Contact sensitization to hair colours in acquired dermal macular hyperpigmentation: results from a patch and photo-patch test study of 108 patients.

BACKGROUND: Acquired dermal macular hyperpigmentation (ADMH) is an umbrella term including lichen planus pigmentosus, erythema dyschromicum perstans and pigmented contact/cosmetic dermatitis. OBJECTIVE: To establish contact sensitization to hair colours as an aetiological factor for ADMH. METHODS: Detailed clinical examination, skin biopsies, and patch and photo-patch testing with Indian standard series and patient's own cosmetic products were performed. RESULTS: Thirty-nine (36.1%) patients were found to demonstrate a positive patch/photo-patch test with 35/39 reacting to their own products (all were hair colours) and 16/39 reacting to antigens from commercial series (commonly paraphenylenediamine). Fourteen patients developed delayed hyperpigmentation on positive patch-test sites at 1 month. Higher mean age, symptomatic pigmentation (pruritus, burning and photosensitivity), hair margins involvement (outer surface, helix and lobule of ear; temples and preauricular area), ill-defined lesions, epidermal atrophy and epidermal melanization extending >3 layers were significantly common in patch-test-positive patients. Well-defined lesions, perioral involvement and associated lichen planus were clinical pointers towards patch-test negativity. CONCLUSION: Index study exemplifies that patch-test results have distinct clinical and histopathological correlates in ADMH. Hair dye contact sensitization appears to be an important aetiological factor in about one-third patients presenting with ADMH.

Two differing presentations of periocular dermatitis as a side effect of dupilumab for atopic dermatitis.

Dupilumab is a monoclonal antibody used to treat atopic dermatitis. Worsening of atopic dermatitis and conjunctivitis following dupilumab use are reported adverse effects; however, there is little reported on the nature and mechanism of these complications. Here, we describe two patients with chronic atopic dermatitis who developed new or severely worsened periocular dermatitis, believed to be a side effect of dupilumab injections, and resolution after its discontinuation. We explore the possibility of dupilumab-induced suppression of Th2 mediated inflammation and upregulation of Th1 and IFNγ mediated inflammation as a possible mechanism.

[Granulomatous periocular eruption]. / Dermatite périoculaire granulomateuse.

BACKGROUND: Herein, we report a case of atypical periorificial dermatitis in a patient that had been receiving treatment for some time for atopic dermatitis. The specific feature of this rash was its periocular predominance with no perioral involvement, its clinical aspect and its histological picture evocative of sarcoidosis. PATIENTS AND METHODS: A 33-year-old man was being treated for a atopic dermatitis limited to the face and poorly responsive to dermal corticosteroids. Treatment was initiated with topical tacrolimus 0.1%. After 4 years, dependence on this treatment was noted, with daily application being needed to control the lesions. One year later, symmetric lesions were seen on the eyelids and periorbital regions; these were erythematous, micropapular and poorly delineated in a setting of oedema. Biopsy revealed epithelioid granulomatous inflammation, and, to a lesser degree, sarcoidal giant-cell features without caseous necrosis. Staging tests to identify systemic sarcoidosis were negative. Treatment with hydroxychloroquine at 400mg per day and discontinuation of topical tacrolimus resulted in complete remission of the lesions within 2 months. Hydroxychloroquine was discontinued after 6 months, and no relapses had occurred after 2 years of follow-up. DISCUSSION: Three diagnostic hypotheses may be posited for these granulomatous facial lesions. We opted for a diagnosis of granulomatous periorificial dermatitis despite the fact that exclusively periorbital involvement is rare (this condition is generally associated with perioral dermatitis). The second was that of pure cutaneous sarcoidosis, but the topography and clinical appearance of the lesions did not correspond to any of the cutaneous forms classically described. The third was that of tacrolimus-induced granulomatous rosacea, but the histological picture is different. CONCLUSION: The present case underscores the fact that a histological appearance of sarcoidosis on skin biopsy may be associated with perioral dermatitis.

Perioral dermatitis from high fluoride dentifrice: a case report and review of literature.

Perioral dermatitis is a papulopustular eruption, commonly related to the inappropriate application of topical corticosteroids with occasional reports of inhaled corticosteroids and decreased personal hygiene. We present a case of a 45-year-old female with a one-year history of perioral dermatitis related to the use of highly fluoridated toothpaste commenced to control dental caries.

Perioral dermatitis -- the role of nasal steroids.

We present two patients with allergic rhinitis who developed perioral dermatitis (PD) after initiating intranasal steroid spray. Both patients had been previously misdiagnosed as having contact or seborrheic dermatitis, and therefore inappropriately and unsuccessfully treated with topical steroids. Physicians should be aware of this potential side effect of intranasal steroids to avoid incorrect therapeutic measures. In the setting of nasal steroids use, PD probably is an under-reported and commonly misdiagnosed condition that should be thought when a patient treated with nasal steroids present with small erythematous papules, papulovesicles, and papulopustules occurring against a background of redness, beginning in the nasolabial areas and spreading rapidly to the perioral zone.

Periocular allergic contact dermatitis following topical Mitomycin C eye drop application.

A 63-year-old women had an extensive limbal papilliform tumoural lesion of her left eye. Mitomycin C (MMC) was applied to the area at a dose of 0.2 mg/ml after total surgical excision of the lesion. The lesion was diagnosed as invasive squamous cell carcinoma on histopathology and topical 0.02% MMC was prescribed four times daily to the left eye. A severe per ocular contact dermatitis of the left eye developed two days after starting MMC. The patch test result was positive. The per ocular dermatitis resolved after discontinuation of the topical MMC and treatment with a topical corticosteroid.

Allergic contact dermatitis due to diclofenac sodium in eye drops.

Eyelid dermatitis and/or periocular dermatitis (ED/PD) is commonly seen in a variety of skin diseases such as seborrheic dermatitis, atopic dermatitis and psoriasis, but is most often associated with allergic contact dermatitis (ACD). Here, a case of ACD in an 82-year-old man is described; he used 0.1% diclofenac sodium eye drops and exhibited pruritic erythema on the eyelids. Patch test for diclofenac sodium eye drops was positive. Further patch tests revealed a positive reaction to diclofenac sodium (monosodium 2-[2, 6-dichlorophenylamino] phenylacetate), which was the main component in the eye drop medicine. Diclofenac sodium is a non-steroidal anti-inflammatory drug (NSAID), and is frequently used in everyday oral medications, topical ointments, gel agents and eye drops. Case reports on ACD caused by diclofenac sodium eye drops are extremely rare. Nevertheless, it is necessary to consider ACD due to diclofenac sodium when a patient with ED/PD has a history of use of diclofenac sodium eye drops.

Letter: Perioral dermatitis in a child associated with an inhalation steroid.

Perioral dermatitis, also known as periorificial dermatitis, is characterized by a papular rash involving the perioral, perinasal and periorbital areas of the skin. There are multiple agents that may cause these lesions, with topical steroids being the most common. Inhaled steroids are rarely implicated as a cause of perioral dermatitis. Our case is illustrative because there was a clear association of perioral dermatitis with the use of inhaled steroids and a quick response to the treatment regimen, which included discontinuation of the offending agent.

Case report: Fluocinonide-induced perioral dermatitis in a patient with psoriasis.

Topical corticosteroids are the primary treatment for psoriasis. A patient with psoriasis being treated with topical fluocinonide for lesions on the extremities developed an erythematous facial eruption consistent with perioral dermatitis. When topical agents are applied, they often end up in unintended areas. The potential for drug-induced perioral dermatitis should be considered in psoriasis patients treated with potent topical corticosteroids.

Physical sunscreens with high sun protection factor may cause perioral dermatitis in children.

Perioral dermatitis is common in children and, if untreated, characterized by a chronic course lasting for months. Provocation factors known for adults, especially topical or inhaled corticosteroids, are relevant in children as well. We present eight children - all of them with dry skin - who developed perioral dermatitis after using sunscreens based on micropigments. This suggests that children with dry skin are at increased risk for perioral dermatitis. A history of sunscreen use should be specifically sought in children with perioral dermatitis.

Steroid acne and rebound phenomenon.

BACKGROUND: There have been many reports of topical steroids treatment for the face causing perioral dermatitis, steroid acne, and steroid rebound phenomenon. OBJECTIVE: To assess patient reported outcomes in patients receiving compounded topical (hydrocortisone 0.75% and precipitated sulfur 0.5%) lotion for up to 15 years for common dermatological conditions of the face. METHODS: In a retrospective study, 300 patients were randomly sampled from the dermatology clinic who had used, or were continuing to use, a lotion based, pharmacy-compounded topical preparation for the face. The topical compound was used in therapies for seborrheic dermatitis and combination with prescription topical therapy for patients with acne and rosacea with tolerability problems. RESULTS: None of the 300 patients experienced steroid acne, rebound phenomenon, or perioral dermatitis associated with use of hydrocortisone 0.75% and precipitated sulfur 0.5% on the face. CONCLUSION: There was no evidence found that perioral dermatitis, steroid acne, or rebound phenomenon occurs when sulfur is compounded with topical hydrocortisone 0.75%.

A randomized, double-blind, vehicle-controlled study of 1% pimecrolimus cream in adult patients with perioral dermatitis.

BACKGROUND: Perioral dermatitis (POD) is a common dermatosis without standard therapy. OBJECTIVE: We sought to evaluate pimecrolimus cream 1% in POD. METHODS: We conducted a multicenter, randomized, double-blind, parallel-group study in adult patients with POD treated twice daily with pimecrolimus cream 1% or vehicle until clearance for up to 4 weeks. Follow-up took place 4 and 8 weeks after treatment. RESULTS: Patients treated with pimecrolimus had an average POD Severity Index score of 2.6 compared with 3.5 for patients treated with vehicle. Both groups had baseline scores of 5.2. The between-group difference was 0.9 (95% confidence level 0.4, 1.4, P = .0011). Patients with history of topical corticosteroids benefited most. Pimecrolimus-treated patients reported greater improvement in quality of life. There were no group differences regarding safety. LIMITATIONS: Pimecrolimus vehicle is not a true placebo. CONCLUSIONS: Pimecrolimus rapidly improves clinical symptoms and quality of life of patients with POD, being most effective in corticosteroid-induced POD.