Patch testing with benzoyl peroxide: reaction profile and interpretation of positive patch test reactions.
BACKGROUND
Patch testing with benzoyl peroxide 1% pet. frequently leads to (weak) positive reactions, often with uncertain clinical relevance.


OBJECTIVE
To describe the pattern of patch tests reactions to benzoyl peroxide and to identify patients at risk of a positive reaction.


METHODS
Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 1992-2007.


RESULTS
Benzoyl peroxide 1% pet. was tested in 29 758 patients. Weak positive reactions (erythema, infiltration, possibly papules) occurred in 6.5%, and strong positive reactions (erythema, infiltration, vesicles) in 1.3%. According to logistic regression analysis, strong positive reactions to benzoyl peroxide were associated with leg or face dermatitis, work as dental technicians, young age and being female. Patients with atopic dermatitis had a significantly increased risk of weak positive reactions only.


CONCLUSIONS
Our analysis confirms that benzoyl peroxide 1% pet. is a problematic patch test preparation. Hence, clinical relevance of reactions to benzoyl peroxide has to be assessed very carefully. Patients with atopic dermatitis are particularly prone to irritant reactions to benzoyl peroxide. True allergic reactions may occur in dental technicians and following the treatment of leg ulcers with highly concentrated benzoyl peroxide in past. In contrast, widely used acne treatments with benzoyl peroxide seems to sensitize only rarely.
Ockenfels
Hans-Michael
HM
Department of Dermatology, Klinikum Hanau, 63450 Hanau, Germany. hautklinikum-hanau@ndh.net
Uter
Wolfgang
W
Lessmann
Holger
H
Schnuch
Axel
A
Geier
Johannes
J
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001585:Benzoyl Peroxide / Q000009:adverse effects*; D002648:Child; D003800:Dental Technicians; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000453:epidemiology; D003879:Dermatologic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000188:drug therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D010328:Patch Tests; D012189:Retrospective Studies; D012737:Sex Factors
D003879:Dermatologic Agents; D001585:Benzoyl Peroxide