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Medicament Contact Allergy — SCE Dermatology MCQ

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ModerateInflammatory DermatosesMedicament Contact AllergySCE Dermatology

A 35-year-old woman has discoid eczema. She uses multiple topical products and her eczema is worsening despite treatment. Her dermatologist suspects contact allergy to a topical medicament. What allergens from the 'medicament series' should be included in her patch test assessment?

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Correct answer: A — Lanolin (wool alcohols), preservatives (parabens, formaldehyde releasers, isothiazolinones), neomycin, fusidic acid, corticosteroids (Tixocortol pivalate, Budesonide), and excipients

The medicament/topical series is specifically designed to identify contact allergy to ingredients in topical treatments and is essential when worsening eczema despite treatment suggests superimposed allergic contact dermatitis. Key allergens include: corticosteroids (Tixocortol pivalate — screens for hydrocortisone allergy; Budesonide — screens for non-halogenated corticosteroid allergy), topical antibiotics (Neomycin, Fusidic acid — common medicament allergens), preservatives (parabens, formaldehyde releasers, MCI/MI), lanolin/wool alcohols (in emollients), and base ingredients (cetearyl alcohol, propylene glycol). Corticosteroid allergy is particularly ironic — patients may be allergic to the treatment being prescribed for their dermatitis.

Reference: BAD 2017 Contact Dermatitis; Medicament Series