Erythema multiforme‐like reaction resulting from vitamin K₁ oxide (phytomenadione epoxide)

“Crossed” allergic contact dermatitis caused by oxidized vitamin K1 in a patient previously sensitized to non‐oxidized vitamin K1

“…As the manufacturer did not provide the allergen, the patient was patch tested with the non‐oxidized vitamin K 1 form, to which he developed a positive reaction. Hence, it was concluded that patients sensitized to vitamin K 1 oxide can be tested with the non‐oxidized vitamin K 1 form . As our patient presented with an ACD episode caused by a cosmetic containing vitamin K 1 , and 13 years later had another episode after the first application of a cream containing vitamin K 1 oxide, this probably represents genuine cross‐reactivity, representing the first case described with ACD episodes caused by the phytonadione and phytonadione epoxide contained in cosmetics, and confirming the possibility of such “crossed ACD”.…”

“…Hence, it was concluded that patients sensitized to vitamin K 1 oxide can be tested with the non-oxidized vitamin K 1 form. 6,7 As our patient presented with an ACD episode caused by a cosmetic containing vitamin K 1 , and 13 years later had another episode after the first application of a cream containing vitamin K 1 oxide, this probably represents genuine cross-reactivity, representing the first case described with ACD episodes caused by the phytonadione and phytonadione epoxide contained in cosmetics, and confirming the possibility of such "crossed ACD".In conclusion, we report a case of cross-reaction between nonoxidized and oxidized vitamin K 1 forms. This suggests that patients sensitized to cosmetics containing the non-oxidized form before 2009 should also avoid cosmetics containing the oxidized form.…”

“…Although ACD caused by cosmetic products containing the non‐oxidized form of vitamin K 1 have been widely reported, since it was banned in 2009 only 6 cases of ACD caused by products containing phytonadione epoxide have been observed, with contact allergy to this compound being shown in 4 cases. Although phytonadione oxide has been patch tested in 2 different concentrations (1% and 5% pet.)…”

Contact Allergy in Children

“…-EEM-like eruptions mostly occurring with potent sensitizers or in case of severe contact dermatitis [1], such as with PPD in temporary tattoos [22], a more recent case having been described in 2014 [23], but also with many other allergens, such as plants (poison ivy, St John's wort), tea tree oil, disperse dyes, and mephenesin [1]. Two other recent cases concerned budesonide aerosol [24] and vitamin K 1 oxide [25]. -Lichenoid contact dermatitis has been caused by PPD in temporary tattoos as well [26], occasionally followed by depigmentation of the affected sites [1,22]; also nickel in TENS electrode plates caused leukoderma [27].…”

“…Vitamin and derivatives have also been reported as sensitizers, i.e., panthenol, a vitamin B5 derivative that has anti-inflammatory, woundhealing, and hydrating properties, is a rare but relevant allergen in both topical pharmaceuticals and cosmetics [109], often present in wet wipes [110], and vitamin K 1 oxide (phytomenadione epoxide) has been reported even as the cause of an erythema multiforme-like reaction [25]. Finally, other rare causes of ADC have been described as well, i.e., triethanolamine [111], methoxy PEG-22/dodecyl glycol copolymer [112], and VEA Lipogel [113].…”