Allergic contact dermatitis of the auricle.A 37-year-old man with chronic otitis media Chronic otitis media Inflammation of the middle ear with signs of infection lasting three months or longer. Mentioned in: Myringotomy and Ear Tubes chronic otitis media underwent a left tympanoplasty tympanoplasty /tym·pa·no·plas·ty/ (tim´pah-no-plas?te) surgical reconstruction of the tympanic membrane and establishment of ossicular continuity from the tympanic membrane to the oval window. via a postauricular approach. During surgery, the external auditory canal external auditory canal n. See ear canal. was packed with gelatin foam soaked in neomycin/colistin/hydrocortisone otic suspension. Three days after surgery, the patient began experiencing auricular erythema. At 1 week, he had developed a papular papular characterized by the development of epidermal or oral mucosal papules. bovine papular stomatitis a benign stomatitis caused by a poxvirus in the genus Parapoxvirus. erythematous dermatitis with areas of scaling in addition to a clear, yellowish otorrhea (figure). He also complained of pruritus in the ear and on the skin around the ear. [FIGURE OMITTED] The patient was diagnosed with allergic contact dermatitis allergic contact dermatitis Allergic dermatitis Dermatology A condition caused by cell-mediated immunity due to contact with haptens–eg, nickel, chromates, ursodiols in poison ivy and poison oak, synthetic chemicals, drugs, cosmetics, jewelry, neomycin of the auricle auricle /au·ri·cle/ (aw´ri-k'l) 1. pinna; the flap of the ear. 2. the ear-shaped appendage of either atrium of the heart. 3. formerly, the atrium of the heart. . The dermatitis represented a delayed Gell and Coombs type IV hypersensitivity reaction. The most common cause of this dermatitis is the neomycin component of the otic drops. Previous use of ear drops that contain this agent may sensitize a patient to the antigen. In one study, 13% of patients who were treated for chronic otitis media were allergic to neomycin on skin patch testing. (1) Avoidance of the offending allergens is the most preferable strategy for managing allergic contact dermatitis. For patients who have already been exposed to an offending allergen, medical treatment is indicated. Oral antihistamines and topical corticosteroids often help in the resolution of this condition. In severe cases, oral corticosteroids may be needed and, in cases of bacterial superinfection superinfection /su·per·in·fec·tion/ (-in-fek´shun) a new infection occurring in a patient having a preexisting infection, such as bacterial superinfection in viral respiratory disease or infection of a chronic hepatitis B carrier with , oral antibiotic therapy may also be necessary. Patients who are allergic to topical neomycin may also be allergic to other topical and systemic aminoglycosides, so they should avoid using any of these agents. If there is any doubt as to whether a patient has a true allergy to neomycin, skin patch testing may be performed. Another possible--although uncommon--cause of allergic contact dermatitis is allergy to corticosteroids; patch testing can also be performed if a steroid allergy is suspected. Reference (1.) Yung MW, Rajendra T. Delayed hypersensitivity reaction to topical aminoglycosides in patients undergoing middle ear surgery. Clin Otolaryngol Allied Sci 2002;27(5):365-8. Eric P. Wilkinson, MD; Jose N. Fayad, MD |
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