Airborne contact dermatitis to tetrazepam in geriatric nurses - a report of 10 cases

Abstract

Background Tetrazepam, a benzodiazepine, is a frequently used muscle relaxant. The most common adverse reactions are neurological and gastrointestinal. Cutaneous reactions to tetrazepam are rare and occur predominantly after systemic administration. Objective To present 10 health care professionals who developed airborne contact dermatitis to tetrazepam due to occupational exposure to tetrazepam dusts. Materials and methods We report a series of 10 cases observed in our department between January 2006 and March 2011 where tetrazepam was identified to cause allergic airborne contact dermatitis. Affected individuals were employed as (geriatric) nursing staff, exposed to tetrazepam on a regular occupational basis when crushing tablets for their patients. Upon investigation, patients were patch tested with commercial and customized allergens. This included tetrazepam and in five cases diazepam. Tetrazepam revealed strong positive reactions in all patients. Additional diazepam sensitization was observed in three subjects. Following local treatment and occupational preventive action, patients recovered from their skin symptoms. Conclusions Allergic contact sensitization to tetrazepam and cross-sensitization to diazepam seems to be underestimated and not appropriately diagnosed in patch test clinics, as it is so far insufficiently patch tested. They should be considered when allergic contact dermatitis is suspected, particularly in professionally exposed staff, and tested as supplemental allergens.