Systemic allergic dermatitis from chromium in a multivitamin/multimineral tablet

A 43-year-old non-atopic lawyer presented with a 10-year history of recurrent vesicular eczema on his hands, wrists, feet, ankles, and lower legs mainly after wearing leather gloves, shoes, or boots. Wearing dark coloured socks worsened his foot eczema. He was aware of no other aggravating factor. Patch testing was performed with the extended European baseline series, and with series of preservatives, emulsifying excipients, fragrances, and leather including leather dyes (Brial Allergen, Greven, Germany) using IQ-Chamber® (Chemotechnique Diagnostics, Vellinge, Sweden). Using International Contact Dermatitis Research Group (ICDRG) criteria, a +++ positive reaction developed to potassium dichromate (0.5% pet.), a ++ positive reaction to cobalt chloride (1% pet.), and a + reaction to nickel sulfate (5% pet.), chromium sulfate (0.5% pet.), ammoniated mercury (1% pet.), and phenylmercuric acetate (0.01% pet.) on D2, D3, and D4. The metal and mercury compounds were of past relevance; the former having caused eczema on contact areas of metals such as eyeglass frame or wrist watch, and the latter from use of mercurochrome in the past. He had had no exposure to these for at least a year and he had never used wet cement. In spite of further avoidance of contact with metals, leather, dark coloured textiles, dyes, and a low chromate and nickel diet for the next 1 month, the lesions failed to improve. At that point, the patient reported the daily use of 1–2 multivitamin/multimineral tablets (ONE-A-DAY® Men’s, Leiner Health Products, USA, imported by Bayer Türk Kimya San. Ltd. Şti., Istanbul, Turkey) for the previous 2–3 months. The preparation contained 150 μg chromium chloride as well as 9 μg vitamin B12 (cyanocobalamin) but no nickel. Within 10 days after discontinuation of the tablets and treatment with topical corticosteroids, his eczema resolved completely. After an eczema-free interval of 3 months, systemic challenge with the multivitamin/multimineral tablets one daily orally for three consecutive days resulted in recurrence of acute vesicular eczema on previously involved sites within 2D. A flare in the previous patch test sites was not observed. The tablets were stopped again, and lesions resolved within 10D. Additional patch testing with chromium chloride could not be performed. There was no recurrence of the eczema during a 6-month follow-up.