Allergic contact dermatitis (ACD) occurs when an individual comes into cutaneous contact with a substance to which he or she has been sensitized to, causing a delayed-type hypersensitivity reaction. W..
Allergic contact dermatitis (ACD) occurs when an individual comes into cutaneous contact with a substance to which he or she has been sensitized to, causing a delayed-type hypersensitivity reaction. While the diagnosis may in some cases be easily suspected due to a classic history and exam, not all cases are obvious. Patch testing is an extremely useful process that allows for the diagnosis of ACD to be made while also identifying the specific chemical trigger. Present in beeswax and composed of a mixture of resins, waxes, oils, pollen, and various organic compounds, propolis is a well-known cause of ACD. Here we present the case of ACD to propolis in an unusual product and with impressive clinical findings. A 58 year-old woman of Native American descent with a history of Sjogren's syndrome presented to Dermatology for a one year history of a painful and pruritic rash on her lips and face. She had temporary improvement with a previous course of prednisone followed by relapse upon tapering, but otherwise the rash had been worsening despite the use of high-potency topical steroids. She was also using bear grease and lip butter as moisturizers. On physical exam she had a well-demarcated symmetric perioral erythematous lichenified scaly plaque, as well as confluent erythema and scaling of her mucosal lips. After tinea incognito was ruled out by fungal culture, she subsequently underwent patch testing for suspected ACD. The diagnosis was confirmed with positive reactions at both the 2 day and 7 day reads to propolis and her bear grease and lip butter, both of which contained beeswax. The patient had complete resolution shortly after discontinuation of these products, and she was advised to avoid other products that contain propolis. With a soft and pliable texture and pleasant aroma, propolis is present in many creams, ointments, waxes, lipsticks, and balms. Moreover, with it's reported anti-inflammatory and antimicrobial properties, it can also be found in various cosmeceutical, naturopathic, and homeopathic products. Made from bear fat and beeswax, the bear grease product the patient was using was advertised as having "natural healing benefits" and was purchased at a Native American craft store. This case is unique, as it represents a common allergen found in an uncommon vehicle. Moreover, it illustrates the importance of taking a comprehensive history when assessing for ACD, as well as the utility of patch testing.