rimonidine, a selective α-2 adrenergic receptor (AR) agonist, causes direct vasoconstriction of cutaneous vessels and has been approved for the treatment of persistent facial erythema of rosacea. 1 The use of topical adrenergic agonists as hemostatic agents has been well utilized by nasosinal surgery 2 and ophthalmology. 3 Two of us (R.S. and E.W.) 4 previously reported the use of topical brimonidine, 0.33%, gel in controlling mild postoperative bleeding after Mohs micrographic surgery (MMS). Herein, we report 2 cases of altered mental status likely secondary to central nervous system (CNS) depression after the use of topical brimonidine, 0.33%, gel for hemostasis.

Lichenoid drug reactions have been linked to a long and growing list of medications, most of which are used mainly in adults, making these reactions exceedingly rare in children. To the best of our knowledge, this case report is the first of a lichenoid drug eruption in a child after human papillomavirus vaccination.

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