Reply to ‘Digital dermoscopy analysis and internet‐based program for discrimination of pigmented skin lesion dermoscopic images’

were also photopatch tested with the carprofen agents and none had a positive reaction. We believe that these reactions are due to photoallergy rather than photoxicity because the problem took 3 weeks to develop, she demonstrated strong photopatch testing reactions at three different concentrations of carprofen, all of which were well below the 5% used in previous studies, no other workers were affected and no controls reacted. Carprofen is a propionic acid derivative and was developed for human use but was not launched on the U.K. or U.S. markets. It was subsequently marketed for the management of canine arthritis. One case of canine photosensitivity was reported to the U.S. Food and Drug Administration in 1997. This group of NSAIDs are the commonest NSAIDs that cause photosensitivity from topical and systemic use and include ibuprofen, ketoprofen and benoxaprofen (Opren ), which was withdrawn from the U.K. market in 1982. She had taken ibuprofen purchased over the counter without any problems in the past. Carprofen, unlike other propionic acid derivatives, undergoes photodehalogenation rather than photodecarboxylation, which would make a cross-reaction due to previous exposure to another NSAID such as ibuprofen unlikely. Photodehalogenation results in the formation of an aryl radical. This has a potent effect on lipids, which has been demonstrated experimentally by the photoperoxidation of linoleic acid by carprofen. There have been numerous reports of photosensitivity caused following ingestion of carprofen by humans, some of which were felt to be photoallergic. It has not previously been reported as an occupational contact photoallergen and it seems likely that contact occurred following transfer of the carprofen from her protective clothing on to her skin while changing back into her everyday clothes. It is important that precautions are taken to avoid potential allergens while handling them in the workplace and this case highlights the need for employers and their employees to be vigilant that allergens do not cause problems following transfer on to the skin during the removal of protective clothing.

[1]  Pietro Rubegni,et al.  Automated diagnosis of pigmented skin lesions , 2002, International journal of cancer.

[2]  M. Oliviero,et al.  Automatic differentiation of melanoma from melanocytic nevi with multispectral digital dermoscopy: a feasibility study. , 2001, Journal of the American Academy of Dermatology.

[3]  J. Castell,et al.  Photobinding of carprofen to protein. , 2000, Journal of photochemistry and photobiology. B, Biology.

[4]  P Rubegni,et al.  Digital dermoscopy analysis and internet‐based program for discrimination of pigmented skin lesion dermoscopic images , 2005, The British journal of dermatology.

[5]  M. Miranda,et al.  Photophysical and photochemical characterization of a photosensitizing drug: a combined steady state photolysis and laser flash photolysis study on carprofen. , 1997, Chemical research in toxicology.

[6]  H P Soyer,et al.  Internet‐based program for automatic discrimination of dermoscopic images between melanomas and Clark naevi , 2004, The British journal of dermatology.

[7]  P. Barbini,et al.  Digital dermoscopy analysis and artificial neural network for the differentiation of clinically atypical pigmented skin lesions: a retrospective study. , 2002, The Journal of investigative dermatology.

[8]  Riccardo Bono,et al.  Melanoma Computer-Aided Diagnosis , 2004, Clinical Cancer Research.

[9]  H. Maibach,et al.  Topical nonsteroidal antiinflammatory drugs: allergic and photoallergic contact dermatitis and phototoxicity , 1993, Contact dermatitis.

[10]  K. Schulz,et al.  Photoallergische Reaktion auf Carprofen , 1984 .

[11]  H. Hönigsmann,et al.  Photopatch testing: the 5-year experience of the German, Austrian, and Swiss Photopatch Test Group. , 1991, Journal of the American Academy of Dermatology.