Allergic Contact Dermatitis and Topical Antibiotics

J. Desiree Douglas, MPA, PA-C


Dermatology Nursing 

In This Article

Patient Education

Patients need to alert all health care providers of a bacitracin allergy. Patients should be advised to avoid the following antibiotics:

  • Neomycin

  • Butirosin (ambutylosin)

  • Gentamicin (Garamycin)

  • Streptomycin

  • Tobramycin (Nebcin)

  • Kanamycin

  • Paromomycin

  • Spectinomycin

  • Polymyxin

After a patient is diagnosed with a bacitracin sensitivity, it is important to advise him/her to use safe alternatives. The recommendations are the same when patients are allergic to either neomycin or bacitracin because of the high frequency of co-sensitivity. Safe antibiotic preparations include mupirocin (Bactroban), Ilotycin, and Silvadene products. Nonprescription medications include Aquaphor ointment, Biafine cream, and petroleum jelly (Scheman et al., 2008). Studies have shown no difference in the incidence of infection or healing in patients that used bacitracin ointment versus white petrolatum after dermatology surgery (Gehrig & Warshaw, 2008).

Bacitracin is among a number of allergens that can be retained in fabric. High-formula weight topical medications, including bacitracin, may be difficult to dissolve in water and laundry detergent. Furthermore, purchasing new clothing resulted in resolution of the dermatitis (Nedorost, Kessler, & McCormick, 2007). Providers need to remember this in cases of recalcitrant dermatitis.

In conclusion, topical antibiotic preparations are used commonly. Allergic contact dermatitis caused by neomycin and bacitracin are among the top ten allergens causing ACD (Zug et al., 2009). Health care providers need to prompt patients to disclose the prescription creams and ointments used, as well as over-the-counter products. Patients should be advised to avoid antimicrobial products unless there is a reasonable suspicion or an actual infection to treat. White petrolatum has proven effective on postoperative wounds and it eliminates the risk of ACD and anaphylaxis.