the application of a topical medicament consisting of a compress , poultice , plaster , and tape is prevalent in japan . the vehicle usually contains a nonsteroidal anti - inflammatory drug ( nsaid ) or methyl salicylate as the effective component . it may also contain dl - camphor for relief of peripheral pain , l - menthol for peripheral cooling , and other ingredients , such as paraben , modified rosin , oxybenzone , and diisopropanolamine . we summarize cases of allergic and photoallergic contact dermatitis from an ingredient that were reported during the last decade [ 115 ] . allergic and photoallergic sensitization to two or more allergic or photoallergic substances can simultaneously occur [ 2 , 6 , 12 ] . the effective components , an nsaid   or methyl salicylate , have been shown to be allergens . additives , such as crotamiton , diisopropanolamine [ 6 , 10 , 15 ] , l - menthol [ 12 , 14 ] , paraben , and modified resin [ 11 , 12 ] also have been shown to be allergens . benzalkonium chloride usually induces irritant contact dermatitis , but rarely induces allergic contact dermatitis [ 5 , 1618 ] . ingredients such as ketoprofen [ 14 , 12 ] and oxybenzone   have been shown to be photoallergens . the most hazardous is ketoprofen because of the highly frequent occurrence of photoallergic contact dermatitis [ 14 , 12 ] . the mouse model of photoallergic contact dermatitis from ketoprofen has been established and the pathogenic mechanism has been investigated [ 19 , 20 ] . the clinical feature is typically eczematous reactions , pruritic papular , vesicular , and bullous appearance . the size and shape are dictated by those of the applied vehicle , which is generally rectangular . case 1 was a 68-year - old japanese woman with a rectangular pruritic erythematous macular area on the right knee ( figure 1 ) . in case 1 , patch testing showed a positive reaction at day 2 and 4 to the methyl and propyl paraben contained in the compress that had been used ( figure 2 ) .   some cases may show a rectangular eruption with a diffuse erythematous   or erythema multiform - like generalized reaction . case 2 was an 87-year - old japanese male with a rectangular erythema on the bilateral lower back and the buttock and a diffuse erythema on the trunk and extremities caused by allergic contact dermatitis from the diisopropanolamine in the compresses that he used ( figure 3 ) . the effective component of the nsaid , such as ketoprofen , causes photoallergic contact dermatitis [ 14 , 12 , 13 ] . in such cases , a rectangular - shaped dermatitis with spreading   or erythema multiform - like eruption photoallergic contact dermatitis can be evoked by exposure to sunlight several weeks later after stopping the use of the occlusive products containing ketoprofen , because even several weeks after discontinuing the use of a poultice containing ketoproten , the skin still contains enough ketoprofen to trigger a reaction . one is the use of a topical cream , gel , or stick containing a low - sensitizing nsaid , such as felbinac   or loxoprofen . another is the use of a topical occlusive medicament containing a low - sensitizing nsaid . however , physicians and pharmacologists must keep in mind that systemic contact and photocontact - type dermatitis may be evoked if a person previously sensitized to an nsaid orally takes the same nsaid .   in conclusion , the application of a vehicle consisting of a compress , poultice , plaster , and tape carries a greater risk of sensitization and elicitation of allergic and photoallergic contact dermatitis from an ingredient . for safety , we initially recommend the use of a topical cream , gel , or stick containing a less sensitizing ingredient , and secondarily a topical occlusive medicament containing a less sensitizing nsaid .
the topical application of a medicament vehicle consisting of a compress , poultice , plaster , and tape containing a nonsteroidal anti - inflammatory drug or methyl salicylate is prevalent in japan . 
 the method is effective for conveying ingredients to the muscles via the skin for the relief of muscular pain . 
 however , an ingredient in the occlusive vehicle can cause allergic and photoallergic contact dermatitis . we summarize cases reported over the past decade and 
 discuss the current strategy for diminishing the risk of allergic and photoallergic contact dermatitis .