Sometimes even Dr Google is wrong: An unusual contact dermatitis caused by benzoyl peroxide

Abstract

The use of the internet to obtain medical information is becoming increasingly common among patients as a substitute for consulting a healthcare provider. 1 The present case is a typical example of sequelae of self-diagnosis and self-therapy in a patient who preferred to look for a "do-it-yourself" solution online. CASE REPORTA 32-year-old non-atopic male presented with intense pruritic erythematous dermatitis in his groins and scrotum ( Figure 1A) after selfadministration of various unspecified topical medicaments. The patient reported that he had searched for his symptoms, namely "burning and redness", on Google, and had come to the conclusion he was suffering from an infection. He therefore applied Benzac 5% gel, as suggested online, but the skin eruption worsened. Thereafter, he used PREP cream, which, according to online descriptions, had "calming properties", but there was no improvement. Finally, our treatment with systemic antihistaminic and topical corticosteroids and antibiotics along with cessation of other topical medicaments led to rapid resolution of the dermatitis. Patch testing was performed with the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) baseline series (Lofarma, Milano, Italy) on Van der Bend chambers (Van derBend, Brielle, The Netherlands) and with both of the abovementioned topical products tested "as is". Patch tests were applied under occlusion on the patient's back for 2 days; readings were performed on day (D) 2 and D4 according to ESCD guidelines. 2 A positive reaction (++ on D4) was observed to the patient's own product, Benzac gel 5% ( Figure 1B). Further patch testing with benzoyl peroxide 2% pet. was performed, and yielded an extreme positive reaction (+++) on D4 ( Figure 1C). Allergic contact dermatitis caused by benzoyl peroxide was thus diagnosed. DISCUSSIONThe finding of allergic contact dermatitis induced by an anti-acne product applied to the genital area is quite unusual. The tendency to seek advice concerning health problems online is very widespread.More and more often, patients rely on information that they obtain on the web, which is, however, very often of little scientific value. 1,3 380CORAZZA ET AL.Prompted by this unusual case, we decided to go online to better understand the Italians' interest in the dermatological field. "GoogleTrends" 4 is a novel, freely accessible tool that allows users to interact with internet search data. It may provide insights into population behaviour and health-related phenomena. Google Trends is based on the Google search engine, and shows the frequency of searching for a specific word or topic on the web. Each search term is assigned a number between 0 and 100, which indicates the normalization of the search term's frequency, as compared with the total number of Google searches over time. 3 Line graphs show the relative search volume of each word, and bar graphs show the relative average search volume of each word. We carried out research on Google Trends to compare the trends of 3 common ch...

Contact Allergy—Emerging Allergens and Public Health Impact

“…The fact that self-diagnosis and subsequent treatment may not always be correct and beneficial, respectively, is illustrated by the case of a 32-year-old Italian patient who presented with severe eczema of his groins and scrotum after self-treatment of a presumed infection with an acne medication containing benzoyl peroxide (BPO). No matter which skin changes had initially prompted this treatment, he had acquired contact allergy to BPO with extreme positive reactions upon patch testing [193]. This observation is interesting beyond the actual case, as it is indicative of a presumably increasing problematic trend attending doctors need to be aware of.…”

Google Trends in Dermatology: Scoping Review of the Literature

“…Sometimes even Dr Google is wrong: An unusual contact dermatitis caused by benzoyl peroxide. Contact Dermatitis; 2018 [27] Search queries related to HS e have risen over the last decade. HS-related website analysis demonstrates a need for improvement in quality and readability to raise disease awareness and allow earlier patient presentation for undiagnosed patients.…”

Kontaktallergien – Neu aufkommende Allergene und Auswirkungen für das Gesundheitswesen

“…Dass eine solche Selbstdiagnose und nachfolgende Behandlung nicht immer richtig und hilfreich ist, zeigt der Fall eines 32-jährigen Italieners, der sich mit schwerem Ekzem der Leistenregion und des Skrotums vorstellte, nachdem er zur Selbstmedikation einer vermuteten Infektion ein Aknemittel appliziert hatte, das Benzoylperoxid (BPO) enthielt. Unabhängig von den Hautläsionen, die ursprünglich Anlass zu der Behandlungsmaßnahme gegeben hatten, hatte der Patient eine Kontaktallergie gegen BPO entwickelt und zeigte extrem positive Reaktionen im Epikutantest [193]. Diese Beobachtung ist auch über den konkreten Fall hinaus interessant, da sie stellvertretend für eine wohl zunehmende Problematik steht, derer sich behandelnde Ärzte bewusst sein müssen.…”