A 16-year-old Hispanic female seeks consultation for a rash that has developed around her mouth. The eruption first appeared about 2 weeks ago, shortly after the patient used an OTC depilatory agent. The rash has worsened despite recent applications of topical neomycin ointment. She reports pruritus and occasional burning. Examination reveals erythema, hyperpigmentation, and excoriation of the skin around the corners of the patient’s mouth. The remainder of the skin exam is normal
An allergic contact dermatitis to both the depilatory agent and neomycin was suspected. The patient was advised to discontinue use of both products, and a medium-potency topical steroid was prescribed. She returned for follow-up in 10 days, at which time the condition had improved about 75%. Therapy was changed to 1% hydrocortisone cream. The patient was instructed to return for patch testing if the dermatitis recurred. Sensitizing compounds in depilatory agents include thioglycolate and fragrances. Neomycin was named the 2010 Allergen of the Year by the American Contact Dermatitis Society.
Dr. Schleicher is director of the DermDOX Center in Hazleton, Pennsylvania, a clinical instructor of dermatology at King’s College in Wilkes-Barre, Pennsylvania, an associate professor of medicine at the Commonwealth Medical School in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the University of Pennsylvania in Philadelphia. He is also a member of the EMERGENCY MEDICINE editorial board.
