photo-allergic, as well as immediate reactions (contact urticaria syndrome) and systemic contact dermatitis also occur. Ectopic and connubial dermatitis and exposure in the occupational setting (healthcare professionals, veterinarians, pharmaceutical industry) represent other settings of contact dermatitis to topical drugs.

The active drug or the excipients (preservatives, fragrances) that are responsible for allergic contact dermatitis vary in different studies influenced by local prescribing habits. Antibiotics (neomycin and aminoglycosides, bacitracin, polymyxin B, fusidic acid) and antiseptics (chlorhexidine, povidone-iodine, quaternary ammonium compounds) are among the main culprits, followed by local anesthetics (dibucaine, amethocaine, lidocaine, and benzocaine), corticosteroids (budesonide), nonsteroidal anti-inflammatory drugs (ketoprofen, etofenamate, piroxicam, diclofenac, and benzydamine), but many other drugs can induce contact reactions.

The use of topical drugs on previously damaged skin (stasis dermatitis and/or leg ulcers, otitis externa), under occlusion (transdermal drug delivery systems), onto very thin skin (eyelids), or in body folds (anogenital area) favors skin sensitization and allergic contact dermatitis; mucosal exposure rather promotes the development of immediate-type skin reactions, which can be severe and life-threatening (chlorhexidine). Contact photosensitivity occurs mostly with promethazine and nonsteroidal anti-inflammatory drugs, like ketoprofen, in this case with cross-reactivity to benzophenones, octocrylene, and oral fenofibrate. Active drugs and excipients that sensitize by topical use are one of the main causes of systemic contact dermatitis (aminoglycosides, corticosteroids, acyclovir, dibucaine). Herbal medicines are also an important cause of contact reactions.

Since adverse reactions to drugs are being underreported, the national competent authorities should be informed about such reactions in order to feed these into the European database (“EudraVigilance database”) at the European Medicines Agency (EMA).

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Goossens, A., Gonçalo, M. (2020). Contact Allergy to Topical Drugs. In: Johansen, J., Mahler, V., Lepoittevin, JP., Frosch, P. (eds) Contact Dermatitis. Springer, Cham. https://doi.org/10.1007/978-3-319-72451-5_38-2

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  • DOI: https://doi.org/10.1007/978-3-319-72451-5_38-2

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  1. Latest

    Contact Allergy to Topical Drugs
    Published:
    10 June 2020

    DOI: https://doi.org/10.1007/978-3-319-72451-5_38-2

  2. Original

    Topical Drugs
    Published:
    27 January 2020

    DOI: https://doi.org/10.1007/978-3-319-72451-5_38-1