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Occupational contact dermatitis caused by hydroxychloroquine sulfate

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Inmaculada Herrera-Mozo1 | Pere Sanz-Gallen2      | Bruno Saéz2 | Gabriel Marti-Amengual2

1Unit of Allergy, Clínica Creu Blanca, Barcelona, Spain

2Unit of Occupational Medicine and Toxicology, Department of Medicine, Faculty of Medicine and Health Sciences, Barcelona, Spain

Correspondence

Pere Sanz-Gallen, Unit of Occupational Medicine and Toxicology, Department of Medicine, Faculty of Medicine and Health Sciences, C/Casanova, 143, Barcelona 08036, Spain.

Email: 17039psg@comb.cat

KE YW OR DS : allergic contact dermatitis, case report, hydroxychloroquine sulfate, occupational

Occupational exposure to active pharmaceutical ingredients can have adverse health effects.1 Occupational contact dermatitis caused by 4- aminoquinolines (amodiaquine, chloroquine, and hydroxychloroquine) is rare; 1 case caused by chloroquine sulfate 2 and another caused by hydroxychloroquine3 have been described. We report a case of occu- pational contact dermatitis caused by hydroxychloroquine sulfate in a worker in the pharmaceutical industry.

CASE REPORT

A 42-year-old man, with no history of atopy or lifestyle risk factors, had worked for 18 months in a pharmaceutical company; the first 10 months in the drug packaging section, and the last 8 months in the manufacture of hydroxychloroquine sulfate. A month before con- sultation, a pruritic rash on the back of his hands and wrists had appeared, and topical corticosteroids and oral antihistamines were prescribed. After 2 weeks, when he was free of symptoms, he returned to work. However, 4 days later, a pruritic rash on the hands and wrists appeared again.

Prick tests performed with a non-irritant concentration of

20 mg/L hydroxychloroquine sulfate yielded a negative result. Patch testing was performed with the Grupo Español de Investigación de Dermatitis de Contacto (the Spanish Contact Dermatitis Research Group) (GEIDC) baseline series supplemented with hydroxychloro- quine sulfate 0.5%, 1% and 2% in saline solution.3 Results on day

(D) 2 and D4 showed positive reactions to hydroxychloroquine sul- fate (2%, ++; 1%, ++; and 0.5%, +). Prick tests and patch tests gave negative results in all 6 healthy controls tested. The patient left his job, and his allergic contact dermatitis cleared.

DISCUSSION

Hydroxychloroquine sulfate is a 4-aminoquinoline, like amodia- quine and chloroquine. It is used mainly for the prophylaxis and treatment of malaria, and for the treatment of rheumatoid arthritis and systemic lupus erythematosus. In 1984, Kellet and Beck2 reported a case of a maintenance worker in the pharmaceutical industry who was exposed to chloroquine sulfate powder and pre- sented with rashes on the forearms, face, and eyelids. The patch test was positive only for chloroquine sulfate. Meier et al3 reported a case of bronchial asthma and generalized allergic der- matitis caused by hydroxychloroquine in a worker in the pharma- ceutical industry. Our case was diagnosed as having type IV hypersensitivity to hydroxychloroquine sulfate after 8 months of exposure. As hydroxychloroquine sulfate is a sensitizer, effective preventive measures should be taken to prevent cases such as that reported here.

ORCID

Pere Sanz-Gallen  http://orcid.org/0000-0001-5592-4014

REFERENCES

  1. Heron RJL, Pickering FC. Health effects of exposure to active pharmaceutical ingredients (APIs). Occup Med (Lond). 2003;53: 357-362.
  2. Kellett JK, Beck MH. Contact sensitivity to chloroquine sulphate. Con-

tact Dermatitis. 1984;11:47.

  • Meier H, Elsner P, Wüthrich B. Berufsbedingtes Kontaktekzem und Asthma bronchiale bei ungewöhnlicher allergischer Reaktion vom Spät- typ auf Hydroxychoroquin. Hautarzt. 1999;50:665-669.

How to cite this article: Herrera-Mozo I, Sanz-Gallen P, Saéz B, Marti-Amengual G. Occupational contact dermatitis caused by hydroxychloroquine sulfate. Contact Dermatitis. 2018;1–2. https://doi.org/10.1111/cod.12999