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Systemic allergic dermatitis caused by thiamine after iontophoresis
Author(s) -
Arruti Nagore,
Bernedo Nagore,
Audicana Maria Teresa,
Villarreal Olga,
Uriel Olga,
Muñoz Daniel
Publication year - 2013
Publication title -
contact dermatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.524
H-Index - 96
eISSN - 1600-0536
pISSN - 0105-1873
DOI - 10.1111/cod.12115
Subject(s) - lava , humanities , medicine , art , geology , volcano , geochemistry
A 46-year-old woman developed a pruritic micropapular erythematous rash on the right shoulder after topical application of Voltaren® (diclofenac) and Inzitan® [lidocaine, dexamethasone, cyanocobalamin (vitamin B12) and thiamine (vitamin B1)] by iontophoresis. It resolved over several weeks with desquamation. Patch tests were performed according to International Contact Dermatitis Research Group guidelines (1), with the TRUE Test® system and the implicated drugs, with occlusion for 48 hours and with readings on D2 and D4. On D4, only nickel (++) and epoxy resin (++) gave positive reactions. Skin tests (prick and intradermal; Table 1) (2) showed no sensitization to diclofenac and Inzitan® at immediate and delayed readings (made at 24 hr). Therefore, once informed consent had been obtained from the patient, challenge tests were performed. She tolerated oral diclofenac (50 mg). One hour after the application of intramuscular Inzitan® (one half-ampoule) (the usual method of administration), she developed skin itching, and 24 hr later, erythematous plaques in the forearms and right shoulder (the application area of the iontophoresis treatment). Taking into account these results, skin tests were repeated with each of the components of Inzitan® [lidocaine, dexamethasone, cyanocobalamin (vitamin B12),