Case and research letter
Contact Allergy to Octocrylene in Children: A Report of 2 Cases
Dos casos de alergia de contacto a octocrileno en niños
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Agustí-Mejias, F. Messeguer, J. de la Cuadra, A. Martorell-Aragonés" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Agustí-Mejias" "email" => array:1 [ 0 => "annaagusti@comv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Messeguer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "de la Cuadra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Martorell-Aragonés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Alergia Pediátrica, Hospital General Universitario de Valencia, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dos casos de alergia de contacto a octocrileno en niños" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The incidence of allergic and photoallergic reactions to sunscreen has increased in recent years due to the widespread use of UV filters. We report 2 pediatric cases of contact allergy to octocrylene; while known in adults, this reaction has not been previously reported in children in Spain.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Patient 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 4-year-old girl was referred to our department as she had developed a skin rash on sun-exposed areas the previous summer. The physical examination at the time showed a skin rash consisting of erythematous micropapules on the face and limbs. While wearing sunscreen (Crema Solar Pediátrica Carrefour), the child had been exposed to the sun for 4<span class="elsevierStyleHsp" style=""></span>hours before the rash appeared. The distribution of the rash coincided with the areas where the sun cream had been applied. The patient had no history of atopic dermatitis or of the use of any medications or topical anti-inflammatory creams. We performed patch and photopatch tests with the Marti-Tor UV filter series and with the sunscreen product used by the patient. Positive results (++) were seen at 96<span class="elsevierStyleHsp" style=""></span>hours for the sun cream (Crema Solar Pediátrica Carrefour) and for octocrylene 10% in petrolatum in the photopatch tests. The diagnosis was photoallergic dermatitis to octocrylene.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Patient 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 5-year-old girl was referred to our department following 2 episodes of acute eczema in sun-exposed areas that had been protected with 2 different sunscreens (Isdin Extrem Pediatrics 50+ and Anthelios Dermopediátrics). The patient had no history of atopic dermatitis or of the use of medications or topical anti-inflammatory creams. Patch and photopatch tests were performed using the Marti-Tor UV filter series and the sun creams the patient had used. Positive results (++) were seen at 48 and 96<span class="elsevierStyleHsp" style=""></span>hours for octocrylene 10% in petrolatum and for 1 of the sunscreens, Isdin Extrem Pediatrics 50+, which contained octocrylene 9%. The diagnosis was allergic contact dermatitis to octocrylene.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Greater awareness of the harmful effects of the sun and public health messages have led to a progressive increase in the use of sunscreens. UV filters are now found not only in sunscreens but also in a wide range of skincare and cosmetic products.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> At the same time, however, there has also been an increase in the incidence of sensitization and photosensitization to these filters. UV filters have traditionally been classified as physical or chemical, and chemical filters are more frequently associated with skin allergy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Octocrylene is an organic compound belonging to the cinnamate family. It is a relatively new filter, capable of absorbing both UV-B and UV-A rays. When used in isolation, its sun protection abilities are poor and it is therefore generally combined with other UV filters to offer a higher sun protection factor and a more stable product that is easier to apply and more water-resistant.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Octocrylene has considerable allergenic potential and can induce serious contact eczema, even through passive transfer.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In some series, it has been found to be the main cause of adverse skin reactions to sun care products.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In a review of the literature, we identified 104 cases of allergic and/or photoallergic contact dermatitis to octocrylene, 24 of which involved children.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,5–7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In adults, skin allergy to octocrylene generally affects patients previously sensitized to the nonsteroidal antiinflammatory drug (NSAID) ketoprofen, which acts as a primary sensitizer. Skin allergy to octocrylene in such patients represents secondary sensitization. In recent series, over 80% of patients with contact allergy to octocrylene have been found to have a prior history of photoallergy to ketoprofen, confirmed by a positive photopatch test result.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Furthermore, there are also reports of patients with photoallergy to ketoprofen who had a positive photopatch test to octocrylene, as well as to other UV filters (benzophenone-3), perfumes (cinnamic alcohol), and fenofibrate, even though they had never shown any signs of skin allergy to these substances.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8,9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">No explanation has yet been found for this common association between photoallergy to ketoprofen and octocrylene, 2 chemically dissimilar molecules.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Some authors have, nonetheless, recommended that patients with ketoprofen allergy should avoid chemical filters containing octocrylene (or benzophenone-3), even if they have never developed allergic symptoms following the use of these products.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Most of the pediatric cases of octocrylene allergy in the literature have been diagnosed as allergic contact dermatitis to octocrylene without previous sensitization to ketoprofen. We did not perform photopatch tests with NSAIDs in our patients as there were no reports of topical NSAID use or evidence of associated skin allergy. It would therefore seem that our cases too were examples of primary sensitization to octocrylene without prior sensitization to ketoprofen. In any case, both the patch and photopatch test with benzophenone-3 were negative. The case of our first patient is of particular interest as it involved a diagnosis of contact photoallergy to octocrylene.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We have described 2 cases of contact allergy to sunscreen in children. In both cases, the offending agent was octocrylene, a relatively new chemical filter that appears to have powerful allergenic potential and to act as a primary sensitizer in children. Considering that the use of octocrylene is increasing, we can expect to see more pediatric cases of contact allergic dermatitis to octocrylene, which could be a cause for concern.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Patient 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient 2" ] 2 => array:2 [ "identificador" => "xack72930" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Agustí-Mejias A, Messeguer F, de la Cuadra J, Martorell-Aragonés A. Dos casos de alergia de contacto a octocrileno en niños. Actas Dermosifiliogr. 2014;105:92–93.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact allergy to octocrylene" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Carrotte-Lefebvre" 1 => "A. Bonnevalle" 2 => "M. Segard" 3 => "E. Delaporte" 4 => "P. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 11 | 20 |
| 2024 Octubre | 89 | 49 | 138 |
| 2024 Septiembre | 95 | 35 | 130 |
| 2024 Agosto | 138 | 63 | 201 |
| 2024 Julio | 110 | 43 | 153 |
| 2024 Junio | 124 | 38 | 162 |
| 2024 Mayo | 94 | 30 | 124 |
| 2024 Abril | 82 | 22 | 104 |
| 2024 Marzo | 72 | 29 | 101 |
| 2024 Febrero | 59 | 28 | 87 |
| 2024 Enero | 53 | 40 | 93 |
| 2023 Diciembre | 50 | 19 | 69 |
| 2023 Noviembre | 77 | 33 | 110 |
| 2023 Octubre | 116 | 29 | 145 |
| 2023 Septiembre | 79 | 27 | 106 |
| 2023 Agosto | 59 | 18 | 77 |
| 2023 Julio | 83 | 45 | 128 |
| 2023 Junio | 62 | 24 | 86 |
| 2023 Mayo | 75 | 28 | 103 |
| 2023 Abril | 54 | 24 | 78 |
| 2023 Marzo | 50 | 27 | 77 |
| 2023 Febrero | 52 | 15 | 67 |
| 2023 Enero | 30 | 30 | 60 |
| 2022 Diciembre | 60 | 65 | 125 |
| 2022 Noviembre | 40 | 28 | 68 |
| 2022 Octubre | 44 | 17 | 61 |
| 2022 Septiembre | 51 | 34 | 85 |
| 2022 Agosto | 77 | 33 | 110 |
| 2022 Julio | 56 | 40 | 96 |
| 2022 Junio | 68 | 21 | 89 |
| 2022 Mayo | 76 | 52 | 128 |
| 2022 Abril | 87 | 45 | 132 |
| 2022 Marzo | 96 | 62 | 158 |
| 2022 Febrero | 72 | 40 | 112 |
| 2022 Enero | 46 | 49 | 95 |
| 2021 Diciembre | 63 | 54 | 117 |
| 2021 Noviembre | 73 | 47 | 120 |
| 2021 Octubre | 72 | 43 | 115 |
| 2021 Septiembre | 71 | 45 | 116 |
| 2021 Agosto | 64 | 37 | 101 |
| 2021 Julio | 92 | 39 | 131 |
| 2021 Junio | 55 | 32 | 87 |
| 2021 Mayo | 69 | 33 | 102 |
| 2021 Abril | 160 | 50 | 210 |
| 2021 Marzo | 59 | 24 | 83 |
| 2021 Febrero | 68 | 30 | 98 |
| 2021 Enero | 27 | 26 | 53 |
| 2020 Diciembre | 29 | 29 | 58 |
| 2020 Noviembre | 35 | 24 | 59 |
| 2020 Octubre | 28 | 19 | 47 |
| 2020 Septiembre | 47 | 14 | 61 |
| 2020 Agosto | 25 | 24 | 49 |
| 2020 Julio | 42 | 17 | 59 |
| 2020 Junio | 37 | 28 | 65 |
| 2020 Mayo | 37 | 32 | 69 |
| 2020 Abril | 47 | 21 | 68 |
| 2020 Marzo | 34 | 25 | 59 |
| 2020 Febrero | 9 | 6 | 15 |
| 2020 Enero | 4 | 6 | 10 |
| 2019 Diciembre | 8 | 8 | 16 |
| 2019 Noviembre | 4 | 5 | 9 |
| 2019 Octubre | 0 | 8 | 8 |
| 2019 Septiembre | 8 | 8 | 16 |
| 2019 Agosto | 2 | 9 | 11 |
| 2019 Julio | 6 | 20 | 26 |
| 2019 Junio | 4 | 15 | 19 |
| 2019 Mayo | 6 | 25 | 31 |
| 2019 Abril | 2 | 27 | 29 |
| 2019 Marzo | 2 | 11 | 13 |
| 2019 Febrero | 5 | 4 | 9 |
| 2019 Enero | 1 | 5 | 6 |
| 2018 Diciembre | 5 | 6 | 11 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 2 | 5 |
| 2018 Septiembre | 3 | 1 | 4 |
| 2018 Agosto | 0 | 9 | 9 |
| 2018 Julio | 0 | 3 | 3 |
| 2018 Junio | 0 | 7 | 7 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 3 | 2 | 5 |
| 2018 Febrero | 45 | 5 | 50 |
| 2018 Enero | 54 | 10 | 64 |
| 2017 Diciembre | 57 | 7 | 64 |
| 2017 Noviembre | 49 | 5 | 54 |
| 2017 Octubre | 46 | 6 | 52 |
| 2017 Septiembre | 42 | 18 | 60 |
| 2017 Agosto | 54 | 13 | 67 |
| 2017 Julio | 53 | 8 | 61 |
| 2017 Junio | 79 | 48 | 127 |
| 2017 Mayo | 64 | 24 | 88 |
| 2017 Abril | 59 | 28 | 87 |
| 2017 Marzo | 44 | 21 | 65 |
| 2017 Febrero | 45 | 19 | 64 |
| 2017 Enero | 38 | 24 | 62 |
| 2016 Diciembre | 73 | 18 | 91 |
| 2016 Noviembre | 63 | 11 | 74 |
| 2016 Octubre | 89 | 21 | 110 |
| 2016 Septiembre | 109 | 21 | 130 |
| 2016 Agosto | 77 | 11 | 88 |
| 2016 Julio | 58 | 17 | 75 |
| 2016 Junio | 13 | 9 | 22 |
| 2016 Mayo | 19 | 17 | 36 |
| 2016 Abril | 7 | 2 | 9 |
| 2016 Marzo | 7 | 13 | 20 |
| 2016 Febrero | 6 | 1 | 7 |
| 2016 Enero | 10 | 1 | 11 |
| 2015 Diciembre | 6 | 4 | 10 |
| 2015 Noviembre | 11 | 4 | 15 |
| 2015 Octubre | 4 | 1 | 5 |
| 2015 Septiembre | 7 | 4 | 11 |
| 2015 Agosto | 10 | 4 | 14 |
| 2015 Julio | 75 | 3 | 78 |
| 2015 Junio | 68 | 5 | 73 |
| 2015 Mayo | 94 | 16 | 110 |
| 2015 Abril | 97 | 18 | 115 |
| 2015 Marzo | 54 | 22 | 76 |
| 2015 Febrero | 59 | 12 | 71 |
| 2015 Enero | 54 | 11 | 65 |
| 2014 Diciembre | 42 | 6 | 48 |
| 2014 Noviembre | 48 | 1 | 49 |
| 2014 Octubre | 51 | 3 | 54 |
| 2014 Septiembre | 55 | 7 | 62 |
| 2014 Agosto | 56 | 8 | 64 |
| 2014 Julio | 62 | 8 | 70 |
| 2014 Junio | 59 | 3 | 62 |
| 2014 Mayo | 55 | 9 | 64 |
| 2014 Abril | 35 | 7 | 42 |
| 2014 Marzo | 20 | 4 | 24 |
| 2014 Febrero | 4 | 9 | 13 |
| 2014 Enero | 0 | 1 | 1 |
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