Contact Photoallergy to Isothipendyl Chlorhydrate

Bibas, N.; Sartor, Victor E.; Livideanu, C. Bulai; Bagheri, Haleh; Nougué, J; Giordano‐Labadie, F.; Maza, A.; Paul, C.; Chouini–Lalanne, Nadia; Marguery, M.-C.

doi:10.1159/000338024

Cited by 12 publications

(7 citation statements)

References 4 publications

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“…Nevertheless, the diagnosis of photocontact dermatitis to phenothiazines was made because eczema started on light-exposed areas following use of isothipendyl gel without relapse after discontinuation of the drug. In the literature, two cases of contact dermatitis to isothypendyl have been previously reported, 7,8 including one of our patients. 7 In France, benefit-risk assessment of isothipendyl products was initiated in 2017.…”

Section: Discussionmentioning

confidence: 71%

“…In the literature, two cases of contact dermatitis to isothypendyl have been previously reported, 7,8 including one of our patients. 7 In France, benefit-risk assessment of isothipendyl products was initiated in 2017. Based on data from the French pharmacovigilance database and isothipendyl marketing authorization holders, 20 cases of severe cutaneous adverse reactions were identified (rash, urticaria, photodermatosis, eczema and purpura).…”

Section: Discussionmentioning

confidence: 71%

“…In photoallergic reactions, cross-reactions between molecules belonging to the same chemical class such as phenothiazines may occur. 5,7 In our series, some positive photopatch tests with a + reaction to isothipendyl gel and promethazine may represent just a phototoxic reaction. However, we consider this result as photoallergy owing to prior eczema in the patients.…”

Section: Discussionmentioning

confidence: 77%

“…Case 11 has been previously reported. 7 Of the 14 patients, 3 had a history of photosensitive diseases. Case 3 had solar urticaria and cases 4 and 7 polymorphous light eruption.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Photodermatitis from topical phenothiazines: A case series

et al. 2020

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In Europe, contact photosensitivity to phenothiazines is known particularly in southern countries. Topical phenothiazines are widely used and sold over-the-counter for the treatment of mosquito bites and pruritus in France. Objective:To report a series of cases with photodermatitis to topical phenothiazines. Method:A retrospective study of cases of contact dermatitis to phenothiazines seen in French photodermatology centres was performed. Results:In all, 14 patients with the diagnosis of contact dermatitis to phenothiazines were included. These developed eczema on the application sites, and in 13 the eruption spread to photodistributed sites. Topical products containing isothipendyl were the most common cause of photodermatitis. One patient had photoaggravated eczema due to promethazine cream. All patients stopped using topical phenothiazines and were treated successfully with topical corticosteroids. One patient relapsed and developed persistent light eruption. In all of the 9 cases tested, photopatch testing to the topical phenothiazine used "as is" was positive.Isothipendyl, chlorproethazine and the excipients were not tested. Photopatch tests to chlorpromazine and promethazine were positive in 8/12 and 7/13 tested respectively. Conclusion:Use of isothipendyl and promethazine as over-the-counter (or even prescribed) drugs needs to be limited due to severe reactions and sensitization to other phenothiazines that otherwise will have to be avoided.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 77%

“…Case 11 has been previously reported. 7 Of the 14 patients, 3 had a history of photosensitive diseases. Case 3 had solar urticaria and cases 4 and 7 polymorphous light eruption.…”

Section: Patient Characteristicsmentioning

confidence: 99%

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Photodermatitis from topical phenothiazines: A case series

et al. 2020

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“…bisoctrizole or Tinosorb ® M), ACD from it is due to the surfactant decyl glucoside, in particular, which is added in order to stabilize the sunscreen molecule. 16,17 Topical drugs, such as the non-steroidal anti-inflammatory ketoprofen, piketoprofen, suprofen, etofenamate, piroxicam, and benzydamine, 18 as well as phenothiazine derivatives, i.e., promethazine or chlorproethazine, and isothipendyl chlorhydrate 19 are frequent causes of ACD/PhACD, either by direct application or by transfer from other individuals in close contact (consort or connubial dermatitis). Moreover, some of these chemicals, particularly ketoprofen, exhibit cross-reactions with UV filters, i.e., benzophenone(s) and octocrylene, the latter containing benzophenone residues.…”

Section: This Number Of the Revista Da Sociedade Portuguesa Dementioning

confidence: 99%

Patch and Photo-Patch Testing are Important in Patients with Idiopathic Photodermatoses

Goossens

Gonçalo

2018

SPDV

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This number of the Revista da Sociedade Portuguesa de Dermatologia e Venereologia contains two articles dedicated to idiopathic photodermatoses, for which autoimmune reactions to an unknown endogenous chromophore are suspected to be involved – polymorphous light eruption, actinic prurigo, hydroa vacciniforme, chronic actinic dermatitis, and solar urticarial.1,2 Many of these and other photodermatoses have a very clear clinical presentation, while others may mimic allergic contact dermatitis (ACD) or photo-allergic contact dermatitis (PhACD), a classical T cell-mediated or delayed type IV hypersensitivity reaction to an exogenous chromophore applied on the skin in the presence of, or followed by exposure to ultraviolet (UV) or visible light.3,4 Allergic contact reactions can be followed by persistent photosensitivity and chronic actinic dermatitis, such as in cases of chronic ACD from certain plants, e.g., Compositae that are rich in sesquiterpene lactones,5 fragrances, lichens, and colophony,4 or in PhACD or photo-aggravated ACD from drugs like ketoprofen, etofenamate, and chlorproethazine, or even other contact allergens, such as tosylamide/formaldehyde resin, fragrances, and thiourea derivatives.4The long persistence of these chemicals in the epidermis (for up to at least 17 days in the case of ketoprofen),6 or the formation of endogenous photosensitizers might perhaps explain the progression to chronic actinic dermatitis.4In patients with idiopathic photodermatoses the use of sunscreens is mandatory, however, the sensitization risk from these chemicals may be enhanced by the previous skin inflammation and the need for repeated application for long periods.7 UV filters, which are chromophores that capture UV light, are among the most frequent causes of PhACD,8-11 namely benzophenones, dibenzoylmethane derivatives, octocrylene, and cinammates.9,10,12-14 Although more recent UV filters seem to be more photostable and less prone to induce PhACD,3 a few cases have been described,9 for example, from polysilicone-15 (Parsol®SLX).15 With regard to methylene bis-benzotriazolyl tetramethylbutylphenol (syn. bisoctrizole or Tinosorb® M), ACD from it is due to the surfactant decyl glucoside, in particular, which is added in order to stabilize the sunscreen molecule.16,17Topical drugs, such as the non-steroidal anti-inflammatory ketoprofen, piketoprofen, suprofen, etofenamate, piroxicam, and benzydamine,18 as well as phenothiazine derivatives, i.e., promethazine or chlorproethazine, and isothipendyl chlorhydrate19 are frequent causes of ACD/PhACD, either by direct application or by transfer from other individuals in close contact (consort or connubial dermatitis). Moreover, some of these chemicals, particularly ketoprofen, exhibit cross-reactions with UV filters, i.e., benzophenone(s) and octocrylene, the latter containing benzophenone residues. Also fenofibrate, a systemic drug, shares the benzophenone ring and can cross react with ketoprofen and related molecules.3,20 Furthermore, patients with PhACD from ketoprofen present with concomitant reactions to the perfume ingredient cinnamic alcohol, reactions that at present are difficult to explain by cross-reactivity.21Therefore, patch and photo-patch testing are highly recommended in patients with idiopathic and autoimmune photodermatoses, as well as in all other diseases aggravated by sunlight, in order to detect and avoid exposure to possible aggravating factors, and particularly to UV filters. Recently, recommendations for diagnostic patch testing have been issued by the European Society of Contact Dermatitis (ESCD),22 and in a cooperative effort of the ESCD and European Society of Photodermatology (ESPD), an agreement was not only reached regarding standardized protocols for photo-patch testing,23 but also on the list of 20 allergens to be included in the European baseline photo-patch tests series and an additional extended series including certain classical photo-allergens.24 Last but not least, photo-patch tests with all the patient’s own topical products and systemic photosensitizers to which the patients is exposed are strongly recommended as well, since the outcome may further contribute to the relevance of positive reactions observed, or avoid “false”- negative reactions obtained by testing standardized allergens only.24

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Contact Allergy to Topical Drugs

Goossens¹,

Gonçalo²

2020

Contact Dermatitis

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Contact Photoallergy to Isothipendyl Chlorhydrate

Cited by 12 publications

References 4 publications

Photodermatitis from topical phenothiazines: A case series

Photodermatitis from topical phenothiazines: A case series

Patch and Photo-Patch Testing are Important in Patients with Idiopathic Photodermatoses

Contact Allergy to Topical Drugs

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