摘要
We present the case of an 80-year-old lady known to be sensitive to chlorocresol(4-chloro-3-methyl phenol)who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin.All medications except insulin were stopped,without major improvement.It was noted that the insulin containedm-cresol(m-methyl phenol)so a parabens-based insulin was substituted.There was a significant improvement in her clinical condition within 72hr.Further patch and intradermal testing to the insulin and mcresol was planned,but she developed a nosocomial infection and died.We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity,given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol,particularly as cross-reactivity between different low molecular weight methyl phenols is documented.Local injection site reactions and systemic side-effects including nausea,diarrhoea and vomiting have previously been reported with cresol-containing insulins,although to our knowledge,this is the first reported case of a severe cutaneous reaction.It is important to be aware of m-cresol as a potential allergen,as it is contained in most commercially available insulins.
We present the case of an 80-year-old lady known to be sensitive to chlorocresol(4-chloro-3-methyl phenol)who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin.All medications except insulin were stopped,without major improvement.It was noted that the insulin containedm-cresol(m-methyl phenol)so a parabens-based insulin was substituted.There was a significant improvement in her clinical condition within 72hr.Further patch and intradermal testing to the insulin and mcresol was planned,but she developed a nosocomial infection and died.We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity,given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol,particularly as cross-reactivity between different low molecular weight methyl phenols is documented.Local injection site reactions and systemic side-effects including nausea,diarrhoea and vomiting have previously been reported with cresol-containing insulins,although to our knowledge,this is the first reported case of a severe cutaneous reaction.It is important to be aware of m-cresol as a potential allergen,as it is contained in most commercially available insulins.
