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Systemic contact dermatitis
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Systemic contact dermatitis

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Contributors: Vivian Wong MD, PhD, Susan Burgin MD
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Synopsis

Systemic contact dermatitis (SCD) occurs when systemic exposure to a hapten triggers a contact-type allergic dermatitis, typically causing flares at previous sites of contact dermatitis. SCD has been reported with medications administered orally, transcutaneously, intravenously, per rectum, intravesically, or by inhalation. Other allergens include metals (eg, nickel, cobalt, mercury, gold, chromate), plants (eg, Anacardiaceae, Compositae, Apiaceae, Asteraceae, Parthenium hysterophores, Myroxylon balsamum), foods and beverages (eg, garlic, shiitake mushroom, flaxseed, ethanol), chemicals (eg, acrylates, propylene glycol), medical devices and implants, and aromatic substances (eg, spices, cashew oil smoke). The exact mechanism of SCD is unclear; however, patients can react within hours of the systemically administered drug, suggesting that a Type III as well as Type IV sensitivity reaction may be involved.

The following medications have been reported to cause systemic contact dermatitis:
  • Erythromycin
  • Penicillin
  • Aminoglycosides: gentamicin, streptomycin, kanamycin, and topical neomycin can cross-sensitize
  • Tolbutamide or chlorpropamide in patients sensitized to paraphenylenediamine or paraaminobenzoic acid (PABA) or its esters, or benzocaine
  • Phenothiazine in patients sensitized by topically cross-reacting or related antihistamines
  • Edetate disodium due to exposure to azelastine nasal spray
  • Acetylsalicylic acid from oral aspirin / acetylsalicylic acid
  • Aminophylline in people with ethylenediamine allergy
  • Amlexanox
  • Intravesical dimethyl sulfoxide
  • 5-aminosalicylic acid
  • Codeine
  • Diclofenac
  • Hydroxyquinoline
  • Prednisone
  • 8-methyoxypsoralen
  • Nystatin
  • Phenobarbital
  • Pseudoephedrine
  • Tetraethylthiuram disulfide
  • Vitamin C
  • Vitamin B6
  • Thimerosal from oral or nasal antipneumococcal vaccine
Related topics: Baboon syndrome, Symmetric drug-related intertriginous and flexural exanthema (SDRIFE)

Codes

ICD10CM:
L27.0 – Generalized skin eruption due to drugs and medicaments taken internally

SNOMEDCT:
86062001 – Contact dermatitis due to drugs AND/OR medicine

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 04/18/2017
Last Updated: 01/23/2019
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Systemic contact dermatitis
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Systemic contact dermatitis (Dyshidrotic Hand Eczema) : Dyshidrotic vesicle, Palms
Clinical image of Systemic contact dermatitis
Nitroglycerin reaction.
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