Compound allergy to a skin marker for patch testing: a chromatographic analysis

Abstract

We present details of a patient who was demonstrated to have contact allergy to a solution used to mark sites of application of patch tests, during investigation of allergy to gold and nickel. Negative results were obtained when patch testing was performed using the individual constituents of the marker solution (gentian violet, dihydroxyacetone and acetone). Chromatographic analysis of various combinations of these chemicals did not identify a chemical derivative which might have caused this reaction.

Contact dermatitis from Solvent Yellow 146 in a permanent marker

“…The manufacturer of the permanent markers emphasizes that Edding 3000 products are not legally registered for marking the skin. Contact reactions to other components of markers have been described (1, 2).…”

Compound allergy

“…The studies reviewed above show the formation of a new reaction product as the compound allergen. Cox et al (8) refute the suggestion that the compound allergies they report could be the result of a greater absorption of an allergen than their patch test model. They used a dose 12X that in the original preparation and obtained negative patch test results.…”

“…For example, Cox et a!. (8) rule out the possibility of irritant contact derma-titis from gentian violet dye (used in patch testing as a skin marker), as it is known to produce ulcerative lesions when <~;n irritant, and eczematous lesions when an allergen (20). Also, the combined dye containing the gentian violet had been exposed to thousands of their patch test patients as unwitting controls.…”

“…Cox et al (8) ruled out the possibility of bacterial contamination causing a false-positive result. They performed microbiological investigations to detect bacterial and fungal colonization of the original marker solution, and were also able to produce an allergenic response to a mixture that they had freshly made.…”

“…In the case of compound allergy, however, no ingredient is found to be an allergen on patch testing. The dermatologist can only conclude, after carefully patch testing the (8) Aureomycin® cream (9) UltracooJ® (9) Boots E45® (9) Colgate® toothpaste (9) Haelan® cream (9) cosmetic foundation cream (I) Sepso® (12) budenoside (13) Steri-lette® (14) a) Products contain identifiable new allergens or known allergenic combinations of ingredients b) New allergen not identified or sought.…”