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Indian Journal of Dermatology
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CASE REPORT
Year : 2006  |  Volume : 51  |  Issue : 2  |  Page : 118-119
Steroid acne sparing hansen's patches


Department of Dermatology, Rita Skin Foundation, India

Correspondence Address:
Koushik Lahiri
Rita Skin Foundation, GD-381, Sector III, Salt Lake, Kolkata - 700 106
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.26933

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   Abstract 

A case of steroid acne sparing a patch of Hansen's disease on the forehead of an 18 year old girl is presented here for its unique presentation.


Keywords: Steroid acne, Hansen′s disease


How to cite this article:
Lahiri K, Malakar S. Steroid acne sparing hansen's patches. Indian J Dermatol 2006;51:118-9

How to cite this URL:
Lahiri K, Malakar S. Steroid acne sparing hansen's patches. Indian J Dermatol [serial online] 2006 [cited 2017 Jul 26];51:118-9. Available from: http://www.e-ijd.org/text.asp?2006/51/2/118/26933



   Introduction Top


Steroid acne (SA) is a distinct entity and has been recognized since topical and systemic corticosteroids became popular.[1] In developed countries the problem of SA is restricted to those patients treated with systemic corticosteroids and acneform eruption is listed among the less common side effects of topical steroids.[2] But in a developing country like ours, the situation is somewhat different owing to the indiscriminate use of both topical and systemic corticosteroids under oncologic treatment regimen or after organ transplant.[3] Topical corticosteroids, often the moderate to most potent ones, are used in almost all the dermatological disorders in our part of the world some times even without any prescription of a doctor. We describe an interesting presentation of steroid misuse on a patch of borderline tuberculoid leprosy, where the resultant SA spared the patch and involved the normal skin surrounding it.


   Case Report Top


A 18-year-old female presented with a faintly hypopigmented lesion on her forehead surrounded by flesh coloured papules. The duration of the hypopigmented lesion was eight months and of the popules just two weeks. As the patch was asympomatic, the patient ignored it for long. Later under the influence of her peers, she started applying 0.12% 'betamethasone valerate' cream on that area. A few erythematous, non-itchy papules appeared after two weeks of application. Till she visited us, more papules erupted around the plaque.

On examination it was a hypopigmented, dry, ovoid patch (2.5 cm x 3 cm) on her forehead. Cold perception was diminished on that area but touch and pricking sensations were intact. Perspiration was not reproduced on that patch. Right supraorbital nerve was mildly thickened and tender. Slit skin smear revealed a Bacillary Index (BI) of 1+, i.e., 1-10 Acid Fast Bacilli (AFB) per 100 fields. A diagnosis of borderline tuberculoid leprosy was made. The flesh colored papules constituted the acneform eruption; they were monomorphic and 3 mm in diameter [Figure - 1].


   Discussion Top


Steroid acne (SA) usually appears within two weeks of either systemic or topical corticosteroid therapy and involutes when the drug is withdrawn.[4] Characteristically individual lesions rapidly appear as 1 to 3 mm flesh colored or pink to red, dome shaped papules and papulo-pustules. Presence of comedones in SA is a debatable topic but consensus prevails regarding the monomorphic state of the papules.[4] Histology shows features of a suppurative, granulomatous dermatitis that are related to rupture of the infundibulum.[5] The typical picture reveals infundibular spongiosis and disruption, occasional individual necrotic keratinocytes, lacy hyperkeratosis and perifollicular oedema. This histopathology is same for systemic or topical steroid induced acne though the precise pathogenesis is still uncertain. The offending agent Betamethasone valerate cream (0.12%) is ranked among the moderately potent topical corticosteroid. Development of SA sparing the BT leprosy patch can be explained in the following way.

BT leprosy is characterized clinically as hairless plaques of different sizes and shapes. Marginal definition is less pronounced. Damage of the skin appendages and adnexal structures such as hair follicle, sweat and sebaceous glands and arrector pili muscles occurs by the infiltration.[6],[7] As hair follicle is a prerequisite for the genesis of SA the patch of BT leprosy escaped topical steroid induced acneform eruption where as the surrounding normal skin developed typical lesions of SA, giving rise to this interesting clinical picture.

We describe this phenomenon not only because of its unique mode of presentation, but to make everybody aware of the deleterious practice of OTC delivery of potentially dangerous medicinal formulations.

 
   References Top

1.Sullivan M, Zeligman I, Acneform eruption due to corticotrophin. Arch Dermatol 1956;73:133-41.   Back to cited text no. 1    
2.Arndt KA, Bowers KE, Chuttani AR. Topical and intralesional corticosteroid. In : Manual of Dermatologic therapeutics. Little, Brown and company: Boston; 1995. p. 299-308.   Back to cited text no. 2    
3.O'Connel BM, Abel EA, Nickoloff BJ, Bell BJ, Hunt SA, Theodore J, et al . Dermatologic complication following heart transplantation. J Heart Transplant 1986;5:430-6.  Back to cited text no. 3    
4.Hurwitz RM. Steroid Acne. J Am Acad Dermatol 1989;21:1179-81.  Back to cited text no. 4    
5.Ackerman AB. Histologic diagnosis of inflammatory skin diseaes. Lea and Febiger: Philadelphia; 1978. p. 658-85.   Back to cited text no. 5    
6.Job CK. Pathology of Leprosy. In : Leprosy by Hastings RC, Opromolla DV, editors. Churchill Livingstone: London; 1994. p. 193-224.  Back to cited text no. 6    
7.Pfaltzgraff RE, Ramu G. Clinical Leprosy. In : Leprosy by Hastings RC, Opromolla DV editors. Churchill Livingstone: London; 1994. p. 237-90.  Back to cited text no. 7    


    Figures

[Figure - 1]



 

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    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures

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