Allergic contact dermatitis and systemic contact dermatitis from cinchocaine

Systemic contact dermatitis from cinchocaine

“…Cinchocaine, used mainly in topical antihaemorrhoidals, is a well‐known contact sensitizer (1–5). To our knowledge, it has been reported as a cause of systemic contact dermatitis only once before (6), as in our case in the form of the baboon syndrome (7). Systemic contact dermatitis has also been described from other medicaments, as well as from metals and other compounds (8).…”

Current understanding of Baboon syndrome

“…Itching and burning are usually the accompanying symptoms [2,18,22]. Sometimes, the lesional skin may show tiny papules [2, [23][24][25], vesicles [2,24], bullae [19,22,[26][27][28][29][30], erosions [31,32], petechiae [2,17,22,25,27,[32][33][34] or pustules [2,14,23,24,28,35], the latter raising the question as to whether or not acute generalized exanthematous pustulosis (AGEP) and BS should be regarded as variants of a continuous spectrum of possible clinical manifestations [16]. Concomitant use of iodine and mercury was reported to cause severe vesiculobullous lesions in one case due to the interaction between mercury and iodine to form iodide of mercury, which is harmful to the skin and can lead to cutaneous necrosis [30].…”

“…Current understanding of Baboon syndrome who already had perianal eczema [72], bufexamac- [73] and cinchocaine (dibucaine)-containing [24,74] ointments applied to perianal skin and rectal mucosa for hemorrhoids had led to BS, presumably from systemic mucosal absorption. All patients had previous cutaneous contact with the inducer drug and demonstrable cutaneous sensitization as shown by positive patch test results [17].…”

“…Systemic re-exposure to previously sensitized drugs mainly by ingestion or injection, and less frequently by percutaneous/permucosal absorption via topical use [24,[72][73][74], would then lead to SAD or BS.…”

“…Examples of systemic absorption following topical exposure Inhalation of mercury vapor mainly from broken thermometer [16] or nickel vapor from paints [65]; ingestion of food containing nickel [65] or nickel-chelating agents [1] or accidental ingestion of mercury-containing cream [62]; suppositories containing balsam of Peru [5] Contact with poison ivy [202] Contact allergenic druginduced BS Yes Yes Aminophylline [93,94], neomycin [95], nystatin [96], corticosteroids [77,97], erythromycin[18], amoxicillin [29], ampicillin[1], 5-aminosalycilic acid [72], bufexamac [73], cinchocaine [24,74] Oral [44,103], clindamycine [104], roxithromicin [105], allopurinol [38], contrast media [32,46], cimetidine [106], deflazacort [41], hydroxyurea [36], heparin [39], intravenous immunoglobulin [45], mitomycin C [71,107], naproxen [32], oxycodone [32], salsalate [25], terbinafine [58], cetuximab [35], valacyclovir [108] Oral (the majority); intravenous [32,35,39,45,46]; intravesical …”