Occupational allergic contact dermatitis from systemic drugs

Health-care workers (HCWs) and professionals working in the pharmaceutical industry are at risk of developing occupational allergic contact dermatitis (OACD) from systemic drugs (or drug intermediates).

To study demographic characteristics and identify systemic drugs responsible for OACD in patients investigated for contact allergy during the period 2001-2019.

In the study period, 9780 patients were patch tested with the European baseline series, sometimes with additional series, and other relevant potential allergens. All patients with a positive patch-test reaction to systemic medication exposed to at work were included for further analysis.

Of 1248 HCWs examined in our clinic, 201 suffered from OACD. In 26 (13%) dermatitis was caused by skin contact with a systemic drug: 19 nurses, five chemists working in the pharmaceutical industry, one physician, and one veterinarian. In total, 45 positive patch-test reactions to 20 different systemic drugs were found, with tetrazepam (n = 11), ranitidine hydrochloride (n = 5), and zolpidem (n = 4) being the most frequent. Three pharmaceutical chemists were sensitized to a drug intermediate. The lesions were mostly localized on the hands, but often also on the face, as airborne dermatitis.

As much as 13% of OACD in HCWs, diagnosed in our tertiary referral center, was attributable to systemic drugs, most frequently in nurses.