Erythema multiforme and urticaria. Eruptions induced by chemically related ophthalmic anticholinergic agents

Guill, Marshall A.

doi:10.1001/archderm.115.6.742

Cited by 10 publications

(5 citation statements)

References 6 publications

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“…An EM-like picture as an expression of contact allergy has previously been described for many topical medications: bufexamac (19,20), chloramphenicol (21), dinitrochlorobenzene (22), diphenylcyclopropenone (23), econazole (24), ethylenediamine and clioquinol (25), idoxirudine (26), ketoprofen (27), lincomycin (28), mafenide acetate (29), mephenesin (30,31), neomycin (25), povidone iodine (32), proflavine (33,34), promethazine (25), pyrrolnitrin (25,26,35), scopolamine (36), sulfonamide (25,37,38), and vitamin E (39). Phenylbutazone can now be added to this list.…”

Section: Discussionmentioning

confidence: 84%

Erythema‐multiforme‐like contact dermatitis due to phenylbutazone

1995

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A 65-year-old woman presented with a severely itchy prethoracal eruption of erythematous, edematous papules and papulovesicles. These were much more pronounced on the right side, with some presternal confluence, and had already been spreading for 3 days. She also had erythematous papules on both inner thighs. A week before the onset, she had applied the revulsive (counterirritant) cream NF V for 4 days to the right side of the thorax for muscle pain, which she stopped when the eruption started. Revulsive cream contains phenylbutazone as active ingredient and also menthol, cetyl alcohol, propylene glycol, lavender oil, and methyl nicotinate. In spite of a corticosteroid cream and an oral antihistamine, the dermatitis spread. She had also been taking diphenylhydantoin and levodopa for many years and piroxicam for I week.As she recalled a reaction I 0 years previously after using a phenylbutazone-containing ointment (Butazolid-ine®), and because of suspicion of allergy to the revulsive cream and its failure to respond to topical corticosteroids, oral methylprednisolone was given. 2 days later, the eruption had spread and become more painful. The right side of the thorax (the left being less affected) showed a monomorphic eruption of papulopustules, with confluence presternally and in the right axilla. There was a sharp delineation towards the back. A toxicoderma or viral rash was considered as the diagnosis. Systemic corticosteroid was stopped and a menthol lotion prescribed. By 5 days after the 2nd visit, however, large plaques had appeared in the precordal region, right submammary fold and under the right axilla, by confluence of erythematous macules and papules. On the right breast, cocardiform lesions were present. A potent corticosteroid ointment was prescribed, which the patient applied just once. All the lesions regressed in a week.Patch tests with the standard series and with the patient's own medications yielded the following results: D2 D3 Standard series balsam of Peru + fragrance mix ?+ ++ Own medications revulsive cream NF V ++ +++ Butazolidine® ointment ++ +++ phenylbutazone (2% pet.) ++ ++ oxyphenbutazone (5% pet.)This patient had thus developed allergic contact dermatitis from the revulsive cream, having previously been sensitized by Butazolidine® ointment. Discussion

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Section: Discussionmentioning

confidence: 84%

Erythema‐multiforme‐like contact dermatitis due to phenylbutazone

1995

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“…Scopolamine solutions or creams have only rarely been identified with skin reactions (25)(26)(27)(28)(29). Guill et al (25) reported a generalized erythema multiforme eruption following the use of a 0.25% ocular solution.…”

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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“…reactions have appeared in the literature. Several pharmaceutical ingredients have been identified as triggering substances such as BCG scarification material (1), ethylenediamine (2), mafenide acetate (3), neomycin (2), promethazine (2), pyrrolnitrin (2,4), scopolamine (5), sulfonamide (2,6,7), and vioform (2). Other eliciting materials have been identified in laboratory chemicals (8)(9)(10)(11)(12), plants, (13)(14)(15)(16)(17), woods (18)(19), insecticides (20), formaldehyde in printed circuit boards (21), PPD (2), a spray cologne (22), metals (23,24), soap (25), and epoxy resin (26).…”

mentioning

confidence: 99%