PEARLS & ZEBRAS
Allergic Contact Cheilitis to Amine Fluoride in a Toothpaste Caterina Foti, MD, Paolo Romita, MD, Davide Ficco, MD, Domenico Bonamonte, MD, and Gianni Angelini, MD PRECI´S We report the first case of contact allergy to amine fluoride from a toothpaste, a well-tolerated ingredient widespread for its remineralizing and anticaries properties.
DISCUSSION A 50-year-old not-atopic woman presented with a 1-month history of cheilitis (Fig. 1) characterized by intense itch. History revealed that her lesions appeared 2 months after the usage of a new toothpaste. One month after the complete resolution of the dermatitis, obtained by a once-daily topical application of mometasone furoate and tocopherol lip balm for 1 week, patch testing was performed using the Italian Society of Allergological, Occupational and Environmental Dermatology standard baseline series, our ‘‘cheilitis series,’’ and with toothpaste 3% petrolatum, which were read at days 2 and 4 following the International Contact Dermatitis Research Group guidelines. ROAT test with toothpaste as is was performed on the volar aspect of the forearm (twice daily 5 5-cm applications for a maximum of 7 days). She showed a positive patch test to toothpaste 3% petrolatum (2+ reaction) and a positive ROAT after 4 applications. Hence, we performed patch tests with the ingredients of the toothpaste kindly provided by the manufacturer at the appropriate concentration. Only an ingredient of the toothpaste, amine fluoride 5% aqueous, was positive with erythematous papulovesicular lesions at days 2 and 4. An additional reading performed at day 7 confirmed the positive result. Patch tests were carried out also with dilutions of amine fluoride 5% petrolatum with NaCl solution at 1:10, 1:20, and 1:50. At days 2 and 4, positive reactions were observed to amine fluoride at all dilutions. Ten healthy volunteers were patch tested with toothpaste 3% petrolatum and with amine
From the Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Italy. Address reprint requests to requests to Caterina Foti, MD, Unit of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Policlinico, Piazza Giulio Cesare, 11, I-70124 Bari, Italy. E-mail: [email protected]. The authors have no funding or conflicts to declare. DOI: 10.1097/DER.0000000000000053 * 2014 American Contact Dermatitis Society. All Rights Reserved.
Figure 1. Allergic contact cheilitis to amine fluoride in a toothpaste.
fluoride 5% aqueous, turning out negative. We therefore concluded the patient had allergic contact dermatitis (ACD) to amine fluoride. Fluoride has been described to provoke noneczematous skin reactions, such as urticarial perioral dermatitis, acne-like eruptions, and ulcerous stomatitis.1Y4 In addition, contact allergy to amine fluoride was reported in 1997 by Ganter et al,5 who described a case of stomatitis in a boy who used a gel containing this ingredient. Our case is, as far as we are aware, the first reported case of ACD to toothpaste caused by amino fluoride. Contact sensitivity to this latter compound has been demonstrated by positive patch test and additionally confirmed by ROAT test and negative results in healthy control subjects. Moreover, our patient was begun on toothpaste free of amine fluoride and has had no further relapse of the cheilitis.
ZEBRA This was a unique example of ACD to a toothpaste caused by amine fluoride presenting as an eczematous cheilitis.
REFERENCES 1. Camarasa JG, Serra-Baldrich E, Lluch M, et al. Contact urticaria from sodium fluoride. Contact Dermatitis 1993;28:294. 2. Saunders MA. Fluoride toothpastes: a cause of acne-like eruptions. Arch Dermatol 1975;111:793. 3. Mellette JR, Aeling JL, Nuss DD. Fluoride toothpaste: a cause of perioral dermatitis. Arch Dermatol 1976;112:730Y731. 4. Douglas TE. Fluoride dentrifice and stomatitis. Northwest Med 1957; 56:1037Y1038. 5. Ganter G, Disch R, Borelli S, et al. Contact dermatitis and stomatitis due to amine fluoride. Contact Dermatitis 1997;37:248.
Foti et al ¡ Allergic Contact Cheilitis to Amine Fluoride
Copyright © 2014 American Contact Dermatitis Society. Unauthorized reproduction of this article is prohibited.
209
Allergic Contact Cheilitis to Amine Fluoride in a Toothpaste Caterina Foti, MD, Paolo Romita, MD, Davide Ficco, MD, Domenico Bonamonte, MD, and Gianni Angelini, MD PRECI´S We report the first case of contact allergy to amine fluoride from a toothpaste, a well-tolerated ingredient widespread for its remineralizing and anticaries properties.
DISCUSSION A 50-year-old not-atopic woman presented with a 1-month history of cheilitis (Fig. 1) characterized by intense itch. History revealed that her lesions appeared 2 months after the usage of a new toothpaste. One month after the complete resolution of the dermatitis, obtained by a once-daily topical application of mometasone furoate and tocopherol lip balm for 1 week, patch testing was performed using the Italian Society of Allergological, Occupational and Environmental Dermatology standard baseline series, our ‘‘cheilitis series,’’ and with toothpaste 3% petrolatum, which were read at days 2 and 4 following the International Contact Dermatitis Research Group guidelines. ROAT test with toothpaste as is was performed on the volar aspect of the forearm (twice daily 5 5-cm applications for a maximum of 7 days). She showed a positive patch test to toothpaste 3% petrolatum (2+ reaction) and a positive ROAT after 4 applications. Hence, we performed patch tests with the ingredients of the toothpaste kindly provided by the manufacturer at the appropriate concentration. Only an ingredient of the toothpaste, amine fluoride 5% aqueous, was positive with erythematous papulovesicular lesions at days 2 and 4. An additional reading performed at day 7 confirmed the positive result. Patch tests were carried out also with dilutions of amine fluoride 5% petrolatum with NaCl solution at 1:10, 1:20, and 1:50. At days 2 and 4, positive reactions were observed to amine fluoride at all dilutions. Ten healthy volunteers were patch tested with toothpaste 3% petrolatum and with amine
From the Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Italy. Address reprint requests to requests to Caterina Foti, MD, Unit of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Policlinico, Piazza Giulio Cesare, 11, I-70124 Bari, Italy. E-mail: [email protected]. The authors have no funding or conflicts to declare. DOI: 10.1097/DER.0000000000000053 * 2014 American Contact Dermatitis Society. All Rights Reserved.
Figure 1. Allergic contact cheilitis to amine fluoride in a toothpaste.
fluoride 5% aqueous, turning out negative. We therefore concluded the patient had allergic contact dermatitis (ACD) to amine fluoride. Fluoride has been described to provoke noneczematous skin reactions, such as urticarial perioral dermatitis, acne-like eruptions, and ulcerous stomatitis.1Y4 In addition, contact allergy to amine fluoride was reported in 1997 by Ganter et al,5 who described a case of stomatitis in a boy who used a gel containing this ingredient. Our case is, as far as we are aware, the first reported case of ACD to toothpaste caused by amino fluoride. Contact sensitivity to this latter compound has been demonstrated by positive patch test and additionally confirmed by ROAT test and negative results in healthy control subjects. Moreover, our patient was begun on toothpaste free of amine fluoride and has had no further relapse of the cheilitis.
ZEBRA This was a unique example of ACD to a toothpaste caused by amine fluoride presenting as an eczematous cheilitis.
REFERENCES 1. Camarasa JG, Serra-Baldrich E, Lluch M, et al. Contact urticaria from sodium fluoride. Contact Dermatitis 1993;28:294. 2. Saunders MA. Fluoride toothpastes: a cause of acne-like eruptions. Arch Dermatol 1975;111:793. 3. Mellette JR, Aeling JL, Nuss DD. Fluoride toothpaste: a cause of perioral dermatitis. Arch Dermatol 1976;112:730Y731. 4. Douglas TE. Fluoride dentrifice and stomatitis. Northwest Med 1957; 56:1037Y1038. 5. Ganter G, Disch R, Borelli S, et al. Contact dermatitis and stomatitis due to amine fluoride. Contact Dermatitis 1997;37:248.
Foti et al ¡ Allergic Contact Cheilitis to Amine Fluoride
Copyright © 2014 American Contact Dermatitis Society. Unauthorized reproduction of this article is prohibited.
209
