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Severe facial dermatitis as a late complication of aesthetic rhinoplasty; a case report
© Rajabian et al; licensee BioMed Central Ltd. 2004
Received: 28 October 2003
Accepted: 31 March 2004
Published: 31 March 2004
Contact dermatitis, as a cutaneous complication after rhinoplasty, is of early onset, limited and transient. The cause of this dermatitis is irritant or allergic. Late onset skin complications are rare and non-inflammatory.
We are reporting an unexpected, severe allergic contact dermatitis of the face, in a young female, appearing one month following aesthetic rhinoplasty. She failed to respond to ordinary treatments for dermatitis. We did standard battery – including nitrofurazone, tincture of benzoin and hydrocortisone – patch test for the patient that showed sensitivity to benzoin and corticosteroid.
In summary we report a case of a severe allergic contact dermatitis of the face, in a 21-year-old girl who underwent corrective aesthetic rhinoplasty, appearing one month following surgical operation. We were unable to find a similar report in the medical literature.
Cutaneous problems after rhinoplasty are usually early, minor, and transient . Most common being contact dermatitis, appearing as rashes or pustules with or without allergic reactions from the tape which might have been used with tincture of benzoin or a preparation containing gum mastic [2, 3]. These substances are frequently used as a dressing support and to increase adhesive strength of the tape. The tape can cause necrosis, a major complication, if applied too tightly [1, 4]. Patients with acne might find their condition temporarily worse just after rhinoplasty as a result of the local effect of the dressing or the systemic response to the operation .
We report a severe dermatitis of the nose and adjacent skin areas starting one month after aesthetic rhinoplasty in an otherwise healthy young girl.
Late onset skin problems following corrective rhinoplasty are rare and limited to non-inflammatory conditions such as permanent redness and telangiectasias of the nasal skin [1, 4]. These small spider lesions do not transgress from the nasal skin and usually are seen in patients with a diathesis toward capillary telangiectasias. Inclusion mucoid cyst is another late non-inflammatory complication of rhinoplasty [4–6].
Acute contact dermatitis as a complication of rhinoplasty may have an irritant or allergic causation.
Irritant contact dermatitis is the most common contact-related dermatosis. The injury to the skin may be mild, with only erythema, or severe with tissue necrosis and bulla formation. The patient may note a stinging or burning sensation with the onset of blisters or erythematous plaques which may spread from the area of contact to adjacent skin [2, 7].
Allergic contact dermatitis is a delayed cell-mediated immunologic reaction to an exogenous allergen. It usually occurs between 24 and 48 hours after contact, but may be delayed up to 14 days. The eruption tends to be associated with moderate to severe erythema and pruritus with acute weeping and crusted vesicles. Diagnosis of allergic contact dermatitis may be confirmed by patch testing [2, 7]. In a recent study, 45 out of 477 patients had a positive reaction to compound tincture of benzoin, which was the third most common allergen in their series. Of these 45 patients, 14 had strong positive reactions, but only two definitely recalled exposure to compound tincture of benzoin, and these were clinically revealed .
The treatment for acute contact dermatitis, whether allergic or irritant includes removal of the source, expression of pustules, irrigation with a drying desquamating soap and use of topical and systemic steroids as well as systemic antihistamines [1, 2, 7].
The patient reported herein represents an interesting, unexpectedly late occurrence of acute contact dermatitis following rhinoplasty. One month after surgery, when every thing was over and she was supposed to refer to the clinic for follow up, she started to show symptoms of dermatitis. This timing of onset of symptoms suggests an allergic phenomenon. She gave no history of any episode of dermatitis, either irritant or contact type to happen previously. Interestingly patch testing was positive only for benzoin and steroids. Therefore, she did not respond to neither topical nor systemic steroid. Also, she had received antibiotic agents. This patient probably had allergic contact dermatitis (from tincture of benzoin or topical steroid), except for the fact that she did not have pruritus associated with the rash.
When everything was discontinued, gradually dermatitis settled down. Of course, frequent and vigorous massaging with tap water and plain soap has accelerated her improvement. There is a single report of refractory facial cellulitis following cosmetic rhinoplasty after cord-blood stem cell transplantation .
Written consent was obtained from the patient for publication of her details and figures. The authors thank the patient for this consent.
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