Acute allergic contact dermatitis caused by sulphites in a cosmetic and a pharmaceutical cream

Sulphites are widely used for their antioxidant and preservative properties, notably in pharmaceuticals and personal care products.1-3 Even though sulphites are recognised as contact allergens, their relevance in cases of acute contact dermatitis can rarely be labelled as definite.1-5 We present a case of acute facial contact dermatitis caused by a cosmetic cream designated for ‘sensitive’ skin and aggravated by a pharmaceutical cream. A 41-year-old woman with a history of recurrent erythematous plaques on the cheeks was prescribed by her dermatologist three cosmetic creams, including Sebium Sensitive (BIODERMA, NAOS, Aix-en-Provence, France). After 2 days of application, she noted a worsening of her facial lesions and new itching and burning sensations. She was then prescribed desonide 0.1% cream and ketoconazole 2% cream (KETODERM, Janssen-Cilag, Beerse, Belgium). One day later, her dermatosis had worsened even more, leading her to the dermatology emergency room. Erythematous and very oedematous plaques on her cheeks and nose were noted (Figure 1). An acute contact dermatitis was suspected, which resolved in 1 week with the exclusive use of desonide cream. The patient was patch tested with the European baseline series, a Chemotechnique Diagnostics (Vellinge, Sweden) cosmetics series and the suspected products tested ‘as is’ (three facial creams, KETODERM and desonide cream). Patch tests were applied on her upper back in IQ Ultra chambers (Chemotechnique Diagnostics) and read at Day (D) 2 and D4 in accordance with the International Contact Dermatitis Research Group guidelines. Positive reactions were noted for sodium metabisulphite 1% pet. (Chemotechnique Diagnostics; ++/++), KETODERM (++/++) and Sebium Sensitive (−/++) (Figure 2). Both creams contained sulphites. We report an acute contact dermatitis induced by a moisturising cream designated for ‘sensitive’ skin containing sodium metabisulphite, further aggravated by a therapeutic cream containing sodium sulphite. Regarding the short delay between the first application of Sebium Sensitive and the acute dermatitis onset, our patient was probably previously sensitised to sulphites, which could potentially explain her previous episodes of facial erythema. Moreover, the exacerbation after applying KETODERM can be explained by a cross-reaction between sodium sulphite and sodium metabisulphite.1, 6 Just as the American Contact Dermatitis Society chose sulphites as the Allergen of the Year for 2024,1 our rare case highlights the relevance of sensitisation to sulphites. It is also a reminder to be suspicious of all topical products used, even pharmaceuticals and cosmetics labelled to be appropriate for ‘sensitive’ skin. Valérie Beaulieu: Investigation; writing – original draft; writing – review and editing. Ilaria Matei: Writing – review and editing. Nancy Hajjar: Investigation; writing – review and editing. Saskia Ingen-Housz-Oro: Writing – review and editing. Haudrey Assier: Writing – review and editing; investigation; methodology; validation. The authors declare no conflict of interest. The authors obtained informed written consent from the patient for the photos to be used.

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