Inmaculada Herrera-Mozo¹ | Pere Sanz-Gallen²      | Bruno Saéz² | Gabriel Marti-Amengual²

¹Unit of Allergy, Clínica Creu Blanca, Barcelona, Spain

²Unit of Occupational Medicine and Toxicology, Department of Medicine, Faculty of Medicine and Health Sciences, Barcelona, Spain

Correspondence

Pere Sanz-Gallen, Unit of Occupational Medicine and Toxicology, Department of Medicine, Faculty of Medicine and Health Sciences, C/Casanova, 143, Barcelona 08036, Spain.

Email: 17039psg@comb.cat

KE YW OR DS : allergic contact dermatitis, case report, hydroxychloroquine sulfate, occupational

Occupational exposure to active pharmaceutical ingredients can have adverse health effects.¹ Occupational contact dermatitis caused by 4- aminoquinolines (amodiaquine, chloroquine, and hydroxychloroquine) is rare; 1 case caused by chloroquine sulfate ² and another caused by hydroxychloroquine³ have been described. We report a case of occu- pational contact dermatitis caused by hydroxychloroquine sulfate in a worker in the pharmaceutical industry.

CASE REPORT

A 42-year-old man, with no history of atopy or lifestyle risk factors, had worked for 18 months in a pharmaceutical company; the first 10 months in the drug packaging section, and the last 8 months in the manufacture of hydroxychloroquine sulfate. A month before con- sultation, a pruritic rash on the back of his hands and wrists had appeared, and topical corticosteroids and oral antihistamines were prescribed. After 2 weeks, when he was free of symptoms, he returned to work. However, 4 days later, a pruritic rash on the hands and wrists appeared again.

Prick tests performed with a non-irritant concentration of

20 mg/L hydroxychloroquine sulfate yielded a negative result. Patch testing was performed with the Grupo Español de Investigación de Dermatitis de Contacto (the Spanish Contact Dermatitis Research Group) (GEIDC) baseline series supplemented with hydroxychloro- quine sulfate 0.5%, 1% and 2% in saline solution.³ Results on day

(D) 2 and D4 showed positive reactions to hydroxychloroquine sul- fate (2%, ++; 1%, ++; and 0.5%, +). Prick tests and patch tests gave negative results in all 6 healthy controls tested. The patient left his job, and his allergic contact dermatitis cleared.

DISCUSSION

Hydroxychloroquine sulfate is a 4-aminoquinoline, like amodia- quine and chloroquine. It is used mainly for the prophylaxis and treatment of malaria, and for the treatment of rheumatoid arthritis and systemic lupus erythematosus. In 1984, Kellet and Beck² reported a case of a maintenance worker in the pharmaceutical industry who was exposed to chloroquine sulfate powder and pre- sented with rashes on the forearms, face, and eyelids. The patch test was positive only for chloroquine sulfate. Meier et al³ reported a case of bronchial asthma and generalized allergic der- matitis caused by hydroxychloroquine in a worker in the pharma- ceutical industry. Our case was diagnosed as having type IV hypersensitivity to hydroxychloroquine sulfate after 8 months of exposure. As hydroxychloroquine sulfate is a sensitizer, effective preventive measures should be taken to prevent cases such as that reported here.

ORCID

Pere Sanz-Gallen  http://orcid.org/0000-0001-5592-4014

REFERENCES

1. Heron RJL, Pickering FC. Health effects of exposure to active pharmaceutical ingredients (APIs). Occup Med (Lond). 2003;53: 357-362.
2. Kellett JK, Beck MH. Contact sensitivity to chloroquine sulphate. Con-

tact Dermatitis. 1984;11:47.

• Meier H, Elsner P, Wüthrich B. Berufsbedingtes Kontaktekzem und Asthma bronchiale bei ungewöhnlicher allergischer Reaktion vom Spät- typ auf Hydroxychoroquin. Hautarzt. 1999;50:665-669.

How to cite this article: Herrera-Mozo I, Sanz-Gallen P, Saéz B, Marti-Amengual G. Occupational contact dermatitis caused by hydroxychloroquine sulfate. Contact Dermatitis. 2018;1–2. https://doi.org/10.1111/cod.12999