臨床小児皮膚科 オープンアクセス

抽象的な

Unique Piercing Site Drug Reaction

Margaret Kaszycki*, Andreas Bub

Hyperhidrosis piercings of the body and ears is a popular practice amongst the US adolescent population. Localized infections and reactions are common, including allergic contact dermatitis, bleeding, scarring, and keloid formation. Piercing the skin serve as a site of trauma, thus predisposing patients to these complications. Enhancement of systemic reactions to localized regions is an uncommon phenomenon but has been reported in several cases such as chemotherapy-induced radiation dermatitis. We present a case of lamotrigine induced erythema multiform major in a 17 years old female, whose diagnosis was delayed due to initial presentation mimicking disseminated herpes simplex virus, Bechet’s, and an autoimmune condition due to unknown steroid use. In addition, the patient had enhancement of erythema and pain around multiple facial piercings. Although the cause of enhancement at the piercing sites is unclear, the bodily piercings may serve as an example of an enhanced immunologic reaction at Immuno Compromised Districts (ICD). ICDs are areas of skin that have experienced prior trauma resulting in chronic skin changes resulting in enhanced or weakened immunologic reactions. This case highlights a unique localized complication of body piercings as well as several important learning points including the complications of piercings, importance of medication reconciliations, atypical presentations of diseases secondary to patients concealing relevant medical information, the benefit of broad differentials, and overlapping disease presentations resulting in delay of correct diagnoses.