title: Allergic contact dermatitis to proparacaine with subsequent cross-sensitization to tetracaine from ophthalmic preparations.
abstract: We report 2 cases of allergic contact dermatitis (ACD) to proparacaine and tetracaine. Patient 1 is an ophthalmologist with chronic finger pad dermatitis sensitized to the topical anesthetic proparacaine. Despite discontinuance of proparacaine and substitution with a patch test negative agent, tetracaine, his hand dermatitis persisted. Follow up patch testing documented that acquisition of contact allergy to tetracaine as well as thiuram had taken place. Patient 2 had a periocular eczematous dermatitis with ACD to both proparacaine and tetracaine. Cross sensitization between related topical ophthalmologic anesthetics has been suggested to be a rare occurrence. We suggest that allergic sensitization and possible cross-reaction to topical anesthetics in ophthalmologists and ophthalmologic technicians is an occupational hazard. Chronically eczematized skin might result in increased exposure to contact allergens and result in concomitant allergic sensitization. ACD to topical anesthetic agents among ophthalmologists should be recognized as a potential hazard.
authors.affiliation: Department of Dermatology, University of California, School of Medicine, San Francisco, CA, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Dannaker
authors.forename: H I
authors.initials: HI
authors.lastname: Maibach
authors.forename: E
authors.initials: E
authors.lastname: Austin
mesh_terms: D000485:Allergens / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D003429:Cross Reactions; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005143:Eyelids; D005260:Female; D006229:Hand Dermatoses / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000009:adverse effects*; D010328:Patch Tests; D011430:Propoxycaine / Q000009:adverse effects; D013748:Tetracaine / Q000009:adverse effects
chemical_list: D000485:Allergens; D000779:Anesthetics, Local; D009883:Ophthalmic Solutions; D013748:Tetracaine; C005717:proxymetacaine; D011430:Propoxycaine