calcipotriene and Dermatitis--Allergic-Contact

A 64-year-old woman developed an itchy papulovesicular dermatitis at the periphery of psoriatic plaques on the lower legs after the daily application of calcipotriol ointment (Psorcutan Salbe) for 2 weeks. She had used the same ointment for 4 weeks 6 months before. Patch testing revealed strongly positive reactions to the marketed product and to the active ingredient calcipotriol in a concentration series (2.0, 10.0 and 50.0 microg/ml in isopropyl alcohol). A repeated open application test (ROAT) on the forearms showed a vesicular dermatitis after 4 days on the side that received the calcipotriol ointment, whereas the control with the placebo ointment remained completely negative. Histologic examination of the + + patch test reaction was in line with the picture of contact allergy. Retesting after 6 months confirmed the hypersensitivity, with a positive reaction even at 0.4 microg/ml. For comparison, the ROAT with calcipotriol ointment was performed for 2 weeks on both forearms of 15 volunteers never exposed to calcipotriol before. Only 2 subjects developed a slight reaction on days 5 and 11, respectively. Based on this case and on previous reports in the literature, calcipotriol must now be regarded as both a contact allergen and an irritant. For patch testing, a concentration of 2 microg/ml in isopropyl alcohol is the most suitable. If the reaction is only weakly positive and not reproducible after some time, it might be of the irritant type. In unclear cases, a ROAT should be performed. A severe papulovesicular dermatitis within 1 week will confirm the presence of contact allergy.

Topics: Administration, Cutaneous; Calcitriol; Dermatitis, Allergic Contact; Dermatologic Agents; Dose-Response Relationship, Drug; Female; Humans; Middle Aged; Ointments; Patch Tests; Psoriasis

Two patients with psoriasis were treated with calcipotriol cream, and both developed contact dermatitis. Patch test results were positive to calcipotriol and negative to the ingredients of the vehicle in both cases. The first case may be explained by a compound allergy or by a false-negative reaction to calcipotriol due to the very low concentration used for patch tests. The second patient was clearly positive to calcipotriol despite low concentration. This is the first case reported thus far with sensitivity to calcipotriol at a concentration < 2 mc/mL, as recommended in other studies.

Topics: Administration, Topical; Calcitriol; Dermatitis, Allergic Contact; Dermatologic Agents; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Patch Tests; Psoriasis

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Betamethasone; Calcitriol; Dermatitis, Allergic Contact; Dermatologic Agents; Double-Blind Method; Drug Therapy, Combination; Humans; Nickel; Patch Tests

The immunomodulatory role of vitamin D and its analogues has been demonstrated in vitro and in vivo using animal models. We evaluated the effect of a vitamin D analogue, calcipotriene, in vivo on human subjects using a contact hypersensitivity model.. Subjects were pretreated with topical calcipotriene, simulated solar radiation, or both on buttock skin. They were then sensitized and challenged using the contact allergen dinitrochlorobenzene. Immune response was measured by change in skinfold thickness before vs after elicitation across the challenge sites.. Calcipotriene-treated individuals demonstrated 64% immunosuppression compared with untreated controls. This is equivalent to the immunosuppression induced by UV exposure.

Topics: Administration, Cutaneous; Allergens; Calcitriol; Dermatitis, Allergic Contact; Dinitrochlorobenzene; Humans; Langerhans Cells; Patch Tests; Sunlight

One hundred and sixty-eight individuals (psoriatic patients treated with calcipotriol with dermatitis due to calcipotriol, psoriatic patients treated with calcipotriol with no dermatitis, psoriatic patients never treated with calcipotriol, patients with eczema and healthy volunteers) were patch-tested (Finn chambers, back, 48 h) with dilutions of calcipotriol ointment (50, 10, 2, 0.4 micrograms/g) and an ointment vehicle. Test evaluation was based on clinical scoring and various non-invasive measuring methods. Doubtful (?+) and weak (1+) reactions were common, irrespective of patient group and history. Moderate (2+) reactions were uncommon and with no increased frequency among psoriatic patients with adverse dermatitis during calcipotriol treatment. The blood flow of test sites measured by laser Doppler flowmetry was, however, increased in psoriatics, who developed dermatitis during calcipotriol treatment as an isolated finding. Furthermore a 1-week repeated open application test (ROAT) was performed on all subjects. None of the persons having a strong reaction in the patch test showed any dermatitis in the ROAT test, indicating that they were not sensitized. Calcipotriol was found to be a mild irritant of the non-corrosive type, i.e. with no influence on the skin barrier. Reactions were dominated by redness (increased laser Doppler flow and chroma a*) and only oedema formation in advanced reactions. The calcipotriol dose-irritation curve was found to be scattered. Calcipotriol induced no increase of transepidermal water loss (TEWL) versus the ointment vehicle, but the ointment vehicle itself increased TEWL. The special ointment vehicle needed for calcipotriol for stability reasons may itself be irritant and cause some impairment of the skin water barrier, with increase in TEWL values. Future patch test studies for calcipotriol allergy should not be done with this vehicle. The non-irritant threshold concentration of calcipotriol in an appropriate test vehicle is still unknown.

Topics: Adult; Aged; Calcitriol; Dermatitis, Allergic Contact; Dermatitis, Contact; Dermatologic Agents; Double-Blind Method; Drug Eruptions; Female; Humans; Male; Middle Aged; Ointments; Patch Tests; Pharmaceutical Vehicles; Psoriasis; Skin

Thymic stromal lymphopoietin (TSLP) is a key cytokine that initiates and promotes allergic inflammation both in humans and mice. It is well known that TSLP is important in initial step of inflammation by stimulating dendritic cells to promote Th2 differentiation of naive T cells. However, TSLP is abundantly produced in the late phase of inflammation, as well; therefore, we focused on the function of TSLP in chronic Th2-type inflammation. By establishing a novel (to our knowledge) chronic allergic skin inflammation mouse model with repetitive challenges of hapten after sensitization, we demonstrated that CD4 T cell-specific deletion of TSLP receptor (TSLPR) resulted in near-complete ablation of ear swelling and infiltration of CD4 T cells and eosinophils, but after second challenge. Of note, TSLPR deletion on CD4 T cells did not affect acute inflammation. As expected, transfer of Ag-sensitized wild-type CD4T cells, but not of TSLPR-deficient CD4T cells, increased skin inflammation in the model upon challenge. Furthermore, production of IL-4 from TSLPR-deficient CD4T cells in inflamed ear lesions was markedly diminished, demonstrating that TSLP-dependent IL-4 production from CD4T cells was critical for the exacerbation of skin inflammation. Similar results were obtained in Th2-type allergic skin inflammation model using MC903. Collectively, these results indicate that TSLP acts directly on CD4 T cells to elicit pathogenesis of Th2 cells, thereby having a critical role in exacerbation of skin inflammation in the chronic phase.

Topics: Administration, Cutaneous; Animals; Calcitriol; Chronic Disease; Cytokines; Dermatitis, Allergic Contact; Disease Models, Animal; Fluorescein-5-isothiocyanate; Humans; Immunoglobulins; Interleukin-4; Mice; Receptors, Cytokine; Signal Transduction; Skin; Symptom Flare Up; Th2 Cells; Thymic Stromal Lymphopoietin

Calcipotriol, a synthetic vitamin D analogue, is widely used for the topical treatment of psoriasis. It often causes irritant reactions, whereas allergic contact dermatitis has less commonly been reported.. To report on 6 patients (among them an 11-year-old child) who presented with eczematous lesions complicating pre-existing dermatitis, observed in our tertiary referral patch test clinic between 2004 and 2016.. Patch tests were performed with the commercial preparation used by the patients and/or its ingredients, including calcipotriol (2 or 10 µg/ml in isopropyl alcohol), according to ESCD patch test guidelines.. Allergic contact dermatitis was confirmed in all cases, and the lesions improved following treatment with topical corticosteroids and/or oral medication.. When topical treatment with calcipotriol fails to improve, or even worsens, existing skin lesions, contact allergy should be suspected. A patch test concentration of 2 µg/ml in isopropyl alcohol seems to be the most suitable. According to the literature, patients sensitized to calcipotriol may tolerate topical therapy with other vitamin D3 analogues, particularly tacalcitol.

Topics: Adult; Calcitriol; Child; Dermatitis, Allergic Contact; Dermatologic Agents; Female; Humans; Male; Middle Aged; Patch Tests

Topics: Adult; Biopsy, Needle; Calcitriol; Dermatitis, Allergic Contact; Follow-Up Studies; Humans; Immunohistochemistry; Male; Patch Tests; Psoriasis; Risk Assessment

Formaldehyde-releasing preservatives are well-known allergens found in many topical preparations including medications.. To analyze the relevance of a positive patch test to formaldehyde-releasing preservatives in medications containing these preservatives.. Patients were recruited with a history of allergy to one of these preservatives. Patch and use testing to the medications, vehicles, and preservatives were performed. The following medications and their respective preservatives were used: Renova 0.05% cream/quaternium-15, Dovonex 0.005% cream/diazolidinyl urea, and Temovate-E 0.05% cream/diazolidinyl urea.. Nine patients participated in the study. A positive patch test to the preservative was reproduced in six of nine patients, and a questionable reaction occurred in one. Two patients had a positive patch test to the topical medication and one a questionable reaction. There were no definitive positive patch tests to the vehicle but two questionable ones. Use testing revealed three positive reactions to Renova, one to Renova vehicle, and one to Temovate-E vehicle.. The concentration of the preservative in the commercial preparation was often below the threshold necessary to produce a clinical reaction. Use testing is a valuable tool in the complete evaluation of the patient with a positive patch test to a formaldehyde-releasing perservative found in topical medication.

Topics: Administration, Cutaneous; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Calcitriol; Chemistry, Pharmaceutical; Clobetasol; Dermatitis, Allergic Contact; Dermatologic Agents; Double-Blind Method; Formaldehyde; Glucocorticoids; Humans; Keratolytic Agents; Methenamine; Patch Tests; Preservatives, Pharmaceutical; Tretinoin; Urea

A woman developed a pruritic exacerbation of her methotrexate-dependent psoriasis after applying topical calcipotriene ointment. Patch test reactions were positive to propylene glycol 1 percent and white petrolatum, but to none of the other ingredients of the medication. Physicians would be advised to patch test patients to both the therapeutic medication and the excipients of topical substances to which patients have adverse reactions. By so doing, an allergic reaction to one or more of the excipients may be found, thus the patient may be provided the benefit of the topical medication by using it in a form that does not contain the allergenic substance.

Topics: Aged; Antioxidants; Calcitriol; Dermatitis, Allergic Contact; Dermatologic Agents; Female; Humans; Methotrexate; Ointments; Patch Tests; Propylene Glycol; Propylene Glycols; Psoriasis

Topics: Administration, Topical; Calcitriol; Cross Reactions; Dermatitis, Allergic Contact; Dermatologic Agents; Dihydroxycholecalciferols; Humans; Hypersensitivity, Delayed; Male; Middle Aged; Patch Tests; Psoriasis

Topics: Calcitriol; Case-Control Studies; Dermatitis, Allergic Contact; Dermatologic Agents; Drug Eruptions; Humans; Male; Middle Aged; Psoriasis

Topics: Administration, Topical; Adolescent; Calcitriol; Dermatitis, Allergic Contact; Dermatologic Agents; Female; Humans; Psoriasis

Topics: Adult; Calcitriol; Dermatitis, Allergic Contact; Dermatologic Agents; Drug Eruptions; Female; Humans; Leg Dermatoses; Patch Tests; Psoriasis