Iatrogenic allergic contact dermatitis in the (peri)anal and genital area

Abstract

Background: Allergic contact dermatitis (ACD) from topical medication often occurs in occluded areas, for example, with wound treatment, but also in certain body locations, such as the anogenital area.Objectives: To investigate the demographics and specific lesion location of patients with ACD from topical drugs applied onto the (peri)anal/genital area, and to identify the respective causal topical pharmaceutical products and ingredients involved.Methods: From January 2000 to December 10, 2018, 532 patients were tested with the baseline series, sometimes with additional series, and the topical medication used along with the ingredients. The relevant data were extracted from our electronic databases developed in-house.Results: Forty-four patients (9%) out of 473 patients suffering from lesions in the (peri)anal/genital area had positive patch test results to topical drug preparations and/or their ingredients, sometimes in association with cosmetics for intimate hygiene. The most frequent sensitizing active principles were local anaesthetics and corticosteroids, while wool alcohols and to a minor extent benzoic acid were the most frequent culprits among the vehicle components and preservative agents, respectively. Conclusions:The local conditions (eg, occlusion, sweating, moist) in the anogenital area may favour skin sensitization to topical medication used to treat various skin diseases.

A systematic review of allergic and irritant contact dermatitis of the vulva: The most important allergens/irritants and the role of patch testing

“…Of the included studies, 16 studies had a cross‐sectional design, of which nine were retrospective in which databases were used to conduct the study 13–21 . One randomized controlled trial was included 22 .…”

“…The mean age of the total study population was not always provided. The mean age ranged between 35.3 and 59.4 years in the studies that provided this information ( n = 13) 13–20,23,25,27–29 . Of all studies, 14 included post‐menopausal women 13–23,25,28,29 .…”

Contact Dermatitis of the Vulva

“…We suggest initially performing patch tests with the European baseline series and then with additional series with fragrances, preservatives, medicaments, and botanical extracts. We also strongly recommend testing with the patients' own products as well [25].…”

“…Benzoic acid is reported as a frequent cause of iatrogenic ACD (particularly associated with antifungal medication) in the genital area [25]. Isothiazolinones seem to play a predominant role in the etiology of genital ACD [26][27][28][29].…”

Pruritis ani

“…Contact dermatitis sometimes occurs in the peri-anal area with excessive use of various topical agents, such as soaps, creams and toilet paper (Gilissen et al, 2021). Many of these are often used by the patient in an attempt to improve perianal hygiene and consequently improve symptoms, however, this results in an unintended consequence of worsening the symptoms of pruritus ani (Silvestri and Barmettler, 2011).…”