Contact dermatitis to the combination gel of adapalene 0.1% and benzoyl peroxide (PBO) 2.5%

ARTICLE

ejd.2011.1578

Auteur(s) : Audrey Bulinckx¹ audrey.bulinckx@gmail.com, Claire Dachelet¹, Alice Leroy¹, An Goossens², Dominique Tennstedt¹, Marie Baeck¹

¹ Department of Dermatology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 101200 Brussels, Belgium

² Department of Dermatology, University Hospital, 3000 Leuven, Belgium

A fixed-dose combination gel of adapalene 0.1% and benzoyl peroxide (BPO) 2.5% (Epiduo gel^®, Galderma, Bornem, Belgium) is an effective acne vulgaris treatment and offers the advantage of a once daily application [1, 2].

We here report on seven cases of allergic contact dermatitis to BPO contained in this gel.

Between January 2009 and December 2010, six women suffering from mild facial and/or chest acne presented with a similar history of an acute erythemato-vesicular eruption on the areas treated with Epiduo gel^®, which they had applied once a day, as prescribed by their dermatologist (table 1). The eczema resolved within a few days after stopping the applications of Epiduo gel^® and treatment with a topical corticosteroid. None of them presented with a personal history of atopy.

Table 1 Patient's data and patch tests results.

* Time period between first Epiduo gel^® application and first consultation for contact dermatitis

** D: direct ; C: connubial.

One additional woman (nr. 7), who presented with a recurrent eczematous eruption of the cheeks, was not herself treated by Epiduo gel^® but was living with a partner who had used it for facial acne vulgaris. The dermatitis resolved when this topical acne vulgaris treatment was replaced by oral isotretinoine.

All patients were patch-tested with the European baseline series (Chemotechnique, Vellinge, Sweden and Trolab, Almirall Hermal, Reinbek, Deutschland), with PBO diluted 1% in petrolatum (Trolab), adapalene 0.1% in petrolatum (provided by Galderma, Bornem, Belgium) and with Epiduo gel^®, the latter being tested ‘open’, ‘as is’, and diluted 30, 10 and 1% in petrolatum. The patch test materials used were van der Bend chambers (van der Bend, Briele, The Netherlands), covered on the upper back with Mefix^® (Mölnlycke, Sweden).

The results of the patch tests, read at Days 2 and 4, according to the ICDRG criteria, are listed in table 1 and illustrated by figure 1. Ten controls subjects tested negatively to Epiduo gel^® and BPO, excluding irritant reactions.

Adapalene and BPO are both irritant and the latter is also a weak allergen [3, 4], hence the daily use of this combined treatment may enhance the risk of BPO sensitization, even by connubial exposure. Reducing the number of applications and spacing them (mainly at the beginning of the treatment) could perhaps reduce this risk. Sometimes, a positive reaction to myroxolon pereirae may indicate a contact allergy to PBO in patients who are suffering from a facial eczema and have used topical acne treatment containing this particular allergen.

Disclosure

Financial support: none. Conflicts of interest: none.

References

1. Korkut C, Piskin S. Benzoyl peroxide, adapalene, and their combination in the treatment of acne vulgaris. J Dermatol 2005 ; 32 : 169-173.

2. Loesche C, Pernin C, Poncet M. Adapalene 0,1% and benzoyl peroxide 2,5% as a fixed-dose combination gel is as well tolerated as the individual components alone in terms of cumulative irritancy. Eur J Dermatol 2008 ; 18 : 524-526.

3. Ockenfels HM, Uter W, Lessmann H, Schnuch A, Geier J. Patch testing with benzoyl peroxide: reaction profile and interpretation of positive patch test reactions. Contact dermatitis 2009 ; 61 : 209-216.

4. Akhavan A, Bershad S. Topical acne drugs: review of clinical properties, systemic exposure, and safety. Am J Clin Dermatol 2003 ; 4 : 473-492.