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Contact hypersensitivity in rosacea – a study in 82 patients

Editor There are only few data concerning the frequency of contact hypersensitivity (CH) in rosacea, although it in fact can play an important role in the therapy or in the daily life of the patients. The aim of this study was to map the ratio of CH in 82 unselected rosacea patients (68 women, 14 men, over all 18 years, mean age: 54.4) tested in the Department of Dermatology, Venerology and Dermato-oncology of the Semmelweis University between January 2004 and December 2009. The patch tests were performed with Brial GmbH D-Greven series, and the reactions were evaluated (with 48 h occlusion) at 48, 72 and 96 h and on the 7th day. The patients did not take any antihistamine or immunosuppressive agents, and used only indifferent topical treatment 1 week before the tests and at the time of testing. Pregnancy, breast feeding, acute skin symptoms and UV radiation within 6 weeks before testing were drop-out criteria. CH was detected in 29 cases (35.4%). Most common allergens were nickel, balsam of Peru and fragrance mix I (Table 1). Among the relevant allergens, balsam of Peru (5 ⁄ 5), fragrance mix I (4 ⁄ 4), lanalcolum and PPD (3 ⁄ 3) were the most common. Relevant CH can rather be related to cosmetics (46.1%) and washing agents (38.4%). 38.8% of women face creams and make-ups and 20% lotions and gels were in connection with the CH. 27.8% showed CH as a component of therapeutic medical creams. At the time of testing, 80.5% of the patients were over 41 years. In 24 patients, the clinical symptoms had been present for 1–2 years, and in six cases, it was present for over 10 years. Two women had atopic dermatitis. The rosacea symptoms did not show correlation with the occupation of the patients. There is only few data about the ratio of CH in rosacea. In this study, the ratio of CH to nickel (7.3%) meets previous data (3.4–15.5%), to that of balsam of Peru (6.1%) is lower than previous data (6.9–10.4%),and to that of fragrance mix I (4.9%) is lower than previous results (5.2–10.3%). Rosacea patients are very susceptible to adverse reactions caused by external formulations, and so the choice of local treatment and cosmetics is difficult. The presence of CH must be kept in mind. According to our results, relevant CH associate mostly with cosmetics in rosacea patients.