LAUSR

A 72-year-old nonatopic woman presented with a 4-year history of erythema on her face. She had rheumatoid arthritis treated with methotrexate and etanercept. Face dermatitis had been treated with corticosteroid ointments but the eruptions recurred and spread. Because her eruption worsened over the preceding 3 weeks, she presented to our hospital with erythema and vesicles on her face (Figure 1A,B), arms, and legs. From the medical history and clinical picture, allergic contact dermatitis due to cosmetics was suspected. We suggested that she stop her daily cosmetics and use only moisturizer and foundation. With application of topical tacrolimus ointments, her symptoms were eliminated completely. We conducted patch tests with her cosmetics “as is,” the Japanese baseline series, a metal allergen series, and a cosmetic allergen series from our department. Patch tests were performed using Finn Chambers and Patch tester Tori, and the reactions were read on day (D) 2, D3, and D9 in accordance with the International Contact Dermatitis Research Group (ICDRG) criteria. There were positive reactions to a skin-whitening lotion (D3, ?+; D9, ?+), a skin-whitening cream (D3, +; D9, ?+), and 3-O-ethyl-L-ascorbic acid 10% aq. (D3, +; D9, +). 3-O-ethyl-L-ascorbic acid was contained in the skin-whitening cream ingredients. The diagnosis of allergic contact dermatitis caused by 3-O-ethyl-L-ascorbic acid was made. There were also positive reactions to pphenylenediamine (D3, +; D9, ?+), thiomersal (D3, ++; D9, +), and fradiomycin sulfate (D3, +; D9, +). Discontinuation of the use of the skin-whitening cosmetics resulted in complete healing of the erythema without relapse. DISCUSSION