Vulval eczema associated with propolis sensitization from topical therapies treated successfully with pimecrolimus cream

A 67‐year‐old woman presented with a 6‐month history of vulval eczema unresponsive to topical steroids including alclometasone diproprionate (Modrasone ointment) and clobetasol proprionate (Dermovate ointment). She also had a 16‐year history of varicose eczema with intermittent varicose ulcers (though was trouble free at time of presentation). On examination the vulval skin was found to be markedly oedematous, with weeping eczema. Treatment was initiated with daily 1/10 000 potassium permanganate soaks, 50 : 50 white soft paraffin/liquid paraffin to moisturize and an 8‐day course of oral prednisolone commencing at a dose of 40 mg and decreasing by 5 mg/day. Her condition settled quickly. Patch testing to the European Standard, antimicrobial and medicament batteries (including topical steroids) showed at 48 h‐fragrance +/–, primin ++, propyl gallate ++, octyl gallate ++, propolis +, cinchocaine +. As clobetasol proprionate and alclometasone diproprionate ointments both contained propolis as excipients1 the poor response of the patient's vulval eczema was attributed to a contact allergy, sensitization probably having arisen from previous treatments with topical agents for her varicose eczema.