Allergie de contact aux antiseptiques : 75 cas analysés par le réseau Revidal de dermato-allergovigilance

AIM

To determine the clinical features of contact dermatitis caused by antiseptics and to ascertain whether the substance responsible is the antiseptic itself or the excipients.

PATIENTS AND METHODS

A multicenter, retrospective study based on analysis of all cases reported over a 2-year period to the Dermato-Allergology Vigilance network known as Revidal. Each dossier contained details of the clinical characteristics of lesions, the incriminated antiseptic, the mode of exposure and the results of patch tests done with the antiseptic in question.

RESULTS

75 patients (mean age: 44 years) were sensitized to chlorhexidine (14 cases), hexamidine (20 cases), povidone iodine (14 cases), mercuric antiseptics (3 cases), triclocarban (Septivon, 17 cases), hexamidine-chlorhexidine-chlorocresol (Cytéal, 4 cases), or chlorhexidine surfactant (Hibiscrub), cetrimide or chlorhexidine digluconate (Diaseptyl) (1 case each). Exposure was therapy-related (68 cases), work-related (6 cases; 5 in health workers and 1 in a cattle farmer due to povidone-iodine) or related to cosmetics (1 case, hexamidine). The clinical features consisted mainly of localized contact dermatitis, although generalized eczema occurred in 9 cases due to hexamidine contact. Sensitization was due to the antiseptic itself (53 cases) or to the excipients alone (22 cases), particularly in the 17 cases caused by Septivon. In 27/75 cases (35%), patients exhibited polysensitization to antiseptics belonging to different chemical classes or to other topical drugs.

CONCLUSION

Sensitization to antiseptics is probably not rare, with various sources of exposure being present in everyday life. Patch tests are essential for diagnosis in order to distinguish between antiseptic-related and excipient-related sensitization and to screen for polysensitization to topical drugs.

An epidemic of allergic contact dermatitis due to epilating products

Over a period of 19 months, 33 cases of acute allergic contact dermatitis from Veet epilating waxes and/or the accompanying tissue (Reckitt Benckiser, Massy, France) were observed in France and Belgium. The lesions started on the legs and spread to other parts of the body, especially the face, and were sometimes so severe that hospitalization and/or systemic corticosteroids were required. Primary sensitization occurred as early as after the first application in several patients. Patch tests were performed in 26 of the patients and produced strong positive reactions to the tissue (25 times) and/or the wax (13 times). The allergenic culprits in the wax were modified-colophonium derivatives (colophonium in the standard series testing negatively in all except 4 patients), while methoxy PEG-22/dodecyl glycol copolymer and to a lesser degree lauryl alcohol turned out to be the main causal allergens in the tissue.

[Allergies to ketoprofen gels]

A COMMON OBSERVATION: Ketoprofene gels, widely used to treat benign conditions, can provoke local intolerance. The most commonly reported clinical features include eczema, sometimes severe acute contact photoallergy that often spread beyond the site of application and may even lead to a long-duration generalized reaction.

DIAGNOSIS

Photoallergological tests allow positive diagnosis of the ketoprofene-induced contact photosensitization and underline the role of the benzophenone ring, explaining certain cross allergies with fenofibrate and oxybenzone.

PRECAUTIONS FOR USE

The primary rule is to avoid sun exposure, requiring better information for prescribers and patients.

[Eruptive xanthogranulomatosis in a trisomy 21 patient with acute lymphoblastic leukemia]

BACKGROUND

Juvenile xanthogranulomas may be associated with myeloproliferative disorders, usually juvenile chronic granulocytic leukemia.

CASE REPORT

We report the case of a 25-year-old man with Down's syndrome who presented eruptive xanthogranulomas. At this time, the patient was being treated for acute lymphocytic leukemia. The eruption increased with an extensive unusual "satellite" arrangement despite apparent remission of the acute leukemia. Leukemia relapse occurred some months later.

DISCUSSION

This case had an unusual clinical presentation. It also suggests their might be a link between the clinical course of lymphocytic leukemia and juvenile xanthogranuloma.

["Buffalo neck": an unintended secondary effect of treatment with anti-HIV protease inhibitors]

BACKGROUND

Lipodystrophy and other fat distribution disorders have been reported in patients receiving protease inhibitor therapy for HIV infection.

CASE REPORT

A 50-year-old HIV-positive patient was given protease inhibitor therapy (indinavir) for 6 months when he developed a lipomatous formation in the retrocervical area. Abdominal fat also increased in volume and the subcutaneous fat on the lower limbs decreased.

DISCUSSION

We describe the main clinical features of these fat distribution disorders and discuss the pathogenic hypothesis of an interaction between antiprotease activity and hepatic lipoprotein receptor binding.

[Ketoprofen-induced contact photosensitivity disorders: 5 cases]

BACKGROUND

Nonsteroidal antiinflammatory drugs (NSAID) are widely used in topical applications for benign diseases. Adverse skin reactions include contact eczema and photocontact dermatitis. Among the NSAID used in topical applications, arylpropionic derivatives, notably ketoprofen, are frequently implicated.

CASE REPORTS

We observed 5 patients who developed eczema lesions after application of Ketum, a gel containing ketoprofen used on healthy skin after exposure to sunlight. Photoallergy explorations evidenced positive photopatch-tests for ketoprofen with UVA and total light. The anamnesis suggested a photoallergic mechanism which was confirmed by histological examination of the biopsy of a UVA positive photopatch-test and by negative photopatch-tests in 10 healthy controls.

DISCUSSION

The photosensitizing potential of ketoprofen in the UVA spectrum is well known. Although the number of adverse reactions is quite small compared with widespread use, physicians should be aware of this photosensitivity and report all cases to the pharmacovigilance center.

Cutaneous anaplastic T-cell lymphoma in a patient with human immunodeficiency virus infection: detection of Epstein-Barr virus DNA

The Epstein-Barr virus (EBV) genome exists in tumour cells of T-cell lymphomas in non-immunosuppressed patients. We identified EBV-DNA by in situ hybridization in a case of anaplastic T-cell lymphoma associated with acquired immunodeficiency syndrome (AIDS). EBV-DNA has been reported in AIDS-related Hodgkin's disease or B-cell lymphoma, but never in T-cell lymphoma. Although our results suggest that EBV could play a role in the development of these anaplastic T-cell lymphomas, the mechanism of EBV penetration into T-cells remains uncertain.