Postoperative purpuric contact dermatitis: Think about antiseptics

Abstract

We describe two cases of purpuric contact dermatitis occurring immediately after surgery. CASE REPORTSCase 1: A 28-year-old female patient underwent surgery for buttock synechiae as a result of previous surgery for pilonidal sinus. She was positioned prone during the reconstructive surgery. The next day, she presented with a purpuric eruption of the inguinal folds, the anterior part of the thighs, and the right flank, with itching and burning sensations. Lesions were symmetrical and sharply demarcated (Figure 1). The patient reported having a similar eruption a few years before, soon after an abdominoplasty. The lesions healed quickly after application of a corticosteroid cream, leaving residual hyperpigmentation. We suspected the antiseptic solution, povidone-iodine (PV-I) 10% (Bétadine dermique, Mylan Medical, Paris), used during the current surgery as the possible cause of this eruption. Some time after the episode, the patient was patch tested with the European baseline series (Chemotechnique Diagnostics, Vellinge, Sweden), which gave negative results. Bétadine dermique tested "as is" led to purpuric reactions on day (D) 2 and D3 (+ Supporting Information Figure S1), whereas patch tests with an antiseptic/preservative series (Chemotechnique Diagnostics) gave negative results. On the basis of these results, irritant purpuric contact dermatitis caused by PV-I was diagnosed. Case 2: A 34-year-old female patient underwent a surgical procedure for ovarian cancer in a supine position. The next day, she noted a painful and slightly itchy purpuric eruption localized on her buttocks and her back (Figure 2). This disappeared within a few days without treatment, leaving some residual pigmentation. Later, patch tests were carried out with the European baseline series (Chemotechnique Diagnostics), all of which gave negative results. Patch testing with Bétadine dermique "as is" gave positive reactions, with erythema and oedema on D2 (+), and with vesicles on D4 (++). Repeated open FIGURE 1 Case no. 1: purpuric eruptionFIGURE 2 Case no. 2: purpuric eruption CARLET ET AL. 215