The document discusses drug induced contact dermatitis. It notes that contact dermatitis is a common skin reaction to drugs, especially topical medications like antiseptics, antibiotics, steroids, and NSAIDs. The study aimed to identify the most common culprit medications and clinical presentations in patients diagnosed with drug induced contact dermatitis. It found that antiseptics like povidone iodine and NSAIDs like diclofenac gel were most frequently responsible. Most cases were mild to moderately severe and preventable with modified treatment plans.

1. Drug induced contact dermatitis
Dr. Priyank Shah,(P.G student), Dr. Radha Yegnanarayan
(Professor & HOD)
SKN Medical College and General Hospital Pune

2. Introduction
• An adverse cutaneous reaction caused by a drug is any undesirable
change in the structure or function of the skin, its appendages or
mucous membranes, and it encompass all adverse events related to
drug eruption, regardless of the etiology.
• Cutaneous adverse drug reactions (CADR) are the most frequent of
all manifestations of drug sensitivity.
• They manifest with varied and diverse morphological pattern ranging
from trivial urticaria to severe form of vasculitis or toxic epidermal
necrolysis and cutaneous necrosis or gangrene.
Saha Abanti, Das Nilay Kanti, Hazra Avijit; Cutaneous adverse drug reaction profile in a tertiary care out patient setting in Eastern India, Indian
Journal of Pharmacology , December 2012 , Vol 44 , Issue 6

3. • Contact dermatitis (CD) is an inflammatory response of skin
following an exposure to exogenous either allergen or irritant.
• Among the skin complaints caused by drugs, the most frequent one
is contact dermatitis due to topical medications frequently used by
dermatological patients or in post operative patients as antiseptics ordermatological patients or in post operative patients as antiseptics or
for pain relief.
• Among allergic contact dermatitis the topical medications are
responsible for 14-40% of the cases according to various
statistics.(Bernard Y-H. Thong, Teck-Choon Tan; Epidemiology and risk factors for drug allergy; Br J Clin
Pharmacol / 71:5 / 684–700)
• Allergic CD due to drugs often remains undiagnosed, misdiagnosed
or empirically diagnosed when the contributory allergens are not
identified.Ruchi Bhatia, Ali Ali khan; CONTACT URTICARIA: PRESENT SCENARIO; Indian J Dermatol 2009:54(3):264-8

4. • In our region we have been frequently encountering ACD in skilled
urban dwellers as well as unskilled manual labourers from rural
areas
• These patients show varied clinical presentations and disease
course.course.
• A systematic study of these patients, presentations and allergens
responsible in various groups has not been done.
• Hence this study has being conducted to identify the various
presentations of CD.
• An attempt will also be made to identify the most common allergen
in the study population.
Saha Abanti, Das Nilay Kanti, Hazra Avijit; Cutaneous adverse drug reaction profile in a tertiary care out patient setting in Eastern India, Indian
Journal of Pharmacology , December 2012 , Vol 44 , Issue 6

5. Aims and objectives
• To find out the possible culprit medicinal agents/groups
causing contact dermatitis.
• To study various clinical patterns, causality and severity• To study various clinical patterns, causality and severity
of Drug induced contact dermatitis.
• To study the demography of Drug induced contact
dermatitis.

6. Materials and methods
• Minimum sample size 75
• Study Protocol was approved by institutional ethical
committee.
• Informed consent was taken from each patient.

7. • Diagnosis of Drug Induced Contact Dermatitis was done
with an expert opinion of dermatologist along with
standardized questionnaires like
• Naranjo's algorithm (causality assessment)
• Thorton scale
(preventability)
• Modified Schumock scale
• Hart-wig shigel (severity scale)

8. • Inclusion criteria
– Both the sexes were involved.
– patients of any age were included in the study
– Any evidence or history of drug intake
– Red rash, itching, blister around the contact area.
• Exclusion criteria
– No history or evidence of drug intake
– Other dermatological conditions.

9. ResultsResults

10. Results
Sex
44
31
Males
Females

11. Common age groups
20
25
Age groups
X axis- no. of pts.
Y axis- age in yrs
0
5
10
15
20
0-10 .11-20 21-30 31-40 41-50 51-60 61-70

12. Common agents
15
20
25
0
5
10
15
NSAIDs Anti septic Steroids Anti biotics others

13. • The most common antiseptic was Povidone iodine and
amongst the NSAIDs Diclofenac gel was the commonest.
• Neomycin was the commonest antibiotic while others were• Neomycin was the commonest antibiotic while others were
Clindamycin and Framycitin cream and Mometasone furoate
was commonest culprit in steroids while others were
Betamethasone and Budesonide.

14. Hartwig severity scale
• On Hartwig severity scale out of 75patients, 35 were mild
while 40 were moderately severe.
Mild severity - An ADR occurred but required no change in
treatment with the suspected drug or held discontinued ortreatment with the suspected drug or held discontinued or
changed. No Antidote/ treatment is required.
Moderate severity – pt. required either antidote or other
treatment was required or it increases the length of hospital
stay or ADR is the reason for hospital admission.
Severe- permanent harm or leading to death of the pt.
either directly or indirectly

15. • Rash and Itching were the most common symptoms observed in
patients and all the symptoms started decreasing on 5th day and
disappeared on 10th day of the follow up.
• Contact time for Betadine were found to be 12-20 hours, for steroids• Contact time for Betadine were found to be 12-20 hours, for steroids
14-22hours , for antibiotics 16- 30 hours and NSAIDs 7-10hours
• Out of 75 patients 4 patients ( 5.3%) required intervention.( 3
patients stopped taking the drug (diclofenac gel) and 1 patient
switched to oral T/T (oral diclofenac)

16. • Naranjo’s scale attributed all cases as probable ADRs
(possible 1-4, probable 5-8, definite > 9) and possible by
WHO causality scale.
• All cases were proved to be probably preventable by
Modified Schumock and Thronton preventability scale

17. Discussion
• The present work investigated the possible causes of a drug
induced contact dermatitis encountered in our hospital.
• The result from present work showed that Diclofenac gel• The result from present work showed that Diclofenac gel
(NSAID’s), Povidone iodine (antiseptic), Neomycin (antibiotic)
Mometasone (steroid) were the most common causes in their
respective groups.
• 4 cases of CD were reported with heparin cream and 3 cases with
Timolol e/d.

18. • Drug related factors that affect its immunogenicity
include its ability to act as a hapten, a prohapten or to
bind covalently to immune receptors
• Thus, certain classes of drugs tend to be associated with
a higher frequency of drug allergies compared with
others.
Cunha AP, Mota AV, Barros MA, Bonito-Victor A, Resende C. Corticosteroid contact allergy from a nasal spray in a child. Contact Dermatitis.
2003; 48: 277.

19. • Our finding supports the results of Amit vij et al, who observed that
the most common cause of CD were antiseptics and steroids
followed by NSAID’s. It also supports our finding that most common
age group is 21-30years.
• Aiste beliauskene et al, found Povidone iodine as the most common
cause of CD in pts having chronic leg ulcers.
• Seidenari et al, found the most common cause of CD were
antibiotics and the most common age group was 40-60years
Ruchi Bhatia, Ali Ali khan; CONTACT URTICARIA: PRESENT SCENARIO; Indian J Dermatol 2009:54(3):264-8

20. Conclusion
• It is known that topical medicaments can produce contact dermatitis.
• In our study antiseptics and NSAID's were most common groups
producing Contact dermatitis followed by steroids and antibiotics.
• All cases were preventable according to Schumock’s and Thornton
scale.
• While many cases were found to be misdiagnosed or undiagnosed
by the physician , so the Pharmacovigillance of the treatment and
judicious use of medication is required.

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