237 DEXKETOPROFEN-INDUCED PHOTOCONTACT DERMATITIS Photocontact dermatitis due to dexketoprofen Nancy Valenzuela, Lluis Puig, Marı ´a A. Barnadas and Agustin Alomar Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Sant Antoni M. Claret, 167, 08025 Barcelona, Spain Key words: arylpropionic derivatives; cross- sensitivity, dexketoprofen; enantiomer; ketoprofen; medicaments; non-steroidal anti-inflammatory drugs; photoallergy; photocontact dermatitis; piketoprofen. Case Report A 61-year-old woman presented in November 2001 with an acute ec- zematous plaque, over the upper 1/3 of her left leg, of 10days’ duration. She had been applying Enangel A (dexketoprofen trometamol 1.25%, Laboratorios Menarini, Barcelona, Spain) 2 ¿ to 3 ¿ daily to that area for several days prior to the onset. She ad- mitted to moderate sun exposure of the treated area, but did not recall any previous topical or oral treatment with either ketoprofen or dexketop- rofen trometamol. The rash resolved in 1week following topical cortico- steroid treatment, without sequelae or persistent photosensitivity. Patch test results with the GEIDC standard series were positive for nickel sulfate (πππ), Myroxylon Pereirae resin (ππ), cobalt chloride (πππ), and palladium chloride (π π). Patch test results with an NSAIDs series (ketoprofen 1% pet., piroxicam 1% pet., diclofenac 5% pet., fepradin- ol 1% pet., benzydamine chloride 3% pet., ibuprofen 5% pet., thiosalicylic acid 0.1% pet., phenylbutazone 1% pet., piketoprofen 2% pet.) plus Enan- gel A 1.25% as (is) were negative. Photopatch test (following ir- radiation with UVA 8J/cm 2 at D2) re- sults were positive for ketoprofen 1% pet. (πππ), piketoprofen 2% pet. (π) and Enangel A 1.25% as is (ππ π). Patch and photopatch tests were then done with the components of En- angel A (dexketoprofen, trometamol, ethyl alcohol 96%, carbomer, laven- der essence HBE-8028), kindly pro- vided by the manufacturer. Only the photopatch test with dexketoprofen 1% pet. was positive at D4 (ππ). Discussion Photocontact dermatitis due to top- ical ketoprofen was first reported in 1985 in Spain (1), and has since been the subject of several single case re- ports and series, especially in coun- tries where topical application is popular and/or sun exposure is likely (1–5). Cross-reactions have been demonstrated between ketoprofen and other arylpropionic derivatives, such as tiaprofenic acid, suprofen, ibuproxam, piketoprofen or flurbi- profen, both clinically and by patch and photopatch testing (2, 4, 5). Photoallergy is due to the benzo- phenone moiety of ketoprofen, but not to the arylpropionic function (4, 6). This induces cross-reactivity to fenofibrate (3, 4), unsubstituted benzophenone (4) and benzo- phenone-containing sunscreens (3), such as benzophenone-3 or benzo- phenone-10, which should probably not be used in such patients. The therapeutic effect of keto- profen, a racemic mixture of 2 en- antiomers, is due to the (S)-(π)-en- antiomer (dexketoprofen), while the (R)-(–)-enantiomer is devoid of bio- logical activity (7). This is the 1st re- port of topical photocontact derma- titis from dexketoprofen trometamol, to our knowledge. Our patient was also shown to cross-react to racemic ketoprofen and piketoprofen, which are also available topically. Concomi- tant sensitization to both ketoprofen and piketoprofen has previously been described (2), but cross-reac- tivity has not been demonstrated in other patients with contact derma- titis from ketoprofen (8) or photocontact dermatitis from pike- toprofen (9). References 1. Alomar A. Ketoprofen photodermat- itis. Contact Dermatitis 1985: 12: 112–113. 2. Gracia Bara M T, Matheu V, Pe ´rez A, Dı ´az M P, Martı ´nez M I, Zapatero L. Contact photodermatitis due to keto- profen and piketoprofen. Alergol In- munol Clin 1999: 14: 148–150. 3. Albe `s B, Marguery MC, Schwarze H P, Journe ´ F, Loche F, Bazex J. Pro- longed photosensitivity following contact photoallergy to ketoprofen. Dermatology 2000: 201: 171–174. 4. Le Coz C, Bottlaender A, Scrivener J, et al. Photocontact dermatitis from ketoprofen and tiaprofenic acid: cross-reactivity study in 12 consecu- tive patients. Contact Dermatitis 1998: 38: 245–252. 5. Pigatto P, Bigardi A, Legori A, Valsecchi R, Picardo M. Cross-reac- tions in patch testing and photopatch testing with ketoprofen, thiaprophen- ic acid and cinnamic aldehyde. Am J Contact Dermat 1996: 7: 220–223. 6. Bosca F, Miranda M A. Photosensit- izing drugs containing the benzo- phenone chromophore. J Photochem Photobiol B 1998: 43: 1–26. 7. Barbanoj M J, Antonijoan R M, Gich I. Clinical pharmacokinetics of dexketoprofen. Clin Pharmacokinet 2001: 40: 245–262. 8. Miralles J C, Negro J M, Sa ´nchez- Gasco ´n F, Garcı ´a M. Ketoprofen contact dermatitis with good piketop- rofen tolerance. Alergol Inmunol Clin 2001: 16: 105–108. 9. Goday J J, Oleaga J M, Gonzalez M, Del Pozo J, Fonseca E. Photoallergic contact dermatitis from piketoprofen. Contact Dermatitis 2000: 43: 315. Address: Dr Agustin Alomar Department of Dermatology Hospital de la Santa Creu i Sant Pau Sant Antoni M. Claret, 167 08025 Barcelona Spain Tel. π34,932919013 Fax: π34,932919136 E-mail: aalomar/hsp.santpau.es