Disabling work-related persistent photosensitivity following photoallergic contact dermatitis from chlorpromazine and olaquindox in a pig breeder
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Department of Occupational and Social Medicine, Georg-August-University of Göttingen, Germany
Department of Dermatology and Venerology, Georg-August-Universitiy of Göttingen, Germany
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Birgit Emmert   

Department of Occupational and Social Medicine, Georg-August-University of Gottingen, Waldweg 37, 37073 Gottingen, Germany
Ann Agric Environ Med. 2007;14(2):329-333
The use of veterinary medicines and medicated feed has a potential for the exposure of agricultural workers to pharmaceuticals with phototoxic and photoallergic side-effects. We present a 67-year-old self-employed farmer and pig breeder with a 22-year history of severe persistent photosensitivity following photoallergic contact dermatitis due to direct occupational dermal and airborne contact to chlorpromazine (sedative) and olaquindox (antibiotic and animal growth promoter, AGP). His first dermatitis symptoms appeared at the age of 45 when the pig breeding was intensified. He showed erythematous, scaly, and pruritic plaques localized symmetrically on the sun-exposed backs of his hands, fingers, and forearms, spreading to his face and other sun-exposed body sites. Without protective measures, he injected the animals with chlorpromazine. Besides, for several years he mixed by hand a powder containing olaquindox into the pigs' dry food. Epicutaneous and photo-patch tests showed positive reactions to promethazine, chlorpromazine, and olaquindox. In spite of the complete avoidance of the identified photoallergens for several years, his life is still extremely disabled due to the persistent photosensitivity. Our case report stresses the observation that olaquindox and chlorpromazine as phototoxic agents and photoallergens are capable of inducing a persistent and severe photosensitivity for many years, even after termination of exposure. Although the use of phenothiazine derivates and APGs for animals has meanwhile been banned in the European Union (EU), AGPs are still widely used in Asia. Physicians, especially occupational physicians, should be still aware of these phototoxic and photoallergic agents to reduce the burden of skin disease at work.
Allen JE: Drug-induced photosensitivity. Clin Pharm 1993, 12, 580-587.
Anonymus: EU Council Directive Regulation 2788/98. OJL 1998, 347, 31-32.
Barbaud A, Collet E, Martin S, Granel F, Trechot P, Lambert D, Schmutz JL: Contact sensitization to chloproethazine can induce persistent light reaction and cross-photoreactions to other phenothiazines. Contact Dermatitis 2001, 44, 373-374.
Brehler R, Hellweg B: Beurteilung von Epikutantestreaktionen nach den Empfehlungen der Deutschen Kontaktallergie-Gruppe (DKG). Der Deutsche Dermatologe 1995, 43, 688-690.
Chignell CF, Motten AG, Buettner GR: Photoinduced free radicals from chlorpromazine and related phenothiazines: relationship to phenothiazine-induced photosensitization. Environ Health Perspect 1985, 64, 103-110.
de Vries H, Bojarski J, Donker AA, Bakri A, Beyersbergen van Henegouwen GM: Photochemical reactions of quindoxin, olaquindox, carbadox and cyadox with protein, indicating photoallergic properties. Toxicology 1990, 63, 85-95.
Ertle T: Berufl ich bedingte Kontakt- und Photokontaktallergie bei einem Landwirt durch Chlorpromazin. Derm Beruf Umwelt 1982, 30, 120-122.
Frain-Bell W, Gardiner J: Photocontact dermatitis due to quindoxine. Contact Dermatitis 1975, 1, 256-257.
Francalanci S, Gola M, Giorgini S, Muccinelli A, Sertoli A: Occupational photocontact dermatitis from Olaquindox. Contact Dermatitis 1986, 15, 112-114.
Hao L, Chen Q, Xiao X: Molecular mechanism of mutagenesis induced by olaquindox using a shuttle vector pSP189/mammalian cell system. Mutat Res 2006, 599, 21-25.
Hochsattel R, Gall H, Weber L, Kaufmann R: Photoallergische Reaktion auf Olaquindox. Hautarzt 1991, 42, 233-236.
Kumar A, Freeman S: Photoallergic contact dermatitis in a pig farmer caused by olaquindox. Contact Dermatitis 1996, 35, 249-250.
Kurita M, Shimauchi T, Kobayashi M, Atarashi K, Mori K, Tokura Y: Induction of keratinocyte apoptosis by photosensitizing chemicals plus UVA. J Dermatol Sci 2007, 45, 105-112.
MacIntosh AI, Neville GA: Liquid chromatographic determination of carbadox, desoxycarbadox, and nitrofurazones in pork tissues. J Assoc Off Anal Chem 1984, 67, 958-962.
Meyer JD, Chen Y, Holt DL, Beck MH, Cherry NM: Occupational contact dermatitis in the UK: a surveillance report from EPIDERM and OPRA. Occup Med (Lond.) 2000, 50, 265-273.
Moore DE: Drug-induced cutaneous photosensitivity: incidence, mechanism, prevention and management. Drug Saf 2002, 25, 345-372.
Neumann NJ, Lehmann P: The photopatch test procedure of the German, Austrian and Swiss photopatch test group. Photodermatol Photoimmunol Photomed 2003, 19, 8-10.
Neumann NJ, Blotz A, Wasinska-Kempka G, Rosenbruch M, Lehmann P, Ahr HJ, Vohr HW: Evaluation of phototoxic and photoallergic potentials of 13 compounds by different in vitro and in vivo methods. J Photochem Photobiol B 2005, 79, 25-34.
Rünger TM, Lehmann P, Neumann NJ, Matthies C, Schauder S, Ortel B, Münzberger C, Hölzle E: Empfehlung einer Photopatch-Test Standardreihe durch die deutschsprachige Arbeitsgruppe „Photopatch-Test“. Hautarzt 1995, 46, 240-243.
Sanchez-Perez J: Airborne allergic contact dermatitis from olaquindox in a rabbit breeder. Contact Dermatitis 2002, 46, 185.
Schauder S: Gefahren durch Olaquindox. Photoallergie, chronisch photosensitive dermatitis und extrem gesteigerte Lichtempfi ndlichkeit beim Menschen, Hypo-aldosteronismus beim Schwein. Derm Beruf Umwelt 1989, 37, 183-185.
Schauder S, Berger H: Aktinisches Retikuloid nach photoaller-gischem Kontaktekzem durch Chlorpromazin bei einem Schweinemäster. Dermatosen 1991, 39, 12-17.
Schauder S, Schröder W, Geier J: Olaquindox-induced airborne photoallergic contact dermatitis followed by transient or persistent light reactions in 15 pig breeders. Contact Dermatitis 1996, 35, 344-354.
Scott KW and Dawson TAJ: Photo-contact dermatitis from the presence of quindoxin in animal staffs. Brit J Derm 1974, 90, 543-546.
Śpiewak R, Dutkiewicz J: Occupational airborne and hand dermatitis to hop (Humulus lupulus) with non-occupational relapses. Ann Agric Environ Med 2002, 9, 249-252.
Śpiewak R: Berufsbedingte allergische Rhinokonjunktivitis, Proteinkontaktdermatitis, Asthma bronchiale und Kontakturtikaria auf Rinderallergene bei einer Landwirtin. Allergologie 2004, 27, 402-407.
Śpiewak R, Dutkiewicz J: A farmer`s occupational airborne contact dermatitis masqueraded by coexisting rosacea: delayed diagnosis and legal acknowledgement. Ann Agric Environ Med 2004, 11, 329-333.
White I: Phototoxic and photoallergic reactions. In: Rycroft RJG, Menne T, Frosch PJ, Lepoittevin J-P (Eds): Textbook of contact dermatitis, 367-379. 3rd ed. Springer, Berlin 2001.
Wilkinson DS: Connubial photodermatitis. Contact Dermatitis 1975, 1, 58.
Woodward KN: The toxicity of particular veterinary drug residues. In: Watson D (Ed): Pesticides, Veterinary and Other Residues in Food, 175-223. Woodhead Publishing/CRC Press, Cambridge/Boca Raton 2004.
Zaynoun S, Johnson BE, Frain-Bell W: The investigation of quinoxin photosensitivity. Contact Dermatitis 1976, 2, 343-352.
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