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At First Glance: Psoriatic Response to Transdermal Nicotine Patch Application.

Joseph M LaRochelle1,2, Victoria R Dimitriades3

  • 1College of Pharmacy, Xavier University of Louisiana, New Orleans, Louisiana, USA.

Dermatopathology (Basel, Switzerland)
|February 22, 2020
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Summary

This case highlights how clinical history alone can mislead diagnosis between contact dermatitis and psoriasis. A patient initially suspected of allergic contact dermatitis was diagnosed with guttate psoriasis after further evaluation.

Keywords:
Contact dermatitisNicotinePsoriasisRash

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Area of Science:

  • Dermatology
  • Immunology
  • Pathology

Background:

  • Contact dermatitis and psoriasis are common, distinct skin pathologies.
  • Accurate diagnosis of skin disorders often relies on patient history.
  • Relying solely on history can present diagnostic challenges.

Observation:

  • A patient presented with a new abdominal rash after starting nicotine patches for smoking cessation and a recent antibiotic-treated pharyngitis.
  • The rash worsened despite topical steroid treatment and nicotine patch cessation.
  • Patch testing for nicotine and chemical sensitizers yielded negative results.

Findings:

  • Skin biopsy confirmed the diagnosis as guttate psoriasis.
  • The initial clinical presentation and history were misleading for contact dermatitis.
  • A preceding streptococcal infection is suspected as the trigger for guttate psoriasis.

Implications:

  • This case underscores the limitations of relying solely on clinical history for diagnosing skin disorders.
  • It highlights the importance of considering alternative diagnoses and utilizing diagnostic tools like biopsy.
  • Understanding potential triggers for psoriasis, such as infections, is crucial for effective management.