title: Sources of sensitization, cross-reactions, and occupational sensitization to topical anaesthetics among general dermatology patients.
abstract: BACKGROUND
  Contact sensitization to local anaesthetics is often from topical medicaments. Occupational sensitization to topical anaesthetics may occur in certain occupations.
  
  
  OBJECTIVE
  The aim of the study was to analyse the occurrence of contact sensitization to topical anaesthetics in general dermatology patients.
  
  
  METHODS
  Patch testing with topical anaesthetics was carried out in 620 patients. Possible sources of sensitization and the clinical histories of the patients are analysed.
  
  
  RESULTS
  Positive patch test reactions to one or more topical anaesthetics were seen in 25/620 patients. Dibucaine reactions were most common (20/25), and lidocaine sensitization was seen in two patients. Six patients had reactions to ester-type and/or amide-type anaesthetics concurrently. Local preparations for perianal conditions were the most common sensitizers. One patient had developed occupational sensitization to procaine with multiple cross-reactions and with concurrent penicillin sensitization from procaine penicillin.
  
  
  CONCLUSIONS
  Dibucaine-containing perianal medicaments are the major source of contact sensitization to topical anaesthetics. Although sensitization to multiple anaesthetics can be seen, cross-reactions are possible. Contact sensitization to lidocaine is not common, and possible cross-reactions should be determined when reactions to lidocaine are seen. Occupational procaine sensitization from veterinary medicaments is a risk among animal workers.
authors.affiliation: Department of Dermatology, Allergy Unit, Turku University Central Hospital, PO Box 52, 20521 Turku, Finland. jussi.liippo@utu.fi
authors.forename: Liippo
authors.initials: L
authors.lastname: Jussi
authors.forename: Kaija
authors.initials: K
authors.lastname: Lammintausta
mesh_terms: D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology; D009783:Dermatitis, Occupational / Q000175:diagnosis* / Q000209:etiology; D003992:Dibucaine; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology; D004347:Drug Interactions; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008012:Lidocaine; D008297:Male; D010328:Patch Tests / Q000379:methods; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D003992:Dibucaine