Contact dermatitis due to topical cosmetic use of vitamin K

Vitamin K exists in 4 different forms: vitamin K1 (phytomenadione), the natural form; vitamin K2 (menaquinone) from intestinal bacterial synthesis; and vitamin K3 (menadione) and K4 (menadiol) as synthetic analogues (1). The lipid-soluble vitamin K (phytomenadione) causes more cutaneous reations than its water-soluble analogues (2). In previous reports, cutaneous hypersensitivity reactions to injection of vitamin K were seen in patients with liver disease, suggesting a relationship (1). There are also reported cases of cutaneous reactions to vitamin K1 after its intramuscular injection in patients who have it for hypothrombinemia without liver disease (1, 3). Reactions to water soluble vitamin K are less common, because vitamin K is absorbed through the skin (2). Contact dermatitis due to vitamin K for topical use is uncommon and only a few cases of occupational contact dermatitis from vitamin K3 have been so reported (46). All such cases were in employees in veterinary and pharmaceutical laboratories who had contact with the vitamin in their work. In these cases, the form of vitamin K is always K3 (menadione), which also, in high enough concentration, causes an irritant contact dermatitis (2). No cases of allergic contact dermatitis due to vitamin K1 for topical cosmetic use have previously been reported.