Allergic contact dermatitis to ethylhexylglycerin in a cream

Abstract

A 64-year-old woman, retired nurseassistant and kindergarten teacher,had had recurrent hand eczema formore than 30 years. She had a previ-ously documented contact allergy tonickel sulfate, potassium dichromate,and cobalt chloride and also hadmucosal atopy. For some time be-cause of chronic eczema, she hadbeen treated systemically with pred-nisolone in short courses and withmethotrexate. In recent years, she ex-perienced seasonal variation in der-matitis with summer exacerbation.She had for some time used VichyCapital Soleil Mexoryl XL 60/16(Vichy, Asnie`res-sur-Seine, France)as sunscreen product.Because of severe aggravation offacial, arm, and hand eczema, shewas referred to the department andtreated with an alternative topicalcorticosteroid, and the use of cosmet-ics was stopped owing to the suspi-cion of contact allergy to some ofher topical remedies. The dermatitissubsided, and she was subsequentlypatch tested with the standard seriessupplemented with Compositae aller-gens and her own topical products.Readings according to InternationalContact Dermatitis Research Grouprecommendations at D3 and D7showed positive reactions (þ, þ)toher Vichy sunscreen cream and toCompositae mix 6% pet. (þ, þ?).She had weak positive reactions tothe sesquiterpene lactone mix (þ?,þ?) and parthenolide (þ?, ) presentin the standard series. Testing withthe Compositae mix ingredientsshowed positive reaction to tansyextract (þ?, þ?) and fewerfew (þ?,þ?).Further,she hada weakreactionto a locally manufactured skin carecream, and it was reproducible atretesting. However, repeated openapplication test (ROAT) for 7 dayswas negative. The remaining patchtests were negative. Skin prick testswere positive to birch pollen andmugwort. A ROAT was performedwith the Vichy sunscreen cream, andit was strongly positive after 6 appli-cations on D3. At request, LO´realkindly provided relevant informationand product ingredients for patchtesting. She reacted strongly positiveto a single ingredient, ethylhexylgly-cerin 5% pet. (þþ, þ), and a ROATwith ethylhexylglycerin 5% in pet.wasstronglypositiveonD2afteronly4applications.Thereactionspreadtothe entire right arm and also to theface. A total of 25 consecutive con-trols tested with ethylhexylglycerin5% pet. were negative.