Allergic contact cheilitis from D&C Red no. 7 in lipstick

A 40-year-old housewife was renovating her bathroom using Tile Magic (Knauf DIY, Maidstone, UK). This ‘do-it-yourself ’ (DIY) product renovates ceramic tiles in 4 steps, finishing with the application of an isocyanate coating to the tiles with a roller. While using Tile Magic, within an hour of completing the 4th stage, the patient developed severe pruritic erythema on the face, neck and arms, associated with peri-orbital oedema. This settled with potent topical application of corticosteroids over 2 weeks. She had had a similar, although less marked, reaction after using the final stage of Tile Magic, 3 months earlier. The manufacturer of Tile Magic listed the constituents of the isocyanate coating for us. The patient was patch tested with the British standard series, a glue series and a further range of isocyanates, including diphenyldimethyldiisocyanate,toluenediisocyanate, isophorone diisocyanate and 1,6-hexamethylene diisocyanate (Chemotechnique Diagnostics, Malmö Sweden). Readings were taken at D2 and D4, and 1,6-hexamethylene diisocyanate gave a þþ reaction on both days. The other isocyanates were negative, as were all the remaining tests. 1,6-hexamethylene diisocyanate was one of the listed constituents of the final coating stage of Tile Magic.

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