Allergic contact dermatitis caused dexpanthenol—But is that all?

Abstract

Dexpanthenol is an analogue of pantothenic acid (vitamin B 5 ) that is used in pharmaceuticals and cosmetics. 1 Pantothenic acid is essential for the synthesis of coenzyme A in cells involving in the Krebs cycle. CASE REPORTA 49-year-old Caucasian man presented with generalized eczema of the trunk and limbs that had lasted for~10 days. Eight weeks before, he had sustained a few scratches on the right leg caused by plants during occupational gardening. He reported having applied a dexpanthenol-containing cream, and, a few days later, he developed local erythema and vesicles, with subsequent spreading.Allergic contact dermatitis caused by the topical drug was considered. Use of the cream was stopped, and the patient was treated with oral prednisolone. After rapid improvement, topical methylprednisolone aceponate cream was prescribed to achieve complete remission. However, the patient mentioned worsening of the residual dermatitis after applying the latter cream, and stopped using it. Physical examination showed an itchy erythematous desquamative plaque on the right leg (Supporting Information Figure S1).Patch testing with IQ Ultra chambers was performed with the Portuguese Contact Dermatitis Research Group baseline series, a cosmetics and excipients series (Chemotechnique Diagnostics, Vellinge, Sweden), and the dexpanthenol-containing cream used, tested "as is." Readings were performed on day 3 according to European Society of Contact Dermatitis guidelines, and showed positive reactions to cetearyl alcohol 20% pet., dexpanthenol 5% pet., and the dexpanthenol-containing cream. Both ingredients were present in the dexpanthenol-containing cream, and cetearyl alcohol was also present in the methylprednisolone aceponate cream (Figure 1).

Allergic contact dermatitis in a psoriasis patient caused by cetylstearyl alcohol

“…A few cases related to cetylstearyl alcohol in topical treatments have been reported, including cases caused by Thrombocid ointment 6 (LACER, S.A.), Burnol‐plus cream 7 (Reckitt Benckiser [M] SDN. BHD), and Bepanthene Plus cream 8 (Roche Polska).…”

Calcium pantothenate is present in cosmetics and may cause allergic contact dermatitis

“…However, a case of systemic allergic dermatitis (flare up of hand eczema) after the ingestion of a nutritional supplement with it in a patient previously sensitized to dexpanthenol in a baby cream has been published 4 . On the other hand, contact dermatitis from D‐panthenol, a vitamin B5 alcohol analogue stereoisomer, has recently been the focus of several publications 5‐8 and its inclusion in cosmetic and topical drug patch tests series has been encouraged 6,7 . Immediate hypersensitivity to D‐panthenol has also been described involving one patient with contact urticaria (from a hair conditioner) and another patient with an anaphylactic reaction (from oral multi‐vitamin tablets) as well as prior contact urticaria (from a sunscreen) 9,10 …”

Kontaktallergien – Neu aufkommende Allergene und Auswirkungen für das Gesundheitswesen

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