Author: V. Dimov, M.D., Fellow, Creighton University Division of Allergy & Immunology
Reviewer: S. Randhawa, M.D., Fellow, LSU (Shreveport) Department of Allergy & Immunology
A 25-year-old Caucasian female developed worsening symptoms of facial dermatitis during the last 3 months. She started using over-the-counter hydrocortisone cream yesterday and her symptoms are better now. This is the third episode of similar complaints in the last 3 months. She reports long term use of the acne cream Proactiv, which contains benzyl peroxide, and she also uses Eucerin lotion on her face.
Medications
Her medications include Allegra (fexofenadine), Flonase (fluticasone nasal) and levothyroxine. Proactiv and Eucerin.
Past medical history
She has a long history of allergic rhinitis and conjunctivitis.
Physical examination
The physical examination is positive for facial erythema with some eyelid eczema.
What is the most likely diagnosis?
Facial dermatitis related to Proactiv, containing benzoyl peroxide. The etiology of the dermatitis is either irritant or allergic contact dermatitis to benzoyl
peroxide. Considering that she had two prior episodes that resolved and the rash is not worsening now, the most likely explanation for her condition is irritant contact dermatitis to benzoyl peroxide.
What treatment would you suggest?
The patient was advised to use hydrocortisone at the lowest of concentration of 1%, daily, on the face, for a week. She had to stop using Proactiv immediately. She could still use Eucerin daily.
Final diagnosis
Irritant contact dermatitis to acne medication that contains benzoyl peroxide.
Benzoyl peroxide (BP) is shown to be a weak allergen. In a study of 25 guinea pigs, only 5 were sensitized in the TINA test. BP is a skin irritant. However, only 11 of 155 acne patients had clinical signs of intolerance, which settled despite continued use in 10 cases.
References
Purpuric contact dermatitis to benzoyl peroxide. van Joost T, van Ulsen J, Vuzevski VD, Naafs B, Tank B. J Am Acad Dermatol. 1990 Feb;22(2 Pt 2):359-61.
Allergic contact angioedema to benzoyl peroxide. Minciullo PL, Patafi M, Giannetto L, Ferlazzo B, Trombetta D, Saija A, Gangemi S. J Clin Pharm Ther. 2006 Aug;31(4):385-7.
Allergic and irritant potential of benzoyl peroxide. Haustein UF, Tegetmeyer L, Ziegler V. Contact Dermatitis. 1985 Oct;13(4):252-7.
Contact dermatitis due to benzoyl peroxide. Morelli R, Lanzarini M, Vincenzi C, Reggiani M. Contact Dermatitis. 1989 Mar;20(3):238-9.
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Published: 01/30/2010
Updated: 01/30/2010
1 comment:
Last year i started using proactive the "refining mask" it worked good for a few months in getting rid of those zits fast. i dont have acne, i have a few pimples here and there, but it was at a time where i was switching bc, and it made me break out. after about 3 months of using this product, i started noticing these red marks (small bumps) on my face. I thought they where pimples, so i put more proactiv on. they got worse and worse over a few months, and i started googling it. I found contact dermitius, and my symptoms where the same. I went to the doctor and she perscribed me some betaderm. my symptom went away pretty fast, and i used the cream for a month. thinking it was now safe to use a different acne cream, i bought one to cover up a couple small marks. the next day..my rash was back even worse then it ever was. proactive ruined my skin completely.... i dont recomend this to anyone.. honestly, i hope i help atlest one person from this.
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