Allergic contact dermatitis to topical fluorouracil

Abstract

We designed a prospective and retrospective study to determine the incidence of allergic contact dermatitis to topical application of fluorouracil. Intracutaneous and epicutaneous skin tests of various fluorouracil concentrations were given to patients who were to be treated with the drug for actinic keratoses (group A) and to patients who had previously been treated with fluorouracil for actinic keratoses (group B). Six patients in group B had allergic contact dermatitis to topical fluorouracil. The common clinical characteristic of the six patients was a severe pruritic eruption at the site of fluorouracil application. Allergic contact dermatitis should be suspected in the presence of severe pruritus or a severe eczematous response in patients treated with topical fluorouracil.

Allergic contact dermatitis from stearyl alcohol in Efudix® cream

“…Criteria for differentiating an allergic contact dermatitis from irritant contact dermatitis due to Efudix ® cream have been proposed by Goette et al (1): an allergic reaction is more likely if there is (a) development of a severely pruritic eczematous dermatitis at the site of application, (b) occurrence of a widespread pruritic eczematous eruption at a distant site and (c) a positive patch test reaction.…”

“…Efudix ® cream or topical 5% 5‐fluorouracil (5‐FU) is an antimitotic cream used to treat premalignant and malignant skin lesions (1). Although it commonly causes cutaneous irritation, allergic contact dermatitis is uncommon (2).…”

Systemic contact dermatitis from 5–fluorouracil

“…In addition, development of erythematous irritant contact dermatitis around or at sites of 5-FU ~pplication is frequent. In 1977, Goette et al (6) postulated several diagnostic features that may help to differentiate this common irritant contact dermatitis from true allergic contact dermatitis from 5-FU (6). Development of acute, localized dermatitis, shortly after 5-FU application, should raise the clinical suspicion of allergic contact dermatitis.…”

“…Development of acute, localized dermatitis, shortly after 5-FU application, should raise the clinical suspicion of allergic contact dermatitis. Only scattered descriptions documented by positive patch tests have been reported (5)(6)(7). Some authors have postulated that occlusive treatments may also increase the risk of sensitization to 5-FU (7).…”

Topical Fluorouracil Therapy for Precancers and Cancers of the Skin

“…Clinically significant allergic contact dermatitis has been reported to develop in approximately 1 percent of patients treated with topical FU (13, 14). Although an infrequent complication, allergic contact dermatitis to either the FU or the propylene glycol must be promptly recognized by the physician, so that the FU can be discontinued and appropriate therapy instituted.…”