Carta Acesso aberto Revisado por pares

Allergic contact dermatitis caused by lanolin (wool) alcohol contained in an emollient in three postsurgical patients

2010; Elsevier BV; Volume: 62; Issue: 6 Linguagem: Inglês

10.1016/j.jaad.2009.10.020

ISSN

1097-6787

Autores

Josephine Nguyen, Gregory T. Chesnut, William D. James, Michael Saruk,

Tópico(s)

Skin Protection and Aging

Resumo

To the Editor: Aquaphor (Beiersdorf; Wilton, CT) is a popular water-in-oil emollient. Its main ingredients include 43% petrolatum, mineral oil, ceresin wax (mineral wax), and lanolin (wool) alcohol. Lanolin is derived from the sebaceous glands of sheep. It is a highly complex and variable mixture of long chain esters, lanolin alcohols, and lanolin acids. The exact sensitizing component of lanolin has not been isolated. However, most scientists agree the allergens are lanolin (wool) alcohols.1Sulzberger M.B. Lazar M.P. A study of the allergenic constituents of lanolin (wool fat).J Invest Dermatol. 1950; 15: 453-458Crossref PubMed Scopus (19) Google Scholar Aquaphor is used postsurgically as an emollient, especially to cover clean surgical wounds. We report three patients who were found to be allergic to Aquaphor when it was used in postsurgical dressings instead of over the counter topical antibiotic ointments. Upon subsequent patch testing, these three patients were found to be more specifically allergic to lanolin (wool) alcohol. A 90-year-old woman who had undergone electrodessication and curettage of a small superficial multicentric basal cell carcinoma on her back 2 days earlier presented with a pruritic erythematous eruption surrounding the surgical site. The inflammation was sharply demarcated where her bandage had been placed and did not involve the adhesive portions of the bandage. Patch tests were performed 1 month later on the right inner arm using the Finn chamber technique against Aquaphor and the individual ingredients contained in this compound: white petrolatum, mineral oil, ceresin wax, and lanolin (wool) alcohol (Fig 1). The patient showed a brisk positive reaction both to Aquaphor and lanolin (wool) alcohol. Similarly, an 81-year-old woman and a 49-year-old woman underwent surgical procedures and developed erythematous eruptions that were well demarcated to nonocclusive areas of the bandages that were placed over the wound for the first 48 hours. Subsequent patch testing in both showed a brisk positive reaction both to Aquaphor and lanolin (wool) alcohol. All three of our patients reported herein were sensitive to Aquaphor and specifically lanolin (wool) alcohol when it was used as a topical emollient applied postoperatively over surgical wounds. Aquaphor has been cited as causing acute contact dermatitis as a result of the lanolin (wool) alcohol in the past,2Guin J.D. Eyelid dermatitis: experience in 203 cases.J Am Acad Dermatol. 2002; 47: 755-765Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar but not specifically as it relates to surgical dressings, to our knowledge. Wool alcohols 30% in petroleum have been included in the European standard series since 1969. In the United States, patch testing for lanolin allergy with 30% wool alcohol is accomplished with the T.R.U.E. test (site no. 2). Although the prevalence of lanolin allergy among healthy individuals is low (0.9-2.3%), studies suggest that contact allergy to topical medicaments becomes more common with advancing age.3Green C.M. Holden C.R. Gawkrodger D.J. Contact allergy to topical medicaments becomes more common with advancing age: an age-stratified study.Contact Dermatitis. 2007; 56: 229-231Crossref PubMed Scopus (58) Google Scholar In addition, the incidence of positive patch test reactions to wool alcohols increases in patients with leg ulcers, stasis dermatitis, and other contact allergies.4Machet L. Couhe C. Perrinaud A. Hoarau C. Lorette G. Vaillant L. A high prevalence of sensitization still persists in leg ulcer patients: a retrospective series of 106 patients tested between 2001 and 2002 and a meta-analysis of 1975-2003 data.Br J Dermatol. 2004; 150: 929-935Crossref PubMed Scopus (123) Google Scholar In these three cases, the open wounds may have been more fertile ground for the antigen to be presented. Many physicians routinely use Aquaphor ointment on surgical wounds to avoid developing acute contact dermatitis from topical antibiotics. However, given the findings reported here—especially in view of the significant percentage that elderly patients make up in terms of those people undergoing skin cancer surgery requiring postoperative dressings—we feel that white petrolatum is the preferred choice for the aftercare of clean surgical wounds, having been shown to be safe and effective with little potential for the development of allergic contact dermatitis.5Smack D.P. Harrington A.C. Dunn C. Howard R.S. Szkutnik A.J. Krivda S.J. et al.Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial.JAMA. 1996; 276: 972-977Crossref PubMed Google Scholar The lanolin paradox revisitedJournal of the American Academy of DermatologyVol. 64Issue 1PreviewTo the Editor: We commend Nguyen et al1 on their observation of lanolin allergic contact dermatitis in 3 postsurgical patients following application of Aquaphor Healing Ointment (AHO) (Beiersdorf, Wilton, CT). Lanolin continues to be a significant problem allergen in our pediatric contact dermatitis population and notably from this same source. Recently, we have been testing our children with a history of burning or irritation from AHO to a panel of the 8 individual product ingredients (lanolin, bisabolol, ceresin wax, panthenol, glycerin, mineral oil and petrolatum, provided by Beiersdorf). Full-Text PDF

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