Allergic contact dermatitis from ketoconazole.

Ketoconazole is a widely used imidazole antifungal agent. True contact allergy to topical ketoconazole is rare, and few cases of patients with contact allergy to ketoconazole have been reported. We present the case of a patient with a history of undiagnosed recurrent dermatitis who developed acute facial swelling and pruritus after using ketoconazole cream and shampoo for the treatment of seborrheic dermatitis. Patch testing revealed true contact allergy to ketoconazole without cross-reactivity to 4 other imidazole antifungals. Review of the patient's medical record suggested that prior incidences of dermatitis might have been due to ketoconazole exposure. When the patient avoided this imidazole agent, the dermatitis resolved.