Allergic Contact Dermatitis to Testosterone and Estrogen in Transderraal Therapeutic Systems

摘要

A 74-year-old male patient with the diagnosis of hypogo-nadism presented with a rash at the site of Androderm 5 mg/24 hour patch application. He was instructed to apply triamcinolone acetonide 0.1% ointment underneath the testosterone patch, but the rash did not improve. He ultimately underwent patch testing. Patch tests to testosterone in an ethanol vehicle at concentrations (1%, 2.5%, 5%, and 10%) were negative. However, at the same concentrations in a petrolatum vehicle, the patient developed positive reactions at all concentrations during follow-up at 72 hours, which increased in reactivity at 96 hours. The Androderm transdermal therapeutic systems (TTS) patch contained testosterone, ethanol, purified water, glycerol, glyceryl monooleate, methyl laurate, carbomer copolymer (type B), and sodium hydroxide. He was patch tested to components provided by the manufacturer, with a positive to testosterone in petrolatum but no reaction to all others. Consequently, the Androderm TTS patch was discontinued, and he was switched to testosterone intramuscular injections without any systemic or local dermatitis.