Topical medicaments

Kimber, I. et al., Assessment of the skin sensitizing potential of topical medicaments using the local lymph node assay An inter-laboratory evaluation, J. Toxicol. Environ. Flealth 53, 563, 1998. 

Oh C, Lee J. Contact allergy to various ingredients of topical medicaments. Contact Dermatitis 2003 49 49-50. 

Topical corticosteroids are usually given in combination with other topical treatments for the treatment of chronic plaque psoriasis. Sensitive areas, such as the face, should be treated with a mild corticosteroid and other areas, such as the scalp, with moderate to potent corticosteroids. In general, use should be maintained as early improvements in the condition are not maintained if use is halted. Such a pattern of use may worsen the condition, possibly causing a deterioration of the condition to unstable forms, such as erythrodermic or pustular psoriasis. Co-administration of topical medicaments usually involves alternating administration of each product. Scalp psoriasis is normally treated with softening emollients in combination with salicylic acid with coal tar or sulphur. 

Absorbent cotton is available in different qualities varying with the length and diameter of the cotton staple. It is available in the form of rolls and balls and is used for cleansing and swabbing wounds, preoperative skin preparation, and the application of topical medicaments to the skin. 

Excipient residues may also compromise safety or tolerance. Wool fat or lanolin derived from sheep wool may contain low levels of insecticides from sheep treated for parasites. These insecticide levels are probably too low to cause direct toxicity, but may cause allergic reactions when lanolin in cosmetics or topical medicaments is applied to the skin. 

Diethyl sebacate is an emulsifier used in cosmetics and topical medicaments. In contrast to the emulsifying agents stearyl alcohol, stearic acid, and glyceryl stearate, diethyl sebacate is considered to be a rare sensitizer. 

Antimicrobial drugs are widely used in topical medicaments, cosmetics, household products, and industrial biocides. Depending on their concentrations, they can function as disinfectants, antiseptics, or preservatives. The prevalence and rank order of sensitization to antimicrobial allergens in Europe have been reviewed (1,2). The most frequent antimicrobial allergens in 8521 patients who were patch-tested between 1985 and 1997 in Belgium are given in Table 1 (2). 

Chan TY. The risk of severe salicylate poisoning following the ingestion of topical medicaments or aspirin. Postgrad Med J 1996 72(844) 109-12. 

The authors proposed that the topical medicament had contained ethylenediamine. 

Skinner SL, Marks JG. Allergic contact dermatitis to preservatives in topical medicaments. Am J Contact Dermat 1998 9(4) 199-201. 

Bruynzeel DP, van Ketel WG, Young E, van Joost T, Smeenk G. Contact sensitization by alternative topical medicaments containing plant extracts. The Dutch Contact Dermatoses Group. Contact Dermatitis 199227(4) 278-9. 

Pahnitate-related substances are viscous oils used in cosmetics and topical medicaments. In lipsticks they replace castor oil (1). Allergic reactions to lipsticks have been reported to be caused by a variety of allergens, for example azo dyes, colophony, lanolin, castor oil, sunscreens, and para-tertiary butylphenol. 

In allergic contact dermatitis due to topical medicaments (6), any constituent of the formulation can be responsible for the adverse event—the vehicle, preservative, emulsifier, perfume, or the active drug. Hence, patch tests should be carried out with all active and supposedly inactive ingredients of the incriminated topical drug. 

Other sources of preservatives are topical medicaments and body care products. Parabens, chloracetamide, and formaldehyde-releasing preservatives, like diazoUdinyl urea, imidazoUdinyl urea, bronopol, and quaternium 15, should also be considered (15). 

Contact allergy should always be suspected in patients with anogenital dermatitis, especially if the perianal area is involved. In patients with other chronic inflammatory diseases of the anogenital region, for example lichen sclerosus, contact allergy should also be excluded, since long-term use of topical medicaments on compromised skin carries an increased risk of sensitization. 

Reports of contact allergy to topical medicaments containing sodium metabisulfite are rare (9). In two cases, a topical corticosteroid formulation that contained sodium metabisulfite (Trimovate cream) caused contact allergy patch tests were positive with both sodium metabisulfite and Trimovate cream (10). 

Chen, H.H., Tseng, M.P., and Hsu, CJ. 2003. A patch test study of 27 crude drugs commonly used in Chinese topical medicaments. Contact Dermat. 49, 8-14. 

Interestingly, the drug is specifically effective against Clostridium welchii as a prophylaxis of wounds in the form of topical medicaments viz., lotions, ointments, or dusting powder. 

Meneghini, C.L., F. Rantuccio, and M. Lomuto. 1971. Additives, vehicles and active drugs of topical medicaments as causes of delayed type allergic dermatitis. Dermatologica 143 137-147. 

Chan, T. Y. 1996a. Potential dangers from topical preparations containing methyl salicylate. Hum. Exp. Toxicol. 15(9) 747-750. Chan, T.Y. 1996b. The risk of severe salicylate poisoning following the ingestion of topical medicaments or aspirin. Br. Med. J. 72(844) 109-112. 

Bmynzeel, D.P., W.G. Van Ketel, E. Young, T. Van Joost, and G. Smeenk. 1992. Gontactsensitizationby alternative topical medicaments containing plant extracts. Contact Dermat. 27(4) 278-279. Galloway, S.M., M.J. Armstrong, C. Reuben, et al. 1987. Chromosome aberrations and sister chromatid exchanges in Chinese hamster ovary cells Evaluations of 108 chemicals. Environ. Mol. Mutagen. 10(Suppl. 10) 1-175. 

Sensitization to wool alcohols is a well-known phenomenon (Mortensen 1979 Schnuch et al. 1993a), but its increase within 2 years (Tables 2 and 3) cannot easily be explained. Wool alcohols are not only used in topical medicaments and cosmetics, but also in other products of daily use (Hausen et al. 1979) and in industrial applications (Calnan 1979). It is probable that different processing of the raw material yields wool alcohols of different quality and varying allergenicity (Clark et al. 1981 Edman and Moller 1989),... 

Phenol is no longer widely used as a skin antiseptic but, in dilutions of o.5-2.o%, it is sometimes prescribed as an antipruritic in topical medicaments and... 

Several contact allergens, e.g., metal, topical medicaments, wood and industrial chemicals have been reported to cause erythema multiforme-like eruptions. These allergic contact reactions can be confirmed by positive patch-test reactions. The morphology of these reactions includes target-like erythemacular, and urticarial lesions. Such eruptions have been described as UPPE to distinguish them from the erythema-multiforme (Goh 1989). 

Use tests and open tests are sometimes used as synonyms. The original (provocative) use (or usage) tests were intended to mimic the actual use situation (repeated open applications) of a formulated product, such as an oil, shampoo or a topical medicament. A positive result supported the suspicion that the product had caused the patient s dermatitis. Nowadays, these tests are increasingly used to evaluate the clinical significance of one or more ingredients of a formulated product previously found reactive by ordinary patch testing. The concentration of the particular ingredient can be so low that one may wonder whether the positive patch-test reaction can explain the patient s dermatitis. 

Detailed patch testing of patients with other types of eczema, (seborrhoeic, discoid, stasis, etc.) has demonstrated that they frequently have contact allergies to topical medicaments, preservatives or perfumes, but the relevance is usually uncertain. Whether the frequency is higher than that in the normal population has not been settled. It is possible that a contact dermatitis is superimposed on the original eczema, and change of topical remedies can result in clearance. 

Brand CU, Balmer Weber BK (1995) Contact sensitivity to 5 different ingredients of a topical medicament (imacort dream). Contact Dermatitis 33 137 Brubacher JR, Hoffman RS (1996) Salicylism from topical salicylates review of the literature. J Toxicol Clin Toxicol 34 431-436... 

Fisher A A (1982) Contact dermatitis from topical medicaments. Semin Dermatol 1 49-57... 

Wool alcohols (cosmetics and topical medicaments) Mercaptobenzothiazole and mercapto mix (rubber materials)... 

Allergic contact dermatitis occurs most commonly from nickel-containing objects, plants (such as Rhus)y rubber, adhesives, or dyes in athletic tape, gear, or running shoes, and topical medicaments. Reactions are induced or elicited by the athlete s perspiration, which leaches the chemical allergens from their gear (Cronin 1980). Table 6 lists common contact allergens in the athlete and their recommended patch-test concentrations (Marks and DeLeo 1997). 

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