Delayed Cutaneous Reaction to Phytonadione

Type IV hypersensitivity to vitamin K

“…The lipid‐soluble vitamin K 1 (phytomenadione) causes more cutaneous reactions than its water‐soluble analogues. The literature lists two main types of reactions following parenteral injection of vitamin K 1 : pruritic erythematous plaques at the injection site 1–2 weeks after the administration of vitamin K 1 , resolving within weeks or months, are the more common (3–8). Scleroderma‐like lesions have more rarely been described, with or without preceding inflammation (9, 10).…”

“…In all cases described, only the whole preparation of vitamin K 1 (in its vehicle) or vitamin K 1 alone elicited positive patch tests. When individual additives were tested, the results were negative (6–9). However, patch testing may be falsely negative and i.d.…”

“…However, patch testing may be falsely negative and i.d. tests necessary to exclude the diagnosis completely (6, 7, 10). Patch testing to vitamin K 4 (menadiol) have generally been negative (4, 9).…”

Cutaneous allergic reaction to intramuscular vitamin K1

“…In most cases, there is an approximate 10–14 day lag between the first dose and appearance of the rash, 2 , 16 –20 , 22 , 23 and subsequent patch and intradermal testing produces a reaction in 3–5 days, and 1–2 days, respectively 2 , 4 , 16 , 19 , 20 , 22 , 23 . A recall phenomenon has also been described in several patients, 2 , 16 , 23 in which patch or intradermal testing at a distant location precipitates an eczematous flare at the original reaction sites. Lesional biopsies consistently show spongiosis of the epidermis, dermal oedema, and a perivascular mononuclear and eosinophilic cellular infiltrate, 2 , 18 , 20 , 21 consistent with a delayed‐type hypersensitivity reaction.…”

“…In addition, castor oil is a well‐documented cause of contact dermatitis due to lipsticks 25 . However, of the 31 cases of application site eczematous reaction to vitamin K1 described in the English language literature, only seven were tested with the polyethoxylated castor oil vehicle as well as the whole preparation 19 , 22 , 23 (six intradermal and one patch test), and all were negative to the vehicle. Roche Products in Australia has recently withdrawn this vehicle for vitamin K1 used in adults, replacing it with the Mixed Micelles vehicle.…”