Indian Journal of Dermatology
CORRESPONDENCE
Year
: 2016  |  Volume : 61  |  Issue : 3  |  Page : 340--341

Pigmented contact dermatitis resulting from self-medication for postherpetic neuralgia


Shekhar Neema1, Manas Chatterjee1, Tanushree Mukherjee2, Shilpa Jha2,  
1 Department of Dermatology, Command Hospital (EC), Kolkata, West Bengal, India
2 Department of Pathology, Command Hospital (EC), Kolkata, West Bengal, India

Correspondence Address:
Shekhar Neema
Department of Dermatology, Command Hospital (EC), Kolkata, West Bengal
India




How to cite this article:
Neema S, Chatterjee M, Mukherjee T, Jha S. Pigmented contact dermatitis resulting from self-medication for postherpetic neuralgia.Indian J Dermatol 2016;61:340-341


How to cite this URL:
Neema S, Chatterjee M, Mukherjee T, Jha S. Pigmented contact dermatitis resulting from self-medication for postherpetic neuralgia. Indian J Dermatol [serial online] 2016 [cited 2022 May 22 ];61:340-341
Available from: https://www.e-ijd.org/text.asp?2016/61/3/340/182431


Full Text

Sir,

Herpes zoster is caused by reactivation of varicella zoster virus in dorsal root ganglia. Reactivation occurs due to decrease in virus-specific cell-mediated immunity resulting from aging or immunosuppression.[1] Complications of herpes zoster can be classified as cutaneous, neurological, or visceral complications. Postherpetic neuralgia (PHN) is defined as persistence of pain more than 30 days after healing of lesions. It is the most common complication of herpes zoster and can be disabling. Approximately 10% of individuals develop PHN and incidence of PHN increases in elderly.[2] Other complications which have been described are encephalitis, myelitis, cranial nerve palsies, pneumonitis, hepatitis, or acute retinal necrosis.[3] Cutaneous complications of herpes zoster can be cutaneous dissemination, superadded bacterial infection, scarring, keloid formation, pigmentary abnormalities, or granuloma annulare. We report an unusual cutaneous complication of herpes zoster which resulted from persistent treatment resistant PHN.

A 64-year-old female with no known comorbidities presented with complaints of dark discoloration of face for last 1 year. She developed herpes zoster ophthalmicus on left side 3 years ago which was followed by corneal ulceration in left eye leading to corneal opacity, and she continued to have persistent pain in left side of face which was stabbing in nature and severe enough to disturb her sleep. She was treated with capsule Pregabalin, Nortriptyline, and Jaipur block with which she had partial relief, she continued to apply counterirritant balm to soothe her pain. She started developing insidious onset gradually progressive darkish discoloration of skin of face for last 1 year. Examination revealed diffuse hyperpigmentation of upper face and reticular pattern of pigmentation in lower face. She also had patchy scarring alopecia and depigmentation on left side of forehead along with corneal opacity in left eye. Rest of dermatological examination was within normal limits. Dermoscopic examination using polarized light showed bluish-gray colored granules of pigment suggestive of the presence of pigment in deep dermis. Histopathological examination revealed basal cell vacuolization, melanophages in superficial and deep dermis, and superficial perivascular infiltrate [Figure 1]a,[Figure 1]b,[Figure 1]c. Diagnosis of pigmented contact dermatitis (PCD) was made, the patient was told to stop application of balm, apply tacrolimus ointment twice daily and her pain medicines were optimized for better control of PHN.{Figure 1}

PCD is a noneczematous type of contact dermatitis. It is proposed that low-level persistent contact with chemicals result in cytolytic reaction at basement membrane resulting in pigment incontinence.[4] Patch testing and repeat open application test can be used to identify culprit chemical causing PCD.[5] Histopathology and recently dermoscopy can aid in diagnosis of this entity. Topical calcineurin inhibitors and avoidance of chemicals have been used for management of PCD.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Argoff CE. Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med 2011;123:134-42.
2Kost RG, Straus SE. Postherpetic neuralgia – Pathogenesis, treatment, and prevention. N Engl J Med 1996;335:32-42.
3Gnann JW, Whitley RJ. Natural history and treatment of varicella-zoster in high-risk populations. J Hosp Infect 1991;18 Suppl A: 317-29.
4Nakayama H, Matsuo S, Hayakawa K, Takhashi K, Shigematsu T, Ota S. Pigmented cosmetic dermatitis. Int J Dermatol 1984;23:299-305.
5Rietschel RL, Fowler JF Jr. Allergy to preservatives and vehicles in cosmetics and toiletries. In: Fisher's Contact Dermatitis. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 211-59.