274 Pediatric Dermatology Vol. 25 No. 2 March ⁄ April 2008
6. Shim JH, Seo SJ, Song KY et al. Development of multiple pigmented nevi within segmental nevus depigmentosus. J Korean Med Sci 2002;17:133–136. FEDERICO BARDAZZI, M.D. RICCARDO BALESTRI, M.D. ANGELA ANTONUCCI, M.D. GIUSEPPE SPADOLA,. M.D. Department of Clinical and Experimental Medicine, Division of Dermatology (C. Varotti), University of Bologna, Bologna, Italy Address correspondence to Federico Bardazzi, viale Carducci 7, 40125 Bologna, Italy, or e-mail:
[email protected].
TEMPORARY LOCALIZED HYPERTRICHOSIS AFTER HENNA PSEUDOTATTOO
Abstract: We report the case of a 5-year-old boy who had a temporary dragon-shaped henna pseudotattoo, reinforced 4 days later. Two weeks later, as the pseudotattoo began to disappear, hypertrichosis developed in the area corresponding to the previous psuedotattoo. Skin biopsy showed an increase in vellus hair follicles, with slight peripheral fibrosis. After 4 months, the hypertrichosis resolved spontaneously.
Hypertrichosis is defined as hair growth that is abnormal for the age, sex or race of an individual, or for a particular area of the body. It can be either congenital or acquired (1). It can also be produced by certain topically applied substances (1–3). Henna is a vegetable dye obtained from the leaves of an indigenous shrub, Lawsonia inermis. Although it exists worldwide, its use is especially frequent in Arab and Indian countries for the cosmetic care of skin, hair, and nails (4). It also has therapeutic properties as an antifungal and tuberculostatic agent (5). The use of henna to paint the skin and draw temporary tattoos (pseudotattoos) has become popular worldwide. We report a case of a henna pseudotattoo resulting in temporary hypertrichosis. CASE REPORT A healthy 5-year-old boy had a temporary dragonshaped henna pseudotattoo placed. The tattoo covered an area of about 9 · 4 cm on his left scapula. Four days later, as the colors were lightening, the pseudotattoo was reinforced. Two weeks later, when the pseudotattoo again began to fade, hypertrichosis appeared over the same area as the tattoo. One week later (approximately 1 month after the application of the pseudo tattoo), he
Figure 1. Hypertrichosis in the area of the tattoo resembling a dragon.
was referred to our department for evaluation. Hypertrichosis confined to the area of the previous pseudotattoo was noted (Figs. 1 and 2). Two cutaneous biopsies were then performed. One of them was taken on the surrounding skin, with no pathological findings. The second biopsy, performed on the hypertrichosis area, showed an increase in the number of vellus hair follicles, and slight peripheral fibrosis. The hypertrichosis resolved spontaneously, with the vellus hair beginning to disappear 4 months later. No residual lesions were evident 5 months after the pseudotattoo had been placed. DISCUSSION The appearance of hypertrichosis in the area of the pseudotattoo leads us to suspect that it was due to one of the additive substances used with the henna. However, as the pseudotattoo was performed by a street vendor, we were unable to ascertain its exact composition. The addition of several substances to reduce the cost and application time increases the duration of pseudotattoos and enables different shades to be produced. However, this has also led to the appearance of adverse reactions, such as allergic contact dermatitis and even more serious reactions such as hemolytic anemia, angioedema, and
Brief Reports
275
SUCCESSFUL TREATMENT OF RECALCITRANT WARTS WITH TOPICAL SQUARIC ACID IN IMMUNOSUPPRESSED CHILD
Abstract: Although spontaneous resolution of verrucous vulgaris is the norm, many treatment modalities are available including local destruction, chemotherapy, immunotherapy, and sensitizing agents. The choice of treatment will vary with patient’s age and desire for treatment, prior treatments, potential side effects, location of lesions, and patient’s immune status. Treatment of verruca vulgaris in immunosuppressed patients presents therapeutic challenges as lesions in this population are often refractory to conventional modalities. Here we present a case of successful treatment of recalcitrant warts with topical squaric acid in an immunosuppressed child.
Figure 2. Higher magnification drawing the contour of the original tattoo.
anaphylactic reactions (4,5). To our knowledge, no previous cases of pseudotattoos resulting in temporary hypertrichosis have been reported. REFERENCES 1. Wendelin DS, Pope DN, Mallory SB. Hypertricosis. J Am Acad Dermatol 2003;48:161–190. 2. Prats I, Herranz P, Lo´pez de Ayala E et al. Focal hypertrichosis during topical tracrolimus therapy for childhood vitiligo. Pediatr Dermatol 2005;22:86–87. 3. Herane MI, Urbina F. Acquired trichomegaly of the eyelashes and hypertrichosis induced by bimatoprost. J Eur Acad Dermatol Venereol 2004;18:644–645. 4. Lestringnat GC, Berner A, Frossard PM. Cutaneous reactions to henna and associated additives. Br J Dermatol 1999;141:598–600. 5. Ko¨k AN, Ertekin MV, Ertekin V et al. Henna (Lawsonia inermis Linn.) induced haemolytic anaemia in siblings. Int J Clin Pract 2004;58:530–532. JAVIER DEL BOZ, M.D. TRINIDAD MARTI´N, M.D. ELIA SAMANIEGO, M.D. A´NGEL VERA, PH.D. DULCE MORO´N, M.D. VICENTE CRESPO, PH.D. Department of Dermatology, Complejo Hospitalario Carlos Haya, Ma´laga, Spain Address correspondence to Javier del Boz, Ph.D., Department of Dermatology, Complejo Hospitalario Carlos Haya, Servicio de Dermatologı´ a del Hospital Civil, Plaza del Hospital Civil s ⁄ n, CP 29010, Ma´laga, Spain, or e-mail:
[email protected].
BRIEF REPORT A 5-year-old White boy with end stage renal disease secondary to posterior urethral valves presented with a ‘‘wart’’ on his left thumb that failed to respond to topical salicylic acid and imiquimod prescribed by his pediatrician. The patient had received a recent renal transplant, but was currently off all immunosuppressive medications. Physical examination revealed a 5-mm verrucous papule on the left thumb with no other signs of verrucae. Cryotherapy was initiated, and the patient was to apply imiquimod cream nightly and salicylic acid 40% in petrolatum each morning. One week later, the patient received a second renal transplant and restarted immunosuppressive therapy (mycophenolate mofetil, tacrolimus). Over the next 2 years, multiple treatment regimens including cryotherapy, surgical removal, dichloroacetic acid, podophyllin, and cantharidin with podophyllin and salicylic acid without occlusion did not resolve the patient’s verruca that steadily increased in size and spread to other areas (Fig. 1A). The patient received sensitization on the medial upper arm with a quartersized area of 2% squaric acid covered in a clear adhesive bandage and was instructed to wash off the area the following day. Two weeks later, the patient began home application of 0.4% squaric acid solution gradually increasing the frequency of application to daily over the next 4 months. At the patient’s next visit, the patient’s mother noted that all the warts had decreased in size. However, the response to the 0.4% squaric acid had
