Paradoxical worsening of clinical symptoms after the withdrawal of the causative drug was reported in several cases of DRESS syndrome. 3 Clinical features appear commonly 2 to 4 weeks after administration of the offending drug. Clinical presentation consists of cutaneous manifestations and visceral involvement. Several case reports of Lamotrigine-induced DRESS syndrome manifested fever, rash, lymphadenopathies, eosinophilia, and hepatitis. The latter is the most reported manifestation. The typical skin lesions consist of a morbilliform eruption, involving over 50% of the body, usually associated with facial edema and infiltrative lesions. Our case is unusual by its clinical presentation. To the best of our knowledge, this is the first case with purpuric edema of extremities with palmoplantar involvement. Previously, two cases of Lamotrigine-induced DRESS syndrome were associated with purpura. The first case developed purpuric lesions on ankles, knees, and buttocks. 4 Although, the second case, lesions were widespread with palate involvement (Table S1). 5 Severe cutaneous adverse effects caused by Lamotrigine were associated with rapid dose titration, concurrent valproic acid administration, and the history of an anticonvulsant-associated allergic skin reaction. 6 In our case, the concomitant intake and increase of Valproic acid dose may have worsened skin lesions. Valproic acid is an enzyme inhibitor that prolongs the half-life of Lamotrigine, elevates its serum levels, and potentializes cutaneous side effects. 7 Systemic steroids are indicated in case of visceral involvement including transamininase levels >5 times normal, renal involvement, pneumonia, cardiac involvement, or hemophagocytosis. 8 Systemic steroids were given to our patient because of the severity of skin lesions.
Contact leukoderma (CL) is a term used to describe depigmentation due to the application of certain chemicals to the skin. Rarely, it can follow allergic or irritant contact dermatitis. 1 We present an original case of CL after allergic contact dermatitis (ACD) caused by thiuram.
ObjectiveThis study aimed to evaluate the frequency of allergic contact dermatitis among children with atopic dermatitis (AD), the most common sensitizer, and the associated risk factors.MethodsThis retrospective study included children with AD who underwent patch testing at our dermatology department between 2005 and 2021.ResultsEighty patients were included. The average age was 77.6 months (4 months–17 years), divided as follows: children (76.3%), infants (11.3%), and teenagers (10%). The sex ratio (M/F) was 1.35. Thirty-two patients (40%) had positive patch test results. Allergic contact dermatitis was significantly more frequent among patients with severe AD (40.6%) than among those with moderate or mild AD (16.7%, P = 0.017). The most frequent allergens were nickel sulfate (23.7%), cobalt chloride (12.5%), potassium dichromate (8.7%), textile dyes (6.2%), and lanolin (5%).ConclusionsContact allergies are a common problem in children with AD. They seem to be at risk of sensitization to certain allergens mainly metals and components of skincare products. Patch testing should be performed whenever allergic contact dermatitis is suspected and in cases of severe AD.
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