Footwear contact dermatitis from dimethyl fumarate


  • Conflicts of interest: There are no financial or other arrangements with the companies whose products are mentioned in this article.
    Ethics: Each patient has agreed that the affected areas of her body were depicted in accordance with the Helsinki Declaration of 1975, as revised in Edinburgh, 2000.
    Submission: This article is original and unpublished, and not being considered for publication elsewhere.
    This manuscript has been edited by native English-speaking experts of BioMed Proofreading.
    The paper as an e-poster was presented at 22nd World Congress of Dermatology 2011 in Seoul, Korea, and received a Gold Triangle Award.

Dr. Danka Švecová, md, PhD
Department of Dermatoneverology
Faculty of Medicine
Comenius University
Mickiewczova 13
813 69 Bratislava


Background  Dimethyl fumarate (DMF) is an effective inhibitor of mold growth. In very low concentrations, DMF is a potent sensitizer that can cause severe allergic contact dermatitis (ACD). It has been identified as the agent responsible for furniture contact dermatitis in Europe. The aim of this study was to evaluate patients in Slovakia with footwear ACD associated with DMF, with regard to clinical manifestations, patch test results, and results of chemical analysis of their footwear.

Methods  Nine patients with suspected footwear contact dermatitis underwent patch testing with the following allergens: samples of their own footwear, commercial DMF, the European baseline, shoe screening, textile and leather dye screening, and industrial biocides series. The results were recorded according to international guidelines. The content of DMF in footwear and anti-mold sachets was analyzed using gas chromatography and mass spectrometry.

Results  Acute ACD was observed in nine Caucasian female patients. All patients developed delayed sensitization, as demonstrated by positive patch testing using textile footwear lining. Seven patients were patch tested with 0.1% DMF, and all seven were positive. Chemical analysis of available footwear showed that DMF was present in very high concentrations (25–80 mg/Kg).

Conclusions  Dimethyl fumarate is a new footwear allergen and was responsible for severe ACD in our patients. To avoid an increase in the number of cases, the already approved European preventive measures should be accepted and commonly employed.