CONTACT PUZZLE

Allergic ContactDermatitis From aBleaching CreamNuria Barrientos, J. Ortiz-Frutos,E. Gomez, and L. Iglesias

A 47-YEAR-OLD WOMAN was advised to usedaily a depigmenting cream containing hy-

droquinone (5%) and glycolic acid (10%) aftera peeling session with glycolic acid (70%) toprevent postinflammatory hyperpigmentation.Seven days later, she developed erythematousand vesicular itchy plaques on the face at thesites of application. This was followed by a phaseof crusting (Fig 1). She was treated with topicalcorticosteroids and discontinuation of the bleach-ing cream. The lesions disappeared 15 days later.

The patient was patch tested with the GrupoEspanol de Investigacion Dermatitis Contacto(GEIDC) standard series, cosmetics battery, herbleaching cream, and hydroquinone 1% in petro-latum (pet). We used TRUE test (Pharmacia,Hillerød, Denmark) and Leukotest (BDF, Ham-burg, Germany). Patch tests were applied to theupper back. Readings were made at 48 and 96hours using the International Contact Dermati-tis Research Group (ICDRG) score.

From the Department of Dermatology, Hospital Universitario 12 deOctubre, Madrid, Spain.

Address reprint requests to Nuria Barrientos, MD, Hospital 12 deOctubre, Servicio de Dermatologıa, Carretera de Andalucıa Km 5,400,28041 Madrid, Spain.

Copyright © 2001 by W.B. Saunders Company1046-199X/01/1201-0007$35.00/0doi:10.1053/ajcd.2001.22634 Figure 1.

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Contact Puzzle features brief case reportsthat illustrate dramatic and/or unusual exam-ples of contact dermatitis. Submitted manu-scripts should be a maximum of 6 pages printedin 12-point font, double spaced. Format includesCase Report, Diagnosis, Discussion, and Refer-ences (6 or less). A color photograph(s) of theclinical problem is required; color photo-graph(s) of patch test results or other ancillarytest is optional.

American Journal of Contact Dermatitis, Vol 12, No 1 (March), 2001: pp 33-34 33

Diagnosis

Allergic contact dermatitis to hydroquinone con-tained in bleaching cream.

Discussion

Patch testing revealed a 11 reaction to bleach-ing cream and 1 to hydroquinone (Fig 2). Hy-droquinone is used as an inhibitor in acrylicmonomers, an antioxidant in animal feed, and aphotographic reducer and developer. In derma-tology, it is widely used as a hypopigmentingagent. It is relatively safe at concentrations nothigher than 2%. The most common problemscaused by hydroquinone are irritant dermati-tis, leukoderma, ochronosis-like pigmentation,and postinflammatory hyperpigmentation.1 An

achromic patch test reaction to hydroquinonederivatives also has been described.2 Sensitiza-tion to monobenzyl ether of hydroquinone oc-curs frequently, whereas hydroquinone is aweak sensitizer.3

Allergic contact dermatitis caused by hydro-quinone contained in therapeutic creams isextremely rare, but some cases have been re-ported.4,5 Contact hypersensitivity to mono-benzyl ether and other hydroquinone deriva-tives occur more frequently.6,7 In our patient,sensitization to hydroquinone might have beenfacilitated by increased penetration into theskin after the keratolytic effect of peeling.

References

1. Engasser PG, Maibach HI: Cosmetics and dermatology:Bleaching creams. J Am Acad Dermatolol 5:143-147, 1981

2. Sanz de Galeno C, Aguirre A, Zabala R, et al: Achromic patchtest from hydroquinone monobenzyl ether. Contact Derma-titis 29:43-44, 1993

3. Van Ketel WG: Sensitization to hydroquinone and monoben-zyl ether of hydroquinone. Contact Dermatitis 10:253, 1984

4. Romaguera C, Grimalt F: Dermatitis from PABA and Hydro-quinone. Contact Dermatitis 9:226, 1983

5. Camarasa JG, Serra-Baldrich E: Exogenous ochronosis withallergic contact dermatitis from hydroquinone. Contact Der-matitis 31:57-58, 1994

6. Alsina MM, Velez R, Gibert E, et al: Dermatitis de contactopor aplicacion de hidroquinona respetando areas de vitıligo.Med Cut I B L 22:395-398, 1994

7. Lyon CC, Beck MH: Contact hypersensitivity to monobenzylether of hydroquinone used to treat vitiligo. Contact Derma-titis 39:132-133, 1998

Figure 2.

Barrientos et al34