Photoallergic hand eczema due to benzydamine

ARTICLE

Auteur(s) : O. LASA ELGEZUA, P. EGINO GORROTXATEGI, J. GARDEAZABAL GARCÍA, J.A RATÓN NIETO, J.L DÍAZ PÉREZ

Servicio de Dermatología. Hospital de Cruces Plaza de Cruces s/n 48903 Baracaldo (Vizcaya) País Vasco. Bilbao. Spain

Article accepted on 29/09/2003

Hand dermatitis is a very common disorder in dermatology that can be due to many causes. Among these, allergic or irritant contact dermatitis and atopic dermatitis are the main ones [1], while ultraviolet light induced cases are much more infrequent. Some of the different sensitizers are usual products in daily life but the patient does not relate them with the cutaneous eruption.

Case report

A 65-year-old woman was referred to our department in December 2001 for hand eczema present since the summer. On examination, the dermatitis involved the dorsum of both hands being more severe on the right one (Fig. 1).
The palms were unaffected as well as the rest of the skin. She did not relate the eczema with any of the conventional sensitizers or irritants and apart from arterial hypertension treated with Micardis^® (telmisartan) since three months previously, she was in good general health.
In February 2002 epicutaneous patch tests with standard GEIDC series and telmisartan were performed, with negative results at 48 and 96 hours. The patient was then carefully questioned with special attention to the products she used to handle. Only then she told us that she had used Rosalgin^® daily for external genital cleansing for several years, a gynaecological solution containing benzydamine 0.1%.
In March 2002 new epicutaneous patch and photopatch tests were performed with Rosalgin^® 0.1% diluted in water and benzydamine 3% pet according to the standard battery of the Spanish Photobiology Group [2]. Patch testing was negative but photopatch testing, with 10 J/cm² UVA (365 nm) was strongly positive with both preparations (Table I) (Fig. 2).

It was concluded that the dermatitis was produced by traces of the gynaecological solution that remained on the patient's hands with posterior sunlight exposure. With the diagnosis of photoallergic contact dermatitis to benzydamine the patient stopped her use of Rosalgin^® so hand lesions disappeared and no recurrences have been observed since then.

Discussion

Benzydamine is a NSAID whose sensitizer and photosensitizer ability has been known for a long time. Cross-reactions with other NSAIDs have been suggested in one case [3]. It is available in Spain as cream for topical application, oral rinse and gynaecological solution. It is known that prescriptions by gynaecologists in this last form have progressively increased in Spain. Despite this widespread use reported cases of photoallergic dermatitis to benzydamine are rare.
We have only found 7 reported cases: 3 after topical application [4-6], 2 after oral intake [7-8] and 2 due to Rosalgin® [9-10]. In Spain, De la Cuadra et al. documented 6 cases of photoallergy due to Rosalgin®, similar to ours [11-12]
We think that this case is of interest because of the apparent non-relationship between the sensitizer factor and the clinical presentation. The patient did not present any lesion on the areas that had contact with the solution, lesions involved only the dorsum of the hands where sunlight developed the dermatitis. Knowing its widespread use, we think that benzydamine is an under-diagnosed cause of hand eczema. We would like to emphasise the importance of a good anamnesis about all the products the patient handles in his daily life. We suggest asking patients with hand eczema about possible contact with benzydamine containing products, especially in the cases that involve just the dorsum of the hands. n

References

1. Ken Landow MD. Hand dermatitis. Postgrad Med 1998; 103: 1: 141-52.

2. Ortiz de Frutos FJ, De la Cuadra J, Gardeazabal J et al. Resultados del fotoparche empleando batería de fotoalergenos estándar del Grupo Español de Fotobiología. Actas Dermosifilograficas 1999; 90: 609-11.

3. Goday JJ, Ilardia R, Soloeta R. Allergic contact dermatitis from benzydamine with probable cross-reaction to indomethacin. Contact Dermatitis 1993; 28: 111-2.

4. Goncalo S, Sousa I, Freitas JDG et al. Photoallergie à la benzydamine. Actualité en Dermo-Allergie 1982; 5: 61-4.

5. Motley RJ, Reynolds AJ. Photodermatitis from benzydamine cream. Contact Dermatitis 1988; 19: 66.

6. Vicenzi C, Cameli N, Tardio M, Piraccini BM. Contact and photocontact dermatitis due to benzydamine hydrochloride. Contact Derrmatitis 1990; 23: 125.

7. Ikemura I. Contact and photocontact dermatitis due to benzydamine hydrochloride. Japanese Journal of Clinical Derrmatology 1971; 25: 129.

8. Fernández de Corres L. Photodermatitis from benzydamine. Contact Dermatitis 1980; 6: 124-5.

9. Conde-Salazar L, Guimaraens D, Gonzalez M et al. Fotodermatitis alérgica de contacto por bencidamina. Actas Dermo-Sifiliográficas 1996; 87: 310-4.

10. Navarro LA, Jorro J, Morales C et al. Fotodermatitis alérgica de contacto por clorhidrato de bencidamima. Revista Española de Alergología e Inmumología Clínica 1996; 11: 5: 239-42.

11. De la Cuadra J, Rodríguez M, Pérez A. Fotoalergia a un jabón vaginal con bencidamina. Boletín del GEF: VII Reunión del Grupo Español de Fotobiología. Madrid 1993.

12. De la Cuadra J, Pérez A, Escutia B et al. Fotoalergia por jabón vaginal con bencidamina (Rosalgin^®): una década más tarde. Boletín del GEF: XVI Reunión del Grupo Español de Fotobiología. Madrid 2001.