Indian Journal of Dermatology
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ORIGINAL ARTICLE
Year : 2007  |  Volume : 52  |  Issue : 4  |  Page : 194-197
Study of contact dermatitis due to topical medicaments and cosmetics by patch testing


Department of Dermatology, JJM Medical College, Davangere, Karnataka, India

Correspondence Address:
Amit Vij
S-477, Greater Kailash-1, New Delhi - 110 048
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.37725

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   Abstract 

Background: Contact dermatitis is the most common immunological disorder encountered by the dermatologist and it arises when a person develops delayed type of hypersensitivity reaction to a substance coming in contact with his skin. The patch test is at present a helpful test for demonstrating contact type of allergy that identifies the cause of allergic contact dermatitis. Aim: To study the common topical medicaments and cosmetics capable of producing contact dermatitis and value of patch testing in these situations. Materials and Methods: One hundred patients suspected of having contact sensitivity to topical medicaments and common cosmetics were subjected to patch testing with the finished commercial product being used by the patient and the antigens of the Indian Standard Series and Cosmetic series kit. Results: Positivity with patch test of 96.65% was observed in patients with contact dermatitis to topical medicaments, whereas 85% of the patients with cosmetic dermatitis were tested positive. Among the cases with contact dermatitis to topical medicaments, Neomycin was tested positive in more number of patients and among the patients with cosmetic dermatitis; Kum-Kum powder and Fairness cream were tested positive in more number of patients. Conclusion: It is well known that topical medicaments are known to produce contact dermatitis; the cosmetics that are claimed to be very safe by their manufacturers do not stay much behind in doing so.


Keywords: Contact dermatitis, cosmetics, patch testing, topical medicaments


How to cite this article:
Vij A, Murthy P M, Ravindra K. Study of contact dermatitis due to topical medicaments and cosmetics by patch testing. Indian J Dermatol 2007;52:194-7

How to cite this URL:
Vij A, Murthy P M, Ravindra K. Study of contact dermatitis due to topical medicaments and cosmetics by patch testing. Indian J Dermatol [serial online] 2007 [cited 2019 Jun 26];52:194-7. Available from: http://www.e-ijd.org/text.asp?2007/52/4/194/37725



   Introduction Top


Topical medicaments causing contact dermatitis is seen in three groups of individuals - patients who use the drugs for topical treatment of their diseases; doctors, nurses and dispensers who use drugs for their patients; and workers employed in the manufacturing of drugs in the pharmaceutical industry. These agents produce hypersensitivity leading to initiation and exacerbation of dermatitis.

Cosmetics causing contact dermatitis shows patterns that are characteristics of the cosmetic used. It is by and large limited to the area where the cosmetic is applied and thus generally there is no difficulty in recognizing the cause. A large number of cosmetics used in India are common to those used in the western countries but there are several others like kum kum, bindi and turmeric powder which are not used in the west.

The present study deals with the incidence of hypersensitivity to various topical medicaments and the common cosmetics available in India.


   Materials and Methods Top


The study was conducted from January 2002 to December 2003 on patients who attended the outpatient department of Dermatology and Venereology of JJM Medical College, Davangere, Karnataka, India, and it involved patients suspected of having contact sensitivity to topical medicaments and common cosmetics.

Patch testing was done after complete subsidence of signs and symptoms and after complete withdrawal of the drugs. The patch testing was done with the finished commercial product being used by the patient and the antigens of the Indian Standard Series and Cosmetic series kit (Systopic, New Delhi). For all patch tests, 0.05 ml of the testing substance was placed on a 1-cm square piece of cotton wool, which was placed on 2.5-cm square of 8-layer cotton gauze that was occluded with a 4-cm square piece of adhesive micropore plaster onto the back of the patient. The allergens were also tested using readymade aluminum chambers (Finn Chambers) already mounted on hypoallergenic tape.

Semisolids were directly applied to the chamber that filled more than 50% of the chamber volume. Liquids were placed on a filter paper disc in the chamber and moistened thoroughly. The personal care products were diluted as required to avoid irritant or strong reactions and applied immediately. The test strip chamber sites were numbered for later identification.

Skin was made sure that it was clean, healthy and free of ointments, lotions, powders, acne, dermatitis, scars, hair or any other condition that might interfere.

The patient was made to stand or sit in a relaxed position with the back bent slightly forward. The prepared patches were applied to the upper back adjacent to the vertebrae. Tape was affixed to the skin at the lower end and slowly rolled up the back, pushing out air. The chambers were gently pressed to skin to ensure an even distribution of allergens. The tape was gently but firmly rubbed to ensure good adherence.

The patients were refrained from exposing patch tests to excess moisture or sweat and were called for patch test removal in 48 h.

The site of chambers location was marked prior to removal.

The Finn chambers were removed from skin contact and occlusion was verified (the ring-shaped depression around each test) and skin reactions were read not less than 20 min after the removal.

A second and third skin reaction reading was advised at 72 and/or 96 h after patch test placement. The changes were observed in skin reactions.

The patch test reactions were graded as follows:

? faint macular erythema, doubtful reaction

+ erythema, discreet papules, non-vesicular weak allergic reaction

++ erythema, papules, vesicles, vesicular strong allergic reaction

+++ intense erythema, coalescing, extreme allergic reaction vesicles, bullous or ulcerative


   Results Top


Patch testing was carried out in 100 patients out of which 60 patients presented with contact dermatitis to topical medicaments and 40 patients had contact dermatitis to cosmetics. The details of results are as shown in the tables.

Thirty percent of the patients with contact dermatitis to topical medicaments belonged to topical medicaments belonged to age groups 11-20 years and 32.5% of the patients with cosmetic dermatitis belonged to the age group of 21-40 years.

Males constituted majority of patients (56.6%) in patients with contact dermatitis to topical medicaments whereas females constituted majority of patients with cosmetic dermatitis.

Contact dermatitis to topical medicaments was observed in 93.3% of urban people whereas 75% of the patients with cosmetic dermatitis were urban people.

Students constituted the majority of the patients (33.3%) with contact dermatitis to topical medicaments whereas housewives constituted the majority of the patients (55%) of cosmetic dermatitis.

The most common complaint of patients with contact dermatitis to topical medicaments was burning (71.6%) whereas itching was the most common complaint of patients with cosmetic dermatitis (52.5%)

Trauma was the most common associated condition observed in 20% of the cases.

The distribution of lesions was mainly on the head and neck in both contact dermatitis to topical medicaments (53.3%) and cosmetics (97.5%). Among the topical medicaments, Betamethasone 17-valerate and neomycin combination cream (6.6%), whereas among the cosmetics, fairness creams (22.5%) were the most common offending agent.

A positivity of 96.65% was seen in patients with contact dermatitis to topical medicaments whereas 85% of the patients with cosmetic dermatitis were tested positive.

Among the cases with contact dermatitis to topical medicaments [Table - 1], Neomycin was tested to be positive in more number of patients (16.6%) and among the patients with cosmetic dermatitis [Table - 2], Kum-Kum powder (12.5%) and Fairness cream (12.5%) were tested positive in a greater number of patients.


   Discussion Top


Contact dermatitis to topical medicaments was more common than cosmetic dermatitis in this study, which indicates the extensive and indiscriminate use of topical medicaments for dermatological problems, many times on their own by the patients. In a study by Narendra and Srinivas, [1] topical antibiotics and preservatives together accounted for 27.5% of contact dermatitis and was a major cause of iatrogenically induced dermatitis. The incidence of contact dermatitis due to topical medicaments was high in the present study and it involved only two groups with contact dermatitis.

Contact dermatitis to topical medicaments was observed in people in their second decade of life, whereas that due to cosmetics was seen more in the people belonging to the third and fourth decades of life. The age incidence shows variations across the races and regions. In the present study, almost more than ¾ patients were less than 40 years. This is attributable to the inclination of this group with regard to skin care and also more common usage of topical medicaments.

Contact dermatitis to topical medicaments was more in case of males; this observation was concurrent with the studies by Singh et al. [2] and Bheekam Singh et al. , [3] whereas the higher incidence of contact dermatitis to cosmetics in females depicts the extensive use of cosmetics among females, which was also observed in studies by Romaguera et al. , [4] De Groot et al. , [5] Thomson and Wilkinson, [6] Adams et al. [7] and Wesley and James. [8]

Both contact dermatitis to topical medicaments and cosmetics was more in urban people, which reflects their health awareness and cosmetic attitude; this was concurrent with the study of Dogra et al . [9]

In the present study the most common associated condition for which topical medicament was used was trauma and the occurrence appears to be coincidental.

Head and neck were the most common sites involved in both the groups because these medications and cosmetics were more extensively used on these areas, particularly the cosmetics that were involved in the studies by Morris, [10] Adams and Maibach, [11] Pasricha [12] and de Groot et al . [5]

Among the cases with contact dermatitis to topical medicaments, neomycin was tested positive in a greater number of patients (16.6%), which was similarly observed by Narendar and Srinivas, [1] Britton et al. , [13] Morris, [14] Lim et al. , [15] Goh, [16] Bajaj and Gupta [17] and many more studies around the world.

Among the cosmetics, fairness creams, Kum kum powder (applied on forehead and scalp) were the most offending agents due to which 10% patients developed depigmentation and 7.5% developed hyperpigmentation. In a multicentric study by Pasricha, [12] 22.80% were tested positive to Kum kum powder. Similar results were observed in studies of Bajaj et al. , [18] Dogra et al. [19] and Rafeeq Moiden et al . [20]

 
   References Top

1.Narendra G, Srinivas CR. Patch testing with Indian standard series. Indian J Dermatol Venereol Leprol 2002;68:281-2.  Back to cited text no. 1    
2.Singh KK, Singh G, Chandra S, Mukhija RD, Mohan L. Allergic contact dermatitis to antibacterial agents. Indian J Dermatol Venereol and Leprol 1991;57:86-9.  Back to cited text no. 2    
3.Mahaur BS, Sharma VK, Kumar B, Kaur S. Prevalence of contact hypersensitivity to common antiseptics, antibacterials and antifungals in normal persons. Indian J Dermatol Venereol and Leprol 1987;53:269-72.  Back to cited text no. 3    
4.Romaguera C, Camarasa JM, Alomar A, Grimalt F. Patch tests with allergens related to cosmetics. Contact Dermatitis 1983;9:167-8.  Back to cited text no. 4  [PUBMED]  
5.de Groot AC, Bruynzeel DP, Bos JD, van der Meeren HL, van Joost T, Jagtman BA, et al . The allergens in cosmetics. Arch Dermatol 1988;124:1525-9.  Back to cited text no. 5  [PUBMED]  
6.Thomson KF, Wilkinson SM. Allergic contact dermatitis to plant extracts in patients with cosmetic dermatitis. Br J Dermatol 2000;142:84-8.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Adams RJ, Maibach HI. A five year study of cosmetic reactions. J Am Acad Dermatol 1985;13:1062-9.  Back to cited text no. 7    
8.Emmons WW, Marks JG Jr. Immediate and delayed reactions to cosmetic ingredients. Contact Dermatitis 1985;13:258-65.  Back to cited text no. 8  [PUBMED]  
9.Dogra A, Minocha YC, Sood VK, Dewan SP. Contact dermatitis due to cosmetics and their ingredients. Indian J Dermatol Venereol Leprol 1994;60:72-5.  Back to cited text no. 9    
10.Morris SD, Rycroft RJ, White IR, Wakelin SH, McFadden JP. Comparative frequency of patch test reactions to topical antibiotics. Br J Dermatol 2001;146:1047-51.  Back to cited text no. 10    
11.Adams RM, Maibach HL. A five year study of cosmetic reactions. J Am Acad Dermatol 1985;13:1062-9.  Back to cited text no. 11    
12.Pasricha JS. Contact dermatitis caused by cosmetics. Chapter 5 in Contact dermatitis in India, 2 nd ed. The Offsetters: New Delhi; 1988. p. 67-86.  Back to cited text no. 12    
13.Britton JE, Wilkinson SM, Oirmed A, English JS, Gawkrodger DJ, Ormerod AD, et al . The British standard series of contact dermatitis allergens: Validation in clinical practice and value for clinical governance. Br J Dermatol 2003;148:259-64.  Back to cited text no. 13    
14.Morris SD. Comparative frequency of positive allergic patch test reactions to topical antibiotics. Br J Dermatol 2001;145:98.  Back to cited text no. 14    
15.Lim JT, Goh CL, Ng SK, Wong WK. Changing trends in epidemiology of contact dermatitis in Singapore. Contact Dermatits 1992;26:321-6.  Back to cited text no. 15    
16.Goh CL. Contact hypersensitivity to topical antimicrobials. Contact Dermatitis 1989;21:166-71.  Back to cited text no. 16    
17.Bajaj AK, Gupta SC. Contact hypersensitivity to topical antibacterial agents. Int J Dermatol 1986;25:103-5.  Back to cited text no. 17    
18.Bajaj AK, Gupta SC, Chatterjee AK. Contact depigmentation from free para-tertiary butylphenol in bindi adhesive. Contact Dermatitis 1990;22:99-102.  Back to cited text no. 18    
19.Dogra A, Minocha YC, Sood VK, Dewan SP. Contact dermatitis due to cosmetics and their ingredients. Indian J Dermatol Venereol Leprol 1994;60:72-4.  Back to cited text no. 19    
20.Kumar JV, Moideen R, Murugesh SB. Contactants in Kum-Kum dermatitis. Indian J Dermatol Venereol and Leprol 1996;62:220-1.  Back to cited text no. 20    



 
 
    Tables

  [Table - 1], [Table - 2]

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    Abstract
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