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Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review

immediate, intense, disabling pain of exposed skin and mucosal surfaces. Law enforcement agencies in the U.K. use highly concentrated CS sprays which are composed of CS gas dissolved as 5% w ⁄v in a solvent of methylisobutylketone with nitrogen as a propellant. These sprays emit a pressurized jet of CS solution and are thus more concentrated than an aerosol. People who have been exposed to significant CS gas exposure should have affected clothing removed as soon as possible. Portions of our patient’s clothing were reportedly saturated with CS gas and he remained in this clothing for several hours. The sites affected by his AGEP rash corresponded exactly with the sodden parts of his clothing. Although CS gas has been reported to produce severe allergic contact dermatitis and blistering reactions, CS gas induced-AGEP has not been previously reported in the medical literature. If patch testing is to be carried out, which our patient declined, it has been recommended to be undertaken at dilutions from CS 0Æ1% to 0Æ0001% in acetone. However, under U.K. firearm law, CS incapacitant sprays are classified as prohibited weapons, which makes it difficult to obtain CS for patch testing. In a recently reported case, CS was obtained from a government laboratory, with special handling procedures, for patch testing. We propose that this case highlights the need to consider topical agents as a potential rare cause of AGEP and present the first reported case of CS gas-induced AGEP.