Contact dermatitis from ketoconazole

Case no. 1 A 36-year-old man presented in May 1992 with an erythematous, edematous, vesicular dermatitis with severe itching of the abdomen, inguinal region and legs. His practitioner had prescribed a cream containing ketoconazole for tinea cruris. 2 weeks later, the patient developed intensely itchy erythema, edema and vesicles in the inguinal region, with subsequent spread to the abdomen and legs. The dermatitis completely cleared with boric acid solution dressings and topical and systemic corticosteroid therapy within 2 weeks. There was no personal or family history of atopy, contact dermatitis or previous drug reaction. A month later, he was patch tested with the GIRDCA standard series and Nizoral cream (as is). At 3 days, there was a + + + reaction to the cream. Subsequent patch tests with the pure imidazole component of the cream (1% and 2% eth.) and with other ingredients were carried out. All reactions were negative, except for a + + + reaction to ketoconazole.