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Lichenoid contact dermatitis secondary to methylisothiazolinone (MI).pdf

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Lichenoid contact dermatitis secondary to methylisothiazolinone (MI).pdf

CASE REPORT Lichenoid contact dermatitis secondary to methylisothiazolinone (MI) James Raymond, BComLLB(Hons), Bpharm, MBBS, Mtax, LLM, Mmed,a Joseph Konya, MBBS, MMed, FACD,b and Sophie Bakis-Petsoglou, MBBS, BA, MMed(ClinEpi), FACDc New South Wales, Australia Key words: contact; dermatitis; lichenoid; methylchloroisothiazolinone; methylisothiazolinone; preservatives. INTRODUCTION Methylisothiazolinone and methylchloroisothia- zolinone (MI/MCI) are broad-spectrum preservatives widely used in cosmetics and household and industrial products. It is well known that MI/MCI can cause allergic contact dermatitis with a spongiotic reaction pattern.1 Because of this reaction, restrictions have been placed on the concentration of MI/MCI used in products.2 In recent years the prevalence of allergic contact dermatitis to isothiazolinone preservatives, namely, MI/MCI, has increased dramatically.3 Cosmetic products are some of the major sources of exposure. Lichenoid reactions are rare in allergic contact dermatitis.4 To our knowledge, the occurrence of lichenoid contact dermatitis to MI/MCI has not been reported. We report a case of photo-aggravated lichenoid contact dermatitis in a 63-year-old man secondary to MI. CASE REPORT A 63-year-old man with Fitzpatrick skin type 5 was referred for assessment and management of an acute (4 month) on chronic (3 years) history of a pruritic, photo-distributed rash in February 2014. The rash was clinically suggestive of a photo-aggravated eruption with lichenoid features. Distinctly violaceous plaques affected the scalp, the lower third of the forehead, the medial cheeks, the temples bilaterally (Fig 1) and a fixed erythematous plaque appeared on the V of the patient’s anterior neck. Scattered similar plaques were seen on the left forearm and trunk (the latter more suggestive of psoriatic plaques). This eruption occurred on a From Mid-North Coast Area Health Service (NSW)a; The Skin Hospital Westmead, Sydney Adventist Hospital Epping Derma