Report Details Presentation, Treatment of Poppers Dermatitis

Adam Friedman, MD
Credit: George Washington School of Medicine

A new study is shedding light on more than a dozen cases of poppers dermatitis, including clinical presentation, management, and causes.

"Our findings reveal a critical gap in knowledge surrounding the dermatological risks of poppers,” said senior investigator Adam Friedman, MD, chair of the Department of Dermatology at the George Washington School of Medicine and Health Sciences.¹ “As these substances gain traction in certain communities, it’s vital for both users and healthcare professionals to be informed about the potential for dermatitis and other adverse effects."

Poppers, also known as amyl nitrate, are a group of psychoactive inhalants that have gained a reputation as a recreational drug dating back several decades. Over time, poppers use has become less common but still occurs in many communities, including men who have sex with men.

As a result of stigmatization around drug use and lingering societal stigma towards the LGBTQIA community, patients may be less likely to report poppers use, which can compound challenges in diagnosis in management.^1,2

To better understand presentation and management of poppers dermatitis, Investigators launched a comprehensive literate search of all published cases of poppers contact dermatitis within the PubMed, Google Scholar, and Scopus databases using search terms such as dermatitis' and 'poppers' or 'alkyl nitrites' or 'amyl nitrites' or 'isobutyl nitrites' or 'propyl nitrites’. From each identified case, investigators pulled data related to age gender, type of alkyl nitrite, men who have sex with men (MSM) association, time to reaction onset, morphological characteristics, diagnosis of contact dermatitis, patch testing completion, lesion location, and treatments.^1,2

From their search, investigators identified 13 reports detailing 14 cases of poppers dermatitis for inclusion in their analyses. This cohort had an age range of 23 to 56 years, the mean age was 39 years, 85% identified as male, and 7 of 7 patients providing sexual orientation identified as men who have sex with men. Only 42.86% of cases reported the type of alkyl nitrite. Among these, 80% reported amyl nitrite as the offending agent.¹

When examining clinical presentation, investigators reported dermatitis manifested within 1 day of exposure to poppers among 35.7%, within 1 to 7 days among 21.5%, within 1 week to 1 month in 21.4%, and more than 1 month after exposure in 14.3%. The most commonly affected locations were perinatal (64.3%) and perioral (21.4%) regions. Further assessments of clinical presentation suggested the most common morphological descriptions of these lesions were erythematous (57.1%), crusted (35.7%), vesicular (28.6%), impetiginized (28.6%), ulcerated (21.4%), eczematous (14.3%), pruritic (14.3%), and vitiligous (7.1%).¹

Investigators pointed out patch testing was used in 3 cases. Among this group, 2 were diagnosed with allergic contact dermatitis and the other was diagnosed with an irritant reaction. The remaining 11 cases were diagnosed solely on clinical presentation. Among this group, the most common diagnoses of contact dermatitis were irritant contact dermatitis (35.7%), unspecified forms of contact dermatitis (28.6%), allergic contact dermatitis (14.3%), and both allergic contact dermatitis and irritant contact dermatitis (14.3%). Of note, 60% of patients diagnosed with irritant contact dermatitis were attributed to a suspected poppers spillage event or unintentional contact with poppers (P <.001).¹

When examining treatment approaches to these cases, investigators pointed out the most common treatments were topical steroids (14.3%), emollients (14.3%), antibiotics (7.1%), laser therapy (7.1%), complete termination of poppers use (7.1%), and wound disinfection and gauze application (7.1%). However, investigators pointed out 6 of the 14 cases did not specify the treatments employed.¹

“Both patients and providers may be unaware of the adverse effects of poppers due to a lack of education as well as societal stigmatization of these drugs as being used by sexually promiscuous gay men,” said lead investigator Vincent Pecora, BA, lead author and medical student at the George Washington School of Medicine and Health Sciences.² “However, understanding the risks is essential for protecting your health.”

References:

1. Pecora VA, Azim SA, McCormick E, Friedman A. A Brief Report of 13 Cases of Poppers Dermatitis. J Drugs Dermatol. 2024;23(10):899-902.
2. George Washington University. New study highlights risks of poppers dermatitis among gay men. Newswise. October 3, 2024. Accessed October 8, 2024. https://www.newswise.com/articles/new-study-highlights-risks-of-poppers-dermatitis-among-gay-men.