Cetirizine induced bullous fixed drug eruptions

Background Hand and/or feet eczema may be due to contact dermatitis, either irritant or allergic in nature. Difficulties often arise in distinguishing purely endogenous eczema from the possibility of contact dermatitis clinically. Patch test is carried out to detect the presence of allergic contact dermatitis. This is important for optimum patient care and to obtain a favourable outcome. Objectives To identify the demography, clinical characteristics and causative allergens of hand and/or feet eczema among patients from the patch test clinic. Methods Patients who attended the patch test clinic in the Department of Dermatology, Hospital Kuala Lumpur from 2003 to 2007 were evaluated retrospectively. All of them were having hand and/or feet eczema. Data were collected for their demography, sites affected and patch test findings. Results 379 patients were included in the study. The age of patients ranged from 6 years to 78 years with an average of 36.7 years. Their occupations ranged from blue collar (20.3%) and white collar (38.3%) workers, housewives (9.5%), pensioners (7.1%) and students (20.3%). Clinical presentations included isolated hand eczema (34.6%), isolated feet eczema (21.9%), hand and feet eczema (19.0%), and hand and/or feet with eczema with involvement of other parts of the body (24.5%).The mean duration of eczema was 3.8 years. The rate of positive patch test was 58.0 %( n = 220/379).Clinically relevant allergens were identified in 123 (32.5%) patients only. Fifty two percent of the clinically relevant allergens were identified from the European Standard Series patch test, 9.0% from the Specific Series patch test and 39.0 % from the patients’ own personal products that were tested. The most common source was metal items containing nickel (33.3%), followed by toiletries (14.6%) and detergents (10.6%). Other sources include fragrance, cosmetics, rubber, medicaments and hair dye. In 256 (67.5%) patients, there were no underlying causes detected, and they were managed as endogenous hand and feet eczema. There is a possibility that the causative allergen was not suspected/tested and hence not detected. Conclusion Hand and/or feet eczema can affect any age group and patch testing forms a very important diagnostic tool in the management.