Although irritant contact dermatitis secondary to BPO is common, allergic contact dermatitis is rare. Here, we present a baker who developed allergic contact hand dermatitis to BPO in the bleached flo..
Although irritant contact dermatitis secondary to BPO is common, allergic contact dermatitis is rare. Here, we present a baker who developed allergic contact hand dermatitis to BPO in the bleached flour he used at work. Case Presentation: A 64-year-old man presented with a pruritic dermatitis involving the hands. Treatments had included triamcinolone 0.1% ointment and fluocinonide 0.05% ointment without resolution. Given the lack of improvement, the patient was referred for patch testing. Of note, the patient is a baker and has frequent contact with flour. He recalled that the onset of pruritus was associated with switching from unbleached flour to bleached flour at work.The patient underwent patch testing with the North American 80 Comprehensive Series (NAC-80). Positive reactions at the 48-hour patch read were as follows: 1+ to balsam of peru and benzoyl peroxide. The 1-week patch read resulted in a 2+ reaction to benzoyl peroxide. After avoidance of benzoyl peroxide by switching to unbleached flour and balsam of peru, the patient noted significant improvement in his pruritus and dermatitis. At his post-patch test visit, the majority of lesions had resolved with fluocinonide 0.05% ointment and avoidance of allergens. Discussion: Benzoyl peroxide dermatitis is rare and typically associated with acne medication. Providers should consider other sources of benzoyl peroxide as allergens when appropriate. Other occupational allergens, such as Balsam of Peru in bakers, should be considered as well.