Dermatologists in Victoria are calling for bufexamac to be banned in Australia due to its lack of efficacy and propensity to cause severe allergic contact dermatitis.
Writing in the journal Contact Dermatitis, Dr Gwyneth Wong, Dr Sarah Shen and Associate Professor Rosemary Nixon, said the NSAID was never approved in countries such as the UK or the US and its approval revoked in Europe in 2010.
Yet it is still available here in first aid creams used to treat minor skin conditions.
They described a case report of severe allergic contact dermatitis requiring hospitalisation following application of Apohealth First Aid Cream to a superficial abrasion on the patient’s right foot.
The patient was otherwise well with a history of atopy and recurrent vesicular hand eczema.
She first developed erythematous papules and plaques at the site of application, followed by painful facial erythema and oedema that was exacerbated by sun exposure.
“Despite commencing on a slow weaning course of prednisolone and topical mometasone 0.1% cream, her symptoms worsened and the eruption extended to include a well-demarcated violaceous erythema on her lower limbs and urticarial papules coalescing into plaques on her torso.”
“The patient was admitted for inpatient care seven days after the eruption begun and improved after 5 days of regular wet dressings and topical betamethasone dipropionate 0.05% ointment to her body and methylprednisolone aceponate 0.1% ointment to her face.”
Subsequent patch testing to the first aid cream’s ingredients confirmed the diagnosis of allergic contact dermatitis as a reaction to bufexamac.
The dermatologists warned allergic contact dermatitis to bufexamac had a variable presentation and was often misdiagnosed as erysipelas or cellulitis.
“Interestingly, the eruption often worsens and spreads even following cessation of bufexamac use,” they said.
“This case highlights that there is no reason to justify the continued use of topical bufexamac, given its propensity to cause severe ACD and lack of efficacy.”