Department of Dermatology, University Hospital of Nancy, Fournier Hospital, Nancy, France.
G Ital Dermatol Venereol. 2009 Oct;144(5):527-36.
The management of patients who have developed a contact dermatitis due to topical drugs requires to stop the suspected drug application, to treat the patient with corticosteroid ointments, to perform dermatoallergological investigations e.g. drug patch tests in case of contact eczema and diluted prick tests in case of contact urticaria in order to determine whether the adverse drug reaction was due to excipients or to the drug itself. Patients with chronic leg ulcers have a high risk of contact dermatitis to topical drugs and to antiseptics. It is necessary to advise the patient concerning the avoidance of topical but also systemic readministration of the responsible molecule. An excipient responsible in inducing a contact sensitization to a topical drug can also be found in cosmetics, the name of the responsible excipient has to be given to the patient under the common name but also under the INCI name. In most of the cases there is no risk in systemically administering iodine, sulfites or vehicles in a sensitized patient who had developed a contact dermatitis to topical medications. When the drug itself is responsible in inducing a contact allergy it is necessary to determine if cross reactions with other drugs can occur and if the responsible molecule can induce systemic cutaneous adverse drug reactions if the drug is systemically readministered. Among NSAID there is no cross reactions between bufexamac and diclofenac, between salicylamide, glycol salicylate, salicylic acid and acetylsalicylic acid. In case of photosensitization 1) to ketoprofen or 2) piroxicam the topical and/or systemic administration of the following molecules are contraindicated with respectively 1) ketoprofen, tiaprofenic acid, fenofibrate, oxybenzone or 2) piroxicam, thimerosal. A patient sensitized to corticosteroid ointment has to be tested in order to determine which corticosteroid classes are sensitizing. The topical and systemic administrations of molecules belonging to the sensitizing classes (A, B, C, D1 or D2) have to be forbidden.
对于因局部用药物而发生接触性皮炎的患者，需要停止可疑药物的应用，用皮质类固醇软膏治疗患者，如果发生接触性皮炎，则进行皮肤科过敏检查，例如药物斑贴试验，在接触性荨麻疹的情况下进行稀释划痕试验，以确定不良反应是由赋形剂还是药物本身引起的。患有慢性腿部溃疡的患者有发生局部用药物和防腐剂接触性皮炎的高风险。有必要告知患者避免局部和全身再次使用负责的分子。引起局部药物致敏的赋形剂也可在化妆品中找到，必须将负责的赋形剂的名称以通用名和 INCI 名告知患者。在大多数情况下，对于已经发生局部用药物接触性皮炎的敏化患者，全身给予碘、亚硫酸盐或载体没有风险。如果是药物本身引起接触过敏，则有必要确定是否会与其他药物发生交叉反应，以及如果负责的分子如果全身重新给药，是否会引起全身性皮肤不良反应。在 NSAID 中，布非昔布和双氯芬酸之间没有交叉反应，水杨酰胺、水杨酸乙二醇酯、水杨酸和乙酰水杨酸之间也没有交叉反应。在光过敏的情况下 1）酮洛芬或 2）吡罗昔康，局部和/或全身使用以下分子是禁忌的，分别为 1）酮洛芬、噻洛芬酸、非诺贝特、氧苯酮或 2）吡罗昔康、汞。必须对局部用皮质类固醇软膏致敏的患者进行测试，以确定哪些皮质类固醇类别具有致敏性。必须禁止局部和全身使用属于致敏类别（A、B、C、D1 或 D2）的分子。
