Eric Van Hecke

Contact sensitivity to imidazole derivatives.

Miconazole is a widely prescribed topical anti· fungal agent available in this country as Dak· tarin® cream, powder, lotion, gel, tincture and as Daktacort cream. Daktacort® cream is Daktarin® cream with 1 % hydrocortisone. Daktarin® and Daktacort® preparations are ad· vocated in the treatment of dermatophytosis, pityriasis versicolor and candidiasis of the skin. Contact sensitivity to miconazole is uncommon. Three cases have been described (Van Ketel 1974, Degreef & Verhoeve 1975, Samsoen & Jelen 1977). We recently saw two new cases and report on cross sensitivity to other imida· zole derivatives.

Contact sensitivity to enilconazole

A 43-year-old female technician in a veterinarians laboratory developed a scaly red patch on the dorsal aspect of the right hand. Her employer considered the lesion as a dermatophytic infection of the skin and gave her the veterinary antimycotic Imaverol®. 2 weeks later, she consulted us with an acute eczematous contact dermatitis of the right hand and forearm. After discontinuing Imaverol®, the dermatitis healted quickly with wet dressings and topical steroids. Patch tests with the European standard tray and additional standard allergens revealed contact sensitivity to balsam of Peru. Patch tests with an antimycotic tray showed allergy to several imidazole derivatives: econazole, enilconozale, isoconazole, micon-

Contact dermatitis to ethoxyquin in animal feeds.

A 56-year-old man complained of an itchy, erythematous and finely scaly, occasionally oozing eruption for the past 2 years. The dermatitis started on the face and extended to the hands and forearms. A protective effect of clothing was noted. The eruption looked somewhat like a photodermatitis. The patient is the owner of a farm. He feeds calves with a dusty animal feed daily. Patch tests with a standard tray and additional series of allergens revealed sensitivity to p-phenylenediamine, sulfanilamide, p-amino-azo-benzene and mercury. The animal feed and its components were also tested. Positive tests were obtained with the animal feed and ethoxyquin (Table 1). The factory which supplies the animal feed was willing to make a feed without ethoxyquin. Since using this feed, the patient has no skin complaint.

Ethylenediamine sensitivity from exposure to epoxy resin hardeners and Mycolog cream.

Sensitivity to ethylenediamine and to epoxy resin hardeners was found in three patients with long standing contact dermatitis. In one patient, a young man, the sensitivity was elicited by occupational contact with epoxy resin hardeners and subsequently sustained by use of Mycolog cream. In two patients, both elderly women, the condition was only due to use of Mycolog cream. These case histories and test results indicate that use of Mycolog cream can result in occupational disease viz. contact dermatitis from epoxy hardeners.

Allergic contact dermatitis from an ostomy bag

tules with folliculitis, without any les10ns on the fingers. Microscopically, our findings are essentially the same as described by Schwartz (3), but our case also showed denudation of superficial layers of the ep1derm1s above, and marked fibros1s at the base of, acne les10ns. In additiOn to the development of acne and folliculitis locally, other possible s1gns of chrome toxicity to diesel oil were also observed. These were azoospernua, hepatitis and psycholog~cal symptoms. Azoospermia (4) has been reported m workers handling lead m ethylated gasoline. Diesel oil, however, does not contam any lead. Azoospermia m tlus patient may therefore be a chance finding. However, it appears more likely that hepatitis (5) and psychological symptoms (6), wh1ch are encountered amongst solvent and gasoline workers, could have been caused by diesel oil exposure. Diesel oil tox1city m th1s patient appeared to be charactensed by psychological symptoms, hepatomegaly, acne and folliculitis of exposed skm, and possibly also azoospermia. The patient has already been relieved of local symptoms by a change of occupation. His diesel oil tox1city could probably have been avmded m the first place with adequate preventive measures. Acknowledgement

Contact dermatitis from Zovirax cream

Case no. 1 A 25-year-old woman presented with an acute dermatitis of the lips and surrounding skin, starting a few days after applying Zovirax cream for recurrent herpes infection. She also used a lipstick: Labello Sun. She had used Zovirax cream 5 times in the past year. After clearance of the dermatitis, repeated patch tests (up to 15 months later) in several sessions demonstrated contact allergy to nickel sulphate, balsam of Peru, butylated hydroxyanisole and isopropyl dibenzoylmethane. Strongly positive reactions were obtained after 2 and 4 days to Labello Sun lipstick and Zovirax cream (Table!). Out of the constituents supplied, the base of Zovirax cream was made up by a local pharmacist. Patch tests with this base, with and without 5% acyclovir, remained negative. Her nickel and balsam of Peru allergies were of past relevance. The allergies to butylated hydroxyanisole and isopropyl dibenzoylmethane were attributable to La bello Sun lipstick, from which both chemicals have recently been omitted.

Allergic contact dermatitis by oral disulfiram.

A 35-year-old man presented on July 1, 1983 with dyshidrotic eczema of the hands and feet, nummular patches of vesicular and oozing dermatitis on the arms and legs and a similar patch around an old operation scar on the left abdominal wall. He stated that he was an alcoholic. A subcutaneous implantation of I g disulfiram (EsperaJ®) was performed in July 1981. No lesion was noticed at that time on the skin. On June 20, 1983 oral treatment with 400 mg disulfiram (Antabuse®) was commenced. Within a few days, the present dermatitis developed. Treatment consisted in withdrawal of oral disulfiram and topical application of a steroid cream. Within 2 weeks, the dermatitis healed, including the

Contact sensitivity to vincamine tartrate

A 39-year-old man had an acute eczematous contact dermatitis of the eyelids and neck. The eruption healed quickly with wet dressings and a corticosteroid cream. Two weeks later he relapsed and showed lesions in the flexures of the arms. He worked in a pharmaceutical industry. On both occasions he had extracted vincamine tartrate out of Vinca sp. plants prior to the development of the dermatitis. During this work, dust particles of ground plants are spread in the air. Patch tests with the European standard tray showed no contact sensitivity. The patch test with a 1 % aqueous solution of vincamine tartrate gave a + + + reaction. In five volunteers, a 1 % and 10 % solution of vincamine tartrate gave negative results. We concluded that our patient had an airborne eczematous contact dermatitis caused by contact allergy to the vincamine tartrate component of the Vinca plant. Valer (1965) described contact dermatitis in 18 of 48 workers from Vinca alkaloids. He found 11 positive on patch testing. There was cross-sentivity to Rauwolfia alkaloids. Vincamine is advocated in Belgium for cerebral circulatory disturbances. It seems likely that this drug may be the cause of an eczematous eruption in people taking it. However, one can assume that induction of sensitization can be achieved only through the skin. If this is true, only very few patients will eventually develop an eruption while taking vincamine.

Skin testing with simple equipment in photodermatoses.

We have reviewed 275 patients who were tested in the light testing clinic in the 10 years from 1972 to 1981. 151 patients (55%) were referred with eczematous changes of the skin attributed to light, while 76 (28%) had a history of polymorphic light eruption. Light tests gave abnormal results in 54(36%) of the dermatitis group, showing a photoallergy in 17 patients and UV sensitivity with or without sensitivity to visible light in 30 patients. 7 out of 10 cases with clinical reactions to phenothiazines also had abnormal test results.