A case of contact dermatitis caused by timolol in anti‐glaucoma eyedrops

Abstract

The side-effects of eyedrops employed for glaucoma treatment may first manifest after years of use, and can be localized [dermatitis, conjunctivitis (1), and nail pigmentation (2)] or generalized [bullous pemphigoid (3), toxic epidermal necrolysis (4), and anaphylactic reactions (5)].A 70-year-old man with glaucoma was treated with eyedrops containing timolol maleate and brimonidine tartrate for > 2 years. The patient presented with erythematous and oedematous pruritic lesions on both cheeks (Fig. 1a).

Allergic contact dermatitis caused by timolol eyedrop application for classic Kaposi sarcoma

“…Contact dermatitis from topically applied timolol eyedrops has been observed on patients for antiglaucoma therapy [3][4][5] and more recently on paediatric patients on treatment for infantile haemangiomas. 6 Recommendations for timolol patch testing propose a concentration of 0.25-1% aq, 7 but b-blocking agents are known to give false-negative patch test results.…”

“…to avoid false-negative test results. 3,5 As patch testing is usually performed on the lower back, with thicker skin than eyelid skin, chemicals might not penetrate as easily, that is why some authors recommend ROAT or a provocative use test, or standardised tape-stripping of the patch test area before allergen application; however, this may increase the risk of false-positive reactions. 8 Benzalkonium chloride is a quaternary ammonium cationic detergent widely used as a preservative and antiseptic.…”

“…Contact dermatitis from topically applied timolol eyedrops has been observed on patients for antiglaucoma therapy 3‐5 and more recently on paediatric patients on treatment for infantile haemangiomas 6 …”

Allergic contact dermatitis caused by timolol eyedrop application for infantile haemangioma

“…Since timolol has been used for anti‐glaucoma therapy, ACD caused by timolol eyedrops has been reported among adults . Moreover, because of the broad use of beta‐blockers for the treatment of infantile haemangioma, both topical and systemic, an increasing number of such reactions among the specific paediatric population can be expected.…”

“…Allergic contact dermatitis (ACD) caused by timolol eyedrops is well known, whereas ACD following its use for the treatment of infantile haemangiomas has hitherto not been reported.…”