povidone-iodine and Dermatitis--Allergic-Contact

A 59-year-old woman who had had several episodes of contact urticaria after hair treatment, developed anaphylaxis after vaginal application of povidone-iodine solution for disinfection. Prick tests showed wheal-and-flare responses to both povidone-iodine (0.1% aqueous) and polyvinylpyrrolidone (povidone, PVP) (0.001% aq.), but not to iodine or polyoxy-ethyrenenonylphenyl ether, both of which are also contained in povidone-iodine solution. We confirmed that basophils from her peripheral blood released considerable amounts of histamine on stimulation by PVPs. It appeared that both the shampoo and the permanent-wave solution contained polyvinylpyrrolidone N, N-dimethyl aminoethyl methacrylic acid copolymer diethyl sulphate solution and polyvinylpyrrolidone styrene-copolymer emulsion. Both these agents in the hair care products provoked an immediate skin response on prick testing. We speculate that sensitization to PVP had been established by these hair care products at a beauty parlor. She was recommended to avoid PVP-containing products and remained free from symptoms thereafter.

Topics: Administration, Intravaginal; Anaphylaxis; Dermatitis, Allergic Contact; Diagnosis, Differential; Female; Hair Preparations; Humans; Intradermal Tests; Middle Aged; Pharmaceutic Aids; Povidone; Povidone-Iodine

Topics: Anti-Infective Agents, Local; Bandages; Dermatitis, Allergic Contact; Dermatitis, Irritant; Humans; Iodine Compounds; Iodophors; Povidone-Iodine; Wound Infection; Wounds and Injuries

Skin does not react in an identical way to the action of chemicals over all anatomic sites. Accordingly, distinct regional differences have been described in relation to irritancy. The present study assesses the regional variations of stratum corneum (SC) reactivity to 3 proprietary antiseptic solutions (povidone iodine (PVP-I), 70 mg/ml and 100 mg/ml, and chlorhexidine digluconate 50 mg/ml) using the corneoxenometry (CXM) bioassay. SC was harvested from the volar forearm, the forehead and the back in 30 young adults. Each SC sample was covered by one of the neat test product or deionized water for 2 hr at 20 degrees C. The intrinsic staining property of each antiseptic on SC was assessed by reflectance colorimetry. For the CXM bioassay, samples were then stained by a toluidine blue-basic fuschin solution in order to show protein denaturation induced by the test products. The colorimetric index of mildness (CIM = L*- Chroma C*) was measured by colorimetry. Data show that PVP-I 100 mg/ml was the least reactive antiseptic to the SC. It was significantly milder than the 2 other antiseptics.

Topics: Adult; Anatomy, Regional; Anti-Infective Agents, Local; Back; Chlorhexidine; Colorimetry; Dermatitis, Allergic Contact; Female; Forearm; Forehead; Humans; Irritants; Male; Patch Tests; Povidone-Iodine; Skin

Topics: Dermatitis, Allergic Contact; Dermatitis, Irritant; Humans; Irritants; Patch Tests; Povidone-Iodine

Topics: Adult; Anti-Infective Agents, Local; Antineoplastic Agents; Central Venous Catheters; Cyanoacrylates; Dermatitis, Allergic Contact; Dermatitis, Irritant; Humans; Male; Povidone-Iodine; Testicular Neoplasms; Tissue Adhesives

Allergy evaluation by patch testing with povidone-iodine (PVP-I) or iodine remains challenging, because current patch test preparations frequently lead to false-positive or irritant skin reactions.. To investigate different preparations for iodine patch tests and to assess their clinical relevance with repeated open application tests (ROATs).. We monocentrically analyzed 95 patients with suspected allergy to disinfectants in retrospect who underwent parallel iodine patch testing with four preparations: PVP-I 2% aq., 5% aq., 10% aq., and iodine 0.5% pet.. In 27 of 95 patients (28.4%), we found positive reactions to one of the four test preparations. After ROATs in 22 of these 27 positively tested individuals, only one patient was diagnosed with iodine allergy. In contrast, 31 of 95 patients (32.6%) showed irritant or questionable patch test reactions on day 2 (D2) and/or D3 and/or D7 to one or more test preparations. Testing with PVP-I 2% aq. resulted in the lowest number of doubtful skin reactions while detecting the single allergic patient.. PVP-I 2% aq. was found to be the optimal patch test preparation. In general, iodine allergy appears to be substantially overestimated, and positive patch test responses to iodine should prompt an urgent ROAT for confirmation before diagnosing iodine allergy.

Topics: Dermatitis, Allergic Contact; False Positive Reactions; Humans; Iodine; Patch Tests; Povidone-Iodine; Retrospective Studies

Topics: Administration, Topical; Age Factors; Anti-Infective Agents, Local; Biguanides; Dermatitis, Allergic Contact; Female; Follow-Up Studies; Glucuronates; Humans; Incidence; Male; Multivariate Analysis; Operative Time; Patch Tests; Postoperative Complications; Povidone-Iodine; Retrospective Studies; Risk Factors

Iodopropynyl butylcarbamate (IPBC) is a broad-spectrum preservative for use in several product types, including cosmetics, in which its concentrations have been limited by EU legislation because of concerns related to its iodine content and release, and the risk of subsequent iodine overdose.. To report on concomitant patch test reactions observed with iodine and IPBC in patients sensitized to iodine-containing antiseptics.. Between 2012 and 2018, seven patients, six from Belgium and one from France, two suffering from acute dermatitis during surgical interventions, four from dermatitis caused by wound treatment, and one from occupational dermatitis, were shown to be sensitized to iodine and/or povidone-iodine (PVP-I), which was considered to be relevant for their dermatitis. All patients were coincidentally also patch tested with IPBC.. All patients showed positive patch test reactions to several other allergens, including IPBC. No relevance could be detected for IPBC.. We suspect that, notwithstanding the absence of firm evidence for IPBC being dehalogenated to produce free iodine in animals or in humans, the patch test reactions to IPBC in iodine-allergic subjects were possibly caused by free iodine released from this preservative agent, thus underlining the EU restrictions regarding the use of this preservative in cosmetics.

Topics: Adult; Aged; Anti-Infective Agents, Local; Carbamates; Dermatitis, Allergic Contact; Dermatitis, Occupational; Female; Humans; Iodine; Male; Middle Aged; Patch Tests; Postoperative Complications; Povidone-Iodine

Topics: Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Humans; Patch Tests; Povidone-Iodine

Anti-vascular endothelial growth factor (VEGF) medication, injected intravitreally, is currently the standard of care in patients with different retinal pathologies. Since its introduction in 2006, an increasing number of patients have undergone this procedure in Ghent University Hospital. Strikingly, more patients were diagnosed with contact dermatitis caused by ophthalmic products used during intravitreal injection procedure.. To identify which of the substances used during intravitreal injection is most likely to cause contact dermatitis.. Sixteen patients who developed a burning and stinging sensation and swelling of the eyelids after intravitreal injection were tested. All patients were patch tested with the Belgian baseline series, as well as a cosmetic, a pharmaceutical and an ophthalmic series, including the different eye drops used during the intravitreal injection procedure.. Fourteen of 16 patients reacted to at least one of the substances used during the injection procedure. Nine patients reacted to phenylephrine (56%), 5 to iso-Betadine(®) ophthalmic solution (31%), and 3 patients to sodium metabisulfite (16%).. The most common causal allergen was phenylephrine, being positive in 56% of patients. Patients most likely become sensitized because of the high frequency of usage of phenylephrine during repeated intravitreal injections and follow-up consultations.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Female; Humans; Intravitreal Injections; Male; Middle Aged; Ophthalmic Solutions; Patch Tests; Phenylephrine; Povidone-Iodine; Sulfites; Vascular Endothelial Growth Factor A

We present a case of a 15-month-old boy with Cornelia de Lange Syndrome (NIPBL gene mutation). On a PSG, central sleep apnea (central apnea-hypopnea index of 19/hour) and nocturnal hypoventilation (transcutaneous CO2 > 50 mmHg for 53% of the night) were found. A positive pressure initiation study was aborted because the patient developed a serious adverse reaction. The differential diagnosis included a skin fragility condition versus an allergic contact dermatitis to the interface; this could be from the povidone-iodine solution used to clean the NiPPV interface or from the plastic of the interface itself. A skin biopsy was performed which was normal. The reaction was likely secondary to an allergic contact dermatitis from the povidone-iodine solution used to clean the NiPPV interface. The patient is currently tolerating NiPPV.

Topics: Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Facial Dermatoses; Humans; Infant; Male; Masks; Polysomnography; Positive-Pressure Respiration; Povidone-Iodine; Severity of Illness Index; Sleep Apnea, Central

Povidone iodine (PVP-I) is a chemical complex of polyvinylpyrrolidone (also known as povidone or PVP) and elemental iodine. Iodine containing compounds are widely and commonly used as antiseptics and disinfectants. They are available in various forms like aqueous solution, tincture, aerosol, ointment, or foam. Skin irritation to them is due to the oxidative effects of iodine. Because of the low free iodine concentration in povidone-iodine, skin irritation is less frequent from short contact (1).. We report two cases, both with no history of allergy to any drugs, who developed an allergic reaction 24 hours after the usage of povidone iodine as a pre-operative antiseptic to prepare (scrub) the lower third of face before surgical removal of third molars. This case report was granted an exemption by the ethical committee of our institution review board. The Helsinki declaration doesn't apply to this case presentation.. PVP-1 is the most commonly used antiseptic scrubbing solution prior to most surgeries. However, allergic contact dermatitis due to PVP-I has not been extensively documented or reported and hence under evaluated, compared to other commonly encountered allergens. There is almost general agreement to the proposition that PVP-I is a very rare sensitizer (2,3) though there are some conflicting reports on the matter. However, sometimes when prolonged skin contact with PVP-I occurs when used as a pre-operative antiseptic agent, it can cause allergic dermatitis (4,5). Does this finding make pre-operative testing for allergies to PVP-1 necessary in all patients? A point to ponder.

Topics: Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Humans; Oral Surgical Procedures; Povidone-Iodine

Topics: Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Female; Hand Dermatoses; Humans; Middle Aged; Povidone-Iodine

Topics: Allergens; Back; Dermatitis, Allergic Contact; Diagnosis, Differential; Eosinophilia; Humans; Leg; Male; Middle Aged; Patch Tests; Povidone-Iodine; Severity of Illness Index

500 consecutive patients were patch tested with a 10% povidone-iodine (PVP-I) solution, diluted 10 times in water. Readings were made at 2 and 4 days. 14 of the 500 (2.8%) showed a positive test to PVP-I. The 14 positive patients to PVP-I were subjected to a repeated open application test (ROAT) with a PVP-I solution, as is; 2 of the 14 were recorded as positive. It was concluded that only 2 of the 500 patients had true allergic contact dermatitis from PVP-I (0.4%). This study emphasizes the need for more complete investigation, when testing with some allergens, when they share both irritant and allergenic properties, such as PVP-I. The approach is important to rule out false-positive patch test reactions and to assess true clinical relevance.

Topics: Allergens; Anti-Infective Agents, Local; Belgium; Dermatitis, Allergic Contact; Female; Humans; Male; Patch Tests; Povidone-Iodine; Risk Factors; Time Factors

Iodine preparations are widely used antiseptics, yet limited information exists on their irritant potential and threshold for diagnostic patch testing. We examine this issue by using iodine in different preparations and concentrations. A total of 24 fair-skinned, healthy volunteers without a history of iodine allergy, ranging in age from 18 to 65 years (mean age 49.5 + 10.7 SD), were recruited. Concentrations of 0.5%, 1%, 5% and 10% iodine in petrolatum (pet.), 0.5%, 0.75% and 1% iodine in 70% isopropyl alcohol (IPA) and 1%, 5%, 7.5% and 10% of povidone-iodine (PVP-I) were applied for 2 days to the intrascapular area on the back or to the volar forearm between cubital fossa and wrist using Finn Chambers on Scanpor. Test sites were read 2 days (D2) and 4 days (D4) after patch application. Skin reactions were graded according to the following scheme: 0 = no reaction, + = questionable erythema, 1 = definite erythema, 2 = erythema and induration and 3 = vesiculation. Mild-to-moderate reactions (+ to 2) were observed in 75% of the subjects patched with 5% iodine in pet. at 2-4 days after application. Almost all subjects reacted to 10% iodine at D2 and D4, with 65% exhibiting erythema and induration or vesiculation. A large number (33%) of the subjects developed some reactions to the low concentration (0.5%) of iodine in 70% IPA at D2. Vesicles were seen in 54% of the subjects patched with 1% iodine in 70% IPA at D4. Only 1 subject reacted to 7.5% and 10% PVP-I. Iodine can be irritant to normal skin in pet. and in 70% IPA. Pet. possibly enhances skin contact with iodine, thus increasing its irritant capacity. Alcohol removes sebum from the skin surface, and it might increase iodine penetration into the skin, causing a higher degree of irritation. PVP-I is relatively non-irritant, because its iodine is complexed in an iodophor. For diagnostic patch testing, we recommend using iodine at less than 1% in pet. and at less than 0.5% in 70% IPA. For PVP-I, 10% appears non-irritant. With the variation in patch-test irritant response, interpretation of the patch-test response in the light of clinical history is mandatory.

Topics: 2-Propanol; Adolescent; Adult; Aged; Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Dose-Response Relationship, Drug; Female; Humans; Iodine; Male; Middle Aged; Patch Tests; Petrolatum; Povidone-Iodine

Allergic dermatitis around the catheter exit site, caused by topical antiseptics such as povidone iodine and chlorhexidine gluconate, is an uncommon complication in patients on chronic peritoneal dialysis (CPD). As yet, published reports concerning this rare non catheter-related complication are few. The frequency of this type of dermatitis is not known, because reports of isolated cases constitute the only source of information. Here, we report our clinical experience with 2 patients (2.3%) among the 86 children with end-stage renal disease who underwent CPD treatment at our center during the period between November 1995 and December 2004. These 2 pediatric patients developed allergic contact dermatitis, with extensive patchy and linear erythema around the exit-site area because of administration of povidone iodine solution. The symptoms subsided within a week in both patients after daily topical application of normal saline solution was started. Allergic dermatitis caused by povidone iodine at the site of the catheter exit should be kept in mind as a complication in patients on CPD. Antiseptic solutions should be used cautiously in these patients.

Topics: Adolescent; Anti-Infective Agents, Local; Catheters, Indwelling; Child, Preschool; Dermatitis, Allergic Contact; Drug Hypersensitivity; Humans; Male; Peritoneal Dialysis; Povidone-Iodine

A 14-year-old girl developed an eruption on her upper arm of pruritic, follicular papules each time she received a vaccination. This was initially thought to be a local reaction to the vaccines. After a similar rash appeared at a venepuncture site, a contact allergy to the alcohol swabs used before the procedures was postulated. A repeated open application test clarified this observation.

Topics: 2-Propanol; Adolescent; Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Diagnosis, Differential; Female; Humans; Hypersensitivity; Phlebotomy; Povidone-Iodine; Viral Vaccines

A contact dermatitis due to to povidone-iodine (PI) which seemed to be a strong irritant reaction is described. Nevertheless, patch-test results suggested an allergic reaction that is cell mediated.

Topics: Adult; Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Dermatitis, Irritant; Humans; Male; Patch Tests; Povidone-Iodine

Povidone-iodine (polyvinylpyrrolidone-iodine, PVP-I) solution is an effective and safe disinfectant agent used throughout the world; however, prolonged exposure to PVP-I solution may cause irritation or rarely severe skin reactions. When PVP-I as is in the aqueous state is used for patch testing, a false-positive result is likely to arise due to irritation. Patch testing to exclude allergic contact dermatitis caused by PVP-I should be done with dried 10% PVP-I solution, 10% PVP-I gel, 8% sodium thiosulfuric acid and a mixture of 10% PVP-I solution and 8% sodium thiosulfuric acid.

Topics: Aged; Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Humans; Male; Middle Aged; Patch Tests; Povidone-Iodine

We report 19 patients who developed extensive patchy or linear erythema on both sides of the buttocks, the back and the posterior areas of the thighs within a few days following operations or cardioangiography. The erythema was sometimes deeply infiltrative and was also accompanied by bullae and erosion. Patch tests of the patients were strongly positive for 10% povidone-iodine (PVP-I, Isodine) solution; however, they were negative for 10% PVP-I solution with the same amount of 8% sodium thiosulfate and for 5% potassium iodide in petrolatum. In all control individuals, the only positive result was that of a patch test with 10% PVP-I solution within 8 h after application. We diagnosed our patients as having irritant contact dermatitis caused by 10% PVP-I solution during the procedure, which might have drained along the skin to the side of the buttocks or the back. We here indicate that prolonged contact with a large quantity of 10% PVP-I solution should be avoided to prevent this problem.

Topics: Adult; Aged; Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Female; Humans; Male; Middle Aged; Patch Tests; Postoperative Complications; Povidone-Iodine

Topics: Achilles Tendon; Adult; Anti-Infective Agents, Local; Arthritis; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Dermatitis, Allergic Contact; Diagnosis, Differential; Female; Humans; Iodophors; Male; Middle Aged; Patch Tests; Patellar Dislocation; Povidone-Iodine

10 cases of contact dermatitis which began during the application of povidone-iodine preparations were examined with patch tests using 2 kinds of povidone-iodine preparations and their ingredients, i.e., povidone-iodine, polyoxyethylene nonylphenyl ether and glycerin, and also the components of povidone-iodine, i.e., iodine and polyvinylpyrrolidone. All 10 cases reacted positively to the povidone-iodine preparations and povidone-iodine, 3 out of the 10 to polyoxyethylene nonylphenyl ether, 1 out of the 9 tested to iodine, while no positive response was found to glycerin or polyvinyl-pyrrolidone. It was difficult to distinguish between allergic responses from irritation, as responses to patches of povidone-iodine and its preparations usually include irritation at high frequencies. Based on comparison of results with a control group, however, those showing + or stronger reactions to 2% povidone-iodine at days 3 to 5 were considered to be allergic. Thus, 4 out of the 10 cases were considered as sensitization to povidone-iodine. Another 3 cases were found to be polyoxyethylene nonylphenyl ether sensitized, and another 1 iodine sensitized, while the patch test reactions of the other 2 were considered to have been elicited by irritation.

Topics: Adult; Aged; Aged, 80 and over; Allergens; Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Dermatitis, Irritant; Female; Glycerol; Humans; Iodine; Iodophors; Irritants; Male; Middle Aged; Patch Tests; Pharmaceutic Aids; Polyethylene Glycols; Povidone; Povidone-Iodine; Surface-Active Agents

Topics: Adolescent; Dermatitis, Allergic Contact; Humans; Iodophors; Male; Middle Aged; Patch Tests; Povidone-Iodine; Skin

Topics: Anti-Infective Agents, Local; Dermatitis, Allergic Contact; Humans; Male; Middle Aged; Patch Tests; Povidone-Iodine; Skin Ulcer