Occupational allergic contact dermatitis from alkylammonium amidobenzoate

Quaternary ammonium compounds are water-soluble antimicrobials which are widely used in disinfectants, sterilizers, skin cleansers and antiseptic creams. One quaternary ammonium compound, alkylammonium amidobenzoate (Osmaron B) has for decades been used in udder ointments. Here we present a ship technician with occupationally induced sensitization to alkylammonium amidobenzoate. The diagnosis was reached only when it emerged, after careful questioning, that the patient was exposed to a substance peculiar to his workplace but not to his occupation and was then patch tested for it. It turned out that an udder ointment had been used at the patient's workplace as a hand ointment. Patch testing was positive to the patient's hand ointment, and Osmaron B at 0.1-0.01% in petrolatum. Other sensitizing quaternary ammonium compounds, namely benzalkonium chloride, benzethonium chloride, benzoxonium chloride, N-benzyl-N,N-dihydroxyethyl-N-cocosalkyl-ammonium chloride, cetalkonium chloride, cetylpyridinium chloride, cetrimonium bromide, chloroallylhexaminium chloride, dequalinium chloride, domiphen bromide, methylbenzethonium chloride and 2,3-epoxypropyl trimethyl ammonium chloride are reviewed briefly. The importance of patch testing to all materials in use by the patient is emphasized. It is also important to select non-allergenic hand creams for use at work places.