Periorbital allergic contact dermatitis resulting from topical retinoic acid use

Abstract

Contact dermatitis to topical tretinoin or retinoic acid is rarely described. We outline the case of a 20-year-old woman presenting with bilateral periorbital dermatitis against the background of longstanding use of retinoic acid for the ocular complications of toxic epidermal necrolysis. Patch testing confirmed a contact allergy to retinoic acid and the symptoms of the dermatitis resolved after the cessation of retinoic acid.

Irritant contact dermatitis, multiple pyogenic granulomas and vitiligo following topical application of tretinoin

“…Contact dermatitis have been reported to develop during topical tretinoin treatment for skin diseases [1][2][3][4] ; these are considered allergic contact dermatitis. Severe irritant contact dermatitis to topical tretinoin or retinoic acid has been described rarely.…”

“…Skin irritation induced by tretinoin is commonly observed; however, severe irritant contact dermatitis to topical tretinoin or retinoic acid is rare, although there have been several reported cases of allergic contact dermatitis (ACD). [1][2][3][4] Pyogenic granuloma (PG) is a benign, acquired vascular lesion occurring on both skin and mucous membranes. The etiology of PG is unknown; however, it is thought to be associated with chronic irritation, minor trauma, and infections.…”

“…Topical tretinoin is now widely used for various dermatoses and skin tumors, including acne, keloids, for prevention of scar formation after burns, and others. Skin irritation induced by tretinoin is commonly observed; however, severe irritant contact dermatitis to topical tretinoin or retinoic acid is rare, although there have been several reported cases of allergic contact dermatitis (ACD) 1‐4 …”

Allergic contact dermatitis caused by topical antiacne drugs

“…However, only 11 out of 155 acne patients had clinical signs of ACD [29]. In a Nordqvist and Mehr (1977) 1 Tretinoin [8] Rudzki and Grzywa (1978) 1 Tretinoin [9] Romaguera and Grimalt (1980) 1 Tretinoin [10] Blondeel ( [20] Anderson and Gebauer (2014) 1 Tretinoin [21] Special Report Veraldi Spanish study published in 1994 [30], 272 children <14 years of age were patch tested: 101 children (37.1%) gave positive reactions to one or more allergens, including BP (10 patients). Finally, seven cases of ACD to BP were reported among the patients who were treated with a fixed combination of 2.5% BP and 0.1% adapalene [33].…”

“…Things to be followed for prevention of RD are: to begin the treatment with lower concentrations of retinoid, when possible; to begin the treatment applying the retinoid daily for a few hours and slowly increasing the application time until skin tolerance is acquired (hardening or accommodation phenomenon) [5] [6] published the first two cases of ACD caused by all-trans-retinoic acid, less than 20 cases have been published [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Most of the cases were caused by tretinoin (TABLE 2) [6-10, 12,13,[15][16][17][18][19]21]. This is due to the fact that tretinoin was the first topical retinoid marketed in the world and is, to this day, one of the most used in acne.…”