Pustular allergic contact dermatitis caused by fragrances.

Pustular allergic contact dermatitis (ACD) is rare, with reactions to the topical antibacterial nitrofurazone (1), isoconazole nitrate (2), topical minoxidil 2% (3), 1% fluorouracil (4), black rubber (5) and tricholoroethylene (6) having been reported. The clinical appearance of pustular ACD has been reported to comprise multiple small pustules, only 0.5–1mm in size, on a background of erythema and swelling, and the condition is associated with marked pruritus. Histologically, there are features consistentwithACD (epidermal spongiosis, dermal oedema, and perivascular mononuclear infiltrate), in addition to epidermal pustules composed of lymphocytes and occasional neutrophils (7). Cultures of the pustulesmust be sterile for a diagnosis of pustular ACD to be made, and the condition must also be distinguished from the more common conditions pustular psoriasis and acute generalized exanthematous pustulosis (AGEP). A case is reported of an elderlymanwhopresentedwith both eczematous and pustular rashes, and who showed multiple eczematous and pustular patch test reactions.