10.5826/dpc.1303a164
text/xml
2160-9381
3096
en
Silvia  Ferrucci
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Abrupt Bullous Cutaneous Eruption After Application of Tacrolimus Ointment and Sun Exposure
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-07-31
2022-12-18
2023-07-31
2023-08-24
e2023164
Dermatol Pract Concept
Silvia  Ferrucci
2023/07/31
10.5826/dpc.1303a164
e2023164
Unit of Dermatology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
2160-9381
en
e2023164
Shaw DW, Eichenfield LF, Shainhouse T, Maibach HI. Allergic contact dermatitis from tacrolimus. J Am Acad Dermatol. 2004;50(6):962-965. doi:10.1016/j.jaad.2003.09.013
Abrupt Bullous Cutaneous Eruption After Application of Tacrolimus Ointment and Sun Exposure
https://dpcj.org/index.php/dpc/article/download/3096/2237
                      Abrupt Bullous Cutaneous Eruption
                        After Application of Tacrolimus
                         Ointment and Sun Exposure
           Cristina Beatrice Spigariolo1, 2, Francesca Barei1, 2, Angelo Valerio Marzano1,2,
                                             Silvia Ferrucci1


1 Unit of Dermatology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
2 Department of Pathophysiology and transplantation, University of Milan, Milan, Italy



Citation: Spigariolo CB, Barei F, Marzano AV, Ferrucci S. Abrupt Bullous Cutaneous Eruption After Application of Tacrolimus Ointment
and Sun Exposure. Dermatol Pract Concept. 2023;13(3):e2023164. DOI: https://doi.org/10.5826/dpc.1303a164
Accepted: January 10, 2023; Published: July 2023
Copyright: ©2023 Spigariolo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: This work was supported by Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan/Italian Ministry of Health
(RC2023).
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Acknowledgement: The patient in this manuscript have given written informed consent to publication of her case details.
Corresponding author: Cristina B. Spigariolo, Unit of Dermatology, Via Pace 9, 20122 Milan (Italy). E-mail: cristina.spigariolo@unimi.it




Case Presentation                                                        tested. An erythematous reaction was seen on the UVA-
                                                                         irradiated skin where tacrolimus 0.03% ointment was ap-
A 46-year-old woman complained of an acute bullous der-                  plied (Figure 1C). Based on medical history, clinical ex-
matitis, which appeared after sun exposure, localized in the             amination and the results of the PPT, we made diagnosis
areas where she applied tacrolimus 0.03% ointment (for                   of photosensitive reaction. The patients’ medical history
her vitiligo) in the previous days. After about 20 minutes of            (acute onset, clinical bullous aspects and lack of prior
solar exposure (using sunscreen SPF50+), she felt a burn-                sensitization) was better compatible with a hyperacute
ing sensation, followed by the appearance of vesiculobul-                phototoxic reaction induced by the Tacrolimus ointment
lous lesions on the abdomen, groins and axilla (Figure 1A).              0.03% rather than a photoallergic one [1].
No other topical or systemic drugs had been used. She
was treated with Prednisone 25 mg/day tapered in 15 days
                                                                         Teaching Point
with scarring resolution in eight weeks (Figure 1B)]. After
clinical resolution, broadband UV) photopatch testing                    Even if tacrolimus ointment is widely used, only one case
(PPT) was performed. The patient sunscreen and the Tac-                  of contact dermatitis was described [2]. To the best of our
rolimus ointment 0.03% used by the patient, together with                knowledge, this is the first case of bullous reaction to Tacro-
Chemotechnique-Diagnostics®           photopatch      series   were      limus ointment after sun exposure.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023164                                                                                 1
    Figure 1. (A) Erythematous-bullous eruption localized on abdomen, groins and axilla characterized by blisters of 1-6 cm in di-
    ameter and serous content. (B) Scarring outcome after 8 weeks. (C) Results of photopatch-testing: an erythematous reaction was
    seen on UVA-irradiated-skin (left side of the patient’s back) where tacrolimus 0.03% ointment was applied, no reactions were
    present on both irradiated and non-irradiated areas where sunscreen and Chemotechnique Diagnostics® photopatch testing series
    were applied.




2                                                                          Image Letter | Dermatol Pract Concept. 2023;13(3):e2023164
References                                                           2. Shaw DW, Eichenfield LF, Shainhouse T, Maibach HI. Aller-
                                                                        gic contact dermatitis from tacrolimus. J Am Acad Dermatol.
 1. Monteiro AF, Rato M, Martins C. Drug-induced photosensi-            2004;50(6):962-965. DOI:10.1016/j.jaad.2003.09.013. PMID:
    tivity: Photoallergic and phototoxic reactions. Clin Dermatol.      15153904.
    2016;34(5):571-581. DOI: 10.1016/j.clindermatol.2016.05.006.
    PMID: 27638435.




Image Letter | Dermatol Pract Concept. 2023;13(3):e2023164                                                                       3
