Published in Dermatology Journal Scan / Research · March 30, 2022 Investigating Associated Factors of Contact Allergy to Antifungals Contact Dermatitis

Abstract

BACKGROUND

Contact allergy has been reported as a side effect of topical antifungals (TAFs), although most evidence has come from small case series.

OBJECTIVE

To investigate the frequency and associated factors of contact allergy to TAFs.

METHODS

We performed a retrospective analysis of the data of the Contact Allergy Unit of a University Dermatology Department between January 2009 and April 2021. From a cohort of 3788 patients tested in our unit, aimed testing was performed in 482 patients using TAFs from Chemotechnique Diagnostics (Vellinge, Sweden), allergEAZE, and, in some cases, commercial preparations 'as is'.

RESULTS

Contact allergy to antifungals was found in 27 patients (0.71% of consecutively tested patients and 5.6% of those who had aimed testing). Foot and leg eczema were the clinical presentation in 12 (44.4%) and 10 (37.0%) patients, respectively. Positive reactions were observed mostly with econazole nitrate 1% alcohol (51.9%), miconazole 1% alcohol (48.9%), tioconazole 28% solution (40.7%), and clotrimazole 5% pet. (18.5%). Fifteen patients (55.6%) had sensitization to more than one antifungal.

CONCLUSIONS

Contact allergy to antifungals was uncommon and occurred mostly associated with foot dermatitis. Most patients were sensitized to more than one chemical, particularly to azoles, which may limit future choices of TAF treatment.

Contact Dermatitis

Contact allergy to antifungals: Results of a 12-year retrospective study

Contact Derm 2022 Feb 17;[EPub Ahead of Print], TF Gomes, R Calado, AL Matos, M Gonçalo 

TAKE-HOME MESSAGE

• Authors retrospectively analyzed a cohort of 3788 patients and found 27 cases of contact dermatitis to antifungals. Foot and leg eczema were the most common clinical presentation of contact allergy to antifungals in 44.4% and 37% patients, respectively. The most common antifungal allergens in patch test positive patients were econazole, miconazole, tioconazole, and clotrimazole with over half of patients (55.6%) demonstrating contact dermatitis to more than one antifungal agent.

• Given the frequency of multiple sensitivities, choice of antifungal agent can be very limited and may support the inclusion of one or two antifungals in a shoe/foot patch test series.

–  Caroline K. Crabtree, MD

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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