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Topical promethazine side effects: our experience and review of the literature.

Cantisani C, Ricci S, Grieco T, Paolino G, Faina V, Silvestri E, Calvieri S - Biomed Res Int (2013)

Bottom Line: Promethazine hydrochloride is a first-generation H1 receptor antagonist, antihistamine, and antiemetic medication that can also have strong sedative effects.The apparent ability of topical H1r/2r antagonists to target epidermal H1/2r was translated into increased efficacy in the treatment of inflammatory dermatoses, likely due to decreased inflammation and enhanced barrier function.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Plastic Surgery, University "Sapienza" of Rome, Viale del Policlinico 155, 00161 Rome, Italy.

ABSTRACT
Promethazine hydrochloride is a first-generation H1 receptor antagonist, antihistamine, and antiemetic medication that can also have strong sedative effects. The apparent ability of topical H1r/2r antagonists to target epidermal H1/2r was translated into increased efficacy in the treatment of inflammatory dermatoses, likely due to decreased inflammation and enhanced barrier function.

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Related in: MedlinePlus

Systemic maculo-papular eruption associated with urticarial rash after topical application of PM for insect bite and solar exposure.
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fig3: Systemic maculo-papular eruption associated with urticarial rash after topical application of PM for insect bite and solar exposure.

Mentions: In our experience photocontact dermatitis due to topical promethazine is the most frequent reactions observed in almost 15% of patients and develops as an acute dermatitis with edema, erythema, papulovesicles, bullous, itching lesions, or erythema exsudativum multiforme-like eruption (Figures 2(a), 2(b), 2(c), and 2(d)) at the application site 1 week to 1 month after the initiation of use, depending on the frequency and intensity of sun exposure. The lesions may be apparently confined to the body sites, such as elbows, knees, ankles, forearms, and thighs, or several parts of the body may be affected where there are insect bites or burns, and sun exposure concomitantly occurs, but may also appear on other sites by transfer (ectopic contact dermatitis by hands or clothing; it may also affect family members due to connubial contact). Moreover, PM contaminates clothing, shoes, and so forth, explaining some of the persistent reactions. Most of them presented with several types of skin lesions. Sometimes patients need systemic treatment with corticosteroids. Emergency visits in the hospital may occur. Cessation of the causative agents and avoidance of sun exposure in combination with topical application of glucocorticosteroids or zinc oxide usually improve the symptoms in 2 weeks. However, residual postinflammatory hyperpigmentation may occur and in a rare instance. In subjects previously sensitized to PM, the systemic absorption of these drugs through multiple routes of administration (oral, parenteral, or topical) can induce the so-called systemic contact dermatitis, which can present as generalized maculapapular, papulovesicular, pustular, or erythematous eruption as well as urticarial rash (Figure 3). Clinical suspicion should be confirmed by patch testing such as SIDAPA (Società Italiana di Dermatologia Allergologica Professionale ed Ambientale) patch test standard series, including fragrance mix and its components (eugenol, isoeugenol, oak moss, geraniol, hydroxycitronellal, amylcinnamaldehyde, cinnamyl alcohol, and cinnamaldehyde) and with the SIDAPA photopatch test series. Patch tests, in patients with contact sensitization to these agents, can evoke false negative reactions because of the intrinsic antihistamine action of Promethazine which may suppress or delay the cutaneous response. Therefore, reading should be postponed on day 5 or 7. At the first reading, the reaction may appear only at the edges of the test area, while it can be completely absent in its central portion, where the antihistamine effect of promethazine is more evident because of the accumulation at higher concentrations. This phenomenon named “edge” or “border effect” fades away on successive readings after a few days.


Topical promethazine side effects: our experience and review of the literature.

Cantisani C, Ricci S, Grieco T, Paolino G, Faina V, Silvestri E, Calvieri S - Biomed Res Int (2013)

Systemic maculo-papular eruption associated with urticarial rash after topical application of PM for insect bite and solar exposure.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852816&req=5

fig3: Systemic maculo-papular eruption associated with urticarial rash after topical application of PM for insect bite and solar exposure.
Mentions: In our experience photocontact dermatitis due to topical promethazine is the most frequent reactions observed in almost 15% of patients and develops as an acute dermatitis with edema, erythema, papulovesicles, bullous, itching lesions, or erythema exsudativum multiforme-like eruption (Figures 2(a), 2(b), 2(c), and 2(d)) at the application site 1 week to 1 month after the initiation of use, depending on the frequency and intensity of sun exposure. The lesions may be apparently confined to the body sites, such as elbows, knees, ankles, forearms, and thighs, or several parts of the body may be affected where there are insect bites or burns, and sun exposure concomitantly occurs, but may also appear on other sites by transfer (ectopic contact dermatitis by hands or clothing; it may also affect family members due to connubial contact). Moreover, PM contaminates clothing, shoes, and so forth, explaining some of the persistent reactions. Most of them presented with several types of skin lesions. Sometimes patients need systemic treatment with corticosteroids. Emergency visits in the hospital may occur. Cessation of the causative agents and avoidance of sun exposure in combination with topical application of glucocorticosteroids or zinc oxide usually improve the symptoms in 2 weeks. However, residual postinflammatory hyperpigmentation may occur and in a rare instance. In subjects previously sensitized to PM, the systemic absorption of these drugs through multiple routes of administration (oral, parenteral, or topical) can induce the so-called systemic contact dermatitis, which can present as generalized maculapapular, papulovesicular, pustular, or erythematous eruption as well as urticarial rash (Figure 3). Clinical suspicion should be confirmed by patch testing such as SIDAPA (Società Italiana di Dermatologia Allergologica Professionale ed Ambientale) patch test standard series, including fragrance mix and its components (eugenol, isoeugenol, oak moss, geraniol, hydroxycitronellal, amylcinnamaldehyde, cinnamyl alcohol, and cinnamaldehyde) and with the SIDAPA photopatch test series. Patch tests, in patients with contact sensitization to these agents, can evoke false negative reactions because of the intrinsic antihistamine action of Promethazine which may suppress or delay the cutaneous response. Therefore, reading should be postponed on day 5 or 7. At the first reading, the reaction may appear only at the edges of the test area, while it can be completely absent in its central portion, where the antihistamine effect of promethazine is more evident because of the accumulation at higher concentrations. This phenomenon named “edge” or “border effect” fades away on successive readings after a few days.

Bottom Line: Promethazine hydrochloride is a first-generation H1 receptor antagonist, antihistamine, and antiemetic medication that can also have strong sedative effects.The apparent ability of topical H1r/2r antagonists to target epidermal H1/2r was translated into increased efficacy in the treatment of inflammatory dermatoses, likely due to decreased inflammation and enhanced barrier function.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Plastic Surgery, University "Sapienza" of Rome, Viale del Policlinico 155, 00161 Rome, Italy.

ABSTRACT
Promethazine hydrochloride is a first-generation H1 receptor antagonist, antihistamine, and antiemetic medication that can also have strong sedative effects. The apparent ability of topical H1r/2r antagonists to target epidermal H1/2r was translated into increased efficacy in the treatment of inflammatory dermatoses, likely due to decreased inflammation and enhanced barrier function.

Show MeSH
Related in: MedlinePlus