Dermatitis
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Erlotinib is a reversible inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase (TK) newly approved for the treatment of refractory, locally advanced, or metastatic nonsmall cell lung cancer. Acneiform skin reactions with EGFR inhibitors are common, with a dose-dependent skin reaction being seen in 50 to 100% of patients. This case illustrates the typical skin reaction seen with EGFR-TK inhibitors and illustrates the lack of reaction in skin with sebaceous glands that have been destroyed by radiation. Discussion of this skin reaction in the literature of dermatology is limited; this case illustrates a pattern of reaction that may suggest a mechanism for this skin reaction pattern to erlotinib.
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Parabens are alkyl ester derivatives of para-hydroxybenzoic acid and are the most commonly used preservatives in the cosmetic industry. Cross-reactions with para-amino compounds, namely, benzocaine and para-phenylenediamine (PPD), have been reported but are thought to be extremely rare. ⋯ This cross-reaction rate is significant in the tested population but still falls within the previously reported rates of sensitivity to parabens in the general population (0 to 3.5%).
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The eutectic mixture EMLA cream has many medical uses, including pain relief for hemodialyzed patients prior to cannulation. Cutaneous side effects associated with its application have rarely been reported. ⋯ Patch testing elicited a positive reaction to several allergens, including EMLA cream "as is" and prilocaine. The lesions resolved after topical treatment with corticosteroids.
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Although chlorhexidine is a widely used substance, allergic contact dermatitis from chlorhexidine has rarely been reported. Our objective was to study all cases of allergic contact dermatitis from chlorhexidine that were seen at St John's Institute of Dermatology from January 1983 to June 2002. The case records of all patients with positive patch-test reactions to chlorhexidine during the study period were retrieved. ⋯ The possible sources of exposure included Hibisol, Hibiscrub, a chlorhexidine spray, and peri- and postoperative antiseptic solutions. We concluded that allergic contact dermatitis from chlorhexidine is rare. However, when it occurs, it may cause a severe dermatitis reaction.