Topical non steroidal anti-inflammatory drugs (NSAIDs)


Widely used in the treatment of various eczemas.
 
Incidence
Difficult to evaluate.
 
French contact dermatitis group (GERDA) recently reported 62 observations.
 
The first national pharmacovigilance inquiry (1993-95) in France reported 260 cases of local intolerance to topical NSAIDs among 11 million units sold.
 
Risk factors
Sun exposure.
 
Summertime.
 
Arylpropionic derivatives (ketoprofen).
 
Clinical manifestations
Contact dermatitis, photocontact dermatitis, contact erythema multiforme.
 
The mean duration of application is 13 days ; eruption may be prolonged (mean duration 25 days) with frequent regional or generalized extension.
 
Oral administration of NSAIDs following cutaneous sensitization may lead to severe generalized eruption.
 
Diagnostic methods
Cutaneous testing
 
Patch-tests and photopatch-tests (UVA, UVB and total light).
 
Oral challenge may be dangerous and should be avoided.
 
Mechanisms
Delayed contact hypersensitivity and virtual photocontact sensitivity (preponderance of UVA).
 
Cross-sensitivity exists between NSAIDs of the same family.
 
Photo allergy is due to the benzophenone moiety of ketoprofen, or thiophene-phenylketone moiety of tiaprofenic acid but not to the arylpropionic function.
 
Management
Avoidance of causative family
 
Use of NSAIDs of other families if mandatory.
 
If there is photosensitivity to ketoprofen or tiaprofenic acid, avoid fenofibrate and benzophenones. Alminoprofen, fenoprofen, flurbiprofen, ibuprofen or naproxen may be tolerated in such cases.
 

References

  1. le Coz C.J, Bottlaender A, Scrivener J.N, Santinelli F, Cribier B.J, Heid E, Grosshans E, "Photocontact dermatitis from ketoprofen and tiaprofenic acid: cross-reactivity study in 12 consecutive patients", Contact Dermatitis, 1998 ; 38: 245-52
  2. Bastien M, Milpied-Homsi B, Baudot S, Dutartre H, Litoux P, "Photosensibilisation de contact au ketoprofene. 5 observations.", Ann. Derm. Venereol., 1997 ; 124: 523-6
  3. Milpied B, "Réseau Revidal et AINS topiques: un an d’expérience", La lettre du GERDA, 1997 ; 14: 50-4

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.