http://informahealthcare.com/cot ISSN: 1556-9527 (print), 1556-9535 (electronic) Cutan Ocul Toxicol, Early Online: 1–2 ! 2014 Informa Healthcare USA, Inc. DOI: 10.3109/15569527.2014.883405
CASE REPORT
Pustular irritant contact dermatitis caused by dexpanthenol in a child Ali Ihsan Gulec1, Hulya Albayrak2, Esma Uslu3, Elife Ba¸skan3, and Cihangir Aliagaoglu1
Cutaneous and Ocular Toxicology Downloaded from informahealthcare.com by University of Washington on 02/02/15 For personal use only.
1
Department of Dermatology, Du¨zce Medical Faculty, Duzce, Turkey, 2Department of Dermatology, Duzce State Hospital, Duzce, Turkey, and Department of Dermatology, Duzce University Medical Faculty, Duzce, Turkey
3
Abstract
Keywords
Pustular irritant contact dermatitis is rare and unusual clinic form of contact dermatitis. Dexpanthenol is the stable alcoholic analogue of pantothenic acid. It is widely used in cosmetics and topical medical products for several purposes. We present the case of 8-year-old girl with pustules over erythematous and eczematous areas on the face and neck. To the best of our knowledge, this is the first case reported that is diagnosed as pustular irritant contact dermatitis caused by dexpanthenol.
Adverse drug reactions, dexpanthenol, pustular irritant contact dermatitis
Introduction Dexpanthenol is the alcohol corresponding to pantothenic acid (the water-soluble vitamin B5)1. Although it is a common ingredient in many pharmaceuticals and cosmetics; contact dermatitis caused by dexpanthenol, is relatively uncommon1,2. One of the unusual clinical pictures of contact dermatitis is pustular allergic or irritant contact dermatitis. Although there was one case that allergic contact dermatitis caused by panthenol in a child3, there was no case that pustular irritant contact dermatitis caused by dexpanthenol in children before our case. We reported the first case of pustular irritant contact dermatitis caused by dexpanthenol in children.
History Received 25 December 2013 Revised 30 December 2013 Accepted 8 January 2014 Published online 7 February 2014
function test, thyroid function tests and erythrocyte sedimentation rate were within normal limits. There were no family, drug or atopy history. A skin biopsy showed subcorneal pustules, spongiosis and an inflammatory infiltrate composed mainly of lymphocytes and some eosinophils and neutrophils (Figure 3). With clinical and histopathologic findings, we diagnosed pustular contact dermatitis. We prescribed topical corticosteroids. After complete resolution of the lesions, we applied the patch tests on the upper back with the European Standard Series included dexpanthenol. The results of patch tests were all negative. We understood helping with this result that the clinic was pustular ‘‘irritant’’ contact dermatitis.
Case An 8-year-old girl presented with pruriginous pustular lesions, pustule remnants and thin scales over an erythematous and eczamatous areas on the face and neck (Figures 1 and 2). These lesions had appeared 2 d after application of a cream contained dexpanthenol. The cream had been used for moisturizing by the patient’s parents. There was no fever, systemic symptoms or positive laboratory tests. Complete blood count, routine biochemistry including hepatic and renal
Address for correspondence: Ali Ihsan Gulec, Duzce Medical Faculty, Duzce, Turkey. E-mail: [email protected]
Figure 1. Erythema and desquamation on the face.
Cutaneous and Ocular Toxicology Downloaded from informahealthcare.com by University of Washington on 02/02/15 For personal use only.
2
A. I. Gulec et al.
Figure 2. Pustula and desquamation on the neck.
Cutan Ocul Toxicol, Early Online: 1–2
Dexpanthenol has also been shown to accelerate skin reepithelialization and activation of fibroblast proliferation and is used for the treatment of minor skin disorders including sunburn and burns6. It is a frequent component of shampoos and hair conditioners as it coats and seals the hair surface, making hair appear more shiny2,7. Although dexpanthenol is widely used, contact dermatitis is relatively uncommon. Allergic contact dermatitis caused by panthenol is considered to be rare, but has been reported following the use of medicaments, moisturizers and sunscreens1,2,4,5,7. And only one case was reported as allergic contact dermatitis caused by panthenol in children3. Our case is the first case that pustular ‘‘irritant’’ contact dermatitis caused by dexpanthenol in children. Pustular allergic or irritant contact dermatitis has been reported previously due to croton oil, merbromine, flu¨orine and minoxidil8–11. But there was no case that pustular contact dermatitis triggered by dexpanthenol before our case, that is, the first case dexpanthenol-induced pustular contact dermatitis. We conclude that our case is interesting as it represents an uncommon reaction to dexpanthenol used very frequently in dermatology.
Declaration of interest The authors declare no conflicts of interests. The authors alone are responsible for the content and writing of this article.
References
Figure 3. Subcorneal pustula and spongiosis H&E 20 (scale bar ¼ 100 mm).
Discussion Dexpanthenol is the stable alcoholic analogue of pantothenic acid, a water-soluble vitamin B5 that is essential for the biosynthesis of coenzyme A4. Dexpanthenol is widely used in a variety of cosmetics, and topical medical, over-the-counter and photoprotective products5. Topical dexpanthenol acts as a moisturizer and maintains skin softness and elasticity4. It reduces trans epidermal water loss, improves hydration of stratum corneum, and stabilizes the epidermal barrier function6. Our patient had used topical dexpanthenol for moisturizing.
1. Roberts H, Williams J, Tate B. Allergic contact dermatitis to panthenol and cocamidopropyl PG dimonium chloride phosphate in a facial hydrating lotion. Contact Dermatitis 2006;55:369–370. 2. Gollhausen R, Przybilla B, Ring J. Contact allergy to dexpanthenol. Contact Dermatitis 1985;13:38. doi: 10.1111/j.16000536.1985.tb02493.x. 3. Chin MF, Hughes TM, Stone NM. Allergic contact dermatitis caused by panthenol in a child. Contact Dermatitis 2013;69: 321–322. 4. Stables GI, Wilkinson SM. Allergic contact dermatitis due to panthenol. Contact Dermatitis 1998;38:236–237. 5. Fernandes S, Macias V, Cravo M, et al. Allergic contact dermatitis caused by dexpanthenol: report of two cases. Contact Dermatitis 2012;66:160–161. 6. Ebner F, Heller A, Rippke F, et al. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol 2002;3:427–433. 7. Jeanmougin M, Manciet JR, Moulin JP, et al. Contact allergy to dexpanthenol in sunscreens. Contact Dermatitis 1988;18:240. doi: 10.1111/j.1600-0536.1988.tb02812.x. 8. Torinuki W, Tagami H. Pustular irritant dermatitis due to croton oil. Evaluation of the role played by leukocytes and complement. Acta Derm Venereol 1988;68:257–260. 9. Barrazza V, Ollivaud L. Merbromine-induced pustular contact dermatitis. Contact Dermatitis 1999;40:219. doi: 10.1111/j.16000536.1999.tb06043.x. 10. Ste´ciuk A, Dompmartin A, Saussey J, et al. Pustular contact dermatitis from fluorine in an antirust solution. Contact Dermatitis 1997;36:276–277. 11. Rodrı´guez-Martı´n M, Sa´ez-Rodrı´guez M, Carnerero-Rodrı´guez A, et al. Pustular allergic contact dermatitis from topical minoxidil 5%. J Eur Acad Dermatol Venereol 2007;21:701–702.
CASE REPORT
Pustular irritant contact dermatitis caused by dexpanthenol in a child Ali Ihsan Gulec1, Hulya Albayrak2, Esma Uslu3, Elife Ba¸skan3, and Cihangir Aliagaoglu1
Cutaneous and Ocular Toxicology Downloaded from informahealthcare.com by University of Washington on 02/02/15 For personal use only.
1
Department of Dermatology, Du¨zce Medical Faculty, Duzce, Turkey, 2Department of Dermatology, Duzce State Hospital, Duzce, Turkey, and Department of Dermatology, Duzce University Medical Faculty, Duzce, Turkey
3
Abstract
Keywords
Pustular irritant contact dermatitis is rare and unusual clinic form of contact dermatitis. Dexpanthenol is the stable alcoholic analogue of pantothenic acid. It is widely used in cosmetics and topical medical products for several purposes. We present the case of 8-year-old girl with pustules over erythematous and eczematous areas on the face and neck. To the best of our knowledge, this is the first case reported that is diagnosed as pustular irritant contact dermatitis caused by dexpanthenol.
Adverse drug reactions, dexpanthenol, pustular irritant contact dermatitis
Introduction Dexpanthenol is the alcohol corresponding to pantothenic acid (the water-soluble vitamin B5)1. Although it is a common ingredient in many pharmaceuticals and cosmetics; contact dermatitis caused by dexpanthenol, is relatively uncommon1,2. One of the unusual clinical pictures of contact dermatitis is pustular allergic or irritant contact dermatitis. Although there was one case that allergic contact dermatitis caused by panthenol in a child3, there was no case that pustular irritant contact dermatitis caused by dexpanthenol in children before our case. We reported the first case of pustular irritant contact dermatitis caused by dexpanthenol in children.
History Received 25 December 2013 Revised 30 December 2013 Accepted 8 January 2014 Published online 7 February 2014
function test, thyroid function tests and erythrocyte sedimentation rate were within normal limits. There were no family, drug or atopy history. A skin biopsy showed subcorneal pustules, spongiosis and an inflammatory infiltrate composed mainly of lymphocytes and some eosinophils and neutrophils (Figure 3). With clinical and histopathologic findings, we diagnosed pustular contact dermatitis. We prescribed topical corticosteroids. After complete resolution of the lesions, we applied the patch tests on the upper back with the European Standard Series included dexpanthenol. The results of patch tests were all negative. We understood helping with this result that the clinic was pustular ‘‘irritant’’ contact dermatitis.
Case An 8-year-old girl presented with pruriginous pustular lesions, pustule remnants and thin scales over an erythematous and eczamatous areas on the face and neck (Figures 1 and 2). These lesions had appeared 2 d after application of a cream contained dexpanthenol. The cream had been used for moisturizing by the patient’s parents. There was no fever, systemic symptoms or positive laboratory tests. Complete blood count, routine biochemistry including hepatic and renal
Address for correspondence: Ali Ihsan Gulec, Duzce Medical Faculty, Duzce, Turkey. E-mail: [email protected]
Figure 1. Erythema and desquamation on the face.
Cutaneous and Ocular Toxicology Downloaded from informahealthcare.com by University of Washington on 02/02/15 For personal use only.
2
A. I. Gulec et al.
Figure 2. Pustula and desquamation on the neck.
Cutan Ocul Toxicol, Early Online: 1–2
Dexpanthenol has also been shown to accelerate skin reepithelialization and activation of fibroblast proliferation and is used for the treatment of minor skin disorders including sunburn and burns6. It is a frequent component of shampoos and hair conditioners as it coats and seals the hair surface, making hair appear more shiny2,7. Although dexpanthenol is widely used, contact dermatitis is relatively uncommon. Allergic contact dermatitis caused by panthenol is considered to be rare, but has been reported following the use of medicaments, moisturizers and sunscreens1,2,4,5,7. And only one case was reported as allergic contact dermatitis caused by panthenol in children3. Our case is the first case that pustular ‘‘irritant’’ contact dermatitis caused by dexpanthenol in children. Pustular allergic or irritant contact dermatitis has been reported previously due to croton oil, merbromine, flu¨orine and minoxidil8–11. But there was no case that pustular contact dermatitis triggered by dexpanthenol before our case, that is, the first case dexpanthenol-induced pustular contact dermatitis. We conclude that our case is interesting as it represents an uncommon reaction to dexpanthenol used very frequently in dermatology.
Declaration of interest The authors declare no conflicts of interests. The authors alone are responsible for the content and writing of this article.
References
Figure 3. Subcorneal pustula and spongiosis H&E 20 (scale bar ¼ 100 mm).
Discussion Dexpanthenol is the stable alcoholic analogue of pantothenic acid, a water-soluble vitamin B5 that is essential for the biosynthesis of coenzyme A4. Dexpanthenol is widely used in a variety of cosmetics, and topical medical, over-the-counter and photoprotective products5. Topical dexpanthenol acts as a moisturizer and maintains skin softness and elasticity4. It reduces trans epidermal water loss, improves hydration of stratum corneum, and stabilizes the epidermal barrier function6. Our patient had used topical dexpanthenol for moisturizing.
1. Roberts H, Williams J, Tate B. Allergic contact dermatitis to panthenol and cocamidopropyl PG dimonium chloride phosphate in a facial hydrating lotion. Contact Dermatitis 2006;55:369–370. 2. Gollhausen R, Przybilla B, Ring J. Contact allergy to dexpanthenol. Contact Dermatitis 1985;13:38. doi: 10.1111/j.16000536.1985.tb02493.x. 3. Chin MF, Hughes TM, Stone NM. Allergic contact dermatitis caused by panthenol in a child. Contact Dermatitis 2013;69: 321–322. 4. Stables GI, Wilkinson SM. Allergic contact dermatitis due to panthenol. Contact Dermatitis 1998;38:236–237. 5. Fernandes S, Macias V, Cravo M, et al. Allergic contact dermatitis caused by dexpanthenol: report of two cases. Contact Dermatitis 2012;66:160–161. 6. Ebner F, Heller A, Rippke F, et al. Topical use of dexpanthenol in skin disorders. Am J Clin Dermatol 2002;3:427–433. 7. Jeanmougin M, Manciet JR, Moulin JP, et al. Contact allergy to dexpanthenol in sunscreens. Contact Dermatitis 1988;18:240. doi: 10.1111/j.1600-0536.1988.tb02812.x. 8. Torinuki W, Tagami H. Pustular irritant dermatitis due to croton oil. Evaluation of the role played by leukocytes and complement. Acta Derm Venereol 1988;68:257–260. 9. Barrazza V, Ollivaud L. Merbromine-induced pustular contact dermatitis. Contact Dermatitis 1999;40:219. doi: 10.1111/j.16000536.1999.tb06043.x. 10. Ste´ciuk A, Dompmartin A, Saussey J, et al. Pustular contact dermatitis from fluorine in an antirust solution. Contact Dermatitis 1997;36:276–277. 11. Rodrı´guez-Martı´n M, Sa´ez-Rodrı´guez M, Carnerero-Rodrı´guez A, et al. Pustular allergic contact dermatitis from topical minoxidil 5%. J Eur Acad Dermatol Venereol 2007;21:701–702.
