Severe cutaneous reaction to Bufexamac in an antihaemorrhoid ointment

History and findings: A 49-year-old woman presented with acute perianal ves icular/bullous contact dermatitis. Other areas were over the trunk, face, n eck and wrists. She reported occasional application of an ointment (Mastu S (R)) to treat her hemorrhoids. Investigation: Patch tests (basic series-anal block, own ointment, local an esthetic, cosmetics) provoked strong vesicular and bullous reactions of per sisting creascendo type, spreading far beyond the site of application, to B ufexamac, to a derivative of hydroxxamine acid, and to local applied ointme nt with mild or moderate antiinflammatory action. Treatment and course: A week after the patch tests there was a flare-up of the previous foci of dermatitis. These reactions subsided two days later af ter intravenous injection of prednisolone. The skin lesions healed after ra pid reduction of the systemic treatment and local application of corticoste roids, bathing with tanning substances and basic preparations. Conclusion: While Bufexamac is not absorbed when applied rectally, perianal contamination may not be avoidable on intra-anal application and can produ ce sensitizateion.