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Allergic contact dermatitis from kojic acid

Case Report A 55-year-old woman was referred with worsening hand eczema of 22 months duration. She had worked in a canteen for 30 years, having the occasional episode of eczema affecting the dorsum of her hands alone. 2 months prior to the onset of the recent eruption, she changed to a different workstation and became responsible for ‘‘buttering’’ approximately 200 slices of toast in the mornings in under 1 h. She was right-handed and took the toast from the toaster with this hand, holding the slice, prior to spreading with margarine, in her left. She developed problems with her palms and fingertips of both hands. There was minimal exposure to onion and none to garlic. She noticed that her hands improved when on holiday and at the weekends. There was no history of atopy. Hormone replacement therapy had been started 5 years earlier. On examination, she had circumscribed fissured scaly patches on the fingers and palms, with accentuation on the pulps of the fingers. There were associated hyperkeratotic patches on the palms. She was patch tested to the European standard series and fresh onion but showed no relevant positive reactions. She was advised to use hydrocolloid dressings on her fingertips for protection and gloves whilst at work, but found these measures impractical.