ABSTRACT
Thermal burns can occur during seizure. This diagnosis can be difficult in case of atypical lesions, even more if the epilepsy is unknown and in case of seizures with loss of consciousness and/or an unwitnessed epileptic attack. We report two cases of cutaneous bullous lesions initially misdiagnosed as severe acute cutaneous adverse reactions (generalized bullous fixed drug eruption and Stevens-Johnson syndrome). In the two cases, the clinical aspect, necrotic evolution, and absence of obvious attributable medication allowed to revert to the diagnosis of burns due to boiling water revealing previously unknown epilepsy. For both, surgical management with skin graft was performed, and antiepileptic treatment was introduced. Facing unexplained burns, occult epilepsy should be investigated. Questioning of patient and relatives is crucial.
Subject(s)
Burns/etiology , Burns/therapy , Epilepsy/complications , Water , Adolescent , Aged, 80 and over , Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Female , Humans , Male , Missed Diagnosis , Skin Transplantation , Stevens-Johnson Syndrome/diagnosisSubject(s)
Imidazoles/adverse effects , Pityriasis Rubra Pilaris/chemically induced , Protein Kinase Inhibitors/adverse effects , Pyridazines/adverse effects , Aged , Antineoplastic Agents/adverse effects , Drug Eruptions/etiology , Drug Eruptions/pathology , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Pityriasis Rubra Pilaris/pathologyABSTRACT
BACKGROUND: Induction of delayed hypersensitivity reactions by red tattoos has been occasionally reported. Little is known about the inks used. Azo pigments have been implicated in some instances, but there is only one reported case involving quinacridones. OBJECTIVES: To describe the clinical and pathological features and outcome of skin reactions induced by red tattoo pigments. PATIENTS, MATERIALS, AND METHODS: Six patients with a cutaneous reaction induced by a red tattoo pigment underwent biopsy and prick and patch testing with the inks supplied. RESULTS: We observed seven reactions in the 6 patients. Histology showed various patterns: three lichenoid, two eczematous, and two pseudolymphomatous. Five reactions occurred with azo pigments, and two with quinacridones, in both cases with Violet 19 and Red 122. Four inks were tested. Only one patch test gave a positive result at a late reading (day 7). Prick tests gave negative results. The reactions required various treatments, including laser treatment for 2 patients. Activation of the reaction in 1 case was transient. CONCLUSION: Azo pigments and quinacridones both triggered reactions with similar clinical aspects but with varying histological findings. Patch and prick test results were disappointing with both. Reactions occurred following laser use in 1 case.