Our patient’s case shows the implications of the ubiquitous use of propylene glycol. Some examples of common sources of exposure to propylene glycol are listed in Box 1. Cutaneous exposure to propylene glycol usually occurs through contact with cosmetics or topical medications. In industry, it is used as an intermediate for the synthesis of other chemicals, as a solvent and as a plasticizer. It is also used as a preservative in food and as a humectant food additive. As a vehicle, it is found in many topical, oral and injectable pharmaceutical preparations and in some ultrasound gels and electrocardiogram electrodes. Considered an excellent carrier and solvent, propylene glycol is used widely in emollient creams, lotions and personal hygiene products because it easily penetrates the skin. Propylene glycol (Propan-1,2-diol, E1520) is a colourless, viscous and virtually odourless dihydric alcohol with a very low toxicity. Fluocinonide 0.05% cream also contains propylene glycol, hence the worsening of our patient’s dermatitis. Patch-testing in our patient showed that the offending agent was not the NSAID, but rather propylene glycol, which is present in the vehicle of the cream.
#Voltaren cream Patch#
Positive results were found for other agents in the patch test as well but were not relevant to the dermatitis.ĭiclofenac cream contains propylene glycol, diclofenac, dimethyl sulfoxide, ethanol and glycerin.
#Voltaren cream skin#
Positive skin reactions to propylene glycol (3+) and to the patient’s own diclofenac cream (3+) were found.
The Finn chambers and tape were removed at 48 hours, and a reading was performed at 96 hours. The patient was instructed to avoid activity that could disturb the chambers, such as bathing or exercise. Diluted allergens in Finn chambers were placed on uninvolved skin on the patient’s back and held in place using nonallergenic tape.
#Voltaren cream series#
The dosage of prednisone was tapered over three weeks, resulting in improvement in the dermatitis.Ī patch test was performed using the standard screening series of 65 allergens developed by the North American Contact Dermatitis Group, as well as the patient’s own diclofenac cream, fluocinonide 0.05% cream and selected additional allergens. The fluocinonide 0.05% cream was discontinued and a course of oral prednisone 40 mg daily was prescribed. He was instructed to stop using diclofenac cream and given oral clarithromycin 250 mg twice daily for five days and fluocinonide 0.05% cream topically twice daily.Īlthough the patient noted an improvement in the rash with use of the fluocinonide 0.05% cream, the dermatitis worsened after one week. The patient may have been sensitized by treatment with the cream the previous year. We diagnosed contact dermatitis caused by allergy to the diclofenac cream with possible impetiginization. The affected area extended from the elbow to just above the wrist and corresponded to the area of application of the diclofenac cream ( Figure 1).Īllergic contact dermatitis on the forearm of a 40-year-old man after the use of diclofenac cream. At that time, a mild erythema had developed on his left forearm after one week of application of the cream and had resolved on its own.Įxamination revealed an extensive, poorly demarcated, erythematous and scaly plaque on the left extensor forearm with vesicles and yellow crusting. He reported that he had used the diclofenac cream one year earlier for tendonitis. He was not taking medications and had no known allergies. The patient’s medical history included Crohn disease. Although the patient had noted some improvement in the tendonitis, he stopped using the diclofenac cream on the fifth day because of the rash. The eruption was intensely itchy and spread from the elbow to the wrist. The area had become slightly erythematous three days later and then rapidly developed blistering on the fourth and fifth days. One week earlier, he had experienced tendonitis in his left elbow and had treated it with diclofenac cream, a topical nonsteroidal anti-inflammatory drug (NSAID), applied four times daily. A 40-year-old man presented with a severe rash on his left forearm.
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