Contact dermatitis due to nitroglycerin ointment

Hendricks, A. A.

doi:10.1001/archderm.115.7.853

Cited by 9 publications

(11 citation statements)

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“…Oral nitroglycerin did not provoke a cutaneous reaction either in our patient or in the cases reported by Hendricks et al [4]. The local concentration of antigen and the duration of exposure are among the factors contributing to the development of contact dermatitis.…”

Section: Discussionsupporting

confidence: 56%

“…The local concentration of antigen and the duration of exposure are among the factors contributing to the development of contact dermatitis. Thus, the plasma level of oral nitroglycerin may be sufficient to sensitize a patient as reported by Hendricks et al [4], and Camarasa and Perez [5], but appears in sufficient to elicit a cutaneous reaction in a nitroglycerin-patch-test-positive patient.…”

Section: Discussionmentioning

confidence: 78%

“…Einert et al [2] and Bressler [3] reported the development of contact dermatitis to nitroglycerin in workers of an industrial set ting. Hendricks et al [4] reported 2 cases of allergic contact dermatitis from nitroglyce- rin in a nitroglycerin ointment. Camarasa et al [5] recently applied a patch test to nitro glycerin in 22 patients on oral nitroglycerin.…”

Section: Discussionmentioning

confidence: 99%

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Multifocal Contact Dermatitis to Nitroderm TTS 5 with Extensive Postinflammatory Hypermelanosis

1987

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Multifocal Contact Dermatitis to Nitroderm TTS 5 with Extensive Postinflammatory Hypermelanosis

1987

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“…The other patient developed a generalized eruption 6 months after beginning nitroglycerin therapy. 2 others demonstrated contact dermatitis from the ointment and patch testing revealed a positive reaction to the nitrate (15). The severity of reaction required cessation of topical treatment in both.…”

Section: Adverse Reactionsmentioning

confidence: 99%

A review of contact dermatitis associated with transdermal therapeutic systems

Holdiness

1989

Contact Dermatitis

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The literature is reviewed for contact dermatitis associated with transdermal therapeutic systems. Clonidine, nitroglycerin, scopolamine, estradiol and testosterone are utilized in such applications, and fentanyl is under investigation. Most cutaneous reactions are limited to localized dermatitis; however, generalized systemic effects may occur. Investigators are reporting skin-related side-effects in up to 50% of patients using transdermal clonidine; however, with the other agents, this is demonstrated much less frequently. Reactivation of the dermatitis via oral medication, following sensitization to the patch, is noted in rare instances.Key words: transdermal therapeutic systems; contact dermatitis; adverse cutaneous reactions; donidine; nitroglycerin; scopolamine; estradiol; testosterone; fentanyl. Accepted fur publication 20 August 1988Transdermal therapeutic systems (TTS) have made possible effective "rate-controlled" transcutaneous administration of certain drugs. A number of other advantages include elimination of gastrointestional absorption, reduced total dosage, less expense than intramuscular or intravenous administration where applicable, avoidance of "first-pass" inactivation by the liver, use of agents with a narrow therapeutic index, and improved compliance with decreased administration cycle. Although these devices have proven quite useful, they are not without side-effects. One limitation is that of contact dermatitis, which in some instances necessitates discontinuation of the patch. It is the intention of this article to review the local and systemic side-effects of these systems.5 TTS are commercially available, which contain the compounds clonidine, nitroglycerin, scopolamine, estradiol, and testosterone; fentanyl is currently under investigation. Each consists basically of 4 membranes, as demonstrated in Fig. 1. The reservoir is surrounded by an occlusive backing membrane, which prevents the outward diffusion of the drug. A control microporous membrane allows diffusion of the medication at a constant controlled rate into the skin, with an adhesive for attachment to the surface. The approximate thickness of the 4 membranes is 0.2 mm. Adverse ReactionsClonidine is a centrally acting alpha-agonist used primarily as an antihypertensive agent. Standard predictive tests in guinea pigs indicate that it is not a contact allergen, as confirmed by clinical trials with the oral form (1). However, when the transdermal patch became available, a larger than expected proportion of users became sensitized. The most commonly reported side-effects of dry mouth and drowsiness were generally decreased with transdermal therapy (2, 3). Rebound hypertension with the patch has only rarely been reported (4, 5).

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“…After this became available, there were several reports of allergic reactions. The most frequent presentation was allergic contact dermatitis at the site of application (Hendricks & Dec 1979;Sausker & Frederick 1978;Zugerman et al 1979), but angioedema with swelling of the oral and conjunctival mucosa has also been described (Chandraratna & O'Dell 1979).…”

Section: Nitroglycerin (Glyceryl Trinitrate)mentioning

confidence: 99%

Skin Sensitivity and Transdermal Drug Delivery

Carmichael¹

1994

Drug Safety

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Transdermal devices are now marketed for the delivery of systemic medication through the skin. Advantages associated with transdermal drug delivery include avoidance of first-pass metabolism and improved patient compliance. Drugs currently available by this route include scopolamine (hyoscine), nitroglycerin (glyceryl trinitrate), estradiol, nicotine and clonidine. This novel development has brought in its wake a specific constellation of skin sensitivity problems, which vary widely in incidence between drugs. Varying the site of drug administration to minimise these reactions is important. Any eczematous reaction can be treated with a moderately potent topical steroid. Tolerance to oral challenge in those with topical sensitivity occurs, but caution is still advocated before proceeding to this step. The increasing use of transdermal drug delivery systems across many specialties means that problems of skin sensitivity are of growing relevance to the dermatologist, the hospital specialist and the primary care physician.

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Contact dermatitis due to nitroglycerin ointment

Cited by 9 publications

References 0 publications

Multifocal Contact Dermatitis to Nitroderm TTS 5 with Extensive Postinflammatory Hypermelanosis

Multifocal Contact Dermatitis to Nitroderm TTS 5 with Extensive Postinflammatory Hypermelanosis

A review of contact dermatitis associated with transdermal therapeutic systems

Skin Sensitivity and Transdermal Drug Delivery

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