Prurito genitales y perianal

Journal Scan / Research · January 24, 2021

Iatrogenic ACD in the Perianal and Genital Area

Contact Dermatitis

TAKE-HOME MESSAGE

• The authors evaluated data from patch-tested patients who presented with eczematous dermatitis to a tertiary referral center in Belgium from 2000 to 2018. Forty-four patients (30 women and 14 men; average age 51 years) were identified as having vulvar, penile and/or scrotal, or perianal and/or anal dermatitis, which was felt to be an iatrogenic cause of allergic contact dermatitis (ACD). Thirteen patients (30%) had a history of atopic dermatitis. The most common location for the iatrogenic ACD was vulvar skin in women (61% of women) and the perianal area in men (35% of men); however, 19 patients had more than one location involved. The single most identified allergens were lidocaine (n = 4) and budesonide (n = 3). Neomycin (n = 2), betamethasone dipropionate (n = 2), and hydrocortisone (n = 2) were also noted allergens. Wool alcohols (n = 5) were the most common vehicle component, and benzoic acid (n = 4) was the most common preservative agent noted.

• Topical corticosteroids and local anesthetics were the most common allergens identified in this study. It is important to keep in mind that the anogenital area can become sensitized to various topical medications typically used to treat skin conditions in this region.

– Alex Noble, MD

Written by

Kelly H. Tyler MD, FACOG, FAAD

Moisture, occlusion, friction, oh my!! Is anyone brave enough to meet and tackle the mighty anogenital dermatosis? Well, don't be a coward. Just heed the helpful advice of these authors who identified the most prevalent causative ingredients and products in Belgian patients with allergic contact dermatitis of the vulva, penis, scrotum, anus, and perianal areas. 

Not surprisingly, patients with dermatitis in this region will do anything to alleviate their symptoms. They not only apply prescribed medications such as topical steroids, but they often utilize a multitude of over-the-counter preparations such as topical anesthetics and personal care wipes. That being said, the results of this study are not surprising. Of the 9% of patients with anogenital dermatoses and positive patch tests, the most common relevant allergens were local anesthetics, corticosteroids (often combined with antifungals or antimicrobials), the vehicle component wood alcohol, and the preservative benzoic acid. 

As dermatologists, we are constantly on the lookout for over-the-counter products with fragrances and certain preservatives as causes of allergic contact dermatitis; however, because sensitization is more frequent in occluded and permeable anogenital skin, it is equally important to consider prescribed medications such as topical steroids. This study reminds us to keep iatrogenic causes of allergic contact dermatitis in mind for patients who don't respond as expected to appropriate treatment regimens.

Abstract

BACKGROUND

Allergic contact dermatitis (ACD) from topical medication often occurs in occluded areas, for example, with wound treatment, but also in certain body locations, such as the anogenital area.

OBJECTIVES

To investigate the demographics and specific lesion location of patients with ACD from topical drugs applied onto the (peri)anal/genital area, and to identify the respective causal topical pharmaceutical products and ingredients involved.

METHODS

From January 2000 to December 10, 2018, 532 patients were tested with the baseline series, sometimes with additional series, and the topical medication used along with the ingredients. The relevant data were extracted from our electronic databases developed in-house.

RESULTS

Forty-four patients (9%) out of 473 patients suffering from lesions in the (peri)anal/genital area had positive patch test results to topical drug preparations and/or their ingredients, sometimes in association with cosmetics for intimate hygiene. The most frequent sensitizing active principles were local anaesthetics and corticosteroids, while wool alcohols and to a minor extent benzoic acid were the most frequent culprits among the vehicle components and preservative agents, respectively.

CONCLUSIONS

The local conditions (eg, occlusion, sweating, moist) in the anogenital area may favour skin sensitization to topical medication used to treat various skin diseases.

Contact Dermatitis

Iatrogenic Allergic Contact Dermatitis in the (Peri)Anal and Genital Area

Contact Derm 2020 Dec 22;[EPub Ahead of Print], L Gilissen, I Schollaert, S Huygens, A Goossens