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Diclofenac-Induced Allergic Contact Dermatitis: A Series of Four Patients

View Article: PubMed Central - PubMed

ABSTRACT

Allergic contact dermatitis is an immune-mediated antigen-specific skin reaction to an allergenic chemical that corresponds to a delayed-type hypersensitivity response (type IV reaction). Allergic contact dermatitis should be suspected when skin lesions are localized to the site of previous applications of the culprit drug. Lesions appear after re-exposure in susceptible persons, with delayed onset (more than 24 h after exposure). The gold standard for diagnosis is patch (epicutaneous) testing; identification and removal of any potential causal agents is crucial. Diclofenac sodium 1% topical gel contains active (diclofenac sodium) and inactive ingredients. It is a widely used non-steroidal anti-inflammatory drug, known to cause allergic contact dermatitis, and especially photoallergic contact reactions. We present four cases of diclofenac-sodium-induced allergic contact dermatitis, diagnosed based on clinical grounds: intensively itchy eczematous lesions on the sites of drug application after several days of treatment. No allergic history and no other drug intake were reported by the patients. The application of diclofenac sodium 1% topical gel was strictly forbidden in all cases; potent topical steroids proved to be effective in all cases within 2 weeks of therapy. Patch tests were performed in all cases with European standard battery, with patients’ own diclofenac sodium 1% topical gels and with diclofenac sodium 1% in petrolatum 3 weeks after completion of local steroid therapy. Readings were done after 48 h (Day 2) and 72 h (Day 3) and proved to be positive only to patients’ diclofenac sodium 1% topical gel and diclofenac sodium 1% in petrolatum. No sun exposure was allowed during the testing, and any other treatments were forbidden.

No MeSH data available.


Clinical presentation of Case 1
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Fig1: Clinical presentation of Case 1

Mentions: A 62-year-old female patient diagnosed many years ago with rheumatoid arthritis, treated orally with methotrexate 10 mg/week, applied DSTG 1% gel twice daily on her left wrist under occlusive dressing. She noticed erythema with slight edema on the site of drug application on the third day of use (Fig. 1). She also complained of pruritus. The patient had no history of atopy, no allergy history in the past, no other recent drug intake apart from methotrexate. Discontinuation of DSTG 1% gel was strongly advised. Potent steroid cream (mometasone) was applied once daily for the following 2 weeks resulting in full recovery of the skin. Patient was referred to the Allergy Department for patch testing 3 weeks after the cessation of topical corticosteroid therapy. No sun exposure was allowed during the testing, any other treatments were forbidden. Patch test readings were done after 48 h (Day 2) and 72 h (Day 3) and were positive only to DSTG 1% (+/++) and 1% diclofenac sodium in petrolatum (+/++); therefore, the ACD to diclofenac sodium was confirmed. The Naranjo Adverse Drug Reaction (ADR) Probability Scale was used and the score was calculated (patient’s total score was 6, indicating a probable ADR).Fig. 1


Diclofenac-Induced Allergic Contact Dermatitis: A Series of Four Patients
Clinical presentation of Case 1
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120621&req=5

Fig1: Clinical presentation of Case 1
Mentions: A 62-year-old female patient diagnosed many years ago with rheumatoid arthritis, treated orally with methotrexate 10 mg/week, applied DSTG 1% gel twice daily on her left wrist under occlusive dressing. She noticed erythema with slight edema on the site of drug application on the third day of use (Fig. 1). She also complained of pruritus. The patient had no history of atopy, no allergy history in the past, no other recent drug intake apart from methotrexate. Discontinuation of DSTG 1% gel was strongly advised. Potent steroid cream (mometasone) was applied once daily for the following 2 weeks resulting in full recovery of the skin. Patient was referred to the Allergy Department for patch testing 3 weeks after the cessation of topical corticosteroid therapy. No sun exposure was allowed during the testing, any other treatments were forbidden. Patch test readings were done after 48 h (Day 2) and 72 h (Day 3) and were positive only to DSTG 1% (+/++) and 1% diclofenac sodium in petrolatum (+/++); therefore, the ACD to diclofenac sodium was confirmed. The Naranjo Adverse Drug Reaction (ADR) Probability Scale was used and the score was calculated (patient’s total score was 6, indicating a probable ADR).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Allergic contact dermatitis is an immune-mediated antigen-specific skin reaction to an allergenic chemical that corresponds to a delayed-type hypersensitivity response (type IV reaction). Allergic contact dermatitis should be suspected when skin lesions are localized to the site of previous applications of the culprit drug. Lesions appear after re-exposure in susceptible persons, with delayed onset (more than 24 h after exposure). The gold standard for diagnosis is patch (epicutaneous) testing; identification and removal of any potential causal agents is crucial. Diclofenac sodium 1% topical gel contains active (diclofenac sodium) and inactive ingredients. It is a widely used non-steroidal anti-inflammatory drug, known to cause allergic contact dermatitis, and especially photoallergic contact reactions. We present four cases of diclofenac-sodium-induced allergic contact dermatitis, diagnosed based on clinical grounds: intensively itchy eczematous lesions on the sites of drug application after several days of treatment. No allergic history and no other drug intake were reported by the patients. The application of diclofenac sodium 1% topical gel was strictly forbidden in all cases; potent topical steroids proved to be effective in all cases within 2 weeks of therapy. Patch tests were performed in all cases with European standard battery, with patients’ own diclofenac sodium 1% topical gels and with diclofenac sodium 1% in petrolatum 3 weeks after completion of local steroid therapy. Readings were done after 48 h (Day 2) and 72 h (Day 3) and proved to be positive only to patients’ diclofenac sodium 1% topical gel and diclofenac sodium 1% in petrolatum. No sun exposure was allowed during the testing, and any other treatments were forbidden.

No MeSH data available.