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Allergic contact dermatitis of head and neck by propolis contained in a shampoo

A 42-year-old woman was referred to our contact eczema department with head and neck eczema lasting 6 months. The patient had been diagnosed initially with atopic dermatitis of a head and neck pattern. However, treatment with topical methylprednisolone aceponate 0.1% cream did not improve the eczema. Subsequently the patient was treated for 2 weeks with prednisone (1 mg/kg/day) and bilastine 20 mg per day, also without improvement. During re-interview of the patient, the focus was put on cosmetic products, and she reported the use of a new shampoo (Propomel shampoo, NadiPrana, Tarragona, Spain) in the last 8 months and intense pruritus after the use of the shampoo. Nevertheless, she continued using it, as she considered it as a natural and harmless product. The patient denied digestive symptoms related to the consumption of honey. Physical examination showed subacute eczema located on the head and neck (Figure 1A), with more marked desquamation on the eyelids (Figure 1B), and erythematous and edematous confluent papules and plaques on the neckline (Figure 1C). Blood test results were all within normal results. Patch tests were performed with the European comprehensive baseline series (Chemotechnique Diagnostics, Vellinge, Sweden),