Allergic Contact Dermatitis from Diethyl Sebacate in a Topical Antimycotic Medicament

doi:10.4236/jcdsa.2012.23040

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Journal of Cosmetics, Dermatological Sciences and Applications, 2012, 2, 216-218

http://dx.doi.org/10.4236/jcdsa.2012.23040 Published Online September 2012 (http://www.SciRP.org/journal/jcdsa)

Allergic Contact Dermatitis from Diethyl Sebacate in a

Topical Antimycotic Medicament

Ayaka Hirao1, Naoki Oiso1,2*, Megumi Hama1, Noriko Higashimori1, Yoichi Tatsumi2,3,

Akira Kawada1

1Departments of Dermatology, Kinki University Faculty of Medicine, Osaka, Japan; 2Departments of Patient Safety and Management,

Kinki University Faculty of Medicine, Osaka, Japan; 3Departments of Hematology, Kinki University Faculty of Medicine, Osaka,

Japan.

Email: *[email protected]

Received June 24th, 2012; revised July 29th, 2012; accepted August 12th, 2012

ABSTRACT

Diethyl sebacate is used in topical medicaments in United States and Japan. We described a case of allergic contact

dermatitis from diethyl sebacate in a topical antimycotic medicament. Allergic reaction to diethyl sebacate is likely

more common because our group has found three of eight sensitized cases. We believe that an investigation regarding

the sensitized frequency to diethyl sebacate would conduct to improve the safety of products in United States and Japan.

Keywords: Allergic Contact Dermatitis; Patch Test; Allergen; Diethyl Sebacate; Safety Evaluation

1. Introduction

Diethyl sebacate facilitates penetration of effective ingre-

dients [1]. It is used in United States and Japan in some

topical medicaments such as antimycotic, corticosteroi-

dal, non-steroidal anti-inflammatory ointments, creams and

lotions [1]. The substance may provoke allergic contact

dermatitis [1-6].

Topical medicaments usually consist of an effective

drug, additives and a solvent, all of which may induce

allergic reaction. Each ingredient in the same products

may cause allergic and photoallergic contact dermatitis

[7-11]. Thus, patch testing is essential for deciding the

strategy to prevent the recurrence of allergic and photo-

allergic contact dermatitis in each patient as well as to

design the reduction of sufferers in the social society.

2. Case Report

A 39-year-old Japanese man visited us with pruritic ery-

thematous macules and vesicles on the dorsa of the left

foot and toes, where he had applied a topical antimycotic

solution containing liranaftate 2%, a cream containing li-

ranaftate 2%, a cream containing amorolfine hydrochlo-

ride 0.5%, and a cream containing ketoconazole 2% (Fig-

ure 1). A 2-day closed patch test was done with these

topical medicaments. A positive reaction was only ob-

served to the solution containing liranaftate 2% at D2(+)

and D4(+). A second patch test was done using each of

the solution’s ingredients, which were provided by the

manufacturer. This second test produced a positive reac-

tion to diethyl sebacate 5% pet. at D2(+) and D4(+)

(Figure 2). All other ingredients were negative. Diethyl

sebacate is not used in the other used topical medica-

ments or in the cream containing liranaftate 2%.

3. Discussion

Seven of eight cases including this presentation were

sensitized to diethyl sebacate as a result of applying to-

pical antifungal medicaments [2-6]. Three sensitized

cases were found by our group [1,3]. The interview

forms for topical antifungal medicaments usually report

Figure 1. Clinical appearance of pruritic erythematous ma-

cules and vesicles on the dorsa of the left foot and toes.

*Corresponding author.

Allergic Contact Dermatitis from Diethyl Sebacate in a Topical Antimycotic Medicament 217

Figure 2. Patch testing produced a positive reaction to di-

ethyl sebacate 5% pet. at D4(+).

that approximately 1% to 2% of users experience allergic

contact dermatitis to the product. Allergic reaction to die-

thyl sebacate is likely more common.

Allergic contact dermatitis from topical medicaments

has been reported in cases caused by 1) effective drugs

such as clotrimazole [12] and luliconazole [13]; 2) addi-

tives including parabens [14], 1,3-butylene glycol [15],

enoxolone [16], diisopropanolamine [9,10], and menthol

[7]; and 3) solvents like lanoline alcohol [17]. The trend

of the sensitized frequencies has been studied in the well

known allergens such as parabens [18,19] and lanolin al-

cohol [19,20]. However, little is known in diethyl seba-

cate.

Our current case indicates the need to investigate the

sensitization frequency to diethyl sebacate in United States

and Japan for safety for patients.

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