Introduction: Photocontact dermatitis is a type IV delayed hypersensitivity response to an allergen that is activated by radiation energy. Its incidence is uncertain and only a small number of drugs causing such reaction have been studied. This is a case of a 67-year-old filipino male, diabetic, who presented with scaly, erythematous, and hyperpigmented plaques with areas of desquamation and erosions on sunexposed areas of the skin after taking metformin. Case: Four months prior to consult, the patient was diagnosed with type 2 diabetes mellitus and was started on metformin therapy. Days later, he started noticing scaly, erythematous and hyperpigmented plaques with areas of desquamation and erosions on sun-exposed areas, namely the upper and lower extremities, posterior neck, and forehead. There was notable sparing of areas that are usually covered with clothing such as the torso, inguina and both thighs. There were also no lesions on the scalp, palmar aspect of the hands and plantar surface of the feet. Skin biopsy was considered but was not done per patient’s preference. After discontinuation of metformin and avoidance from sun exposure, the skin lesions gradually improved. Conclusion Metformin is rarely associated with adverse skin reactions. The diagnosis of photocontact dermatitis as a side effect of metformin needs to be considered as a differential diagnosis in patients who present with skin rashes, especially in sun-exposed areas. It is recommended that there should be a high-index of suspicion for adverse drug reactions in such patients. This would reduce medical errors and medical cost and would result to prompt initiation of appropriate treatment.
Metformin ; Dermatitis, Photoallergic ; Diabetes Mellitus, Type 2

Fluorescein has been used for decades in ophthalmology for fluorescence angiography and it is the only fluorophore routinely used in experimental dermatology for in vivo study of the skin. It absorbs blue light, with peak absorption and excitation wavelengths between 465 and 490 nm and fluoresces at yellow-green wavelengths of 520~530 nm. The most common side effects are nausea and vomiting, and other adverse events such as a vasovagal response, cardiac or respiratory effects, neurologic manifestations or allergy, including anaphylaxis, were also reported. But a photosensitive reaction to fluorescein is very rare. We report here on a case of photoallergic dermatitis due to fluorescein after fluorescence angiography.
Absorption ; Anaphylaxis ; Dermatitis, Photoallergic ; Dermatology ; Fluorescein ; Fluorescein Angiography ; Hypersensitivity ; Light ; Nausea ; Neurologic Manifestations ; Ophthalmology ; Skin ; Vomiting

BACKGROUND: Use of suncreen is strongly recommended to prevent the harmful effect by ultraviolet (UV) ray, and new diverse synthetic chemicals have been screened and put forward as effective UV filters. However, the most important aspect of developing a novel UV filter is safety. OBJECTIVE: This study aimed to find out if there was any correlation between a high in vitro SPF (Sun Protection Factor) index and skin irritation by using standardized formulations containing organic or inorganic, active sunscreen ingredients. METHODS: HRIPT (Human repeated insult patch test) was conducted on with fifty subjects (male to female ratio as 3: 2, average age was 21.6+/-2.9 years), and in vitro SPFs of sunscreen formulations were measured. Patch tested UV filters (UVA, UVB, and physical blockers) were butyl methoxy dibenzoyl methane (BMDM 2%, 5%), benzophenone-3 (2%, 5%), homosalate (10%, 20%), octyl methoxy cinnamate (10%, 20%), octyl salicylate (5%, 10%), octocrylene (10%, 20%), zinc oxide (10%, 20%)and titanium dioxide (10%, 20%). Skin bioengineering measurements for capacitance, erythema, laser doppler blood flow were carried out before and after HRIPT to compare the subjective observation errors of the conventional scoring system of skin irritation (ICDRG standard). To explore any photoirritability, phototoxicity or photoallergy, individual UV filters were photopatch tested with higher concentrations (5%, 20%) than those of usual photopatch sunscreen test series RESULTS: The range of in vitro SPF revealed from 3.6 to 52.8. A doubtful, rather transient, weak erythema (+0.5) was noted in eight subjects, though the apparent skin irritation reaction can be estimated at over +1 by ICDRG guideline was not found during the HRIPT. The weak erythemas were observed at 20% homosalate, 10% octyl salicylate, 5% octyl salicylate, 20% octyl methoxycinnamate, 10% octyl methoxycinnamate, 10% octocrylene, 20% octocrylene, 5% BMDM, respectively in frequency, thus UVB filters of high concentration were related to weak irritation. Nosignificant differences in the measured skin bioengineering parameters were detected between before and after the HRIPT. Photopatch test failed to find any photoirritability and photoallergy. CONCLUSION: Skin irritability due to high in vitro SPFs appeared to be minimal or remained within the safety margin. However, a weak irritation was suspected from the organic UVB filters under the higher concentration range than its recommended range by regulatory guidelines. As for the newly developed, diverse formulations of multi-organic UV filters claiming high SPFs, dermatologists could consider the potential irritation reactions when it is preferentially used within a population.
Bioengineering ; Dermatitis, Photoallergic ; Dermatitis, Phototoxic ; Erythema ; Female ; Humans ; Methane ; Patch Tests ; Skin* ; Solar System* ; Sun Protection Factor* ; Titanium ; Zinc Oxide

Benzophenones are aromatic ketone derivatives of dibenzoylmethane, exhibiting absorption characteristics not only in the UVC and UVB spectral ranges but also in part of the UVA range, up to 360nm. They are commonly used for extending the spectrum of photoprotection. Benzophenone-3, one of the most popular benzophenones, is the most common cause of sunscreen allergy as well as a substitute of PABA. We report a case of photoallergic contact dermatitis due to benzophenone-3 of sunscreen.
4-Aminobenzoic Acid ; Absorption ; Benzophenones ; Dermatitis, Photoallergic* ; Hypersensitivity

BACKGROUND: Vietnam veterans have suffered from a number of skin and general diseases. But in Korea, there are few reports about the relationship between dioxin and skin disease and dermatologists need more information about it. OBJECTIVE: The purpose of this study was to evaluate the skin and general disease pattern of Koreans who have a history of exposure to dioxin in Vietnam. METHODS: 332 Vietnam veterans who visited St. Mary's hospital between July, 2001 and September, 2001. We perfomed a clinical evaluation, physical examination, medical history, serum and urine chemistry, electrocardiogram, electrodiagnostic study, and a roentgenographic study. For dermatologic evaluation, pathologic examination, KOH mount, fungus culture, and phototest were performed. RESULTS: 1. Among the 332 participating soldiers in the Vietnam war, the mean age of patient was 56.9 years old (the youngest-53 years, the oldest-61 years old). 2. The prevalence of hypertension, hyperlipidemia, diabetes mellitus, liver disease, and peripheral neuropathy of subjects was 12.0%, 6.9%, 5.7%, 4.5%, and 1.2%. 3. The prevalence of xerotic eczema, seborrheic dermatitis, psoriasis vulgaris, photoallergic dermatitis, and chronic urticaria of subjects was 3.9%, 3.9%, 0.9%, 0.6%, and 0.3%. CONCLUSION: The prevalence of general diseases was not significant between Vietnam veterans and controls.
Chemistry ; Dermatitis, Photoallergic ; Dermatitis, Seborrheic ; Diabetes Mellitus ; Eczema ; Electrocardiography ; Fungi ; Humans ; Hyperlipidemias ; Hypertension ; Korea ; Liver Diseases ; Military Personnel ; Peripheral Nervous System Diseases ; Physical Examination ; Prevalence ; Psoriasis ; Skin Diseases ; Skin* ; Urticaria ; Veterans* ; Vietnam*

Ketoprofen, a propionic acid derivative is a non-steroidal anti-inflammatory drug with analgesic activity and it is used in the symptomatic treatment of rheumatoid arthritis and osteoarthritis. When exposed to sunlight, ketoprofen is broken down into various benzophenones. 3-ethyl-benzophenone as the major photoproduct is responsible for the photoallergic reaction to ketoprofen. A 30-year-old male presented with well-demarcated erythematous patches with itching sensation on both his ankle areas. He had applied Ketotop(R) plasters on both his ankle areas for arthralgia, and then the Ketotop(R) plaster-detached areas were exposed to sunlight. Patch test and photopatch test with?as is?showed positive reaction in photopatch test and the ingredients of Ketotop(R) plaster revealed positive reaction to the ketoprofen contained in Ketotop(R) plaster in photopatch test.
Adult ; Ankle ; Arthralgia ; Arthritis, Rheumatoid ; Benzophenones ; Dermatitis, Photoallergic* ; Diethylpropion ; Humans ; Ketoprofen* ; Male ; Osteoarthritis ; Patch Tests ; Pruritus ; Sensation ; Sunlight

Ketoprofen is an nonsteroidal anti-inflammatory drug derived from propionic acid. It has been widely used as topical preparations, as gel or patch. It has been reported that topical ketoprofen can cause contact dermatitis and photocontact dermatitis. We experienced five cases of contact dermatitis, developed after applying ketoprofen patch(Ketotop(R), Pacific pharmaceutical Co., Korea) for the control of oste omuscular or joint pain. While one patient had generalized urticarial eruption, the rest of patents showed localized erythematous pruritic eczematous skin eruptions. It was verified through intradermal skin test and pin prick test that ketoprofen itself was not the causative drug for the skin eruption. Patch test excluded the possibility of allergic skin reaction to rubber compounds. It should be elucidated which compounds are allergic or toxic to the skin, contained in woven fabrics.
Arthralgia ; Dermatitis, Contact* ; Dermatitis, Photoallergic ; Diethylpropion ; Humans ; Ketoprofen* ; Patch Tests ; Rubber ; Skin ; Skin Tests

BACKGROUND: Although dermatologists may encounter photosensitivity patients commonly, most dermatologists are not familiar with diseases manifesting photosensitivity and there is still no clinical study on photosensitivity disease in Korea. OBJECTIVE: We tried to investigate incidences and sorts of photosensitivity diseases with clinical informations. METHODS: We performed a retrospective clinical review of patients who had photosensitivity as a chief complaint in the department of dermatology, Gyeongsang National University hospital from 1991 to 2000. RESULTS: There were a variety of diverse photosensitive diseases in this clinical study. Drug-induced photosensitivity including phototoxicity and photoallergy were fairly common (19.7%), and causative drugs were various including antibiotics, diuretics and even medicinal herb. We could find co-occurrence of some diseases in photosensitivity patients (39.3%), most of which were chronic degenerative diseases. CONCLUSION: Further clinical studies will be needed to get additional and standardized information in Korea, and precise clinical work-ups would be necessary to differentiate variable spectrums of photosensitivity diseases we showed in this study.
Anti-Bacterial Agents ; Dermatitis, Photoallergic ; Dermatitis, Phototoxic ; Dermatology ; Diuretics ; Humans ; Incidence ; Korea ; Plants, Medicinal ; Retrospective Studies

Actinic reticuloid as a manifestation of chronic actinic dermatitis (CAD) is a rare dermatosis whose clinical and histologic features resemble other types of pseudolymphomas including mycosis fungoides and Jessner's lymphocytic infiltration, and it is regarded as an eventual stage of various photodermatoses like photosensitive eczema or persistent light reaction or chronic photoallergic contact dermatitis and so on. Phototests in the patients with actinic reticuloid usually reveal hypersensitivity to UVB, UVA, and sometimes to visible light. We present a case of actinic reticuloid in a 65-year-old male, whose skin lesions developed as erythematous lichenified infiltrating plaques on the face at first, and then spread themselves onto the upper trunk later. Histologically those skin lesions showed the aggregation of atypical lymphocytes and photobiologically the results of phototests revealed photosensitivity to UVB and UVA.
Actins* ; Aged ; Dermatitis, Photoallergic ; Eczema ; Humans ; Hypersensitivity ; Light ; Lymphocytes ; Male ; Mycosis Fungoides ; Photosensitivity Disorders ; Pseudolymphoma ; Skin ; Skin Diseases

One adverse effect of PUVA therapy is the development of severe dermatitis. Only a few cases of photoallergy to psoralens during PUVA therapy have been reported. We describe herein a patient with photoallergic dermatitis induced by PUVA with 8-methoxypsoralen(8-MOP). A 38-year old woman with generalized vitiligo had acute pruritic exanthematous maculopapular lesions in the treated areas after PUVA therapy with 8-MOP. A patch test and photopatch test were performed with 8-MOP, 5-MOP, and 4,5,8-trimethylpsoralen(TMP). The patch test carried out with these psoralen derivatives were all negative, but the photopatch test showed a positive reaction to 8-MOP. The patient consequently had PUVA therapy with 5-MOP and she had no further experience of a photoallergic reaction.
Dermatitis ; Dermatitis, Photoallergic* ; Female ; Ficusin ; Furocoumarins ; Humans ; Methoxsalen* ; Patch Tests ; PUVA Therapy ; Vitiligo