engleski

Development of contact hypersensitivity after application of bioocclusive bandage with ibuprofen

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been applied topically for decades. This route possibly reduces gastrointestinal adverse reactions by maximizing local delivery and minimizing systemic toxicity. Compared with oral NSAIDs, fewer patients taking topical NSAIDs had any adverse events, withdrawals due to side effects, and gastrointestinal side effects, but significantly more patients had local side effects such as rash, itch, and burning. Aim of this case was to facilitate healing of allergic leukocytoclastic vasculitis lesions – symmetric purpuric exanthema and ulcer caused by immune complex reactions on coutaneous capillaries and venules endotel. A 69 year old woman was admitted with shallow secreting and painful ulcerations on her right leg, and hemorrhagic papulesand vesicules symmetrically distributed on both legs (Fig. 1). The histopathologic and immunopathologic examinations confirmed the diagnosis of vesculitis allergic leukocytoclastica (Fig. 2). Patient was administered systemic corticosteroids in a dose of 0.5 mg/kg body weight. Topical therapy revealed application of corticosteroid agents, antiseptic dressings on ulcer, enzymatic debridement, which prevents pain and because of gastrointestinal adverse reactions we decided to use local bioocclusive bandage poliuretan-ibuprofen (INN). After two weeks of therapy introduction, ulcer defect was filled with granulation tissue, with reduction of size, swelling and redness of the surrounding skin, as well as the level of pain. Contact sensitivity appeared as a result of local application of ibuprofen (Fig. 3) which we have proved with epicutaneous test so we end with local application of bioocclusive bandage with ibuprofen. The use of antiseptic measures, ulcer covering with bio-occlusive INN dressings in combination with systemic corticosteroid management resulted in ulcer healing in our patients. Efficient treatment of allergic leukocytoclastic vasculitis with bioocclusive compression bandage was proven. Instructions about avoiding arylpropinic acid derivatives such as ibuprofen, fenoprofen, and ketoprofen were given to our patient.

ibuprofen; drug hypersensitivity; bioocclusive bandage

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