Dermatitis associated with Evans blue dye

A 73-year-old woman developed an allergic contact dermatitis of the feet and legs 24 days following lymphangiography. Dermatitis was accompanied by a generalized urticarial reaction. Intracutaneous skin testing was positive to Evans blue dye, used as a lymphatic marker, but negative to Ethiodol, an iodine-containing contrast medium. Soft tissue x-rays x-rays revealed extravasated Ethiodol in the left leg but not in the right, while dermatitis occurred on both legs. This finding, combined with the positive skin test to Evans blue, stress the importance of testing with both agents when dermatitis develops following lymphangiography. Intracutaneous rather than epicutaneous testing is the indicated route and may be related to the route of sensitization.