Could the small red bumps on my child's chin be an allergic reaction to neomycin (antibiotic) polymyxin B (antibiotic) fluocinolone (corticosteroid) ear drops?

Allergic Contact Dermatitis from Neomycin/Polymyxin B/Fluocinolone Ear Drops

Yes, the small red bumps on your child's chin are very likely an allergic reaction to the neomycin/polymyxin B/fluocinolone ear drops. This represents a contact dermatitis reaction that can occur when medication drips onto the skin and causes sensitization.

Understanding the Reaction

Neomycin is particularly known for causing contact sensitivity reactions:

• The FDA drug label explicitly warns that neomycin sulfate may cause cutaneous sensitization 1
• Contact sensitivity to neomycin has a high prevalence of 13-30% in patients with chronic otitis externa 2
• Manifestations typically include low-grade reddening with swelling, dry scaling, and itching 1
• The reaction can appear simply as small red bumps or failure to heal 1

Why This Happens

The reaction occurs through several mechanisms:

• Initial sensitization phase occurs over 10-14 days of exposure 2
• Subsequent exposure leads to delayed-type hypersensitivity reactions 2
• The reaction can extend beyond the ear canal to involve skin around the ear and neck wherever contact is made 2
• In your child's case, the medication likely dripped onto the chin during administration

Components That May Cause Reactions

Your child's ear drops contain multiple potential allergens:

• Neomycin is most commonly associated with contact sensitivity 2
• Polymyxin B can also cause allergic reactions in 2.3% of patients 3
• The combination of these antibiotics increases risk of reaction
• Preservatives and vehicles in the drops may also contribute to sensitivity 2

Management Recommendations

1. Discontinue the current ear drops immediately

   • The FDA label states: "Discontinue this product promptly if sensitization or irritation occurs" 1

2. Contact your physician for alternative treatment

   • Request non-neomycin containing ear drops
   • Fluoroquinolone preparations (like ciprofloxacin) are recommended alternatives 4

3. Treat the skin reaction

   • Gently cleanse the affected area with mild soap and water
   • Apply a thin layer of hydrocortisone cream to reduce inflammation
   • Avoid harsh soaps or rubbing the area 4

4. Prevent future reactions

   • After administering ear drops, wipe away any excess medication
   • Consider placing a cotton ball gently in the ear canal to prevent drainage
   • Avoid all neomycin-containing products in the future 1

Important Considerations

• Once sensitized to neomycin, your child may react more quickly and severely with future exposures 2
• Simultaneous allergies to neomycin, bacitracin, and polymyxin can occur 5
• The reaction should resolve within days of discontinuing the offending agent
• Document this reaction in your child's medical record to avoid future exposure

When to Seek Further Medical Care

• If the rash spreads, worsens, or develops blisters
• If your child develops fever or appears ill
• If the ear infection symptoms worsen despite alternative treatment

This type of allergic reaction is well-documented and should resolve completely once the medication is discontinued and appropriate alternatives are used.