|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 1 | Page : 63-64
Vignesh Narayan R, Anuradha Bishnoi, Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||07-May-2021|
|Date of Decision||21-Jun-2021|
|Date of Acceptance||17-Jan-2022|
|Date of Web Publication||16-May-2022|
Dr. Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh
Source of Support: None, Conflict of Interest: None
Keywords: Lichenoid dermatitis, non-eczematous dermatitis
|How to cite this article:|
Narayan R V, Bishnoi A, Kumaran MS. Turban Dermatitis. Pigment Int 2022;9:63-4
A 75-year-old male presented with complaints of itchy lesions that erupted acutely over his forehead region. He had no history of hair dye, oil, and hair care product application for the past 10 years. He did not have sudden onset weight loss, photosensitivity, or burning sensation in mouth or lesions elsewhere on his body. Clinical examination showed papular lesions with a lilac gradation over his forehead, nape of neck, and helix and pinna of ears [Figure 1]. Peculiarly there was sparing of hairy part of the scalp and anterior hairline, there was an absence of scaling or erythema. His oral cavity examination was normal and he had no lesions on other parts of his body. The patient wore a turban and a small cloth called ‘Fifty’ over his head, the lesions corresponded to the area where these were in contact with skin [Figure 2]. Upon further inquiry, he stated that he had changed his turban to this new blue color. With suspicion of lichenoid contact dermatitis to dye in his turban, we performed a repeat open application test on the hairless side of his forearm, with two pieces of his fabric of 2 cm2 size, one as is and the other after moistening with normal saline, twice a day for a week. At end of 1 week, there was erythema and induration at the applied site. We had also performed a patch test using standard and cosmetic series which was negative. Histopathological examination of the same had shown the presence of spongiosis, basal vacuolization, absence of apoptotic cells, and presence of melanin incontinence. The patient was asked to discontinue the use of colored turbans in the future. He was prescribed topical sunscreen, topical corticosteroids, and emollients. His lesions resolved by 50% within a period of 8 weeks.
|Figure 1 Lichenification noted over forehead region where the turban was in contact. Note the presence of white hair excludes allergic contact dermatitis to hair dye.|
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Classical eczematous contact dermatitis progresses through an acute phase consisting of erythematous papules, and oozing vesicles that are itchy but then progress to form hyperpigmented scaly lichenified plaques. Noneczematous contact dermatitis is having a prevalence almost equal to or higher than the eczematous variant. Yet it is often underrecognized. The cause is due to differences in the modality of contact, susceptibility of the individual, structure being targeted, and the noxious agent. It may have a myriad of manifestations, of which lichenoid contact dermatitis is one of them. The clinical features resemble lichen planus and may involve the mucus membrane and the skin. It erupts as purplish, polygonal, pruritic papules and often develops after the application of color developers and para-phenylenediamine and its derivatives. In case the eruption is due to color developers, the oral mucosa is spared, but it may be involved in cases due to dental restoration with metal amalgams. However, the patch test will be of eczematous nature. Unlike lichen planus, it develops more acutely and disappears on the withdrawal of the offending agent. Although the histopathology of both would show the presence of basal cell vacuolization and pigment incontinence, there would be a lack of Civatte bodies and the presence of spongiosis in lichenoid dermatitis. The infiltrate is also mild and perivascular as compared to the band-like infiltrate seen in lichen planus.
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| References|| |
Bonamonte D, Foti C, Vestita M, Angelini G. Noneczematous contact dermatitis. ISRN Allergy 2013; 2013:361746.
[Figure 1], [Figure 2]