B. Carew, J. Muir
There have been a number of documented cases of Allergic contact dermatitis (ACD) associated with cigarette smoking. This represents a challenge for clinicians to identify the offending allergen. Cigarettes may contain a number of additives in addition to tobacco that can act as potential allergens. These include coca, menthol, licorice, colophony and formaldehyde in addition to cigarette paper, ﬁ lter paper and the cigarette ﬁ lters themselves. A case is presented of a 21 year old female with bilateral eczematous eruption on 2 nd , 3 rd ﬁ ngers. The patient had instinctively switched smoking hands intermittently to relieve symptoms. In this case the patient was patch tested to the European standard battery that showed positive reactions to formaldehyde and formaldehyde releasing agent, quaternium 15. It is recommended by Glick et al that smokers presenting with ACD should be tested with the standard series of allergens as well as the listed potential cigarette additives and smoked/unsmoked cigarette components. In accordance with these recommendations testing for menthol and colophony was organised with the aid of the Contact Allergy Bank Australia. Licorice was not available. Smoked and unsmoked tobacco and ﬁ lter paper were also tested. Despite conﬁ rmatory testing, the patient has continually refused to quit smoking creating a dilemma regarding the future management and advice given about this problem.