Case and Research Letters
Photoallergic Contact Dermatitis Due to Chlorpromazine: A Report of 2 Cases
Queilitis fotoalérgica de contacto por clorpromazina: descripción de 2 casos
A. Esteve-Martínez
, V. Ninet Zaragoza, J. de la Cuadra Oyanguren, V. Oliver-Martínez
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Departamento de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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Esteve-Martínez, V. Ninet Zaragoza, J. de la Cuadra Oyanguren, V. Oliver-Martínez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Esteve-Martínez" "email" => array:1 [ 0 => "aemder@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Ninet Zaragoza" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "de la Cuadra Oyanguren" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Oliver-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Queilitis fotoalérgica de contacto por clorpromazina: descripción de 2 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 103821 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Eczema affecting the upper and lower eyelids.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 64-year-old woman referred to the skin allergy unit of our dermatology department with a 1-year history of chronic pruritic fissured cheilitis on the lower lip (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The physical examination also revealed dermatitis at the outer margin of the right lower eyelid that appeared in outbreaks, as well as cracked and dyshidrotic dermatitis on the tip of the right thumb that had been present for as long as the cheilitis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Patch testing was performed with the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) and a cosmetics series. The results were positive for cobalt chloride (+++) with no present relevance.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient had been taking Largactil drops (chlorpromazine) 5<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h to treat irritable bowel syndrome for 1 year.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Photopatch testing was performed with chlorpromazine 0.1% in petrolatum (irradiation, 5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>). The result for the patch was negative (–), and that of the photopatch was positive (++). Phototesting was not performed. Given the suspicion of contact photoallergy to chlorpromazine, the drug was switched to levopromazine after patch testing with levopromazine at 1% and 0.1% in petrolatum (patch and photopatch negative).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was free of lesions at a follow-up visit a few weeks later. The condition has been controlled for more than 4 years, with no new outbreaks.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 52-year-old woman was referred for possible contact dermatitis on the right lower eyelid that had begun 2 years previously (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). She also reported pruritic chronic cheilitis that was sometimes cracked and painful and dated from the same period (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). She wore a polymethyl methacrylate ocular prosthesis as a result of enucleation of the right eye after a traffic accident. She was taking eyedrops (Oftalmosa Cusí hydrocortisone ophthalmic ointment, Terramycin ophthalmic ointment 1%, Oftalmowell eyedrops, and Hidrathea eyedrops), as well as several drugs to treat brain injury sequelae resulting from the accident.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Phototesting was performed, as was patch testing with the standard GEIDAC series, a cosmetic series, an acrylate series, and the patient's own products, including all the ophthalmic ointments and eyedrops. The results were positive for paraphenyldiamine and mercury, with no present relevance.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Further questioning revealed that one of the drugs she was taking was Largactil drops 3<span class="elsevierStyleHsp" style=""></span>mg/d.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Given our experience with patient 1, we performed photopatch testing with 0.1% chlorpromazine in petrolatum<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>UV-A (irradiation, 5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>). The result of the patch was negative (–), and that of the photopatch was positive (++). In the phototest, which was performed while the patient was taking chlorpromazine (3<span class="elsevierStyleHsp" style=""></span>mg/d), the minimal erythema dose for UV-B (22.7<span class="elsevierStyleHsp" style=""></span>mJ/cm<span class="elsevierStyleSup">2</span>) and the response to UV-A were considered normal for the patient's skin type (II) and according to local phototesting values.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We also observed dermatitis on the tip of the index finger of the right hand, which was the one used to open the Largactil container, and a punctiform eczematous lesion on the palm, where she sometimes placed the drug before taking it. The patient also reported symptoms of photosensitivity at the onset of her condition (when she was taking chlorpromazine [18<span class="elsevierStyleHsp" style=""></span>mg/d]), which had not appeared since the dose was reduced to 3<span class="elsevierStyleHsp" style=""></span>mg/d. Chlorpromazine was switched to levopromazine after photopatch testing with levopromazine at 1% and 0.1% in petrolatum (patch and photopatch negative).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The patient was free of lesions at the follow-up visit 15 days later and has remained asymptomatic for the last 4 years.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Chlorpromazine is a classic antipsychotic drug of the aliphatic phenothiazine class. It can cause allergic contact dermatitis, especially phototoxic and photoallergic reactions. In fact, it is the archetypal photosensitizing drug. Chlorpromazine has been reported to affect patients who take it and persons who handle it, for example, those caring for people treated with chlorpromazine or persons exposed to the drug in the workplace (eg, nurses, pharmacists, and vets).<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2–4</span></a> In the review of photopatch testing performed by the Spanish Photobiology Group, chlorpromazine 0.1% was positive only twice, and its relevance was unknown.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">We present 2 cases of photoallergic contact dermatitis in women taking chlorpromazine. There are no previous reports in the literature of photoallergic contact dermatitis manifesting as chronic fissured cheilitis and caused by chlorpromazine. Both patients had dermatitis on the tips of the fingers used to open the container. This manifestation has been described elsewhere.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In addition, both patients had occasional or continuous outbreaks of eyelid eczema on the side of the dominant hand.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Both patients only presented symptoms of contact photosensitivity to the drug despite systemic exposure.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> The workup should have been completed with phototesting in patient 1 while she was taking the drug in order to ensure the absence of photosensitivity.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Lastly, we also showed that there was no cross-photosensitization between the aliphatic phenothiazines chlorpromazine and levopromazine; therefore, this drug could be a good option in patients with symptoms of photosensitivity caused by chlorpromazine.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 3 => array:2 [ "identificador" => "xack179861" "titulo" => "Acknowledgments" ] 4 => 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: Esteve-Martínez A, Ninet Zaragoza V, de la Cuadra Oyanguren J, Oliver-Martínez V. Queilitis fotoalérgica de contacto por clorpromazina: descripción de 2 casos. Actas Dermosifiliogr. 2015;106:518–520.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 102457 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chronic eczematous involvement of the lip (presenting complaint).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 103821 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Eczema affecting the upper and lower eyelids.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 525 "Ancho" => 900 "Tamanyo" => 96531 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Chronic cracked cheilitis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Algunas evidencias clínicas sobre la necesidad del calibrado de simuladores solares usados en dermatología" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 12 | 17 |
| 2024 Octubre | 93 | 56 | 149 |
| 2024 Septiembre | 114 | 30 | 144 |
| 2024 Agosto | 134 | 49 | 183 |
| 2024 Julio | 144 | 33 | 177 |
| 2024 Junio | 127 | 42 | 169 |
| 2024 Mayo | 114 | 35 | 149 |
| 2024 Abril | 109 | 33 | 142 |
| 2024 Marzo | 92 | 33 | 125 |
| 2024 Febrero | 85 | 33 | 118 |
| 2024 Enero | 63 | 32 | 95 |
| 2023 Diciembre | 92 | 19 | 111 |
| 2023 Noviembre | 102 | 34 | 136 |
| 2023 Octubre | 76 | 22 | 98 |
| 2023 Septiembre | 117 | 19 | 136 |
| 2023 Agosto | 85 | 22 | 107 |
| 2023 Julio | 137 | 34 | 171 |
| 2023 Junio | 99 | 32 | 131 |
| 2023 Mayo | 83 | 23 | 106 |
| 2023 Abril | 78 | 21 | 99 |
| 2023 Marzo | 61 | 30 | 91 |
| 2023 Febrero | 92 | 25 | 117 |
| 2023 Enero | 58 | 30 | 88 |
| 2022 Diciembre | 77 | 48 | 125 |
| 2022 Noviembre | 47 | 31 | 78 |
| 2022 Octubre | 36 | 18 | 54 |
| 2022 Septiembre | 41 | 40 | 81 |
| 2022 Agosto | 25 | 45 | 70 |
| 2022 Julio | 23 | 34 | 57 |
| 2022 Junio | 31 | 25 | 56 |
| 2022 Mayo | 62 | 45 | 107 |
| 2022 Abril | 92 | 40 | 132 |
| 2022 Marzo | 76 | 63 | 139 |
| 2022 Febrero | 68 | 45 | 113 |
| 2022 Enero | 88 | 50 | 138 |
| 2021 Diciembre | 55 | 43 | 98 |
| 2021 Noviembre | 63 | 40 | 103 |
| 2021 Octubre | 49 | 58 | 107 |
| 2021 Septiembre | 40 | 45 | 85 |
| 2021 Agosto | 91 | 32 | 123 |
| 2021 Julio | 59 | 41 | 100 |
| 2021 Junio | 36 | 34 | 70 |
| 2021 Mayo | 22 | 51 | 73 |
| 2021 Abril | 73 | 48 | 121 |
| 2021 Marzo | 74 | 31 | 105 |
| 2021 Febrero | 65 | 28 | 93 |
| 2021 Enero | 46 | 19 | 65 |
| 2020 Diciembre | 44 | 37 | 81 |
| 2020 Noviembre | 24 | 23 | 47 |
| 2020 Octubre | 35 | 18 | 53 |
| 2020 Septiembre | 33 | 17 | 50 |
| 2020 Agosto | 21 | 16 | 37 |
| 2020 Julio | 16 | 15 | 31 |
| 2020 Junio | 31 | 37 | 68 |
| 2020 Mayo | 28 | 19 | 47 |
| 2020 Abril | 23 | 16 | 39 |
| 2020 Marzo | 32 | 18 | 50 |
| 2020 Febrero | 3 | 1 | 4 |
| 2019 Diciembre | 4 | 2 | 6 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 6 | 1 | 7 |
| 2019 Junio | 0 | 2 | 2 |
| 2019 Mayo | 3 | 19 | 22 |
| 2019 Abril | 2 | 4 | 6 |
| 2019 Marzo | 0 | 3 | 3 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Noviembre | 6 | 0 | 6 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 18 | 2 | 20 |
| 2018 Enero | 21 | 5 | 26 |
| 2017 Diciembre | 37 | 9 | 46 |
| 2017 Noviembre | 20 | 3 | 23 |
| 2017 Octubre | 21 | 7 | 28 |
| 2017 Septiembre | 19 | 3 | 22 |
| 2017 Agosto | 22 | 5 | 27 |
| 2017 Julio | 25 | 9 | 34 |
| 2017 Junio | 23 | 5 | 28 |
| 2017 Mayo | 26 | 7 | 33 |
| 2017 Abril | 24 | 10 | 34 |
| 2017 Marzo | 24 | 6 | 30 |
| 2017 Febrero | 14 | 8 | 22 |
| 2017 Enero | 12 | 3 | 15 |
| 2016 Diciembre | 27 | 10 | 37 |
| 2016 Noviembre | 35 | 8 | 43 |
| 2016 Octubre | 30 | 16 | 46 |
| 2016 Septiembre | 0 | 7 | 7 |
| 2016 Agosto | 0 | 4 | 4 |
| 2016 Julio | 7 | 0 | 7 |
| 2016 Junio | 10 | 2 | 12 |
| 2016 Mayo | 9 | 1 | 10 |
| 2016 Abril | 7 | 6 | 13 |
| 2016 Marzo | 13 | 12 | 25 |
| 2016 Febrero | 11 | 14 | 25 |
| 2016 Enero | 7 | 1 | 8 |
| 2015 Diciembre | 0 | 7 | 7 |
| 2015 Noviembre | 0 | 1 | 1 |
| 2015 Octubre | 0 | 2 | 2 |
| 2015 Septiembre | 0 | 4 | 4 |
| 2015 Agosto | 0 | 2 | 2 |
| 2015 Julio | 0 | 1 | 1 |
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