Allergic contact dermatitis to hexyl cinnamaldehyde, cinnamaldehyde, and 3,4 methylbenzylidene camphor in a patient with previous photoallergic contact dermatitis to dexketoprofen.

Ketoprofen, (RS) 2-(-benzoylphenyl)-propionic acid (C16H14O3), is an arylpropionic acid derivative belonging to the nonsteroidal anti-inflammatory drug family. Synthesized by Rhone-Poulenc SA in the 1960s and marketed internationally since 1973, the drug is used mainly for the treatment of musculoskeletal diseases because of its anti-inflammatory and analgesic properties. It is frequently the cause of allergic contact dermatitis and photodermatitis, which was first described in 1985 by Alomar. Cross-reactions of unknown origin have also been reported with diphenyl ketone, cinnamic alcohol, and cinnamic aldehyde. We present the case of a patient with photoallergic contact dermatitis to dexketoprofen that appeared 7 years after allergic contact dermatitis to cinnamic aldehyde, hexyl cinnamaldehyde, and 3,4 methylbenzylidene camphor. This is the first report of such an association. The patient was a 48-year-old woman who was referred to our dermatitis unit with sudden appearance of lesions on the face, trunk, and limbs. The lesions were intensely pruritic after the application of 2 sunscreens (Piz Buin In Sun FPS 50 and ISDIN Fusion gel FPS 50). The patient had used the sunscreen all over her body on 3 consecutive days 30 minutes before sun exposure. She also reported that the lesions worsened after using body oil the following day. Physical examination revealed erythematous edematous plaques with micropapules, mild desquamation, and fissures on the parts of the skin exposed to the sun (Figure 1). After evaluation at the clinic, she was prescribed betamethasone valerate 0.1% ointment twice daily for 2 weeks, after which time her lesions resolved completely. The patient also reported a 2-year history of very pruritic erythematous lesions on the neck that were occasionally exudative with desquamation and progressed as outbreaks lasting several weeks after application of various colognes and perfumes. Patch testing at our clinic 7 years earlier confirmed a diagnosis of photoallergic dermatitis to dexketoprofen and fenofibrate.