Photodermatitis from ketoprofen with cross-reactivity to fenofibrate and benzophenones.

The aim of this study was to evaluate the possibility of cross-reactivity between ketoprofen, fenofibrate and benzophenones because of their structural similarities. Seven patients presenting photodermatitis from ketoprofen underwent patch and photopatch tests. Ketoprofen, fenofibrate, benzophenone 3, benzophenone 10, benzophenone 4, personal medications and topical creams were tested. All patients had positive patch or photopatch tests to ketoprofen and fenofibrate, four patients had positive UVA photopatch tests to benzophenone 3, and two to benzophenone 10. Patients presenting photosensitization to ketoprofen may also have cross-reactivity to fenofibrate and some benzophenones.

Skin reactions to hydroxyzine.

Sensitivity to histamine H1-antagonists has mainly been observed with phenothiazine and ethylenediamine, and is very rare with hydroxyzine. We report 3 cases of sensitization to hydroxyzine, which was prescribed to treat urticaria and atopic dermatitis. A generalized maculopapular eruption appeared shortly after taking the drug. Patch tests with Atarax tablet were positive +3, and +2 or +3 with different dilutions of hydroxyzine. Patch tests with ethylenediamine, piperazine and other antihistamines were negative; therefore, there is no cross-allergy. We believe these rapid systemic reactions to hydroxyzine after the initial dose may have been due to prior systemic sensitivity to this drug, which cannot be used topically. Allergy to antihistamines must be considered when cutaneous lesions worsen on such therapy.

Occupational contact dermatitis from propacetamol.

We report 4 cases of contact sensitization to propacetamol. They presented with lesions on the hands, forearms, crease of the elbows, and neck. They were all sensitized to multiple allergens and 2 of them were atopic. Patch tests to Pro-Dafalgan and propacetamol were positive; sodium citrate and paracetamol were negative. Our cases were similar to those published for the first time by Barbaud in 1995. The only allergen was propacetamol; patch tests with diethyglycine and paracetamol were negative. Propacetamol chlorhydrate is composed of a complex paracetamol-diethylglycine, which probably acts like a hapten capable of inducing cutaneous allergy. It is an occupational allergy affecting nurses who work in surgery departments or post-anesthesia recovery rooms, where high doses of analgesics are widely used. The patients were not allergic to oral paracetamol. Despite the usual precautions, the mixture of propacetamol chlorhydrate and solvent leaks onto the nurses' hands, suggesting that health care workers handling propacetamol chlorhydrate should wear gloves.

Flutamide photosensitivity.

Flutamide is a non-steroid antiandrogen used in advanced prostate cancer. This drug induces liver toxicity. Other side effects have been reported, especially four cases of photosensitivity. Our patient presented a sun-exposed eruption that disappeared when flutamide was discontinued and relapsed when it was rechallenged. Photopatch tests were negative. UVA MED was much lower during the treatment and the rechallenge of flutamide. The action spectrum of the drug seems to be in the UVA range. According to the literature, this photosensitivity is probably due to a photo-allergic mechanism.

Eczematous-like drug eruption induced by synergistins.

The authors report 4 cases of eczematous-like drug eruption after oral ingestion of synergistins, pristinamycin (3 cases) and virginiamycin (1 case). The lesions occurred after contact sensitization with topical virginiamycin. The clinical symptoms appeared a few hours after ingestion: a generalized maculopapular eruption, sometimes with general symptoms of anaphylactic reaction. Eczema appeared again on initial areas of contact dermatitis. There is a common allergenic group between these 2 antibiotics, which is a macrocyclic lactone. Physiopathology of this drug eruption is not clear: allergic reaction of the delayed type or anaphylactic reaction. Patients allergic to virginiamycin should be strongly cautioned against oral pristinamycin.

Photocontact allergy to oxybenzone: ten years of experience.

Intolerance of sunscreen agents has often been reported in the literature. This mainly comprises photosensitization to sunscreens such as oxybenzone. The aims of this study were to establish the incidence of photocontact allergy to oxybenzone and its relationship with the use of other cosmetics. From 1982 to 1992 we performed photopatch tests on 283 patients with suspected photodermatosis. Forty-six patients (16%) had positive reactions: 61 positive photopatch tests and 9 positive patch tests. Photocontact allergy to sunscreens was divided into 2 main groups: 35 cases to oxybenzone and 17 cases to para-aminobenzoic acid and its derivatives. Among our 35 cases of photoallergy to oxybenzone, more than one third had photoallergy to a daily moisturizer that contained oxybenzone.