Allergic contactdermatitis due to sodiummetabisulfite ina bleaching cream

Contact Dermatitis 2007: 56: 123–124

Pei-Ying Huang and Chia-Yu Chu

Department of Dermatology, NationalTaiwan University Hospital and NationalTaiwan University College of Medicine,Taipei 100, Taiwan

Key words: allergic contact dermatitis;bleaching cream; hydroquinone; sodium meta-bisulfite.

Case Report

A 52-year-old woman presented withchloasma on bilateral zygomatic areasfor several years. She was prescribedwith a bleaching cream, Shines�,

containing 4% hydroquinone as theactive component. After she appliedthis agent for 3 consecutive nights,erythema and swelling occurred onher face. The erythema and swellingresolved within 1 week after she stop-ped using Shines cream. However,when she applied the same bleachingcream again, diffuse erythema withitching papules recurred and per-sisted for 3 weeks. Patch testing toShines cream (as is) showed positivereactions at day (D) 3 and D5. Shewas further patch tested with theingredients of Shines cream. Patchtest reactions were (þþ) at D2 andD4 for sodium metabisulfite in 2%aqua (aq.) 5% aq., 2% pet., and 5%pet.; patch testing with sodium laurylsulfate in 0.1% aq., 0.5% aq., 1%aq., and 0.5% pet. showed irritantreaction at D2 but negative at D4,while the other 8 ingredients wereall negative. The relevant patch testresults led to the diagnosis of allergiccontact dermatitis to sodium metabi-sulfite in a bleaching cream.

Discussion

Sodium metabisulfite, Na2S2O5, isa moderately strong reducing agentand an antioxidant. The major usageincludes food and beverage industry,pharmaceutical preparations, cosmeticspreparations, and photography (1).Sodium metabisulfite is generallyconsidered safe. However, adversereactions to sulfite in foods andpharmaceuticals, including anaphyl-actic shock, asthmatic attacks, urti-caria and angioedema, nausea,abdominal pain, diarrhea, seizures,and death, have been reported (2).A relevant contact allergy to sodiummetabisulfite is not often encoun-tered. But there have been reportsof occupational contact dermatitisin a salad maker (3), baker (1), pastryfactory worker (4), and photographictechnician (5). Allergic contact der-matitis to sodium metabisulfite hasbeen described in topical medica-ments, including ketoconazole (6),corticosteroids (7–9), antihemorrhoi-dal creams (10), and local anesthetics(11). Our patient developed allergiccontact dermatitis to sodium metabi-sulfite in a bleaching cream, whichhas not been reported previously.According to the pharmaceutical fac-tory, sodium metabisulfite is used invery low concentration in Shinescream as an antioxidant to promote

the stability of the hydroquinonecomposition.

The ideal test concentration forsodium metabisulfite has yet to bedetermined (8). Previous studies hadused several different concentrationsand vehicles of sodium metabisulfitefor patch testing, including 0.1%,2%, 5%, and 10% aq., as well as1%, 2%, and 5% pet. (1, 3–5, 8–10).Although higher concentrations(10% and 20% aq.) of sodium meta-bisulfite may be too high and mightproduce false-positive reactions, a con-trol study had showed that the patchtesting of 5% pet. sodium meta-bisulfite would produce only milderythema at D2 but not at D4 (8),indicating that concentrations lessthan 5% would be suitable forpatch testing for sodium metabisul-fite.

The major component of Shinescream is hydroquinone (40 mg/g).Hydroquinone inhibits the conver-sion of dopa to melanin by inhibitingthe activity of tyrosinase, increasesthe degradation of melanosomes,and inhibits the DNA and RNA syn-thesis of melanocytes and is used forchloasma treatment (12). The mostcommon problems caused by hydro-quinone are irritant dermatitis, leuko-derma, ochronosis-like pigmentation,and postinflammatory hyperpigmen-tation. However, allergic contact der-matitis caused by hydroquinonecontained in therapeutic creams isextremely rare (13). It is thus worth-while to perform the patch tests for allthe ingredients to identify the contactallergens if contact dermatitis occursafter using a hydroquinone cream.

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12. RendonM, BerneburgM, Arellano I,Picardo M. Treatment of melasma.J Am Acad Dermatol 2006: 54 (5Suppl. 2): S272–S281.

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Address:Chia-Yu Chu, MDDepartment of DermatologyNational Taiwan University Hospital7 Chung-Shan South RoadTaipei 100,TaiwanTel: þ886 2 23562141Fax: þ886 2 23934177e-mail: chiayu.chu@gmail.com

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