The use of formaldehyde and formaldehyde releasers in hair-straightening formulations started in Rio de Janeiro in 2003. The technique is known as BKT, Brazilian keratin treatment. The aim of this study was to analyze the types of skin reactions presented by patients due to BKT. We describe 7 patients with severe erythema and scurf on the scalp which developed shortly after BKT. The lesions were eczema-like psoriasiform, located mainly on the scalp. Some patients also developed eczema-like lesions and pustules on the face, neck, upper arms, and upper trunk. Dermatoscopic findings included erythema, perifollicular and interfollicular scurf. The peripilar desquamation resembled the outer skin of an onion bulb. Scalp biopsies revealed psoriasiform and spongiotic psoriasiform patterns, one of them similar to anti-TNFα biologic drug psoriasiform alopecia. The possible consequences of the absorption of formaldehyde by hairdressers or clients are still to be verified by the scientific community; however, the skin and scalp reactions observed in our cases suggest a drug reaction phenomenon and not only eczemas of irritant or allergic origin.
We report a 29-year-old black male with cutis verticis gyrata, folliculitis decalvans and folliculitis keloidalis nuchae confirmed by biopsy. He had been using dreadlocks for 5 years before the appearance of the lesions. An activation of the different fibroblast growth factor members may explain the development of hyperproliferation of collagen, fibrosis and keloid lesions. We suggest a hypothesis of a common pathogenesis for the three conditions in a genetically predisposed patient. Inflammation and traction caused by the dreadlocks can act as a possible trigger factor.
A male full‐term infant, who had been exclusively breast‐fed since birth, at 2 months of age developed an erythematous, scaling eruption involving the face (in a periorificial distribution, i.e. mouth, nose, ears, and eyes), hands, and feet, which did not respond to treatment with topical corticosteroids and oral antimicrobials. He was first seen at our institution at 5 months of age (Figs 1 and 2). He had been irritable for the last 2 weeks, but had no diarrhea, alopecia, or anogenital lesions. A clinical diagnosis of acrodermatitis enteropathica was confirmed with a serum zinc level of 41.2 µg/dL (normal, 70–120 µg/dL). His mother had low–normal serum (70.5 µg/dL; normal, 70–120 µg/dL) and normal milk (0.43 µg/mL; normal, 0.2–0.72 µg/mL) zinc concentrations. Within 7 days of starting therapy with zinc sulfate, 10 mg/kg/day, all cutaneous lesions had resolved (Fig. 3).
1
Infant at 5 months of age showing an erythematous, scaling eruption involving the face (periorificial distribution, i.e. mouth, nose, and eyes) and hands
2
Infant with dermatophytosis‐like lesions
3
Infant at 6 months of age after starting oral zinc supplementation. The lesions have resolved
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