Systemic allergic dermatitis (systemic contact dermatitis) from pharmaceutical drugs: A review

Abstract

The literature on systemic allergic dermatitis (SAD; also known as systemic contact dermatitis) is reviewed. Both topical drugs (from absorption through mucosae or skin) and systemic drugs (oral, parenteral, rectal) may be responsible for the disorder. The topical route appears to be rare with 41 culprit topical drugs found to cause SAD in 95 patients. Most reactions are caused by budesonide (especially from inhalation), bufexamac, and dibucaine. SAD from systemic drugs is infrequent with 95 culprit drugs found to cause SAD in 240 patients. The drugs most frequently implicated are mitomycin C, methylprednisolone (salt, ester), and hydrocortisone (salt). The largest group of culprit drugs consisted of corticosteroids (19%), being responsible for >30% of the reactions, of which nearly 40% were not caused by therapeutic drugs, but by drug provocation tests. The most frequent manifestations of SAD from drugs are eczematous eruptions (scattered, widespread, generalized, worsening, reactivation), maculopapular eruptions, symmetrical drug‐related intertriginous and flexural exanthema (SDRIFE [baboon syndrome]) and widespread erythema or erythroderma. Therapeutic systemic drugs hardly ever cause reactivation of previously positive patch tests and infrequently of previous allergic contact dermatitis. The pathophysiology of SAD has received very little attention. Explanations for the rarity of SAD are suggested.

Systemic allergic dermatitis due to budesonide patch testing

“…Besides irritation to the adhesive and subjective complaints (tiredness, feeling unwell, flu-like symptoms, fever, and so on), distant reactions of the skin have been reported. [4][5][6] Skin adverse events include eczematous flare-up reactions, particularly of hand eczema, generalized itch, and rashes. [4][5][6] After transcutaneous exposure to an allergen (hapten), PAPANIKOPOULOU ET AL.…”

“…[4][5][6] Skin adverse events include eczematous flare-up reactions, particularly of hand eczema, generalized itch, and rashes. [4][5][6] After transcutaneous exposure to an allergen (hapten), PAPANIKOPOULOU ET AL. systemic allergic dermatitis may occur to an individual who is sensitized from a former skin and/or mucosal contact, to the same or a cross-reacting molecule.…”

“…systemic allergic dermatitis may occur to an individual who is sensitized from a former skin and/or mucosal contact, to the same or a cross-reacting molecule. 4 The percutaneous absorption of the contact allergen may cause flare-up of a previous contact dermatitis site, or at the site of previous patch tests. 7 Three cases of systemic reactions after patch tests to budesonide have been reported, with concentrations of 1.0% pet.…”

“…8,9 Systemic allergic dermatitis in response to corticosteroids is of infrequent occurrence, probably due to a counterbalance of their anti-inflammatory action. 4 How to cite this article: Papanikopoulou E, Samanis G,…”

“…[1][2][3] A distal reaction, not restricted to the patch test site is unusual. 4 Herein we describe the case of a woman who experienced a systemic reaction after a patch test to budesonide.…”