Study background: topical antifungal drugs are widely used, mostly without confirmation of fun gal etiology of the treated skin disease. This may lead to increased risk of sensitisation. The aim of the study was to assess the frequency of positive patch test reactions to most popular antifun gals in eczema patients, previously treated by general practitioners with topical imidazole antifungals.
Study group: 68 eczema patients, 45 females and 23 males, aged 14-71 years, referred by general practitioners to the dermatology unit for diagnosis after a period of "empirical" therapy including topical antifungals. Patch test were carried out with the 5 most popular topical antifungals in Poland: Clotrimazolum 1% cream (clotrimazole), Polfungicid 5% ointment (chlormidazole), Mycospor 1% cream (bifonazole), Pevaryl 1% cream (econazole), and Daktarin 2% cream (miconazole). The drugs were applied for 48 hours using IQ chambers.
Positive patch tests reactions were found in 6 subjects (2 females and 4 males), who comprised 8.8% of the population studied. Four subjects were reactive to 2 different antifungals and 2 subjects reacted each to one drug. Mycospor 1% cream and Pevaryl 1% cream provoked positive reaction each in four subjects, Clotrimazolum 1% cream and Daktarin 2% cream elicited reactions each in one subject tested. No positive reaction was observed to Polfungicid 5% ointment.
The author concludes that prolonged use of topical antifungal preparations is capable of inducing contact allergy either to the active substance or to the vehicle ingredients. Therefore, the philosophy of trying some "empirical' antifungal therapy without a mycological confirmation should be waived.
KEY WORDS: antifungal therapy, side effects, topical antifungals, drug allergy, eczema patients, patch test.
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