Case and Research Letters
Unilateral Eczema on the Dorsum of the Hand
Eccema unilateral del dorso de la mano
M. Utrera-Busquets
, S. Córdoba, J. Borbujo-Martínez
Autor para correspondencia
Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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8152
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Utrera-Busquets, S. Córdoba, J. Borbujo-Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Utrera-Busquets" "email" => array:1 [ 0 => "martautrerabusquets@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Córdoba" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Eccema unilateral del dorso de la mano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 667 "Ancho" => 1000 "Tamanyo" => 147682 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythema and extensive desquamation on the dorsum of the right hand.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eczema of the hands is a very common cause of consultation in dermatology. The differential diagnosis is broad and includes irritant and contact allergic dermatitis, atopic dermatitis, psoriasis, and dermatomyositis. In unilateral eczema of the hands we must exclude tinea manuum and investigate possible causes of photoallergic contact eczema.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a of 90-year-old woman with a history of hypertension, chronic obstructive pulmonary disease on long-term treatment with inhaled fluticasone, salmeterol, and diltiazem, and squamous cell carcinoma of the vulva arising on lichen sclerosus et atrophicus, partially excised in 2012 and on follow-up in gynecology.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was seen at the end of the summer for a 1-month history of erythema, desquamation, and pruritus on the dorsum of the right hand. She had been treated with topical clobetasol and fusidic acid, but the condition continued to deteriorate.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Examination revealed a very well-defined, intensely erythematous plaque on the dorsum of the right hand, with peripheral desquamation and fissures, with no involvement of the palm or of the other hand (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No lesions were observed at other sites.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In a targeted medical history, the patient stated she had regularly used Rosalgin sachets (benzydamine hydrochloride, Angelini Farmacéutica S.A.) to perform daily lavage of the genital region because of her gynecological disease. She did not use other cosmetic or cleansing products in the area. She was instructed to discontinue the use of the sachets and treatment was started with oral prednisone at a dose of 30<span class="elsevierStyleHsp" style=""></span>mg/d, leading to a rapid resolution of the lesions within a week.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After resolution of the lesions, patch and photopatch testing was performed using the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group and the Marti Tor anti-inflammatory drug series. Patch tests were negative, but photopatch tests were positivity (+) for 1% benzydamine hydrochloride in petrolatum. On the basis of these results we made a diagnosis of photoallergic contact eczema due to benzydamine hydrochloride (a component of Rosalgin sachets). The patient has developed no further lesions and has remained asymptomatic since she was advised to avoid the product.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Benzydamine (1-benzyl-3-[3-(dimethylamino)propoxy]-1H-indazole hydrochloride) is a nonsteroidal anti-inflammatory drug with anti-inflammatory, antipyretic, and analgesic properties.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain it is used topically as an expectorant (Etermol), mouthrinse, lozenges, cream, ointments for joint pain (Tamtum), eyedrops (Vinciseptil), and as a solutions for vaginal lavage (Rosalgin). It is also available in capsule form for the treatment of benign prostatic hypertrophy (Prosturol).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Benzydamine is a substance with sensitizing and photosensitizing capacity after long-term topical use. In addition, some patients can present symptoms of photosensitivity due to mucocutaneous absorption.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In 1971, Ikemura reported a case of eczema in sun-exposed areas after the ingestion of benzydamine hydrochloride,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> and De la Cuadra<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> described the condition after the use of benzydamine as a vaginal lavage. Presentation is usually as chronic hand eczema, typically in a unilateral distribution on the dorsum of one hand, particularly in older women who perform vaginal lavage. Cheilitis is also a common presentation, perhaps even the most common according to some authors.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>After ketoprofen, benzydamine is the most common photoallergen to produce photosensitivity.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In our patient, the presence of lesions on the dorsum of the dominant hand, with no involvement of the area to which the product was applied (external genitalia) or of the contralateral hand, combined with the results of patch and photopatch testing, enabled us to make a diagnosis of photoallergic contact eczema.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Utrera-Busquets M, Córdoba S, Borbujo-Martínez J. Eccema unilateral del dorso de la mano. Actas Dermosifiliogr. 2014;105:884–885.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 667 "Ancho" => 1000 "Tamanyo" => 147682 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythema and extensive desquamation on the dorsum of the right hand.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photoallergic hand eczema due to benzylamine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O. Lasa Elgezua" 1 => "P.E. Gorrotxategi" 2 => "J. Gardeazabal García" 3 => "J.A. Ratón Nieto" 4 => "J.L. Diaz Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Dermatol" "fecha" => "2004" "volumen" => "14" "paginaInicial" => "69" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14965802" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fotodermatitis alérgica de contacto por bencidamina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. De la Cuadra" 1 => "M. Rodríguez" 2 => "A. Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifilogr" "fecha" => "1996" "volumen" => "87" "paginaInicial" => "310" "paginaFinal" => "314" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photodermatitis from benzydamine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Fernandez de Corres" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "1980" "volumen" => "6" "paginaInicial" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7398289" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fotoalergia a un jabón vaginal con bencidamina" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "VII Reunión del Grupo Español de Fotobiología" "etal" => true "autores" => array:3 [ 0 => "J. De la Cuadra" 1 => "A. Pérez" 2 => "M. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Boletín del GEF" "fecha" => "1993" "paginaInicial" => "42" "paginaFinal" => "43" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Photoallergic contact dermatitis from benzydamine presenting mainly as lip dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.M. Canelas" 1 => "J.C. Cardoso" 2 => "M. Gonçalo" 3 => "A. Figueiredo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-0536.2010.01707.x" "Revista" => array:6 [ "tituloSerie" => "Contact Dermatitis" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "85" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20573168" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resultados y evaluación del fotoparche en España: hacia una nueva batería estándar de fotoalérgenos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Cuadra-Oyanguren" 1 => "A. Pérez-Ferriols" 2 => "M. Lecha-Carrelero" 3 => "A.M. Jimenez-Arnau" 4 => "V. Fernández-Redondo" 5 => "F.J. Ortiz de Frutos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifilogr" "fecha" => "2006" "volumen" => "98" "paginaInicial" => "96" "paginaFinal" => "101" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000009/v1_201410280115/S1578219014002595/v1_201410280115/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000009/v1_201410280115/S1578219014002595/v1_201410280115/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002595?idApp=UINPBA000044" ]
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| 2016 Agosto | 0 | 6 | 6 |
| 2016 Julio | 11 | 1 | 12 |
| 2016 Junio | 16 | 10 | 26 |
| 2016 Mayo | 10 | 5 | 15 |
| 2016 Abril | 10 | 10 | 20 |
| 2016 Marzo | 7 | 7 | 14 |
| 2016 Febrero | 10 | 7 | 17 |
| 2016 Enero | 14 | 3 | 17 |
| 2015 Diciembre | 17 | 1 | 18 |
| 2015 Noviembre | 13 | 3 | 16 |
| 2015 Octubre | 11 | 4 | 15 |
| 2015 Septiembre | 9 | 1 | 10 |
| 2015 Agosto | 14 | 3 | 17 |
| 2015 Julio | 25 | 3 | 28 |
| 2015 Junio | 27 | 7 | 34 |
| 2015 Mayo | 30 | 3 | 33 |
| 2015 Abril | 13 | 9 | 22 |
| 2015 Marzo | 12 | 5 | 17 |
| 2015 Febrero | 11 | 1 | 12 |
| 2015 Enero | 5 | 2 | 7 |
| 2014 Diciembre | 5 | 2 | 7 |
| 2014 Noviembre | 5 | 1 | 6 |
| 2014 Octubre | 0 | 1 | 1 |
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