Abstract
A 15-year-old girl with superinfected chronic shoe contact dermatitis applied an ointment containing neomycin and bacitracin on her lesions. Five minutes later, she developed generalized urticaria progressing to nausea, vomiting, diarrhea, and hypotension. Because the patient did not suspect the ointment as a cause of her symptoms, she used the same ointment 4 weeks later, leading to even more pronounced anaphylactic symptoms. Bacitracin elicited a urticarial reaction in the skin rubbing test. Neomycin sulfate was negative both in the rubbing and in the patch test. Bacitracin is a high-molecular-weight antibiotic widely used in topical preparations (over-the-counter [OTC] drugs) for treatment of superficial skin infections. Whereas contact dermatitis to bacitracin is frequent in selected populations, only four cases of anaphylactic reactions to topically applied bacitracin have been described. Because in those cases bacitracin had been applied to stasis ulcers or to large dermatitic areas, considerable systemic absorption of the drug was assumed to be necessary to induce anaphylaxis. Our observation demonstrates, however, that application of bacitracin even to small areas of dermatitic skin (dorsa of the feet) may pose a risk of anaphylactic reactions.
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