Cutaneous reactions to lower aliphatic alcohols before and during disulfiram therapy

Abstract

Cutaneous reactions to ethyl alcohol (ethanol), N-propyl alcohol (1-propanol), isopropyl alcohol (2-propanol), and acetaldehyde were evaluated in a control group and in patients before and while they were receiving disulfiram therapy. Local cutaneous erythema was observed from patch tests with ethyl alcohol, N-propyl alcohol, and isopropyl alcohol in hydrated skin, and from acetaldehyde in dry skin. Since reactions noted from topically applied alcohols before and while the patients were receiving disulfiram therapy were not statistically different, a localized disulfiram-alcohol reaction is unlikely. Erythema resulting from topically applied alcohols occurred in a dose-related manner and was caused by a direct vasodilatory effect on the cutaneous microvasculature. We believe that all true disulfiram-alcohol reactions are systemic, rather than local, in nature and require a substantial amount of alcohol to enter the system.

The pharmacology and toxicology of disulfiram and its metabolites

“…However, Haddock and Wilkin (1982) performed a patch test with 100Yo ethanol, propanol, or isopropanol, applied on non-hydrated as well as on hydrated skin before and after loading doses of 500 mg disulfiram for three days to 22 volunteers. Their conclusion was that they did not observe any potentiating effect of disulfiram on the erythema produced by the patches (52). This is consistent with our own findings on 20 patients treated with therapeutic doses of disulfiram.…”

How irritant are n‐propanol and isopropanol? – A systematic review

“…Nevertheless, Pedersen et al found that the alternate use of detergent and disinfectant caused less irritation than hand treatment with detergent alone 31,32 . Compared to studies that evaluated the irritation potential of ethanol, 6,33 5% v/v isopropyl alcohol does not seem to amplify the irritation potential of ethanol 31,32 …”

A case of ethanol‐induced systemic allergic dermatitis

“…There has been only 1 case of delayed-type hypersensitivity to both eth. and acetaldehyde (11), despite acetaldehyde being more likely to cause irritant dermatitis (9). Similarly, those patch tested with both eth.…”

“…The patient was instructed to keep the area dry to avoid local irritation with added moisture; this irritation is not noted on dry skin, even at eth. concentrations of 100% (9). Her skin was assessed on day 3, and erythema, infiltration and vesicles were observed, compatible with a strong positive reaction (++) to eth.…”