Multiple chemical sensitivities, including iatrogenic allergic contact dermatitis, in a patient with chronic actinic dermatitis: Implications for management

Abstract

Background: Chronic actinic dermatitis represents a spectrum of photosensitive dermatoses. Phototesting and photopatch testing are necessary to elucidate the specific subtype. Such patients may have multiple cutaneous allergies and photoallergies. Objective: This is a case report of a patient with chronic actinic dermatitis whose condition was worsened by certain sunscreens and corticosteroids. Our purpose was to identify the specific subtype of chronic actinic dermatitis and cutaneous allergens. Methods: Phototesting to UVB and UVA was performed. Photopatch testings to standard photoallergens and to Photoplex sunscreen ingredients was performed. Patch testing to standard allergens and proprietary corticosteroids was performed. Results: Positive photoallergies to Photoplex sunscreen and the UVA screen within Photoplex, Parsol 1789 (4-tert-butyl-4′-methoxydibenzoyl-methane), were identified. Positive allergies to Aclovate (alclometasone dipropionate) cream and ointment and Locoid (hydrocortisone butyrate) ointment were identified. The patient showed increased UVB sensitivity. Conclusion: This is a case report of a patient with chronic actinic dermatitis. A relevant photoallergy to Parsol 1789 and corticosteroid sensitivities to aclometasone and hydrocortisone butyrate were identified. Multiple cutaneous allergens may be identified in patients with chronic actinic dermatoses, and avoidance of known allergens may result in significant improvement of the chronic dermatitis.