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Systemic contact dermatitis to hydroxyzine

S Ash1, A J Scheman

  • 1Northwestern University, School of Medicine, Evanston, IL, USA.

American Journal of Contact Dermatitis : Official Journal of the American Contact Dermatitis Society
|March 1, 1997
PubMed
Summary
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Systemic contact dermatitis, an allergic reaction to oral medications, can cause chronic eczema. Identifying and removing the trigger, like hydroxyzine, often resolves the condition.

Area of Science:

  • Dermatology
  • Allergy and Immunology

Background:

  • Systemic contact dermatitis (SCD) is a delayed hypersensitivity reaction to systemically administered substances.
  • Oral medications can cross-react with topical antigens, triggering SCD.
  • Chronic, unresponsive eczema may indicate an underlying systemic cause.

Observation:

  • A patient presented with eczema unresponsive to treatment.
  • Patch testing revealed a positive reaction to ethylenediamine.
  • The patient had a history of taking hydroxyzine for pruritus.

Findings:

  • Repeated oral provocation with hydroxyzine successfully reproduced the patient's eczema.
  • This confirmed hydroxyzine as the causative agent for systemic contact dermatitis.
  • Ethylenediamine is a common metabolite or impurity in hydroxyzine.

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Implications:

  • Systemic contact dermatitis to hydroxyzine should be considered in cases of chronic, recalcitrant eczema.
  • Thorough medication history, including oral drugs, is crucial for diagnosing SCD.
  • Identifying and eliminating the offending agent can lead to significant clinical improvement.