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Case and Research Letter
Allergic Contact Dermatitis Due to Minoxidil in a Patient With Alopecia Areata
Dermatitis alérgica de contacto por minoxidil en paciente con alopecia areata
F.J. Navarro-Triviño, G.-V.A. Pegalajar-García, R. Ruiz-Villaverde
Autor para correspondencia
ismenios@hotmail.com

Corresponding author.
Servicio de Dermatología, Hospital Universitario San Cecilio, Inst Invest Biosanitaria IBS Granada, Granada, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Topical 2&#44;6-diamino-4-piperidinopyrimidine 1-oxide &#40;minoxidil&#41; is probably the most widely used treatment for different types of alopecia&#46; Although the topical solution is usually well tolerated&#44; continued application can sometimes result in itching and irritant contact dermatitis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 38-year-old man with no personal or family history of interest was referred to our cutaneous immunoallergy unit for evaluation of an eczematous neck rash that had developed over the previous 2 months&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">He had been using topical minoxidil &#40;Regaxidil&#41; to treat alopecia areata for the previous 3 months&#46; He mentioned an episode of alopecia areata characterized by multiple patches in childhood &#40;at the age of 6 years&#41; that had been treated with topical minoxidil at an unknown concentration&#46; The treatment led to complete resolution after 6 months&#44; and until now he had not experienced any other episodes&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Physical examination revealed erythematous&#44; edematous papules and patches in the occipital region of the neck &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; The patient was patch tested with the European Baseline Series &#40;Chemotechnique Diagnostics&#41;&#44; 30&#37; aqueous propylene glycol&#44; and minoxidil 1&#37; and 5&#37; in dimethylsulfoxide &#40;DMSO&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The results were interpreted using the criteria of the International Contact Dermatitis Research Group&#46; Readings were performed on days 2 and 4&#46; The reaction to minoxidil 1&#37; and 5&#37; in DMSO was negative on day 2 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41; and positive &#40;&#43;&#43;&#47;&#43;&#43;&#43;&#41; on day 4 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Patch tests with minoxidil 1&#37; and 5&#37; in DMSO were negative in 12 controls&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was diagnosed with allergic contact dermatitis due to minoxidil&#46; The product was discontinued and the lesions disappeared completely within a week&#46; No signs of hair regrowth were observed&#44; despite the inflammatory reaction to contact dermatitis from minoxidil&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Few cases of allergic contact dermatitis due to minoxidil have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Other contact reactions related to the topical application of this product include pustular allergic contact dermatitis&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> occupational allergic contact dermatitis&#44; and pigmented contact dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> A case of persistent allergic patch test reactions to minoxidil manifesting as cutaneous lymphoid hyperplasia has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Choice of vehicle is important for patch testing&#46; Direct testing may generate doubts&#44; as topical minoxidil solution contains propylene glycol&#46; That is why we chose DMSO as a vehicle&#44; as it favors penetration of the active ingredients and is valid for both hydrophilic and lipophilic substances&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The recent introduction of oral minoxidil has revolutionized the treatment of certain forms of alopecia &#40;androgenetic alopecia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Identifying patients sensitized to topical minoxidil could be important&#44; as certain patients with alopecia may require oral minoxidil to control hair loss&#46; Although oral minoxidil can probably be safely used&#44; the possibility of systemic contact dermatitis cannot be fully ruled out&#44; despite early reports suggesting it is unlikely&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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