Solution using Stomahesive® wafers for allergic contact dermatitis caused by isobornyl acrylate in glucose monitoring sensors.

Isobornyl acrylate (IBOA) has recently caused a number of cases of allergic contact dermatitis (ACD) from its use in medical devices. We would like to enhance the awareness of this issue with the reporting of three Australian cases, involving two adults and a child. We also report a successful solution by using hydrocolloid wafer (Stomahesive®) as a barrier. As IBOA is not usually found on baseline patch test series and does not cross-react with other acrylic monomers, ACD to IBOA may be missed by clinicians.

Allergic Contact Dermatitis to Dermabond Prineo After Elective Orthopedic Surgery.

The Dermabond Prineo skin closure system (Ethicon, Somerville, New Jersey) is a wound closure device that combines a 2-octyl cyanoacrylate liquid adhesive and a self-adhesive polyester mesh. Although cyanoacrylates traditionally have been associated with low rates of sensitization, allergic contact dermatitis (ACD) to Dermabond products is being increasingly reported after orthopedic surgery. The authors describe the first case series of ACD to Dermabond Prineo where patch testing confirmed the diagnosis in all patients. Six patients who had suspected Dermabond Prineo ACD after lower limb orthopedic surgery were assessed. Of these patients, 5 had itching within 4 days of surgery and rash within 5 days. All 5 of these patients reported previous exposure to Dermabond products. All patients had removal of the adhesive and mesh earlier than planned and were treated with corticosteroids. In addition, 4 patients received systemic antibiotics; however, only 1 had a microbiologically confirmed superficial skin infection. In all patients, the dermatitis resolved within 2 weeks of dressing removal, with no adverse effect on the orthopedic outcome. Patch testing showed positive reactions to Dermabond Prineo glue for all patients. Orthopedic surgeons should be aware of the potential for ACD to Dermabond Prineo, especially among patients with previous exposure to Dermabond products. The authors discuss the risk factors for ACD to Dermabond Prineo in the orthopedic cohort and provide recommendations for prevention and management. [Orthopedics. 2020;43(6):e515-e522.].

Unsuspected allergic contact dermatitis to alcohol swabs following neurosurgery.

We report a case of a 12-year-old girl with severe allergic contact dermatitis following neurosurgery secondary to topical use of isopropyl alcohol swabs. Alcohol swabs should not be overlooked as potential allergens. In our case, it was initially assumed that the cause of her reaction was either tapes or topical local anaesthetic.

Retrospective study of oral lichen planus and allergy to spearmint oil.

Oral lichen planus (OLP) is a chronic inflammatory disorder with significant morbidity, associated with symptoms of pain and local discomfort. The concept of contact allergy aggravating or inducing OLP is recognised, and reported allergens include amalgam, metals used in dental restoration and flavourings. To date there has been only one case report of a contact allergy to spearmint oil in a patient with a 3-year history of OLP. We retrospectively reviewed our positive spearmint oil patch test data at the Skin and Cancer Foundation Victoria over a period of 11 years. In total 73 patients of the 1467 tested for allergy to spearmint oil had positive patch tests. The total number of patches tested during this time was 6134. Of the 73 positive reactions, 19 (26%) were classified as relevant, in that the patients had a history of using spearmint oil-containing products. Coexisting OLP and a spearmint allergy were found in 14 of these 19 patients. All patients had erosive OLP and were female. Patients, especially women, with OLP recalcitrant to treatment should be patch tested to flavourings, especially spearmint oil. We believe that spearmint allergy should be considered a cause of OLP, or at least, of oral lichenoid reactions.

Allergic contact dermatitis to Myroxylon pereirae (Balsam of Peru) in papaw ointment causing cheilitis.

Two patients presented with cheilitis and perioral dermatitis. Patch testing revealed positive reactions to both Myroxylon pereirae (MP; formerly known as Balsam of Peru) and Lucas Papaw Ointment (LPO; Lucas Papaw Remedies, Bisbane, Qld, Australia). MP was not listed as an ingredient in LPO, however the manufacturer confirmed that a small amount of MP was present in LPO and we believe this to be the cause of the patients' dermatitis.